home Audience 12 Groups of drugs for the treatment of male impotence. Candles for intraurethral administration. Additional remedies for the treatment of erectile dysfunction

Groups of drugs for the treatment of male impotence. Candles for intraurethral administration. Additional remedies for the treatment of erectile dysfunction

According to modern ideas, the concept of "erectile dysfunction" (ED) implies the inability to achieve and / or maintain an erection sufficient for sexual intercourse (NIH Consensus Statement of Impotence, 1993). ED can be classified according to etiology and severity. From the point of view of etiology, organic and psychogenic forms are distinguished. In turn, organic ED is divided into vascular, neurogenic, anatomical and endocrine. The psychogenic form can be generalized and situationally dependent (Lizza and Rosen, 1999) and have subtypes.

I. Generalized form.
A. Generalized alibidemia.

Primary lack of sexual desire.
Decreased sexual desire associated with aging.

B. Permanent suppression of libido.

Promiscuity.

II. situational form.

A. Associated with a partner.

Lack of sexual desire in certain situations.
Lack of sexual desire due to partner's sexual preference.
Severe suppression of libido caused by fear of conflict with a partner or the threat of a change in the usual way of sexual life.

B. Associated directly with sexual intercourse.

Associated with other sexual dysfunction (eg, accelerated ejaculation).
Situational intense negativism (for example, failure expectation syndrome).

C. Associated with psychological distress (depressive monoideism).

Associated with depressed mood (for example, with depression) or severe stress (for example, in connection with the death of a loved one).

In addition to isolated organic and psychogenic forms, ED of mixed origin is common. In addition, ED can occur as a result of taking certain drugs (eg, β-blockers, selective serotonin reuptake inhibitors, diuretics, etc.) (Meinhardt et al., 1997). Depending on the severity of erectile dysfunction, mild, moderate, moderate and severe ED are distinguished.

According to the Massachusetts Male Aging Study (Feldman et al., 1994), the incidence of ED in men aged 40-70 was 52%. In another American study (National Health and Social Life Survey; Laumann

et al., 1999) ED was observed in 31% of men aged 18 to 60 years. In the course of a German study (Cologne Male Survey, Braun et al., 2000), it was possible to establish that the frequency of ED increased by 10% in men aged 40-49 years, by 16% - at the age of 50-59 years, by 34% - at the age of 60-69 years and more than 50% - at the age of 70 to 80 years. Overall, the incidence of ED was 19.2% (ages 30 to 80 years). Similar results were obtained in studies conducted in England and France (Spector and Boyle, 1986; Giuliano et al., 1996). As predicted by Aytac et al. (BJU, Int 1999; 84:450-456), the number of patients with ED will increase from 152 million people in 1995 to 322 million by 2025 (including more than 11.9 million people in Europe, in North America - more than 9.1 million, in Africa - more than 19.3 million, in Asia - more than 113 million people).

In the past it was believed that ED was mainly due to psychogenic factors, but now scientists have learned that it is more likely to develop as a result of organic causes, at least in men over the age of 50 years (Kaiser, 1999).

There are reports in the literature, the authors of which claim that the treatment of ED, which developed against the background of the underlying disease, improves the results of its treatment. For example, C. Hultling (2000) showed that ED treatment significantly improves the quality of life of patients with spinal cord injuries. E. Althof et al. (2000) reported that ED therapy alleviates the course of the disease, which is characterized by a sense of collapse, depression, uncertainty, despair and excitement. E. O. Laumann et al. (1999) found that ED more than 4 times increases the physical dissatisfaction of patients and more than 2 times the emotional.

In addition, it should be noted that ED can be not only a cause, but also a symptom of other serious diseases, such as diabetes, coronary artery disease and depression (I. Goldstein et al., 1998), which in themselves reduce the effectiveness of ED treatment (S. Duttagupta et al., 2001). A recent study by Montorsi et al. (2002) showed that of 90 patients with ED who were followed up for 4 years, 36 (40%) developed coronary artery disease, and 36 of 49 patients (73%) with acute coronary pain or myocardial infarction had ED. before a heart attack (Montorsi et al., 2002). T. Roumeguere et al. reported that 13% of their ED patients had angina, 20% had diabetes, 26% had hypertension, and 77% of patients suffered from dyslipidemic disorders (T. Roumeguere et al., 2001).

The authors of a number of works recommend examining patients with ED in order to exclude the presence of diseases of the cardiovascular system. Others believe that patients who do not have ED, but who have risk factors for cardiovascular disease, such as high blood pressure and hyperlipidemia, as well as smokers, should be warned about the need for medical supervision in order to prevent the development of ED.

The main factors affecting the occurrence of an erection are as follows:

hemodynamic changes;
relaxation of smooth muscles;
regulatory action of neurotransmitters.

Erotic stimuli create pro-erectile processes in the basal ganglia of the cerebral cortex. The excitation formed in the central nervous system is realized due to the peripheral mechanisms of erection. The main one is the relaxation of the smooth muscle elements of the cavernous bodies and cavernous arteries. The cause of the latter is the concentration of free sarcoplasmic calcium. Erection mediators act through its decrease, and their antagonists, on the contrary, cause its increase. The main pro-erectile mediator is nitric oxide (NO), the effect of which is mediated by the guanylate cyclase-cGMP system. Vasoactive intestinal peptide and prostaglandin E1 play an additional role through the adenylate cyclase system. Among their antagonists, it is necessary to name endothelium, vasopressin, calcitonin, and neuropeptide Y. Phosphodiesterases (PDE), enzymes that destroy cyclic mononucleotides (cGMP and cAMP), also take part in the development of detumescence. The greatest value in the smooth muscle structures of the penis is phosphodiesterase-5. Of interest are the mechanisms of regulation of calcium sensitivity, as well as the functioning of special intercellular contacts - nexuses. Phase changes in the activity of the regulatory system and the corresponding fluctuations in smooth muscle tone provide a rhythmic course of erection.

The onset of erection is the result of the interaction of neurogenic, neurochemical and endocrinological mechanisms (Sachs, 2000). The tone of the smooth muscles of the cavernous bodies and blood vessels is controlled by complex biochemical mechanisms that are regulated by the peripheral and central nervous systems. This control is provided by neuroanatomical connections that are part of the innervation of the lower urinary tract (Moreland et al., 2001).

In healthy men, sexual stimulation causes the release of the nitric oxide mediator from non-adrenergic non-cholinergic neurons that innervate the corpus cavernosum of the penis. NO causes intracellular activation of guanylate cyclase, which catalyzes the conversion of 5-GTP to 3'5'-cGMP. The latter mediates intracellular signal transduction, which, through the activation of protein mechanisms, leads to a decrease in intracellular calcium concentration and relaxation of the smooth muscles of the penis, vasodilation and the development of an erection (Moreland et al., 2001).

The main risk factors for developing ED include:

In most cases, ED is caused by several causes. Research by C. B. Johannes et al. (J. Urol. 163.460) showed that at the age of 40-49 years, erectile dysfunction was detected in 12.4% of patients; at the age of 50-59 years - in 29.8%, and at the age of 60-69 - already in 46.6% of patients. Thus, from 40 to 70 years, the risk of developing ED increases by almost 4 times. The most important are cardiovascular risk factors. According to German authors (Braun et al., 2000), 20% of ED patients suffer from diabetes mellitus, 30% have arterial hypertension, 30% smoke, and 38% regularly drink alcohol. Similar results were obtained by Pritzker (1999). In the course of studies performed by this author, it was possible to establish that 20% of patients with ED had undiagnosed diabetes mellitus, 48% had arterial hypertension, and 70% had hypercholesterolemia. Roumeugere et al. (2001) diagnosed diabetes mellitus in 20% of patients with ED, arterial hypertension in 26%, and hyperlipidemia in 76%.

Diagnosis of ED includes establishing the fact of the presence of ED (clarification of the history of the disease, including the IIEF and QoL questionnaires; examination and palpation of the external genitalia; rigiscan test; rigidometry) and finding out the cause of the development of ED (color doppler ultrasound; examination of hormonal status; psychological examination; laboratory tests ; neurophysiological examination; cavernosography; ultrasound of the penis; electromyography of the pelvic floor muscles).

ED treatment

Since many patients and even doctors are sure that ED is not a disease, but a natural process that accompanies the aging of the male body, and also due to the particular delicacy of the problem, only a few patients suffering from this disease resort to medical care. M. Sand et al. (ISSIR, 2002) found that 21% of patients suffering from erectile dysfunction took drugs, while in the group of patients with diabetes this figure was 74%, with coronary heart disease - 54%, and with depression - 37%.

When ED treatment is prescribed, the patient should actively participate in the choice of the type of therapy. At the same time, in addition to the traditional criteria of effectiveness and safety, cultural, religious, social motives, as well as the following factors, play a certain role in making a decision:

ease of therapy;
invasiveness;
the possibility of canceling therapy;
the cost of a course of treatment;
the mechanism of action of the drug (peripheral or central).

In patients with ED, the etiology should first be established and, if possible, the causes of the development of the disease should be eliminated, instead of purely symptomatic treatment (Wespes et al., 2002). However, it has been shown that exposure to only organic risk factors does not lead to a significant improvement in erectile function (Montorsi et al., 2002).

Symptomatic treatments for erectile dysfunction include oral medications, vacuum devices, and/or psychotherapy (Montorsi et al., 2002). If none of these methods is successful, vasoactive agents can be used by various routes (Montorsi et al., 2002): oral, buccal, transdermal, intraurethral, intracavernous, subcutaneous, transrectal.

The most common are oral and intracavernous administration.

Drugs administered intracavernously and their action:

papaverine (non-specific inhibition of PDE5-Ca antagonists);
prostaglandin (activation of adenylcyclase, inhibition of norepinephrine release);
phentolamine (used in combination with other drugs; non-specific blockade of α-receptors);
phenoxybenzamine (α 1 + α 2 receptor binding);
vasoactive intestinal polypeptide (activation of adenyl cyclase), etc.

However, most patients experience significant discomfort and pain during injections. Therefore, 74% of patients choose oral as first-line drugs.

Drugs of different groups used for ED include adrenoblockers (yohimbine, phentolamine), dopamine receptor antagonists (apomorphine), serotonin uptake blockers (trazodone), antipsychotics (sonapax), androgens (testosterone, andriol, mesterolone (Proviron)), adaptogens (pantocrine, eleutherococcus), peripheral vasoactive drugs (nitromaz), NO donors (L-arginine), phytopreparations (herbion urological drops, coprivit, laveron, milona 11, permixon, prostamol uno, prostanorm), etc. In general, the effectiveness of drugs of different groups does not exceed 30% and is not much higher than when using placebo (I. Iribarren et al., 1999).

Medicines intended for oral administration can have a central and peripheral effect. Centrally acting drugs include the dopaminergic receptor agonist apomorphine, testosterone, and the selective α2-adrenergic blocker yohimbine. The latter is a central adrenergic receptor agonist and a peripheral α 2 -adrenergic blocker (Hatzichristou, 2001). In controlled studies, it was found that in terms of effectiveness it did not differ significantly from placebo. Possible side effects: increased blood pressure (BP), anxiety, frequent urination (S. Tam et al., 2001). In this regard, the recommendations of the American Urological Association for the treatment of organic ED indicate that yohimbine is not effective enough (Montague et al., 1996).

The name "apomorphine" comes from the name of the drug morphine (from the Greek apo - "from"). However, the apomorphine molecule is structurally and, most importantly, chemically different from the narcotic drug molecule. Therefore, apomorphine is not an opiate and does not have any narcotic effect. The effect of apomorphine, a dopamine agonist, is due to stimulation of central dopaminergic receptors (mainly D2 and, to a lesser extent, D1) in the paraventricular nuclei of the hypothalamus and the brainstem, which ensures the activation of erectile mechanisms (including NO and oxytocin), leading through a peripheral vasodilating effect to the development erections (Hatzichristou, 2001). In a double-blind placebo-controlled study (Dula et al., 2001), the development of an erection sufficient for sexual intercourse was noted in 46.9% of patients with ED treated with sublingual apomorphine (initially it was observed in 21.9% of patients). In the placebo group, the frequency of adequate erections was 32.3%. Its increase by 14.6% in the main group cannot be regarded as an acceptable result of treatment. This is supported by the low market share of apomorphine drugs for the treatment of ED, which in Europe is less than 5% (IMS, April 2002).

Peripherally acting drugs include prostaglandins E 1 , phentolamine, and phosphodiesterase type 5 inhibitors.

Oral phentolamine (vasomax) has been proposed as a therapeutic agent to improve the natural erectile response to sexual stimulation in patients with moderate erectile dysfunction. Phentolamine is a non-selective inhibitor of postsynaptic α-adrenergic receptors in the smooth muscle structures of the cavernous bodies. Data from a study (Padma-Nathan et al., 2002), which involved more than 2 thousand patients with erectile dysfunction, showed that 51% of patients who used phentolamine at a dosage of 40 mg, and 38% of patients who took 80 mg / days, noted a significant improvement in the quality of erection. Thus, at the end of therapy, 87% of all patients noted an improvement in erectile function. According to other authors, oral phentolamine therapy was effective in 42-69% of cases (A. Zorgniotti, 1994). An interesting fact is that taking phentolamine mesylate for a long course does not have a significant effect on other components of the copulatory cycle: libido, orgasm, ejaculation.

The selective serotonin reuptake inhibitor antidepressant trazodone (azona, trittico) also improves erectile function due to direct α 1 -adrenergic blocking action; it is no coincidence that priapism is described among the side effects of the drug. R. Lance et al. (1995) reported an improvement in erection in 78% of patients under 60 years of age, but other authors did not reveal a significant effect of trazodone on erectile function compared with placebo (R. Costabile et al., 1999; RLance et al., 1995).

PDE inhibitors - sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) - are selective competitive inhibitors of PDE5, an enzyme that destroys cGMP in various tissues. The latter is a secondary NO mediator (Bolell et al., 1996). Drugs of this group enhance the relaxing effect of NO on smooth muscles and are active only when cGMP synthesis is activated (due to NO) (Ballard et al., 1998; Jeremy et al., 1997). Sexual stimulation releases NO in corpus cavernosum nerves, vascular endothelium, and smooth muscle cells, leading to penile and corpus cavernosum vasodilation and erection (Burnett, 1997). By preventing the destruction of cGMP, PDE5 inhibitors enhance the vasodilating effect of NO and restore erection in patients with ED. Currently, 11 groups of PDE isoenzymes (PDE1-11) are known, which, in turn, are divided into 21 subgroups and approximately 53 variants.

PDE isoenzymes are involved in various body functions (Francis et al., 2001; Osteloh, 2001), in particular:

PDE-1 (vascular smooth muscle fibers, brain, heart, lungs) - vasodilation and tachycardia;
PDE-5 (smooth muscle fibers of the cavernous bodies of the penis and blood vessels, lungs, platelets, gastrointestinal tract) - vasodilation, platelet hypoaggregation;
PDE-6 (retina) - change in color perception;
PDE-11 (testicles, heart, skeletal muscle, prostate, liver, kidneys) - possible effect on spermatogenesis and heart.

The results of the studies have confirmed the effectiveness of all three PDE5 inhibitors (in equipotent dosages of Levitra and Cialis, their effectiveness is approximately comparable to Viagra). Direct comparative studies have not been conducted. It is difficult to compare the effectiveness of these drugs based on data from different (not directly comparable) studies, given the differences in efficacy criteria and patient selection. For example, patients who did not respond to sildenafil were excluded from some studies of vardenafil and tadalafil (Porst et al., 2001; Brock et al., 2001; Brock et al., 2002), making it impossible to compare response rates.

It is known that, due to their effect on NO/cGMP, these drugs potentiate the vasodilatory effect and anticoagulant effect of nitrates and NO donators (Angulo et al., 2001; Bischoff et al., 2001). For example, vardenafil (Levitra) has a weak hypotensive effect and lowers blood pressure by a maximum of 5-10 mm Hg. Art. (Sache and Rohde, 2000) and also increases heart rate at 40 mg (Sachse and Rohde, 2000). For these reasons, PDE5 inhibitors should not be prescribed for severe arterial (including orthostatic) hypotension. Treatment of elderly patients with PDE5 inhibitors should be started with low doses due to the increase in these patients of the maximum plasma concentrations of the drug and the duration of the half-life (Porst et al., 2001).

Along with PDE5 inhibitors, in the treatment of organic and psychogenic ED, affinity-purified antibodies to endothelial NO synthase (eNOS) in ultra-low doses, the drug Impaza, have been widely used in recent years. The drug is well tolerated, safe and has no side effects and is significantly superior to placebo: it is effective in 60-85% of patients, it increases the integral indicators of the international index of erectile function (“erectile function”, “satisfaction with sexual intercourse”, “orgasm”, “libido ”, “general satisfaction”) to 72 - 78%.

For the treatment of ED, many natural remedies are also used, such as, for example, tentex forte, laveron, erectin, testalamin. Interest in the methods of so-called biological medicine is great all over the world. This is due to the fact that these drugs have significantly fewer side effects compared to chemotherapy drugs, do not cause addiction and withdrawal syndrome. Many of them are not drugs, but are biologically active supplements.

The problem of diagnosing and treating ED is complex and multifaceted. As scientific research is carried out and practical experience is gained in the treatment of sexual disorders in men, more and more new, previously unknown etiological, pathogenetic, pathophysiological and other factors are revealed, which, in turn, raises new questions for researchers. Perhaps the 21st century will pass under the sign of the final solution of this problem. n

Literature

Andersson K.E., Wagner G. Physiology of erection. Physiol Rev 75, 1995; 191-236.

Andersson K. E. Pharmacology of penile erection. Pharmacol Rev 2001. Vol. 53:417-450.

Brown et al. Epidemiology of erectile dysfunction: results of the "Cologne Male Survey", Int J Impot Res 12(6): 305-31J, 2000.

Laumann E. O., Paik A., Rosen R. C. The epidemiology of erectile dysfunction: results from the National Health and Social Life Survey. Int J ImpotRes 1999; 11 (Suppl.l): S. 60-64.

Mc Kinsey A. C., Pomeroy W., Martin C. et al. Sexual Behavior in the Human Male (Philadelphia, WB Saunders), 1948.

Rosen R. C., Riley A., Wagner G. et al. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49(6): 822-30.

Petrov S. B., Loran O. B., Veliyev E. I. Modern aspects of the treatment of erectile dysfunction. Consilium medicum. - 2003. - No. 2. - S. 3-6.

Rosen R. C. et al. Int J Impot Res., 1999; 11:319-326.

Rosen R. C. et al.: Urology, 1997;49:822-830.

Epstein, Stark, Vorobieva, 1998.

Petrov V. I., Dygai A. M., Martyushev A. V., Sergeeva S. A., Epshtein O. I. A new Russian drug for the treatment of erectile dysfunction. Materials of the Medical and Pharmaceutical Forum. - M., 2002. - S. 86-87.

Smolenov I. V., Dygai A. M., Epshtein O. I. et al.: Ultralow doses of antibodies to endothelial NOS are effective in erectile dysfunction. Pharmacologist. - Vol. 44, No. 2 (Suppl. 1). - 2002. - A 167.

A. A. Kamalov, doctor of medical sciences, professor
S. D. Dorofeev, Candidate of Medical Sciences
E. A. Efremov
Research Institute of Urology, Moscow

Recently, the number of men suffering from erectile dysfunction has been constantly increasing. Experts have developed several basic ways to solve this problem. One of them is medication. Before taking drugs for the treatment of impotence, you need to make sure that they are safe for your health.

Causes of erectile dysfunction

Before starting treatment for impotence, it is necessary to establish the exact cause of the problem. Among them are especially distinguished:

Disruptions in the hormonal system.
Pathology of the vascular system, resulting in less blood flow to the penis.
Diseases of the genitourinary system.
Overweight.
Long-term treatment with the use of potent drugs.
Addiction to smoking or drinking alcohol.
Prolonged stay in a stressful situation, psychological or mental overstrain.
Lack of physical activity.
Diabetes.
Severe intoxication of the body.
Mechanical damage to the penis.

To cope with impotence, it is necessary, first of all, to eliminate its root cause. Sometimes long-term systemic therapy may be required.

In some cases, the cause of failure in personal life may be the sexual incompatibility of sexual partners.

The main forms of release of medicines

For the treatment of impotence in men, drugs are used that can be classified based on the form of release and the way they are used. The following groups of funds are distinguished:

Urethral. These medications are injected into the urethra. For this, a special applicator is used. The procedure is effective only if it is carried out a maximum of 10 minutes before sexual intercourse. In rare cases, treatment provokes pain in the testicles and penis.
Injection. The drug is injected with a thin needle directly into the body of the penis. Such drugs stimulate active blood flow, which leads to a stable erection. The effect persists for 1 - 2 hours. The disadvantage of the technique is the mandatory visit to the doctor. Making an injection on your own is problematic.
Oral. These drugs for impotence are easy to use. This is what explains their popularity. In most cases, medications provoke the expansion of blood vessels that promote erection. Their use leads to increased desire, increased sensitivity, as well as an increase in the duration of sexual contact.
Local. A large number of creams, gels and sprays have appeared on the modern market, which are designed to cope with the problem of impotence. They are produced both on a natural and synthetic basis. The advantage of such funds is that they do not affect the entire body of a man and do not cause toxic damage. It is believed that these drugs are without side effects and with a minimum number of contraindications.

The choice of a specific form of medication will depend on the severity of the disease and the characteristics of the patient's body. If the ailment is purely psychological in nature, then the use of local remedies will suffice.

Varieties of drugs for potency

All drugs for impotence in men can be divided into several groups, based on the principle of their action and the main active ingredient. There are the following types:

Phosphodiestrease type 5 inhibitors.
NO-synthase activators.
Selective α-2-blockers.
Non-selective α-blockers.
prostaglandin analogues.

The choice of a specific remedy and its scheme of application must be selected together with the attending physician. Unauthorized use of such medications often leads to negative health consequences. Particular attention should be paid to people suffering from heart failure and other chronic diseases.

Phosphodiesterase type 5 inhibitors

Medicines in this group help to relax muscle tissue and provide a full flow of blood to the genitals. At the same time, they temporarily block the outflow of venous blood, which leads to a prolonged erection.

The most popular medicines in this category include:

Viagra. Produced on the basis of sildenafil. This substance has an effect for five hours. It is necessary to drink a tablet one hour before sexual intercourse. It is not recommended to take the drug simultaneously with fatty foods. The maximum dose is 100 mg per day. In some cases, after application, side effects may appear: nausea, headaches, visual disturbances, too frequent heartbeat, problems with the digestive system. Refuse to take the drug is necessary for people who have a tendency to spontaneous bleeding, as well as suffering from diseases of the vascular system and liver pathologies.
Levitra. A good drug based on vardenafil. About 90% of men who used it noted the achievement of a quick lasting effect. Unlike Viagra, Levitra works for 9 hours. It is enough to take a pill half an hour before sexual intercourse. At the first application, a dose of 10 mg will suffice. Subsequently, if necessary, increase it. The drug has practically no side effects. In exceptional cases, dizziness, increased fatigue, visual impairment, muscle pain are possible.
Cialis. Its active ingredient was tadalafil. It has a special duration of action - up to 36 hours. The tablet is taken 15 minutes before the onset of sexual intercourse. The daily dosage is 20 mg. The drug has practically no side effects. In exceptional cases, dyspepsia may occur. Such treatment is contraindicated for people with an abnormal structure of the penis and chronic liver failure.

These drugs affect the body of each man in different ways. It is worth trying them all to understand which medication is most effective in a particular case. If side effects occur, the therapy is immediately stopped and a specialist is consulted.

Phosphodienterase inhibitors affect the blood vessels and have a hypotensive effect. Therefore, they are forbidden to be used by men suffering from hypotension and chronic heart disease.

NO synthase activators

Such drugs help to relax the smooth muscles of the vessels, which leads to an increase in their lumen. As a result, blood flow to the penis is greatly increased. They do not have a negative effect on the heart, therefore they are approved for use by people suffering from chronic cardiovascular diseases.

The most effective drug in this group is Impaza. Its regular use helps to fully restore normal potency. The duration of therapy is about 12 weeks. In this case, the drug is used once every two days. No side effects have been identified.

After the end of treatment, they are completely resolved. A man becomes more sensitive, increases libido. It is recommended to take the drug two hours before direct contact with a sexual partner.

Selective α-2-blockers

A prime example of drugs in this category is Yohimbine. Produced from yohimbine hydrochloride. With the right dosages, it gently increases the lumen of blood vessels, stimulates blood flow to the penis. As a result, a man gets a long-lasting high-quality erection. The quality of sperm also improves, which favorably affects the reproductive function. This medication is often used to treat impotence caused by psychological causes.

In some cases, the use of such a tool can provoke the manifestation of negative reactions of the body. Headaches, hand tremors, pain in the digestive tract, tachycardia, and jumps in blood pressure are noted. Such effects may appear when the recommended dosage is exceeded, so carefully read the instructions before using the drug.

Such therapy is not always safe. It is forbidden to use Yohimbine for people suffering from severe forms of liver and kidney failure. The drug is not used in combination with adrenomimetics. With caution, you can use it for glaucoma and peptic ulcer.

Non-selective α-blockers

This group includes products containing phentolamine. It stimulates active blood circulation in the penis, which leads to a stable erection. The most common drugs in this group:

Vasomax. It is especially effective in combination with Papaverine. Ideal for men with moderate impotence. Available in the form of tablets for oral administration.
Phentolamine. Produced in the form of solutions for injection into the male genital organs. The duration of therapy is three to four weeks.

Such medicines are prohibited for use by people suffering from serious pathologies of the vascular system. The exact dosage of medicines must be selected together with the attending physician.

Prostaglandin analogs

A prostaglandin analogue is considered to be a drug that contains alprostadil. Such a medication is available in the form of a solution for urethral administration. It activates blood flow to the penis and reduces venous outflow. This ensures a stable erection without harm to ejaculation.

The effect becomes apparent 10 minutes after the administration of the drug. It keeps for an hour. The medication must be used immediately before sexual contact.

The drug can not be used in conjunction with vasodilators and antihypertensive drugs. Otherwise, the risk of spontaneous bleeding, pain in the abdomen or lower back, and urinary incontinence increases many times over.

Hormonal remedies

One of the common causes of impotence is the lack of sex hormones in the male body, namely testosterone. It is responsible not only for the level of libido and erection, but also regulates spermogenesis. Inadequate testosterone production is more common in older people. In some cases, this phenomenon may be associated with pathological changes in the thyroid gland or adrenal glands.

For the treatment of impotence, testosterone is produced in the form of tablets and solutions for intramuscular injection. The daily dosage is from 40 to 120 mg. The specific amount is selected individually after appropriate laboratory studies.

Such a drug that treats impotence of men cannot be used by those who are diagnosed with prostatic hypertrophy or tumor processes. Contraindications to such treatment are also hypercalcemia, migraines, renal and hepatic insufficiency.

If swelling occurs during testosterone therapy, then the drug should be stopped immediately. Side effects also include testicular atrophy, gynecomastia, degeneration of the seminiferous tubules.

Local funds

Erectile dysfunction can be helped by the use of topical remedies: creams, ointments and gels. They are allowed to be used not only for therapy, but also for the prevention of the problem. In addition to their main purpose, they moisturize the skin, prolong the time of sexual intercourse, and help to get more excited. Such drugs begin to act immediately after application.

The list of the most popular medicines includes:

Heparin ointment. Increases the blood supply to the penis, which leads to a stable erection.
Maxoderm. Available in the form of cream and ointment. It has a fast vasodilating effect, which leads to the instant appearance of an erection.
Himkolin. Indian-made ointment with a pronounced vasodilating effect. Among the main components of the drug are medicinal herbs and essential oils. To achieve a positive effect, the use of such a drug is carried out in courses.
Med Produced in the form of a cream. It is applied to the genitals just before sex. It contains essential oils that enhance attraction.

This is not a complete list of such funds. Novelties of such creams and ointments appear regularly. Often, to choose the right tool for yourself, you need to try several of them.

Biologically active additives

In modern pharmacies, among the various drugs for impotence, you can also find biologically active additives (BAA). They do not have a pronounced therapeutic effect. Their use is designed to stimulate the body to naturally restore the lost function. These products are natural ingredients. Most often, extracts of medicinal plants are used in their production.

The most popular are:

Inforte. Strengthens erection and increases sexual arousal. The action of the drug is aimed at stimulating the production of testosterone in the body. Produced on the basis of ginseng root, Chinese yam, large-flowered Goryanka and other plants.
Alicaps. It can be used immediately before sexual intercourse or during course therapy.
Yarsagumba. The composition of this remedy includes extracts of cordyceps, long-leaved eurycoma, olive fruits and ginseng root. Its use leads to the activation of metabolic processes in the body, the restoration of nervous activity. Yarsagumba enhances erection, increases libido and has a positive effect on the state of the reproductive system of the body.
Laveron. Increases blood circulation in the genitals, increases attraction. Produced on the basis of extracts of hibiscus, garlic, cinnamon, rose and some other plants.

Drugs for the treatment of impotence are effective only if they are used correctly and dosages are strictly observed. Before using them, make sure that you have no contraindications. To increase the effectiveness of medicines will help proper nutrition, the rejection of addictions and maintaining an active lifestyle.

Erectile dysfunction (ED) is a violation of the male sexual organ, in which its combat readiness and rigidity are insufficient to make a full-fledged intimacy with a woman.

In the future, we will write abbreviated ED.

Which specialists help in matters of this disease:

urologists;
sexopathologists;
psychotherapist (if the ailment is psychological in nature).

Main symptoms

too fast completion of intimacy;
the attraction to the beloved woman disappears;
the combat readiness of the male organ can either disappear or appear, there is no constancy;
insufficient hardness and lethargy of the penis;
the man does not show himself the initiative for intercourse;
dulling of past sensations;
a decrease in the frequency of morning and night erections is also a symptom of erectile dysfunction of a weak or already advanced nature;
a man avoids love intimacy and finds all sorts of excuses.

Kinds

There are 3 types of ED depending on the occurrence:

organic. It comes on gradually against the background of any disease. Attraction to women does not disappear, but during intercourse, the rigidity of the organ may suddenly disappear.
Psychogenic. It comes quite unexpectedly. But at the same time, combat readiness during proximity is maintained.
mixed. ED originates from organic and psychological factors combined.

Causes of the disorder

1. Organic

Problems of the cardiovascular system and blood vessels

hypertension;
failures of arterial and venous blood flow;
thrombosis;
atherosclerosis;
vasculitis can also cause erectile dysfunction.

Decreased testosterone levels, disruption of the endocrine system

Drug abuse

drug use;
taking harmful drugs that change the hormonal background;
taking steroids and anabolics.

Disorders of the nervous system and the spine

lower back or spine injuries;
spinal cord injury;
hernia in the lower back;
multiple sclerosis;
epilepsy.

Violations of the male reproductive system and the work of its organs

circumcision or other surgical interventions;
venereal diseases;
bruises and burns of the penis.

2. Psychological

an uncomfortable location for intimacy is also a reason and one of the main causes of psychological erectile dysfunction, the treatment of which is done by choosing a quieter place;
severe psychological stress, depression or stress;
lack of sleep;
conflict with a girl;
psychological childhood trauma;
fear of failing;
low self-esteem;
first night with a new partner;
limiting beliefs.

3. Mixed and others

irregular sex life;
passive lifestyle;
adverse environmental factors.

Statistics on the appearance of ED depending on age

With age, the risk of developing the disease only increases.

20 ways to fix the problem

Let's analyze in detail 20 methods of treating erectile dysfunction at home.

1. Choose the position where your body is upright

Lying on your back during intimacy with your beloved - worst position for men suffering from a problem on the topic that their boyfriend is naughty and soft.
This is so because outflow of blood from the body comes stronger according to the law of attraction.
If you are lying on top and already getting on your stomach, then there is a big risk to quickly reach the finish line and lose the hardness of manhood.
Better use positions where you don't lie at all. You are either on your knees or on your feet, the main thing is body located vertically and blood flow to the organ will be much better.

2. Method for replacing the tourniquet by grabbing at the base

The essence of the method in the fact that when you get an erection, you wrap your fingers around your friend at the base. This especially helps those whose friend is lethargic and combat readiness is quickly lost.
Thus, blood will not leave your dignity, will remain his firmness. Introduce and use this technique to reduce questions about what it is - erectile dysfunction in men.
embrace usually large, index and middle finger with medium strength. Many have seen how tourniquets are applied when bleeding, so as not to lose a lot of blood. It's pretty much the same pattern here. Use it wisely.

3. Do the Kidney Energy Strengthening Technique

The technique is performed in the toilet when you go there in a small way. It consists in the fact that you emit a jet of liquid, standing on tiptoe while straightening your back and not slouching.
Also, it is necessary strain your buttocks and press, deliberately releasing the liquid more strongly on exhalation.
According to what jet force, you will evaluate the level of your skills in bed. If everything ends with his lethargy and dripping, then the male potential in bed is not in the best condition.
Doing the technique frequently strengthens your kidneys and helps you avoid a quick finish. Why sometimes there is no stamina in bed, we wrote in another.

4. Do special physical exercises

What areas of the body should be trained

The main focus of training should be to strengthen the following areas of the body:

pros

The strength and tone of these muscles will help you stay in bed longer, improve blood circulation to the main organ and increase male strength.

Exercise examples

Let us analyze in detail the question of which exercises for erectile dysfunction and the treatment of this disease are used most often.

Press exercise. Sitting on the floor, we fix our legs and begin to raise and lower the body. Repeat the movements until pleasant fatigue occurs. It pumps the abdominal muscles. Strong abs speaks volumes about your ability in bed.
Leg bends 45 degrees. You need to lie on your back with your legs up 90 degrees. Now we begin to lower both legs, first to the left by 45 degrees, and then also to the right, without hurrying anywhere. Repeat the procedure about 10 times.
boat. A well-known exercise, the essence of which is that while lying on your stomach, we begin to simultaneously raise and pull our arms forward and legs back so that only your stomach touches the floor. Hold on as long as we can and return to the starting position.
Bike. It is especially useful to do in the morning. Lying on the bed, we begin to turn the air pedals of an invisible bicycle. There should be a pleasant feeling of fatigue in the press area.
Raising and lowering the pelvis. We find support in the elbows on the edge of the sofa, the body is forward, the legs are bent at the knees, we lean on the soles of our feet. We begin with an open mouth to raise and lower the pelvis, simulating reciprocating movements. A slight tension in the groin muscles will appear - a sign of the correct exercise.
Leggings on the buttocks. We sit on the back point, arms, bent at the elbows, can be extended in front of us, legs forward. Now, alternately step each buttock with maximum amplitude and length. A good sign if it gets hot from doing it.
Squats. Everyone knows squats with a straightened back, which everyone did and knows how to do.

5. Apply the "Special Muscle Contraction" method from behind

The next technique for men on how to treat erectile dysfunction at home is the daily training of the pubococcygeus muscle.

Breathe in through your nose air and begin to take in the anus and the muscles around it, do not exhale the air.
You compress all these muscles as well as in the case when you are trying to restrain the urge to bowel.
Perform compressions with greatest force you can, for effective results. On a leisurely exhalation, you remove tension in the muscles and completely relax.
After a pleasant heat behind and in the crotch area. It means that everything is done correctly. We talked about the pubococcygeal muscle in detail in.

Benefits of exercising frequently:

wakes up libido and energy in the pelvic area;
the psyche relaxes;
prostate massage;
the ability to delay a premature finish appears (techniques for postponing the finish are described);
the male sexual organ becomes stronger.

6. Know the Secret to Morning Testosterone

Use this 6th secret early in the morning to lessen your worries about dealing with mild erectile dysfunction in young or older men.

Research shows that testosterone levels in men are highest in the morning, after waking up. By evening, testosterone levels drop. This rule applies to 80% of men.
Build your day so as to get up in the morning, have breakfast and again go back to your beloved in bed. Be aware that in the morning your results will be better.

Breakfast number 1

Porridge, milk.
Fresh fruits.
Bread.
Boiled eggs.
Curd.
It will be useful to give up coffee and drink herbal tea.

Breakfast number 2

Dinner

Vegetable salad.
Fish meat or chicken without fat.
Baked potatoes or brown rice.
Boiled corn.

For dinner

Milk with the lowest fat content.
Varenets.
Yogurt.
Fruits.

Let us examine the issue of the treatment of erectile dysfunction in men with drugs. What helps?

8. Medicines

Products of partners of our site;
Kapikachu;
Viagra;
Cialis.

9. Vacuum pumps

There are special vacuum pumps that are applied to the genitals. Air is pumped out in it with a small pump, and the pressure created there makes get on alert for your friend.

Simply put, vacuum created there reinforces blood flow into dignity, and due to this it swells. This method also gives its positive effect.

10. Food of the goddess of love Aphrodite

Food is called that because it contains special substances - aphrodisiacs.

Aphrodisiacs are substances that increase sexual desire and ability in bed.

At home, the treatment of erectile dysfunction and the causes of its occurrence is also feasible due to some special products and dishes.

These foods include

11. Take Hot and Cold Baths

Start off need a hot bath. Then go cold. Each bath should be about two minutes.
About temperature cold water - it should be moderately cold, then gradually, after getting used to it, you can lower the temperature.
For the process to be successful, change hot to cold baths 6 times, that is, a total of 12 alternations.
The plus is that it improves blood circulation and also increases the production of hormones in the body. The use of a contrast shower or bath will be one of your effective solutions to the question of how to cure erectile dysfunction at home. We give similar advice on the topic in another.

12. Raisin decoction with milk

Black raisins are thoroughly washed and allowed to boil in milk in a ratio of 30 grams per 300 ml, respectively.
Remove from heat after boiling and let cool.
Such a mixture can be consumed once a day, eating raisins boiled in milk and drinking it with milk.

13. Mix with walnuts

They take a handful of walnuts, peel them and eat them either together with honey, pre-chopped and chopped, or eat whole, while drinking the nuts themselves with goat's milk.

14. Buckwheat porridge according to a special recipe

They take buckwheat, clean it and very well washed by changing the water several times. Cleaned and washed pot with buckwheat poured already boiled water.
The mixture is allowed to stand overnight. The next morning they get rid of the water. Then pour buckwheat kefir with the lowest fat content.
Refuse from adding various spices to the dish in the form of salt and other seasonings.
You can eat porridge as many times a day as you like.
Many do not pay due attention to their diet and eat everything: fatty, fried. It must be understood that this erectile dysfunction in men thus acquires only more power.

15. Pumpkin or melon seeds

Pumpkin seeds and also melon seeds are useful. You can choose any of the seeds and well clear. For example, in a coffee grinder.
Powdered seeds can be eaten with honey or just drink water one teaspoon in the morning, afternoon and after dinner.

16. Decoction of carrots

Pass the peeled carrots through a fine grater. Take already boiled milk and mashed carrots in the ratio of two tablespoons per glass, respectively, and mix.

The resulting mixture is kept on low fire about 15 minutes. Then you can let it cool and drink three times a day.

17. Garlic and onions

The next way to treat erectile dysfunction with folk remedies in men is to cook and eat various dishes along with garlic or onions.

Garlic and onions help increase male power. They can also be added to salads as ingredients, eat a few onions a day when you eat soups or other heavy meals.
Onions can be cut into rings, and garlic is usually finely chopped, and this can be added to various meat dishes.
If you have thoughts about smell after eating garlic, you can remove it parsley, which is also useful in male disorders.

18. Don't forget to run

From the usual run, the benefits are very great. At least if you give it 30-40 minutes per day, the result will not keep you waiting.

You can also run on a treadmill at your own pace.

Improves with running circulation in the pelvis, the blood fills the manhood better and its hardness improves.

19. Give up bad habits

For the treatment of mild erectile dysfunction, when your male libido weakens by half, it is recommended to give up old bad habits.

What should be abandoned:

smoking;
alcohol;
fatty or fried foods;
caffeine (it is better to drink freshly squeezed juices instead).

20. Preventive measures

Get physical as often as possible activity. This will prevent the occurrence of stagnation of blood in the pelvis. Do not give up walking, do gymnastics.
During intimacy with beloved elderly Not recommended often lose seed. Older men are advised to come to the finish line less often. You will see how many advantages this will give you in terms of energy, well-being and potential for the next caresses in bed.
Help solve the problem faster monogamous relationship with a beloved woman. The constancy of relationships and feelings will greatly help you.
Be with your woman in one team, not in different ones. Communicate with each other, listen, ask questions and give feedback to each other. A beloved girl can both help speed up the restoration of male strength, and suppress because of her condemnation and reproach.
Loads both for the psyche and for the body must be moderate, do not forget to take time to just take a break from the routine and unload your head from work.
Don't let obesity and make sure that you are not overweight. And for this, in addition to playing sports, you need to monitor your diet.

That's all. Now you know a lot about drugs for the treatment of erectile dysfunction in men and about effective techniques for eliminating this disorder and raising libido.

Erectile dysfunction is increasingly common in young men. This is due to the wrong lifestyle, alcohol consumption and adverse environmental conditions. All this leads to the development of diseases of organs and systems that affect male power.

What is erectile dysfunction?

Erectile dysfunction is a complete or partial lack of erection, which leads to the inability to have sexual intercourse. Most often, this condition is caused by diseases such as diabetes mellitus, prostatitis and some STDs.

Smoking, drinking alcohol and lack of physical activity have a negative impact on the male body. The problem of erectile dysfunction should be dealt with by a specialist who, on the basis of tests, will establish the cause of the disease and select a competent treatment regimen.

Types of drugs for the treatment of erectile dysfunction

Drugs to improve erectile function are divided into 4 types:

oral;
local;
urethral;
injections.

Oral medications for ED

These include tablets, capsules, and powders that are taken by mouth. They help increase blood flow to the genitals. The duration of the effect is up to 36 hours. It is quite convenient to treat impotence with oral preparations even for men over 50 years old.

The most popular drugs are:

Viagra.
Papaverine.
Laveron.
Levitra.
Cialis.

All drugs to increase potency have contraindications. They are forbidden to take with diabetes or diseases of the heart and blood vessels. Very often they cause side effects such as headache, nausea and increased blood pressure. This suggests that with erectile dysfunction, it is imperative to visit a specialist who will select the most suitable drug.

Men over 50 are recommended to take Yarsagumba Forte. Its popularity is associated with a small number of contraindications and the possibility of taking it for cardiovascular diseases. It is used not only to enhance erection, but also for general healing and rejuvenation of the male body. At the same time, Yarsagumba forte is not inferior in effectiveness to such drugs as Cialis or Viagra.

Creams and gels to increase erection

In our country, few men choose drugs for erection in the form of gels or creams. This is easy enough to explain - they have a very high cost. We recommend that you pay attention to these drugs to increase erection, as they have virtually no contraindications and are applied topically. The action of the drugs begins after 7 minutes, the duration of the effect is about 2 hours.

To save money and not stumble upon a fake, purchase the product only on the official website.

The most popular drug that increases erection is M-16 spray. It is affordable and guaranteed results. At the same time, the time of sexual intercourse, arousal and the quality of getting an orgasm are significantly increased.

How ED drugs work

Drugs for the treatment of erectile dysfunction affect the smooth muscles of the penis, by increasing blood flow in it. They are taken before sexual intercourse. The time of action depends on the specific drug and the individual characteristics of the organism. The dosage of drugs is selected exclusively by the doctor.

In the absence of contraindications and allergic reactions, drugs to improve erection can be used as needed. Some of the medications contribute to the fact that the body begins to work on its own, but for this you need to undergo a course of treatment.

Course application allows you to defeat a disease such as impotence and normalize sexual life. If they are applied from time to time, psychological dependence may develop and making love without them will no longer be possible. This suggests that you should not use an erection-improving drug just to surprise your partner.

Effective remedies for the treatment of erectile dysfunction

Peruvian maca. It has a natural composition that allows you to increase erection and strengthen the male body. After application, there is an increase in sexual desire and an increase in the quality of intimacy.
Hammer of Thor. The drug is prescribed with a decrease in potency. It has a natural composition and does not adversely affect the body. Due to the therapeutic effect of ginseng root, blood flow to the pelvic organs increases, after which a strong erection is achieved. The only drawback is a large number of fakes.
Impaza. In the treatment of erectile dysfunction in men with Impaza, smooth muscle relaxation is observed, which leads to increased blood flow in the penis. In addition to the fact that the drug allows you to increase erection, it contributes to the production of male sex hormones.
Andriol TK. It is used if impotence is caused by low testosterone levels. It does not have a negative effect on the liver and allows you to achieve a lasting result. Has contraindications.

Maral's strength. An unconventional remedy for the treatment of impotence. It contains the blood and horns of marals, as well as vitamin C. It helps to increase erection, the production of sex hormones and sperm. One tablet is taken before sexual intercourse.
Muse. Introduced into the urethra of a man. Allows you to significantly improve your sex life. In some cases, it causes pain in the penis. The disadvantage is the high cost.
Erexil 100. Indicated for weak erection and rapid ejaculation. Included in the treatment of infertility. May be taken with other drugs. Appointed by a specialist.
Yohimbe. A very good remedy, which includes an extract of the yohimbe plant. Due to this, blood flow to the penis increases and there is an increase in sexual desire. There is an improvement in emotional state and physical activity.

Features of drug treatment of ED

Erectile dysfunction should be treated by a specialist. Self-medication can only aggravate the situation and lead to sad consequences.

Most medications affect not only erection, but also the heart and blood vessels. They are completely contraindicated in diseases of these organs. Based on the results of the tests, the doctor will select the optimal drug with minimal side effects. The most influencing factor in the treatment process is the emotional and physical state of the man.

Prevention of erectile dysfunction is to avoid drinking alcohol. Give up bad habits, fill your diet with fruits and vegetables, lead an active lifestyle, and your body will begin to recover on its own, without taking medication.

Erectile dysfunction refers to a type of sexual dysfunction of the male genitourinary system, in which there is a violation, weakening or disappearance of an erection. Sometimes this disease is called impotence. However, most often experts use the term "erectile dysfunction". Be that as it may, but such a disease requires treatment. There are several options for eliminating weak potency, which include the use of various medicines. Today we will look at the most effective drugs for the treatment of erectile dysfunction.

Causes of impotence

All factors that cause erectile dysfunction can be divided into 2 types - psychogenic and physiological. Psychogenic causes include:

depression, stress, fear of sexual intercourse with a new woman, anxiety about their sexual abilities, excessive anxiety. Psychological stress has a negative effect on the process of erection formation. If a man had a weak erection once during intercourse, as a result of which he could not satisfy his partner, the man in the future will be afraid of a repetition of such a situation.

The physiological causes of erectile dysfunction have a larger list of situations leading to sexual weakness:

Pills for the treatment of erectile dysfunction

Phosphodiesterase type 5 inhibitors

Most often, to get rid of impotence, the doctor recommends using them. This is due to the fact that their effectiveness has been confirmed as a result of numerous studies, these funds are in the greatest demand on the market for potency products. These are safe medicines for the treatment and improvement of erections. Phosphodiesterase inhibitors include:

Viagra;
Levitra;
Cialis;
Stendra.

These drugs are ideal for the treatment of impotence, which is caused by vascular disorders - as a result of smoking or a sedentary lifestyle. The mechanism of their influence on the formation of an erection is as follows. Phosphodiesterase type 5 inhibitors increase the concentration of nitric oxide in the vessels and relax the smooth muscles of the cavernous bodies of the penis.

This action causes the flow of a large volume of blood into the vessels of the small pelvis and especially the penis. As a result, an erection occurs, which, if necessary, can last for several hours. These drugs are effective only in case of sexual arousal in men. Viagra, Cialis and Levitra are the most popular home remedies for erectile dysfunction.

Contraindications to their use are:

diseases of the cardiovascular system;
cavernous fibrosis;
priapism;
stroke or heart attack in the last 6 months;
it is forbidden to combine them with nitrate drugs, alpha-blockers, nitric oxide donors and alcohol.

To the number side effects phosphodiesterase inhibitors include:

The most famous representative of the group of selective inhibitors is Viagra, made on the basis of sildenafil . Viagra is available in the form of tablets with a dosage of 25, 50 and 100 mg. The drug is taken orally, 1 time per day, 40-50 minutes before sexual intercourse. The duration of action of Sildenafil is about 6 hours. The invention of Viagra was an accident: scientists were developing a remedy for the treatment of the heart, but during the tests it turned out that sildenafil had one very interesting side effect. It increased the flow of blood to the cavernous bodies and caused an erection.

Cialis tablets based on tadalafil have a dosage of 2.5, 5, 10 or 20 mg. During research it has shown to be a highly effective drug for the treatment of erectile dysfunction in patients of all ages. The drug was well tolerated by most men. Cialis should be taken no more than 1 time per day, orally 30-40 minutes before sex, the time of preservation of its effect is up to 18 hours.

The main component of Levitra is vardenafil. During research the drug showed itself from the best side. Thus, 29 thousand patients took it: in 73% of them, erection improved after taking a Levitra tablet at a dosage of 10 mg, in 88% after taking the second (20 mg). Attempts to have sexual intercourse were successful in 94% of patients, and 87% were able to maintain an erection during sex. You need to use Levitra 1 time per day, inside, 20 minutes before sex. The duration of action of vardenafil is 12 hours.

The drug Stendra, the main ingredient of which is avanafil, during research already 15 minutes after drinking allowed a man to have sexual intercourse. The duration of the drug is 6 hours. Stendra is taken orally, once a day, like other phosphodiesterase type 5 inhibitors.

Homeopathic remedies for the treatment of erectile dysfunction

These drugs only work when a man is sexually aroused. They are quite effective, but their effectiveness is short-lived. The most popular and effective homeopathic remedies for impotence are:

Lycopodium.

So, the basis of Impaza are purified antibodies of endothelial nitric oxide synthase. The mechanism of action of the drug is aimed at increasing the concentration of nitric oxide in the cavernous bodies of the penis, relaxing the cavernous bodies and filling them with blood. This leads to an erection. Impaza is recommended for men whose impotence is caused by both psychogenic and physiological causes.

decrease in physical activity;
decrease in sexual desire;
weakness;
fatigue.

The drug can be taken both in the course version and in the periodic. The course of treatment consists of regular use of Impaza for 3 months. At this time, you need to take 1 tablet every other day, or 2 tablets every day. The drug is taken in the evening, the regularity of admission is determined by the doctor.

During intermittent use, you need to take 2 tablets 2 hours before sexual intercourse. The Impaza tablet should be dissolved in the mouth. Contraindications to taking the drug:

allergy to the ingredients of Impaza;
the presence in a man of galactosemia, a syndrome of impaired absorption of galactose or glucose, lactase deficiency.

Of the side effects, the onset of dyspepsia is possible.

Lycopodium enhances sexual desire, eliminates spasms of the smooth muscles of the penis and treats impotence. Ingredients of the drug:

Lycopodium tablet should be placed under the tongue and sucked until completely dissolved. The drug is used between meals 2 times a day. The duration of admission is determined by the doctor. This homeopathic remedy should not be used if the man is allergic to its ingredients. Side effects can be expressed as an increase in the hypersensitivity reaction.

Herbal preparations for the treatment of impotence

These products are made from various herbs and plants. They are also called bioadditives. Their effectiveness in terms of getting rid of erectile dysfunction has not yet been fully studied. They are less effective than phosphodiesterase inhibitors, but they have less side effects. The most famous herbal remedies include:

Ogoplex;
Sealex Forte;
Golden Horse;
Power khan.

So, the Golden Horse is made on the basis of ginseng root and seahorse extract. The drug not only enhances erection, but also gives the body the strength to perform sexual intercourse. The dosage of the tablet is 700 mg. The course of treatment is designed for 25 days, at this time you need to take 2 tablets - one in the morning and one in the evening. Golden Horse is taken with food and washed down with water. However, in case of diseases of the cardiovascular system or hypersensitivity of the body to the ingredients, the remedy should not be taken.

Ogoplex is a preparation made on the basis of pollen from various plants, which are mixed in appropriate proportions. It not only enhances erection, but also is a prophylactic against prostatitis. The course of treatment is 1 month. You need to take 1 tablet per day with meals. Contraindication to use is the individual intolerance of the body to the ingredients of the product.

The Korean drug for the treatment of erectile dysfunction Power khan allows you to quickly achieve an erection, increase testosterone levels and improve psychological state. It consists of Korean natural ginseng, extracts of black pepper, orange peel, pink watermelon, garlic.

The drug is taken both in a single version and as a course of treatment. The course of treatment involves taking 2 Power khan tablets every evening after meals for 3 months. For a single dose, you need to take 8 tablets 2 hours before sex. The drug has practically no side effects, except for an allergic reaction of the body to the ingredients of the product.

Sealex Forte contains licorice root, yohimbe bark, garlic, ginseng, green tea. The course of treatment is from 1 to 2 weeks, depending on the recommendations of the doctor. The drug should not be taken in case of an allergy from the body to the ingredients.

Hormonal drugs for the treatment of erectile dysfunction

They are prescribed in the event that impotence has arisen under the influence of low testosterone levels. These are Andriol, Sustanon 250, Nebido. All of them are based on testosterone.

Andriol is available in two forms - capsules and injection. The ingredients of the drug are testosterone undecanoate and additional components. The dosage of capsules is 40 mg. The initial dosage of admission is 120 mg. per day for 3 weeks. Capsules are washed down with water during a meal.

As for the solution for injection, its dosage is 400 mg. testosterone in a volume of 4 ml. Injections should be done once a month in the amount of 4 ml. intramuscularly, if necessary, the portion is increased. You can use Andriol only after the advice of a doctor.

The benefits of using Andriol include:

safe for the liver;
it has no pronounced side effects;
does not inhibit the production of hormones in the body.

However, it also has disadvantages:

high cost;
with its help it is difficult to achieve the desired level of testosterone in the blood, since the level of this hormone changes hourly;
Andriol should be taken every day (in capsules).

Nebido is available as a solution for intramuscular injection. They need to be done 1 time in 10-12 weeks. The drug can be used only with the permission of a doctor. Sustanon 250 is taken intramuscularly in an amount of 250 mg. once a week.

Preparations of intracavernous type to increase potency

In this case, the injection is made directly into the cavernous bodies of the penis. The most effective drug of this type is Alprostadil. Its purpose is the treatment of erectile dysfunction of psychogenic or physiological types by expanding blood vessels and increasing blood circulation in the penis.

The initial dose for one injection is 2.5 mcg. The individual portion is determined by the doctor. How to use the drug:

dry matter is dissolved in 1 ml. sodium chloride solution;
after its complete dissolution, the solution is drawn into the syringe;
all air is removed from the needle and syringe;
the needle is inserted from the left or right side of the penis;
do not allow the needle to enter the vessels;
the process of introducing the solution should take no more than 10 seconds;
the injection site is clamped with a swab for 3 minutes.

The first time an injection should be given by a doctor who will explain in detail all the details of its implementation. You can use Alprostadil no more than 3 times a week, while the interval between injections should be at least 24 hours. The drug should not be taken if there are:

hypersensitivity to the drug;
penis deformity;
fibrosis;
hypertension;
leukemia.

Side effects may include:

pain at the injection site;
edema;
the appearance of a hematoma.

The duration of action of Alprostadil is about 5 hours.

Preparations for external use

These include all kinds of gels, ointments and patches. For example, Alprostadil (also available in the form of a gel), Androgel, Androderm. They need to be applied to the skin of the penis regularly, and this can cause burning and itching.

So, Alprostadil-gel during research proved to be highly effective in the treatment of erectile dysfunction. The first such study was conducted in 1999 and included 48 men with erectile dysfunction. The use of the gel resulted in an erection in 67-75% of patients.

Androgel consists of testosterone in the form of a gel, which should be applied to clean surfaces of the abdomen. The contents of the bottle are squeezed into the palm of your hand and rubbed on the skin with a thin layer. Absorption of the drug continues for 5 hours.

Androderm is a patch impregnated with testosterone at a dosage of 2.5 and 5 mg. The patch is glued to a clean surface of the hips, back, shoulders or abdomen in the evening, before going to bed. The area of skin must be free of hair. The effect of the patch lasts for 24 hours, after which you need to use another patch. You can not stick it on the same place 2 times during the week.

These erectile dysfunction drugs are used to solve sexual problems. Please note that the type of treatment depends on the establishment of the causes of impotence. Therefore, before using any medication, it is recommended to consult a doctor who will prescribe the appropriate remedy and course of treatment.

Sources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476024/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4570643/

https://www.ncbi.nlm.nih.gov/pubmed/8858389

https://www.ncbi.nlm.nih.gov/pubmed/11045912