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It acts at the adrenergic receptors in brain centers associated with libido and erection, and it may facilitate stimulated erections.(10)A meta-analysis of 7 randomized, placebo-controlled studies of men with erectile dysfunction showed that yohimbine was better than placebo in treating ED. This benefit was most significant, however, in patients with psychogenic ED, and efficacy was only marginal in patients with organic ED.(13)Yohimbine is generally recommended for those with psy-chogenic ED.(14) Papaverine is an opium alkaloid that inhibits phosphodiesterase at the postreceptor level and induces smooth muscle relaxation in the sinusoids and dilation of helicine arteries.(10)It increases cAMP and cGMP concentrations in penile erectile tissue, thus facilitating erection. It is effective and low in cost but can cause significant priapism and fibrosis when used alone at higher dosages. This adverse-effect profile limits routine use of papaverine; however, lower dosages can be utilized if used in combination with other vasoactive injection therapy. (Phentolamine, a competitive alpha(1) and alpha(2)adrenergic-receptor blocking agent, dilates arteries and abolishes cenforce 100 for sale sympathetic inhibition of erections. Although it does not cause erections alone, it can be used in combination with other vasoactive injection therapy.(10)Significant adverse effects with phentolamine include orthostatic hypotension and tachycardia. Oral phentolamine has been reported to be effective in treating ED and is available in several South American countries but not in the United States. Intracavernous therapy with the lower dosages of combination papaverine and phentolamine is effective in treating ED, is better tolerated, and can be considered for patients who fail with traditional agents. Other combinations include intracavernous therapy with papaverine and alprostadil or with phentolamine and alprostadil. The most effective combination is intracavernous therapy with papaver-ine, phentolamine, and alprostadil (also known as trimix). The response rate with trimix may be as high as 90%.(11) Conclusion ED affects a vast number of men in the United States, and it is one of the most common untreated medical disorders. Sildenafil is a major discovery in the treatment of ED. Although not completely effective in all patients, efficacy rates are high for sildenafil. Alprostadil is another effective treatment option, but it requires patient acceptance of the route of administration. A suitable medication therapy can be selected at the discretion of both the physician and the patient. Newer agents, such as vardenafil, will soon be available for use, and other therapies are in clinical development. Erectile dysfunction and premature ejaculation: underlying causes and available treatments. This review examines the underlying causes associated with ED and PE and evaluates currently available treatment options and those under investigation. Erectile and ejaculatory disorders comprise the most prevalent sexual disorders in men, with erectile dysfunction (ED) primarily affecting aging men who have coexisting morbidities such as cardiovascular disease and diabetes mellitus. Premature ejaculation (PE) can affect men of all ages and is not typically associated with underlying organic disorders but is believed to be associated with imbalances in serotonin neurotransmission. The availability of oral phosphodiesterase inhibitors has revolutionized the management of ED, replacing cenforce 100 for sale less-desirable older products associated with more side effects. Although many efficacious treatment options are currently available and recommended for the management of PE, several challenges remain in bringing the first desirable, safe, and effective FDA-approved drug to the US market. This review examines the underlying causes associated with ED and PE and evaluates currently available treatment options and those under investigation. 2010;45:17-27.) Erectile dysfunction (ED) and ejaculatory disorders such as premature ejaculation (PE) are considered the most common types of sexual dysfunction in men. "The inability to achieve or maintain an erection sufficient for satisfactory sexual performance," is a commonly accepted definition of impotence by the National Institutes of Health; however it is now recognized by the American Urological Association (AUA) as ED. 1 ED reportedly affects up to 40% of cenforce 100 for sale men between the ages of 40 and 70 cenforce 100 for sale and is more likely to develop with aging. 2-4 Despite broad consensus on a single definition, PE is commonly characterized by the inability to sildenafil citrate 100mg tab for sale delay ejaculation, which occurs before or soon after the initiation of intercourse and is subsequently associated with feelings of distress or frustration. 5,6 Unlike ED which is more prevalent in older men, PE is considered one of the most common male sexual disorders and occurs with similar frequency in men, independent of age. The penis is comprised of several key structures: the corpus cavernosum encased within the tunica albuginea, the corpus spongiosum containing the urethra, and the extensive vascular system of arteries and veins. 8 In the flaccid state, penile smooth muscle tissue is contracted and arterial blood flow which supplies the sinusoidal cavities within the pair of corpora cavernosa is equal to venous drainage from them.
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