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Erectile dysfunction is affecting 25-30 million men in United States alone and it accounts for numerous outpatient visits every year.

Though sexuality is a very important issue, it is often overlooked by physicians. Generally, very few patients discuss their sexual problems until and unless the physician specifically asks. That is the reason it is very important for physicians to be comfortable while discussing sexual dysfunction and executing the appropriate remedy.

Currently, various treatment options are available for erectile dysfunction. They are PDE5 inhibitors, injection therapy, other oral prescription medicine, vacuum devices, surgical implants, herbal or over-the-counter medications.

Many people fear needles as way of treatment and are happy with non-invasive drug delivery or method of treatment. The transdermal approach using nitroglycerin cream and paste which is applied to the glans penis is one of the alternatives of topical medications used for treating erectile dysfunction. Side effects include headaches due to its rapid absorption inside the systemic circulation.

Other medicines such as papaverine also have been used transdermally. It is delivered in 15% or 20% base topical gel form and results using a small placebo-controlled trial have shown a increase in blood flow to the penis.

The usage of topically-acting vasodilating medications have met with some limited success. There are generally three main agents that are applied topically and help in promoting erection, but it is advisable to use condoms to prevent adverse effects to the partner. They are papervine, minoxidil and nitroglycerin.

Papervine gel is generally dispensed in 7.5, 15, and 20% formula which is applied to the penis, perineum and scrotum to increases penile blood flow. A phase I-placebo-controlled trial study which used the 20% gel in patients suffering from erectile dysfunction showed much increase in peak systolic flow velocity and cavernous artery diameter. Although papaverine can augment reflex erections, it can cause only 15% functional erection.

Another agent used as vasodilating medications is minoxidil which is used topically using a 2% solution with a dose of 1 ml (.28 mg). Though it is well known for its use in hypertension and alopecia, it is a vasodilator which acts on arterial smooth muscle by opening potassium channel. Minoxidil was found to be more effective than nitroglycerin in producing functional erections. The side effects as a consequence of using minoxidil are very few and include burning at the site of application.

Nitroglycerin is a well-known vasodilator and also a smooth muscle relaxant. Besides it usage for erectile dysfunction, it is used topically in treating Raynaud’s disease and heart disease. The dose for erectile dysfunction is 2 cm of a 2% ointment which is applied 30-60 minutes before sexual intercourse. A placebo-controlled study has shown occurrence of partial to full erection in patients with mixed impotence. More often than not, this is used in case of increased penile rigidity which is not enough to permit penetration. Its side effects are hypotension and headache.

Along with all options available for treatment of erectile dysfunction, it is also advisable to make changes in life styles. The patient must stop smoking, should not drink too much, keep his weight under control and do regular exercises.

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