ED Treatment: Which Pills Are The Most Effective?

Erectile dysfunction(ED) is a condition that leads to the constant inability to achieve and maintain an erection firm enough to have sexual intercourse.

At least one in ten men have, at some point, problems getting or holding an erection. It may be due to physical or psychological causes or both, but regardless of the cause, muscle and blood vessel disorders result in poor blood flow in the penis to obtain and maintain an erection.

Fortunately, there are currently many treatment options for ED, being phosphodiesterase type 5 (PDE5) inhibitors the most effective and recommended ones according to physicians and testimonials.

There are only four main FDA-approved inhibitors that vary in efficacy, effects duration, and side effects. But with such an offer, which one is the best to choose? Let's find out.

One of the most important components responsible for the erection is the corpus cavernosum. Smooth muscle relaxation within this tissue is the key to penile erection during intercourse.

Erection begins with sensory or mental stimulation, or both, and these cause the muscle to relax to allow greater blood flow, ultimately increasing the size of the penis. During it, some natural enzymes regulate the muscular process by preventing its relaxation.

Phosphodiesterases (PDEs) are the enzymes responsible for preventing this relaxation and stopping the erection. Their inhibition causes a greater blood flow to the penis and, therefore, erection. Their three main purposes are 1) smooth muscle relaxation, 2) vasodilation, and 3) penile enlargement.

All men have phosphodiesterases in their bodies because they allow the penis to return to normal after arousal. These attempt to destroy two chemicals essential for corpus cavernosum relaxation: cGMP and cAMP. Specifically, cGMP promotes vasodilation and, in turn, induces the release of more muscle relaxants.

Phosphodiesterase 5 inhibitors aim to inhibit phosphodiesterase 5, responsible for cGMP degradation, stimulate the release of muscle relaxants, such as nitric oxide, and thus achieve a strong, sustainable erection.

Four potent and selective PDE5 inhibitors treat ED: sildenafil, tadalafil, vardenafil, and avanafil. They are not erection starters and need sexual stimulation first.

Sildenafil, or sildenafil citrate, was initially developed to treat heart conditions since it dilated the blood vessel walls. It is now a well-known treatment for erectile dysfunction because of its ability to selectively inhibit phosphodiesterase-5 and promote corpus cavernosum blood inflow.

Key points about sildenafil:

• It is effective within 30 minutes to 1 hour after you take it, so sexual stimulation must occur during this time
• If you are going to masturbate or have sex, be aware that its effectiveness decreases after a fatty meal because it disrupts its proper intestinal absorption.
• You should use it mainly for long-lasting sexual encounters, as its effects can last up to 12 hours after you take it.
• Side effects are usually mild and self-limiting once your body gets used to the pill. The most common are headache, heat and flushing sensation, and intestinal discomfort.

Sildenafil (also commercially known as Viagra) is taken in doses of 25, 50 and 100 mg, with the recommended initial dose starting at 50 mg. However, it should be based on each person's response and side effects, if any.

Tadalafil was marketed in January 2003 with a significant improvement in its time to act. Like sildenafil, it is a potent and selective inhibitor of PDE5.

According to clinical studies, it also has an antihypertensive effect in uncontrolled individuals, with the additional benefit of reducing mortality and morbidity.

Key points about tadalafil:

• It effectively promotes erection from 30 minutes after taking it, reaching its peak after 2 hours.
• Lasts in your body for about 36 hours, so its effects are long-lasting, and you will not need to take another pill if you are likely to have sex again.
• You can take the pill with meals since, compared to Viagra, its absorption is not influenced by food.
• It is more specific to PDE5, so its action on blood vessels, retina, and other organs is low, hence the side effects.

Tadalafil is commercially known as Cialis and is the longest-lasting PDE5 drug for ED. Its recommended doses are lower compared to Viagra, ranging from 2.5mg to 20 mg, but always tailored to the response and tolerance of each person.

Cialis's common side effects include headaches, intestinal discomfort, back pain, nasal congestion, and sweating.

Like the previous ones, it is a potent PDE5 inhibitor launched in 2003 but even more affordable.

• It is effective from 30 minutes after taking it.
• Its effectiveness is reduced if taken with large or fatty meals.
• It is administered in small doses similar to those of tadalafil.
• Like the previous ones, its side effects are usually mild and improve as your body gets used to the pill. Headache, intestinal discomfort, back pain, vision problems, and overheating are mentioned.

Sold as Levitra, Vardenafil comes in doses of 5, 10 and 20 mg. The usually recommended starting dose is 10 mg, but your physician should adjust this depending on your response and side effects.

It is also a powerful and highly selective inhibitor of cGMP-specific type 5 phosphodiesterase. Like the others, it is effective and safe as a treatment for ED.

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