TREATMENT OF PRIMARY sexual dysfunction in men frequently addresses erectile problems. A complex series of nerve impulses, which travel between the brain, spinal cord, and penis, initiate and maintain an erection. Accompanying these signals is an increase in the arterial blood flow to the corpus cavernosa (three cylinder-like areas of spongy tissue in the penis), causing these tissues to expand. The arterial inflow of blood, in association with relaxation of smooth muscle in the penis, compresses small veins through which blood normally exits the penis. This venous compression traps the blood in the penis and causes an erection. When nerve transmission is impaired, a man's ability to achieve or maintain an erection can be affected.
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| MS Oral Medication FDA Approved |
The lower (sacral) area of the spinal cord has nerve pathways traveling to and from the genitals, which allow for reflex erections. Reflex erections that do not involve the middle or upper parts of the spinal cord or brain can usually be triggered by stimulating the penis and scrotum directly. Therefore, some men who have impaired erectile function can obtain reflex erections by vigorously stimulating the penis and scrotum with a vibrator.
Reflex erections can also result from "stuffing." To engage in stuffing, the woman sits astride her partner and inserts the flaccid penis into the (well-lubricated) vagina. Even if a reflex erection does not result from this motion, it frequently produces pleasurable sensations for both partners. However, stuffing must be done in a gentle fashion. The flaccid penis can fold back on itself and become squeezed by the pressure of the partner's weight, which can cause injury to the penis. In the presence of reduced sensation, the damage can go undetected because it occurs inside the penis.
Several options are available for treating erectile problems caused by MS.
Oral medications
Oral medicines known as phosphdiesterase type 5 inhibitors, or PDE-5 inhibitors (e.g., sildenafil citrate - Viagra; vardenafil - Levitra; and tadalafil - Cialis) are used to help with erectile dysfunction. PDE-5 inhibitors work by blocking a chemical in erectile tissues that causes erections to become flaccid, which in turn allows for enhanced erections. In controlled clinical trials, all three of these medicines were associated with significantly improved erectile function and greater frequency of intercourse among men with impotence, whether the impotence was related to physical causes, psychological issues, or both.
All three of the medications are approved by the Food and Drug Administration (FDA) for the treatment of erectile dysfunction in men. Of the three drugs, however, only Viagra (the first of these drugs to arrive on the market) has been specifically tested in men with MS. In a Placebo-controlled clinical trial of Viagra in men with MS, Viagra was shown to have a positive impact on quality of life - including sexual life, partnerships, family life, social contacts, and overall satisfaction. While all three of these medications have been used successfully by men with MS, they do not work for everyone.
The PDE-5 inhibitors, which take 30 minutes to an hour to become effective in the body, vary somewhat in the length of time they remain effective - ranging from a couple of hours to 36 hours. During this period of time, the man is able to achieve an erection in response to appropriate erotic stimulation. In the absence of stimulation, no erection will occur. While these medications enhance erectile function in men with erectile disturbances, they do not improve or increase sexual desire or resolve conflicts or tension within a relationship. Counseling is recommended to help restore intimacy and improve communication for those who have been experiencing significant relationship issues.
Since all PDE-5 inhibitors work with the same biochemical pathway, the precautions and side effects for the three drugs are similar. None are to be used by men who are taking nitrate-based medications (e.g.. ISMO, Imdur, Nitro-Dur, Nitro-Paste, Nitrostat, Nitro-Bid, etc.) because the combination may cause a sudden and potentially dangerous reduction in blood pressure, even if the nitrate medication are used only occasionally. PDE-5 inhibitors cause a small transient decrease in blood pressure in most men.
Coupled with the cardiovascular stress of intercourse, this side effect can cause heart attacks or strokes in men with pre-existing vascular disease. Men with recent heart attacks, significant high blood pressure, and/or heart disease should have a cardiology evaluation prior to starting on any of these medications. While it may be tempting to order one of these medications over the Internet, it is extremely important to consult with a physician before doing so.
Side effects of these medicines in the clinical trials were relatively infrequent, with headache, facial flushing, indigestion, dizziness, nasal congestion, and blue-green visual aura being reported. Priapism (overly prolonged erection) has also been reported as a rare side effect. In a normal erection, the remains rigid because the trapping mechanism keeps blood from flowing out of the penis until ejaculation occurs.
This blockage of blood flow prevents the penis from receiving fresh oxygen for the period of time that the penis remains erect. Therefore, a man whose penis remains erect for too long a period of time risks irreversible damage to the erectile mechanism and to the penis itself. If a man's erection lasts longer than four hours, he must seek immediate medical treatment, since an erection lasting longer than 24 hours will permanently damage penile tissue.
All of the PDE-5 inhibitor medications are relatively expensive, and some insurance companies in the United States will not reimburse for the costs of these medications.
In addition to the PDE-5 inhibitors, there are other oral medicines in development for erectile dysfunction that work by enhancing or blocking chemical pathways in the brain and spinal cord that are related to sexual function. None of these have been tried to date in MS. To find out more, you can check out MS Oral Medication FDA Approved.