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  • Updates on erectile dysfunction and mechanical therapy
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    Robert Incoom, MSc. (Clinical Pharmacology), MPSGH1

    1Head of Clinical Pharmacy Practice, Cape Coast Teaching Hospital, Cape Coast, Ghana

    INTRODUCTION

    Erectile Dysfunction (ED) has been described as a common disorder that exerts profound effect on well-being in many people. The field of erectile dysfunction has undergone considerable transformation in recent times. There is now an improved understanding of the physiological mechanisms of penile erection and how alteration in these mechanisms leads to impotence. Many descriptions have been ascribed to the disease owing to its psychosocial implications. Erectile dysfunction is believed to affect emotional and mental wellbeing, inter-personal relationship and quality of life (Montague, 2002). One of the prominent descriptions attributed to Leo Tolstoy, a Russian writer and philosopher was: ‘Man survives earthquakes, experiences the horrors of illness, and all of the tortures of the soul, but the most tormenting tragedy of all time is, and will be, the tragedy of the bedroom’ (Goldberg, 2003). Regardless of these descriptions, the International Society of Sex and Impotence Research (ISSIR) have defined erectile dysfunction as a persistent inability to achieve or maintain an erection satisfactory for sexual performance (Montague, 2002). The definition has been broadened to take cognizance of mutual satisfaction of the man and his partner and this could explain why erectile dysfunction has also been described as the disease of men that is of utmost concern to their partners as well.

          

    In recent times oral pharmacological therapy has been proposed as the initial option for the treatment of erectile dysfunction. Treatments such as intracavernosal injection of vasoactive agents by patients are increasingly becoming unpopular with the advent of vacuum erection devices, penile implants and vascular reconstructive surgery. Currently, there is limited use of phosphodiesterase type 5 inhibitors in elderly patients, or patients with moderate to severe diabetes, hypertension, and coronary artery disease. Alternative therapies such as Vacuum Erection Device, Penile Prothesis Implants and Penile Vascular Surgery have emerged as the primary options for patients refractory to oral therapy (Pahlajani, Raina, Jones, Ali, & Zippe, 2012). These approaches have added new dimensions to the use hormonal therapy and psychological counseling. In this article, the use of mechanical devices for the treatment of erectile dysfunction will be reviewed.


    PREVALENCE AND CAUSES

    By the year 2001, 150 million men worldwide were reported to have experienced erectile dysfunction, and this population is projected to increase to more than 300 million by the next silver jubilee (Montorsi et al., 2004). Erectile dysfunction is highly prevalent but often under reported. Prevalence is said to be variable from country to country. In the United States an average of about 25 million men are reported to be living with the disorder compared to half a million men in the United Kingdom (Agarwal et al., 2006). The Massachusetts Male Aging Study revealed that 52% of men within the ages of 40 to 70 years in the US had ED and a 32% incidence in the UK (Feldman et al, 1994). Although increasing age has been found to be associated with ED, the condition is said not to be a necessary occurrence of the ageing process (Jin et al., 2006).

          

    The organic or physical risk factors for erectile impotence fall into five main groups. These include: (1) Vascular disorders; which comprise of circulatory problems that interfere with blood supply to the penis e.g. atherosclerosis, diabetes, hypertension and hypercholesterolaemia, (2) Lifestyle factors; smoking, which exacerbates vascular disorders and alcohol intake. (3) Neurological disorders; Diseases such as multiple sclerosis and trauma resulting in pelvic or spinal cord injury, (4) Surgery; (e. g. for prostate disease which might cause damage to the nerves supplying the penis and radiation therapy), (5) Drugs; some antihypertensive medications such as methyldopa, antidepressants and ulcer healing earlier H2 receptor blockers (Shiri et al., 2006; Wespesa et al., 2002).

     
    MECHANISM OF PENILE ERECTION

    The mechanism of erection is said to involve a complex neurovascular phenomenon that relies on neural, vascular, hormonal, and psychological factors. The controlled integration of these processes result in normal erection. It has been proposed that following sexual stimulation there is the release of nitric oxide by the blood vessels into the penile smooth muscles which activate the production of the cytosolic enzyme guanylate cyclase Fig. 1. This subsequently promotes the production of the second messenger cyclic GMP. Cyclic GMP decreases the intracellular calcium and thus results in corpus cavernosa smooth muscle relaxation as shown in fig. 1. The relaxation of the smooth muscle enables increased blood flow into the spongy tissues of the corpora cavernosa. The sinusoidal spaces expand preventing the outflow of blood from the dorsal veins (Fig. 2) thereby resulting in an erection (Goldstein et al., 1998). 



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