Researches of Erectile Dysfunction

Combining Testosterone and PDE5 Inhibitors in Erectile Dysfunction: Basic Rationale and Clinical Evidences

Introduction: Erectile dysfunction (ED) and decline of testosterone levels are frequently observed with age and also in illnesses with a common basis of endothelial damage.

Objectives: To review molecular mechanisms underlying androgen action upon its receptor and phosphodiesterase type 5 (PDE5) expression and regulation by testosterone in cavernous tissue and their clinical implication in the treatment of ED refractory to PDE5 inhibitors (PDE5-Is).

Methods: From January 2003 to May 2005, we performed an extensive, unsystematic MEDLINE literature search reviewing relevant data on basic and clinical studies regarding the efficacy of combination therapies.

Results: Most trails using testosterone alone for treatment of ED in hypogonadal men suffer from methodologic problems and report inconsistent results, but overall the trails suggest that testosterone is superior to placebo. Orally effective PDE5-Is, such as sildenafil, tadalafil, or vardenafil, may be ineffective depending on the demonstration of testosterone regulation of PDE5 expression in human corpus cavernous, and their efficacy may be enhanced by testosterone adjunction whenever necessary.

Conclusions: Screening for hypogonadism in all men with ED is necessary to identify men with severe hypogonadism and some cases of mild to moderate hpogonadism, who may benefit from testosterone treatment. Identification of threshold values for testosterone supplementation to appropriately benefit from PDE5-Is failure may improve clinical management of unresponsive patients with minimization of unwanted effects.

Erectile Dysfunction in Heart Failure Patients

Butea Superba has been used to enhance sexual performanace in men with unknown long-term effects on spermatozoa. This study aimed to investigate effects of chronic treatment of Butea Superba on sperm motility and concentration in rats and mice in correlation with testicular damage. Adult male rats and mice were orally administered distilled water or Butea Superba alcoholic extract (0.01, 0.1 or 1.0 mg/kg BW/day) for 6 months. At the end of the treatment the animals were sacrificed and the spermatozoa recovered from the distal cauda epididymis were analyzed fro sperm concentration and motility in vitro . The testes were processed for histological examination. The results show that long-term treatment with Butea Superba extract significantly increased the sperm concentration and delayed the decreased motility with time. None of signs of sperms anomalies and testicular damanges were observed. This suggests that chronic use of Butea Superba increases the number of sperm, prolongs sperm motility in vitro while produces no changes on sperm morphology. Therefore, chronic use of Butea Superba alcoholic extract may be useful in fertilization.

Sexual Problems in diabetes

• Nitric oxide of neuronal origin is largely reponsible for initiation of tumescence, where as nitric oxide derived from the vascular endothelium of the erectile tissue is important for the maintenance of erection.
• Erectile dysfunction is an early marker of endothelial dysfunction and an important indicator of increased cardiovasular risk.
• Erectile dysfunction in diabetes may also be due, in part, to reduced production of endothelium-derived hyperpolarizing factor which stimulates dilatation of penile resistance arteries