J Korean Med Assoc.  2008 Aug;51(8):770-778. 10.5124/jkma.2008.51.8.770.

Pharmacological Management of Male Sexual Dysfunction

• Chung WS

• KMID: 2185940
• DOI: http://doi.org/10.5124/jkma.2008.51.8.770

Abstract

The erectile dysfunction (ED) and premature ejaculation (PE) are common medical conditions of male sexual dysfunction that affects the sexual lives of millions of men. While many drugs are now available for treating ED and PE, oral pharmacotherapy represents the first-line option for most patients. Phosphodiesterase type-5 (PDE5) inhibitors are currently the most widely prescribed oral agent and have a very satisfactory efficacy-safety profile in all ED patients' categories. Continuous treatments using PDE5 inhibitors and new agents including fast acting PDE5 inhibitors or other intracellular modulators are now under investigation. ED patients who do not respond to oral pharmacotherapy or who cannot use it are good candidates for intracavernosal injection therapy of which efficacy is high but the attrition rate remains significant. Since the pathophysiology of PE is still unclear and there is no approved treatment, it remains to be underdiagnosed and under-treated. The first-line pharmacotherapy for most PE patients is selective serotonin reuptake inhibitors (SSRI) because central 5-hydroxy tryptamine has been implicated as a key mediator of ejaculatory control. Topical anesthetics have also shown varying degrees of efficacy and tolerability. New agents being considered for the on-demand treatment of PE include tramadol and dapoxetine. Therapies for ED or PE will continue to develop as the understanding of those conditions expands. The purpose of this review is to describe the major recent novel advances in the field of medical therapy for the treatment of ED and PE.

Keyword

Erectile dysfunction; Premature ejaculation; Pharmacotherapy

MeSH Terms

Anesthetics
Benzylamines
Erectile Dysfunction
Humans
Male
Naphthalenes
Phosphodiesterase 5 Inhibitors
Premature Ejaculation
Serotonin Uptake Inhibitors
Tramadol
Tryptamines
Anesthetics
Benzylamines
Naphthalenes
Phosphodiesterase 5 Inhibitors
Serotonin Uptake Inhibitors
Tramadol
Tryptamines

Figure

• 

  Figure 1 Action mechanism of PDE5 inhibitor.

• 

  Figure 2 Chemical structures of various PDE5 inhibitors. Note similarity to cGMP in structure.

• 

  Figure 3 A simplified algorithm for sexual activity and cardiac risk in patients with erectile dysfunction.

Reference

1. Rajfer J, Aronson WJ, Bush PA, Dorey FJ, Ignarro LJ. Nitric oxide as a mediator of relaxation of the corpus cavernosum in response to nonadrenergic, noncholinergic neurotransmission. N Engl J Med. 1992. 326:90–94.

2. Montorsi F, Salonia A, Deho F, Cestari A, Guazzoni G, Rigatti P, Stief C. Pharmacologic management of erectile dysfunction. BJU Int. 2003. 91:446–454.

3. Broderick GA. Oral pharmacotherapy and the contemporary evaluation and management of erectile dysfunction. Rev Urol. 2003. 5:Suppl 7. S9–S20.

4. Uckert S, Mayer ME, Stief CG, Jonas U. The future of the oral pharmacotherapy of male erectile dysfunction: things to come. Expert Opin Emerg Drugs. 2007. 12:219–228.

5. Mulhall JP. Current and future pharmacotherapeutic strategies in treatment of premature ejaculation. Urology. 2006. 67:9–16.