Choice of ED Rx now a matter of patient preference
…But open discussions of sexual dysfunction have led to ‘hucksterism’ and false claims
Phosphodiesterase type-5 (PDE-5) inhibitors have revolutionized the treatment of erectile dysfunction and have proven to have both important clinical and social effects. They have moved discussions of sexual dysfunction from the closet to the examination room, not to mention the television set, where the topic is openly discussed in commercials and on talk shows.
“These new medications have really lessened the taboo that once surrounded the subject. The trends [in ED treatment] are more open discussion and less hesitation by family doctors to discuss this,” said John J. Mulcahy, MD, professor of urology at Indiana University Medical Center, Indianapolis.
Several studies introduced at the annual meeting of the European Association of Urology congress in Vienna last month compared the efficacy of sildenafil citrate (Viagra) with that of two new PDE-5 inhibitors — tadalafil (Cialis) and vardenafil (Levitra).
According to Dr. Mulcahy, the differences among all three agents at varied dosages were minimal. Prescribing any of them will ultimately come down to what the patient prefers.
“One [tadalafil] is longer acting, and the incidence of headache for the three drugs may vary by patient, which may be a reason for preference,” he said. “Studies have shown that there is no heart effect [with the three drugs]. It is basically the cardiac condition of the patient that makes the difference. If he has a bad heart, he should not be having sex — with or without clinical assistance.”
However, other ED treatment advances are not forthcoming in the near future.
“There is nothing dramatic on the horizon,” Dr. Mulcahy explained. “The topicals are not showing much promise right now. There is the potential of gene therapy, but that is at least 10 years away, and there is some question as to whether it will be allowed.” he said, adding that a few gene therapy trials have been conducted, but the treatment was associated with serious clinical side effects.
The success of oral ED treatment has opened the door to discussion of sexual function. Dr. Mulcahy said he feels this may lead to more frank discussion of sexual issues between partners, w’ith future emphasis on female sexual dysfunction (FSD).
“FSD is going to be coming into more prominence,” he said. “Only a few urologists are interested now, perhaps because there is so much to do with other clinical issues, and because there is also a manpower shortage. But FSD will be a thrust of research. “But the open discussion of sexual issues has a dark side. Dr. Mulcahy said. Less than scrupulous entrepreneurs are taking advantage of an emerging permissiveness in the media to promote male and female “enhancement” products that have no proven effects.
Dr. Mulcahy said he hopes the future will bring a public response from urologists and other providers against these so-called “nutriceuticals.”
“These are snake oil being sold on evening infomercials. It is hucksterism. It is a ripoff.” he said.