In 2006 a senior client presented a prescription to me for an erection inducer device (vacuum penis pump). I was clueless about the product and, as a pharmacist, I felt guilty about my ignorance of this therapy device for erectile dysfunction (ED).

I promised that I would try to locate it for him. Weeks later I purchased this product abroad and realised that I would need to explain to the client how to use the product. So I did what every good pharmacist would. I got one for myself for product knowledge and demonstration purposes. After observing the effect of the product on my thumb, I was confident that it would work well for my client and, he said it did.

Include the partner

One approach to treating ED is to include the partner in the evaluation and treatment process. This increases the success rate dramatically, especially if stress, anxiety or depression are the cause of ED. Since ED itself can create stress in a relationship, counselling or psychological therapy of both partners may be helpful.

Oral treatment

Oral medications available to treat ED include sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). They all have the same action. They do not, by themselves, produce an erection, but allow an erection to occur after stimulation of the body and mind. They cause the penile blood vessels to relax, increase blood flow to the penis, and also prevent the erection from fading.

Fastest selling medication

Sildenafil (viagra), tadalafil (cialis) and vardenafil (levitra) are oral medications to treat erectile dysfunction (ED).

Sildenafil (Viagra) was released 10 years ago on April 1, 1998. In the first two weeks it became the fastest selling medication in the history of medicine. The tablet can start working within an hour after swallowing it. It can remain active in the system up to four hours. It will take much longer to start working when taken after a meal, especially a high-fat meal.

Tadalafil (Cialis) may have an effect in some men as early as 30 minutes after swallowing it, but other men are able to wait up to 36 hours after taking it before starting sexual activity.

Vardenafil (Levitra) is best taken one hour before sexual activity starts. As with Cialis, only one tablet should be taken within any 24-hour period, but daily use is not recommended.

Men with heart problems which are severe enough to make sexual activity dangerous, should avoid using these medications. They do not work only in the penis, but circulate through the rest of the body, to cause possible side effects as headache, dizziness and a dangerous drop in blood pressure. Changed colour vision and blurred vision have been reported with Viagra use. Men who take nitrate drugs like isosorbide should avoid these ED medicines. These drugs do not fix ED immediately and do not work in most men with diabetes.

Vacuum penis pump

This is a hollow tube closed at one end with a hand or battery-powered pump. The tube is placed over the penis, creating a seal. The pump is used to suck out the air. A vacuum is created which pulls blood into the penis. Once an erection is acquired, a comfortable rubber band (binding device) is slipped around the base of the penis to prevent the blood from leaving the penis. The vacuum tube is then removed. The erection typically lasts long enough for sex to occur. However, the rubber band should not be left on for longer than 30 minutes.

Surgery

If the above methods fail, a prosthetic device which stimulates an erection may be implanted in the penis through an opening in the skin between the testicles. Erections may occur as often and as long as desired. Three-day hospitalisation is usually necessary. The most popular device is inflatable, and it has a high satisfaction rate.

Hormones

ED may be caused by testosterone deficiency in a few men and they may benefit from hormone replacement. Plus, there are two other treatments which involve the use of an artificial hormone called alprostadil. The first dose of each is given by medical personnel, but self-administration may be done after sufficient training.

There is needle injection therapy (Caverject) - a very fine needle is used to inject the hormone into the base or side of the penis. An erection is produced which lasts about an hour. Also, an applicator is used to insert a tiny suppository of alprostadil (MUSE), about half the size of a grain of rice, two inches down into the tip of the penis (urethra) to produce an erection.

Dahlia McDaniel is a pharmacist and final year doctoral candidate in public health at the University of London; email: yourhealth@gleanerjm.com.