The actual treatment with these medications for erectile dysfunction it's important to understand how an erection happens. The first component of an erection is arousal you see something you smell something you hear something or you feel something that gets you aroused which causes your body to release something called nitric oxide and nitric oxide is like the ignition for erections.
In order to get an erection you need arousal and you need nitric oxide so once you get that nitric oxide and that arousal what happens is your body starts releasing a number of chemical messengers and one of these is called cGMP or Cyclic guanosine monophosphate and as these messengers are released the muscles or the smooth muscles in the penis relax this allows blood to flow in and at the same time the veins of the penis get blocked off so that blood flow stays in the penis causing a firm erection and then what stops the erection well.
There are three major things first that nitric oxide or the stimulus for arousal goes away second is that chemical messenger cGMP starts to degrade or break down and lastly your body has a nervous response to ejaculation so when ejaculation happens your nervous system revs up and causes those smooth muscles to now contract to force the blood out of the penis and into the rest of the body which then causes your penis to become flaccid so all of these medications for erectile dysfunction they work by blocking the breakdown of that chemical messenger cGMP and they do so by blocking an enzyme called phosphodiesterase.
I want you to know there are some side effects that are common with all of these medications that include headaches, flushing, nasal congestion, heartburn, and sometimes vision changes also there is one medication that if you're taking you absolutely cannot take these medications and that's called a nitrate medication or a medication with nitrate in it something called nitroglycerin is very commonly prescribed to people who have chest pain or angina is the medical term for it and what that is is it's usually a pill that's given to you to take and put underneath your tongue if you have chest pain that won't go away so if you're on that medication you cannot take any of these medications for erectile dysfunction the reason being is if you take both of these at the same time your blood pressure can drop so low that you may actually have a risk of death.
if you have kidney or liver problems you might have to change the dosing of the medication that you're receiving so you definitely want to get these under the care of a physician you may find some over-the-counter supplements even though they're not supposed to have these medications in them that do have them and those are dangerous because you need to make sure that you're not getting too much or too little of the medication there's also a couple of very rare but very serious side effects with these medications one of these is called priapism and priapism is an erection that lasts longer than four hours and that is actually not a good thing when you have an erection that lasts longer than four hours it actually starts causing damage to the tissues in the penis that can cause irreversible damage.
if someone overdoses on these medications take too many and then can have this problem the other rare side effect that is potentially dangerous is a hearing loss I have never seen that in my career but it has been reported as a very rare but serious side effect. The success rate for both of these medications is about 60 to 80 percent so if you're looking as far as efficacy they're both about the same why am I talking specifically about viagra and Cialis or sildenafil and Tadalafil well because at least in the united states there are the cheapest options for erectile dysfunction and because they are equally effective i tend to prescribe these both most often as far as sildenafil is concerned the origin story
of how they came up with Sildenafil is actually really interesting so it was originally made as a treatment for high blood pressure so they did these clinical trials on patients to see if it would improve their blood pressure and what they found was that it didn't do anything for blood pressure but in fact people started reporting stronger and firmer erections and so that's how viagra was born so specifically talking about sildenafil it is the oldest medication available for erectile dysfunction so it has the longest data on its efficacy and its use so when you take viagra you need to take it about 30 minutes to an hour before intercourse and on an empty stomach if you have a lot of high fat foods before taking viagra it reduces the efficacy of the medication so ideally you want to take out an empty stomach or if you had a very light meal it lasts in the bloods stream for about four hours it's available in different dosing starting from 25 milligrams all the way up to 100 milligrams and it's only offered in what we call on-demand dosing and so what that means is you can only take it at the time prior to intercourse you can't take a daily dose every single day it won't work like that the side effects that are unique to viagra are that sometimes people who take viagra get what we call blue green discoloration or changes in their color vision if that happens you have to stop the vigor right away and talk to your doctor the other side effect that we sometimes see in viagra and not into Tadalafil is nose bleeds although it is in a small percentage of people Tadalafil is a more selective phosphor diesterase inhibitor meaning it more selectively inhibits the enzymes that are responsible for erections and it was released in 2003 so we don't have as much data on Tadalafil as we do on suldenophil similar to sildenafil it needs to be taken about 30 minutes to an hour before intercourse but you can take it on an empty stomach also it lasts in your bloodstream for up to 36 hours.
it's also available in a low dose that you can take every single day and some people like that because they like the spontaneity associated
with taking one pill every single day and then being able to have intercourse whenever you want the on-demand dosing is available from five milligrams to 20 milligrams and you might notice that that's less than the sildenafil dosing it doesn't mean that it's less effective it's just different also the other interesting thing about the low dose daily tadalafil is that it also is useful for men with benign prostatic hyperplasia or BPH you can check out my video about BPH that I made before to learn more about that but what it does is it helps men who have symptoms urinary symptoms associated with BPH specifically having difficulty emptying your bladder straining waking up at night to urinate may be having some urgency go and go or urinary frequency
so if you find yourself having urinary symptoms that are related to BPH and erectile dysfunction.
You might be able to get away with just taking one medication that can help both problems and lastly there's some data to suggest that men who have complete erectile dysfunction they have no erections at all may benefit better from tadalafil than other medications so which one is better for you well i'm going to share some data that i found comparing sildenafil and tadalafil head to head i looked at a meta analysis and i love meta-analyses meta-analyses are studies that look at all the published data on a certain topic and they do a systematic review which means they look at the specific data from all of the studies combine it together and that makes for a much stronger study so you can really look at those outcomes and say well this is what 10 or 15 or 20 studies said so this must be more valid than just one study by itself this particular meta-analysis and systematic review looked at sildenafil versus tadalafil and looked at any study that compared them head to head and they had to use a specific validated questionnaire to compare their erectile dysfunction outcomes they couldn't just say they were your erections better they had to use a questionnaire that has been looked at and validated to show a difference a clinically meaningful difference in erectile dysfunction outcomes on medication in this particular review they include 16 studies with over 5 000 patients so what they found was that efficacy as i mentioned earlier was about the same in both groups but in this they also looked at how the partner felt their erections were as well as the patient's treatment satisfaction , in nine studies they looked at preference they asked them what do you prefer in nine of these studies they found that the men and their partners both preferred to dalla fill over sildenafil so what they found was that persistence and side effects were similar in both groups the only difference in side effects were that sildenafil patients were more likely to have vision changes whereas Tidallafil patients were more likely to have muscle aches so what do I recommend well if you have urinary symptoms with
BPH well then I recommend taking one daily dose of tadalafil every single day if you are willing to
take an on-demand medication to try either one and if one doesn't work go ahead and switch to the other one but always make sure you're doing this under the supervision of a physician there are a number of other treatment options for erectile dysfunction besides medications including a suppository that goes inside the urethra intracavernosal injections vacuum erection devices and penile implants.
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