ED-mystified: lifting the veil on erectile dysfunction

Erectile dysfunction (ED) is an often-taboo subject that is nonetheless a reality for a large proportion of people. If you suffer from ED, it is also important to know that you are not alone. According to the Massachusetts Male Aging Study, the prevalence of erectile dysfunction in cis men is 52%. This study also showed that ED becomes more common with age: about 40% of men are affected at age 40, and nearly 70% are affected at age 70.

Multiple causes

General health:

Conditions like diabetes, hormonal disorders, multiple sclerosis, and diseases affecting the kidneys, vascular, or neurological systems can contribute to ED. Surgery in the pelvic area, such as a prostatectomy or a spinal cord injury, can also cause ED. If ED occurs repeatedly in a person over 50, it is important to speak with a doctor, as it could be a sign of another health problem that needs to be treated (heart problem, poorly controlled diabetes, etc.).

Indeed, since the penile arteries are very small in diameter, when they become narrowed, it leads to an erection problem (blood no longer flows sufficiently into the penis), and this is called a sentinel symptom: two or three years later, the arteries of the brain or heart may also become narrowed. This is why a cardiovascular check-up is essential for people over 50 who experience repeated erection difficulties.

Lifestyle:

A diet high in fat as well as smoking can, among other things, clog arteries, thus affecting the mechanisms of erection. Excessive alcohol consumption can also negatively impact erections by inhibiting the nervous system. Adopting a balanced diet and regular exercise can only improve the situation.

Medications:

Certain medications, such as antihypertensives, antidepressants, anxiolytics, cancer treatments, and estrogens can have an impact on erectile function. If you suspect your medication is the cause, it is crucial to consult your pharmacist or doctor before changing or stopping the treatment.

Psychological causes:

Psychological factors can also greatly disrupt erectile function. Common reasons, such as stress, performance anxiety, a new relationship or sexual experience, depression, and feelings of guilt can all play a role in ED.

This individual psychology approach helps to explore and understand the problem by analyzing cognitions, i.e., a person's thoughts, expectations, and beliefs about sexuality. These thoughts have several influences: life experiences, family history, social conventions, etc. When a doctor believes, in agreement with their patient, that psychological factors are involved in ED, they generally advise consulting a sexologist.

Available treatments

If there is an underlying illness, it will be treated, and the person will also receive treatment to improve their erectile function.

Phosphodiesterase type 5 inhibitors (PDE5-Is)

This class of prescription-only drugs works by relaxing the blood vessels in the penis. This increases blood flow and allows for an erection when there is sexual stimulation. Thus, PDE5-Is are not aphrodisiacs, and sexual stimulation is necessary for the medication to work. Among them are:

• "On-demand" medications, which are taken as needed in anticipation of a sexual act:
  • Sildenafil (Viagra®) and its generic
  • Tadalafil (Cialis®) and its generic
  • Vardenafil (Lévitra®) and its generic

These medications are taken as needed in anticipation of a sexual act. Their effect begins about 30 minutes to 1 hour after taking them. They are effective for a duration ranging from 4 to 36 hours depending on the medication. Viagra® has a shorter duration of action, generally up to 4 or 6 hours, while Cialis® can last up to 36 hours.

• For people who are sexually active and wish to have unplanned sexual intercourse, daily Tadalafil (Cialis®) may be an option. The dosage is, however, lower than the occasional use dosage and varies from 2.5 to 5 mg per day, according to the doctor's recommendations.

Side effects and contraindications

These medications are generally safe for most people. Some side effects are possible with these drugs, but they are normally well-tolerated. By taking the smallest effective dose possible, one usually avoids experiencing bothersome effects. Common side effects are: headaches, flushing, nasal congestion, gastric reflux.

There are also contraindications that must be evaluated by your doctor; he or she will assess your condition and determine the safety of these medications for your health condition.

Dosage

The dose can vary depending on several factors, including age, general health status, and tolerance to side effects. It is crucial not to take more than the recommended dose, as this can increase the risk of side effects and complications.

Drug interactions

Certain drug interactions can be dangerous with these medications. For example, some drugs, as well as grapefruit consumption, can increase the levels of ED medications in the blood, thereby increasing the risk of side effects. Furthermore, nitrates (like nitroglycerin or poppers) are contraindicated with ED medications due to the risk of a dangerous drop in blood pressure. For personalized advice on drug interactions, speak to our pharmacists.

Cost

The cost of ED medications can vary from one pharmacy to another. For example, Viagra® (sildenafil) can cost about $10 per dose and Cialis® (tadalafil) can cost about $15 per dose. It is important to note that most private insurance plans do not reimburse these medications, and they are never covered by the public plan (RAMQ).

Intra-urethral treatment

These medications are administered in the form of mini-suppositories to be inserted into the urinary meatus (Muse® device). An erection is then produced. This is a simple and interesting alternative for the 30% of people for whom tablet medications are ineffective.

What about injectable medications for ED?

Injectable medications like Caverject (alprostadil) and Tri-Mix (a combination of phentolamine, papaverine, and alprostadil) are treatment options for people who do not respond well to oral or mini-suppository medications, or who cannot take them due to contraindications. With this treatment, penile rigidity is achieved even without sexual stimulation and lasts about an hour.

• Mode of administration: these drugs are injected directly into the corpus cavernosum of the penis using a small needle.
• Speed and duration of action: the effect generally begins within 5 to 20 minutes after the injection and can last up to an hour.
• Stimulation necessary: unlike oral medications, these injections generally do not require sexual stimulation to work.
• Side effects and precautions: as with any medication, there are risks of side effects, including local pain, bruising, or, in rare cases, a prolonged erection requiring medical intervention.

Testosterone

If erectile dysfunction is caused by hypogonadism (an abnormal decrease in testosterone), thus implying that the production of sex hormones by the testicles is low, hormone therapy with testosterone may be considered. However, it is only effective in about one-third of cases for regaining functional erections.

Are medications the only remedy for ED?

No. Sexologists can greatly help treat the condition by addressing the psychological and emotional aspects that can contribute to ED.

Erectile dysfunction (ED) is an often-taboo subject that is nonetheless a reality for a large proportion of people. If you suffer from ED, it is also important to know that you are not alone.

Getting a prescription

If you think you need treatment for ED, the first step is to consult a healthcare professional. There is no shame in broaching this sensitive subject with your doctor. In fact, it is a proactive and responsible step to rule out other potential health problems that could be the cause of the ED.

Remember that sexual well-being is not limited to the quality of the erection; communication and intimacy with your partner are also essential components of a satisfying sex life.

For personalized advice and more information on ED treatments, our pharmacists are at your disposal to guide and inform you.