Treatment of Erectile Dysfunction

Sometimes called impotence, erectile dysfunction is a condition that many men will experience over the course of their lives. It affects around half of men in the 40-70 age bracket. That figure increases to 70% of men older than 70.

Erectile dysfunction has a variety of treatment options in the UK, all of which are officially regulated and licensed.

For as many as 80% of men who experience erectile dysfunction, these modern treatment options are safe and effective – and they are also affordable.

What is Erectile Dysfunction?

Known as erectile dysfunction, ED or impotence, this condition is defined by being unable to sustain an erection during sexual activity. It is widespread, particularly in men older than 40. Treatment is relatively simple. The most well-known and effective medications are Sildenafil (Viagra) and Tadalafil (Cialis).

Causes of Erectile Dysfunction

To effectively treat erectile dysfunction, first you need to identify its underlying origin. This could be any of a wide range of causes, some of them physical, some psychological and some related to lifestyle.

Many cases of erectile dysfunction can be linked to impaired blood flow, or to problems with the nervous system. Arousal should lead the brain to signal the nerves, which in turn should lead to muscle relaxation in the penis. As the blood vessels in the penis widen, blood flows in and remains there, causing it to become erect.

Conditions that may impair blood flow include:

• High blood pressure
• Cardiovascular disease
• Diabetes
• Neurological disorders such as Parkinson’s disease
• Mental health conditions such as stress and depression
• Penile injury/tissue damage
• Decreased libido
• Poor lifestyle, such as excessive drinking and smoking
• Obesity
• Hormonal conditions impacting testosterone levels (rare)

What treatments are available and how do they work?

Many drugs are available to treat erectile dysfunction, but the way that they work is similar in all cases. They attempt to improve the flow of blood to the penis, which when accompanied by sexual stimulation may create a sustainable erection. In the UK, the licensed medications are Sildenafil and Vardenafil, often known as Viagra and Cialis.

Sildenafil and Viagra

Sildenafil is categorised as a phosphodiesterase type 5 inhibitor (PDE5). It improves the flow of blood into the penis by relaxing the blood vessels. Men who struggle with erectile dysfunction will then be able to form and sustain an erection with the aid of sexual stimulation.

How do I take it?

An initial dose of Sildenafil is usually one 50mg tablet, taken with water, within a 24-hour period. Usually it should be taken about an hour before the intended sexual activity. It is recommended that you do not eat until at least an hour after swallowing the tablet. The rate of absorption can be affected by food, meaning it may take longer to notice the effects.

How long is it before it takes effect?

It normally takes an hour for Sildenafil to become effective, but you will still need sexual stimulation as well to ensure its effectiveness.

How long will it last?

When combined with sexual stimulation, Sildenafil’s effects may last for up to four hours. That is not to say you will experience a four-hour erection, just that during those four hours, the drug remains active in your body and your likelihood of sustaining an erection will be increased.

How do Sildenafil and Viagra differ?

Both contain sildenafil citrate, and both are delivered at various doses to create an effective erectile dysfunction medication. The main difference is that Sildenafil is generic, whilst Viagra is an official brand name and may therefore cost significantly more.

Commonly seen side effects

• Muscle pain
• Back pain
• Headaches
• Migraines
• Flushed appearance/red face
• Disturbed vision
• Runny or blocked nose
• Nausea
• Indigestion

Product information:

https://www.medicines.org.uk/emc/files/pil.3172.pdf

Tadalafil and Cialis

Tadalafil and Cialis are equal in medical terms, but Tadalafil is a generic, and therefore cheaper, product whilst Cialis is a branded drug. Both can be used to treat adult men who are experiencing erectile dysfunction. Their effects tend to be longer in duration than those of other medications for the same condition, such as sildenafil/Viagra.

How do Tadalafil and Cialis differ?

The only difference is that one is generic and one is branded. It is a legal requirement for manufacturers to demonstrate that any generic medication they offer for sale is safe, stable and effective, with the same potency and quality as the branded version. The primary difference between a generic and a branded drug is the price.

What is Tadalafil Daily?

There are two ways to take Tadalafil: Tadalafil Daily and Tadalafil 36-hour.

You can take Tadalafil Daily once every 24 hours. As you take it every day, you can always be prepared for sexual activity. The 36-hour version is generally taken around 30 minutes before intercourse, which means it needs to be planned in advance.

Tadalafil Daily is available in lower doses of 2.5.mg or 5mg tablets to reflect the more regular usage.

Tablets of Tadalafil 36-hour are delivered in larger 10mg and 20mg doses as they are not taken as frequently.

Which dose is best for me?

Whenever you first take a new medication, it is always best to use a lower dose to start with, in case you experience a negative reaction. If you do undergo any side effects, or if the Tadalafil is simply not working as intended, your pharmacist or doctor may be able to adjust your dosage or make recommendations for an alternative treatment that better suits your needs. The choice between Tadalafil Daily and Tadalafil 36-hour is also very dependent on lifestyle and personal preference.

How does it work?

Like Sildenafil, Tadalafil is a phosphodiesterase type 5 inhibitor (PDE5), capable of encouraging blood flow to the penis by relaxing the relevant blood vessels. To fully achieve erectile function, and then to sustain it, Tadalafil does need to be augmented with sexual stimulation.

How do I take it?

Tadalafil 36-hour (10mg or 20mg): One pill, taken with water, 30 minutes before your intended sexual activity. Use the lower dose initially, then increase or lower as necessary. Never take more than one tablet in a 24-hour period.

Tadalafil Daily (2.5mg or 5mg): Start with the 5mg dose, but adjust if necessary. One tablet, taken with water at the same time every day. Again, never take more than one tablet within a 24-hour period.

Do not take any other medications for erectile dysfunction, such as Sildenafil/Viagra, Vardenafil/Levitra or other formulations of Tadalafil/Cialis, whilst you are still taking Tadalafil Daily.

How long does it take to work?

Tadalafil is generally considered fast-acting due to its rapid rate of absorption, though it will not work effectively without sexual stimulation. Food may slow the rate of absorption, though it is safe to take the tablet with food. You can generally enjoy sexual intercourse between 20 minutes and an hour after your pill.

As Tadalafil Daily uses a lower dose, it does not work as quickly. You will need to take a tablet a day for around 5 days for it to reach full potency. After that point, however, the benefits are continuous. You can instigate sexual activity any time without having to plan ahead to take your medication.

How long do the effects last?

It depends whether you take Tadalafil 36-hour or Tadalafil Daily. The 36-hour version does remain active in your body for up to 36 hours, notably longer than most forms of erectile dysfunction medication. Taking Tadalafil Daily every day ensures the continuous effect of the medication on the body at all times, so you are always prepared for sexual intercourse.

Side Effects of Tadalafil

All medications can cause side effects in some users. Side effects for Tadalafil occur in between 1 in 10 and 1 in 100 men who take the drug. The most frequent side effects include:

• Red/flushed face
• Headache
• Indigestion