Many physicians will seek treatments that run from the least invasive to the most invasive. In many cases, if the patient is on medication for high blood pressure, they will check to see if there are any side effects that may be the cause of the erectile dysfunction.
Sometimes a patient will know of a medication they are taking that is causing problems with erections, and they will share that information with their physician. Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered.
In March 1998, the Food and Drug Administration (FDA) approved Viagra to treat ED, the first pill in a new drug class, phosphodiesterase inhibitors. In August 2003, the FDA gave approval to a second oral medicine, vardenafil hydrochloride (Levitra). Additional oral medicines have since been approved (Cialis, tadalafil) and more are being tested for safety and effectiveness.
Taken an hour before sexual activity, phosphodiesterase inhibitors such as Viagra and Levitra work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.
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