Saturday, December 11, 2010

Therapy of erectile dysfunction with sildenafil improves quality of life and partnership

According to Maslow [I) and others, higher levels of individual and social functioning can only be achieved and maintained, when more basic and par¬ticularly physiological levels of functioning are satisfactory and healthy (Fig. I). Satisfactory partnership and sexuality are core aspects of human well being through the complete course of adulthood. Sexual activity is a major determinant of sexual satisfaction 121. In men and women, sexual dysfunction as a disorder of sexual desire, arousal, or orgasm, and/or sexual pain results in personal distress and reduced quality of life and interpersonal relationships (3-6]. Erectile dysfunction (ED) as the inability to attain or maintain penile erection sufficient for satisfactory sexual performance is age-associated, with estimated prevalence rates of 25-40% among men 40 years old and 60-70% among those 70 years old. ED is a common and multifactorial disease due to organic and/or psychological factors [4, 7].
ED is not a problem only for men, because the relationship between part- ners can also be disturbed. Therefore, adequate treatment of ED is needed and the most convenient and simplest way is oral drug, therapy.
ED treatment with sildenafil
Sildenafill, a phos phodiesterase-(PDE)-5 -selective inhibitor has been the drug of choice for patients with ED since it was launched in March 1998 [8]. The most frequent adverse effects documented with sildenafil usage are headache, flushes, dyspepsia, visual disturbances and nasal congestion. These adverse effects are in most cases dose-related, usually transient and mild, with a low withdrawal rate [9, 101. Several studies performed until recently have shown that sildenafil is a safe and effective treatment of ED in patients with cardio­vascular disease, who do not take nitrates or nitrate donors concomitantly.

Other oral medications for ED include apomorphine, phentolamine, yohilli­binc. trazodone, testosterone and new PDE5 inhibitors such as Nardellatil and tadalafil. According to all available data, the concept of PDE5 inhibition has a central position in recent oral pharmacotherapy of ED. However, larger clini­cal studies of efficacy and safety should be carried out using most of the other above-mentioned oral agents and these may also gain a place in the differen­tial therapy of ED. There are no studies directly comparing sildenafil and other treatments of ED or assessing its role in combination with other therapies [ 101. In patients without contraindications for its use, sildenafil is a highly effective treatment for ED, which can be considered as the first-line therapy in ED with an acceptable risk–benefit ratio. The impact of ED treatment with sildenafil on aspects of partnership and life satisfaction will he outlined in the following Chapters.