How Does ED Medication Work, And Why Can It Make Things Worse?

This podcast is for you. The Modern Man I'm Dr. Anne Truong, your host. I'm an intimate health medical doctor and best selling author of the book Erectile Dysfunction Fix. I'll do a deep dive into sexual health and performance and how it affects men of all ages and backgrounds. So let's get started and be sure to visit my website@sexualhealthformenpodcast.com for more information and resources from the show. See you on the inside. It's not good if you have ED ED is the predictor of heart disease that's going to happen in seven to 10 years. About third of men have a heart attack in about seven to 10 years because Ed is the onset of blood flow restriction that lead to blockage in the penis. And since the penis artery is only 2 millimeter the first one to be affected, the heart arteries are a little bit bigger at around 3 to 4 millimeter. So it is the next thing and that will happen about seven to 10 years. According to the center for Disease Control and Prevention or the cdc, heart disease is the top killer when analyzing data for male of all age groups and ethnicity in a large 2017 data set in the United States. So nearly a quarter of death in male is due to heart disease. Additionally, more men experience heart attack than women, so between 70 to 89% of sudden heart attack are experienced by men. Cardiovascular disease or heart disease is the top cause of death in men and women globally. ED is a warning sign about your heart health, but the good news is you can reverse it when it is early. Erectile dysfunction is not permanent and it can be treated. When is it early? When is it that you have mild ED that you can reverse it? Well, you can take the International Erectile Dysfunction Questionnaire Test which I will put in the show note and you answer five questions and it score from 1 to 5 and 5 is the lowest and 25 is the highest you can score. So if you score 15 or above you are mild. If you score between 8 to 14, you are considered moderate ed and below 7 you are severe. If you are moderate or severe, in addition to lifestyle modification, you may benefit from more aggressive intervention such as doing your own biologic, cellular stem cell therapy, shockwave therapy and testosterone hormone replacement therapy versus the mild group you can actually probably change it with appropriate lifestyle modification. We'll dive more into these treatments in the next few episodes. So let's talk about ED medication and how they work and why they actually make your ED worse. So medications such as Viagra, Cialis and avenavil they're called phosphodiesterase 5 inhibitors and they go by generic names such as sudenafil, Vardenafil, Tadalafil, avenafil. They are all in a big group called phosphodiesterase inhibitors or PDE5 inhibitors. They actually work better in men with psychogenic ED. So all of the four PDE5 inhibitors enhance penile muscles, the corpus cavernosum, to release more cyclic GMP level. Cyclic GMP level actually increase nitric oxide level which then promote an erection in response to sexual stimulation. So most of these medications are actually covered by insurance if it is generic. In the show note, I listed the cost and the mechanism of these PDE5 inhibitors and you can compare. Some are short acting, some are long acting. However, these medications are not indicated in men who on nitrate, a medication for angina or chest pain. So nitrate should not be used within 48 hours after the last dose of ED medication. High blood pressure medication such as alpha blockers and medication for benign prostatic hypertrophy or BPH. You cannot take this ED medication because when you take them with the PDE5 inhibitors, they cause low blood pressure and it may even impair your ejaculation when you take the medication together. But if you don't have these conditions, it is fairly safe to take these PDE5 inhibitors. You just have to monitor your blood pressure. These medications about 70% efficacy. These medications have to be taken on an empty stomach. However, another inconvenience is that you don't have any spontaneity and sexual activity has to be planned one hour ahead. Eating a fatty meal before Viagra or Levitra can actually reduce the effectiveness of the drug. You have to wait about two to three hours after eating a fatty meal before taking the medication. The most common side effects of these PDE5 inhibitors are headache, flushing in the face, neck and chest, upset stomach, indigestion, abnormal vision such as blue vision, nasal congestion, back pain. I actually see this a lot. Nasal congestion and back pain and muscular pain and tenderness, nausea and dizziness. And also a rash, a mild rash on the chest or the back, diarrhea. And also the serious side effect of the PDE5 inhibitor. Sometimes change or loss of vision, ringing in the ears or even hearing loss, chest pain or irregular heartbeat that can happen and shortness of breath as well. When there is irregular heartbeat, lightheadedness or dizziness. And a condition called malignant melanoma or another condition is swelling in the hands, swelling the ankles and the feet, and then Pulmonary hypertension or high blood pressure that occurs in the arteries of the lung. So why is these ED medications are not a long term solution? Number one, even if you've had success in getting or keeping erection with these medications while you're taking it, you may notice that it doesn't work after about two to three years. It's because Viagra or ED medication can lose its effectiveness over time. The reason that is so is because your body changes as your health gets worse. Because the blood flow blockage is getting worse due to the plaque buildup, a condition called atherosclerosis. An ED medication does not treat atherosclerosis. Number two, ED medication do not address the blood flow problem from your groin to your penis. It just makes the blood stay in the penis. Number three, Viagra. ED medication does not help you get aroused. It only help with blood flow to get an erection. Number four, Remember, erection occur when there is the net increase of blood flowing into as compared to the blood exiting. The erectile muscles of the penis have to inflate so that way it blocks the blood from going out. In order to have a net increase in the blood flow of the in more than the out, there are four crucial steps that must take place. And these are the Number one. First, the nerve in the pelvis must send signals or neurotransmitters to the arteries of the penis, directing blood flow. Number two, the arteries must respond to the command of the nerve by opening up and widening the diameter to allow for increasing blood flow. Three, the reptile spongy muscles of the penis or the corpus cavernosum must be compliant. The end is able to stretch out and elongate to accommodate the increase in blood flow. 4. The veins of the penis must allow for a net increase in blood flowing in by closing the drainage of the valve in the veins to keep the blood in the penis. But if there's a problem with any of these four steps on the way to an erection, ED medication will not work. These four steps are involving the nerve, the arteries, the corpus cavernosum in the penis muscles and the veins. ED medications do not work if you have diabetes or prostate surgery because these conditions can also cause damage to the nerve. Or if you have significant obstruction in the blood flow in the arteries of the penis that come from the groin, a condition called atherosclerotic heart disease or plaque buildup. Or if you have Peyronie's disease, which are nodules that are in the penis that cause the bending of the penis. I'll talk more about Peyronie's in later episodes or you have venous leakage in the penis or you may have a psychogenic ED or psychological factor such as anxiety, depression, stress, relationship issues. In the end, I view ED medication as like taking pain medication like oxycodone for back pain. It may work in the short term, but in the long term it does not and it leaves you in a black hole. So what happens if medication ED medication do not work? Well, you have actually several options such as you can supplement testosterone hormone such as and you can take it in a topical or troche which you put it in your mouth and it melts injection or even pellets and we'll talk more about this in a later episode. You can do an intra penile injection with Alprostatal, you can even do an injection with Trimix, you can even use the penis pump. You can even consider as the last resort a penile implant or the best option is that you can use your own stem cell in your body to help treat ED by treating the cause of the ED which is impaired blood flow. This is the newest innovation where your blood or the platelets from your blood is placed in the penis to restore blood flow, therefore an erection. It works by increasing blood flow from the nerve and from the blood vessel to make the penis tissue more compliant and healthy. It is the best long term solution for ED and this procedure is called the prior push shot or the P shot. So in addition to medical intervention, you also want to make lifestyle changes a priority. It's important to address lifestyle factors such as that play a role in ED such as diet, exercise, smoking and sleep and stress control. Some common factors that can lead to conditions affecting blood circulation include toxic habits such as recreational drug and drinking alcohol, even not even having sex frequently. You should have sex three to five times a week is what is recommended. Sleeping less than seven hours and even some frequent common over the counter medication can actually contribute to ed. Do you know that ibuprofen can do this as well as anti inflammatory medication as well as anti ulcer medication in the show Note I will put the list of medication that can actually affect your erection capacity, but make sure to talk to your health care provider if you think that a drug is having an effect on your sexual performance. Never stop taking any medication first without talking to your doctor. Some medication may lead to life threatening reaction if you do not take care when stopping or changing the dosage. So please talk to your doctor first before you do that and I will see you in the next episode, we'll talk or dive more into the different treatment of Ed. Thanks for listening. Be sure to go to my website@sexualhealthformenpodcast.com for more resources. And remember to join my Men's club at Menone Club, a place where I help a community of men regain their sexual confidence. And if you like the show, I would appreciate it. If you subscribe, leave a review on Apple Podcasts or wherever you listen and know that you have sexual vitality for life. Until next time, this is Dr. Ann signing off.