The Phosphodiasterase 5-Inhibitors (PDE-5i) for Erectile Dysfunction (ED): A Therapeutic Challenge For Psychiatrists

Abstract

Erectile function (EF) is a prerequisite for satisfactory sexual intercourse (SI) and central to male sexual functioning. Satisfactory SI eventually initiates orgasm - a biopsychophysiological state of euphoria - leading to a sense of bliss, enjoyment and positive mental well being. For a psychiatrist, treating ED is self-propelled to harmonize these pleasurable experiences alongside with encouragement of physical wellness and sensuality. Hence, the role of PDE-5i is pivotal in this context and constitutes a therapeutic challenge. PDE-5i work via the dopaminergic-oxytocin-nitric oxide pathway by increasing the availability of endothelial's guanosine monophosphate (GMP), immediately causing relaxation of the penile smooth muscle and an erection. The PDE-5i, like sildenafil, vardenafil and tadalafil, are effective in the treatment of ED with some benefits/ flexibilities and disadvantages compared to other treatment modalities. Prescribed PDE-5i exclusively improve EF, fostering male's self-confidence and self-esteem. Treatment failures are associated with factors such as absent (or insufficient) sexual stimulation, psychosexual conflicts and the co-existence of medical disorders. Managing ED requires dealing with underlying medical diseases, addressing other co-morbid sexual dysfunctions like premature ejaculation (PE), and educating the patient on healthy life-styles. Furthermore, by dealing with interpersonal dynamics within the couple and embracing adequate lifestyles (managing stress and revising one's sexual scripts), PDE-5i treatment benefits may be enhanced. In this review, we propose a holistic conceptual framework approach for psychiatric management of patients with ED.

Omega 3 fatty acid improves sexual and erectile function in BPF-treated rats by upregulating NO/cGMP signaling and steroidogenic enzymes activities

“…It is a nonadrenergic and noncholinergic neurotransmitter with vasodilatory function. NO is produced from the penile smooth muscles, and it is activated once there is a sexual stimulus by the dopamine-oxytocin-NO pathway 30 . NO enters the smooth muscle cells of the corpus cavernosum, where it acts on the guanosine cyclase to produce cGMP from guanosine triphosphate (GTP).…”

The prevalence of premature ejaculation and its relationship with polygamous men: a cross-sectional observational study at a tertiary hospital in Somalia

“…Neurophysiological, psychosocial, and cognitive factors are some of the mechanisms that involve the pathophysiology of the disease [ 23 ]. The coexistence of PE and ED should be carefully evaluated and should not be considered to be separate entities that would increase treatment failure rates [ 24 ].…”

Role of Medicinal Plants in Male Erectile Dysfunction

“…Curcuma longa Linn, often identified as turmeric, is a spice used to treat skin illnesses, diabetes, cancer, autoimmune diseases, stomach discomfort, blood purifiers, and hunger stimulants (Koon et al, 2017). Curcumin, aka diferuloylmethane, is an active component from Curcuma longa that affects the penile erectile response.…”