It is known that sexual dysfunction is highly prevalent among the aging population. Many men experience some degree of erectile dysfunction (ED) after turning 50. The condition is more common among African Americans, and it is estimated that about 26% of men over the age of 45 have some degree of ED. Studies show that approximately half of all men with ED will experience some sort of cardiovascular or cerebrovascular event within a year of being diagnosed. These are all major roadblocks in terms of functioning sexually. A new class of medication known as sildenafil has now been shown in a clinical trial to help reduce these negative age-related effects. Reports indicate that this new medication may have significant advantages over older ED treatments such as Viagra (sildenafil citrate) and Levitra (vardenafil HCl).
Positive Results From A Major Trial
According to a new study published in the European Journal of Sexual Medicine, the use of sildenafil at doses of 25-100mg improved erectile function and satisfaction in men with ED who were either unresponsive or poorly responsive to previous treatment with a PDE5 inhibitor. Men in the study were included if they had moderate to severe ED; were not currently taking any ED medication; and were not suspected of having any form of cardiovascular disease or taking any medications that might cause or contribute to ED. The trial, conducted by researchers at the University of Naples, was one of the largest randomized, placebo-controlled studies to date involving sildenafil.
The researchers recruited 1,100 men from 23 countries across Europe, Canada, and Australia for the study. The participants were randomly assigned to receive either sildenafil 100mg or a placebo three times a day for 12 weeks. The primary outcome was change in erectile function from baseline to endpoint as rated on the International Index of Erectile Function (IIEF) questionnaire. Secondary outcomes included safety and tolerability, as well as patient-reported outcomes (e.g., IIEF question 2, intercourse satisfaction).
The average baseline IIEF score was 13.3 for the placebo group and 13.5 for the sildenafil group. At 12 weeks, the average score was 16.4 for the placebo group and 17.6 for the sildenafil group, a significant improvement. At endpoint, 79% of the men in the placebo group and 86% of the men in the sildenafil group experienced an improvement in erectile function compared to baseline. The improvements were independent of age and duration of ED. Based on the results of this study, sildenafil 100mg is now recommended as initial therapy for ED; however, the study was not designed to assess whether or not the drug was safe and effective long-term. There is also a need for more research on the topic. The results were recently presented at the European Association of Urology (EAU) Annual Meeting in Barcelona, Spain.
Why Sildenafil?
One of the major advantages of sildenafil is that it is a once-daily medication. Many men with ED will experience some degree of ED after turning 50, and for those men, once-daily therapy is often preferred to more frequent dosing. Additionally, since sildenafil is a PDE5 inhibitor, it is thought to enhance erectile function primarily by increasing the effectiveness of the nitric oxide (NO) that is naturally produced in the penis. This, in turn, may lead to fewer negative effects (such as headache, flushing) associated with ED treatments. It is also important to note that sildenafil has been demonstrated to have potent anti-inflammatory and anti-ischemic properties; however, the protective effects of this medication are not yet completely understood. In the meantime, it appears to be a viable, well-tolerated option for men with ED who are at risk of or who already experience cardiovascular disease.
Other Important Points
Although results from the above-mentioned study suggest that sildenafil may be a viable and safe option for men with ED, other medications and therapies may also prove effective. Further study is needed to identify the ideal combination of medication and treatment for ED. As previously mentioned, many men with ED experience some sort of negative effect in the form of a headache, flushing, or other problems associated with the use of sildenafil. For those patients, alternative medications might be the best choice. For patients who have not responded well to sildenafil or who experience side effects, other treatment options should be considered. At the end of the day, it is important to keep in mind that ED is a medical issue and not a moral one. Every man should be able to experience and enjoy an active sex life well into old age.