With the prevalence of erectile dysfunction, the use of erectile pills has also increased. It is better to evaluate the cause of erectile dysfunction.

Erectile Dysfunction Pills - Hit or Miss?

Erectile dysfunction,is defined as an inability to maintain a firm enough and lasting erection for satisfactory sexual intercourse or achieve an erection when one wants.

Erectile Dysfunction Pills - Hit Or Miss?

Introduction

Sexual dysfunction is a common problem among both men and women. Approximately 43% of women and 31% of men report suffering from some form of problem during sex.<a href="#accordion">[1]</a>&nbsp;In men, sexual dysfunction encompasses sexual desire, orgasm, pain, and sexual arousal (maintaining erections).<a href="#accordion">[2]</a>&nbsp;Difficulty achieving or maintaining an erection is not unusual. One can experience such problems from time to time, especially if facing relationship problems or dealing with stress. However, if it progressively worsens and affects one&#39;s sexual life, it becomes a health concern.

<a href="https://www.merisehat.pk/disease/erectile-dysfunction">Erectile dysfunction</a>, or ED, is defined as an inability to maintain a firm enough and lasting erection for satisfactory sexual intercourse or achieve an erection when one wants. Although its prevalence increases with age, aging isn&#39;t a cause of ED.<a href="#accordion">[3]</a>&nbsp;Instead, several physical and psychological conditions can predispose one to ED; these include <a href="https://www.merisehat.pk/disease/depression">depression</a>, diabetes, cardiovascular disorders, and obesity.<a href="#accordion">[4]</a>&nbsp;Moreover, the use of certain medications, smoking, drug use, and alcohol consumption can also affect a person&#39;s sexual function.&nbsp;

ED is highly prevalent in the Pakistani male population, affecting 80.8% of men attending primary care clinics.<a href="#accordion">[5]</a>&nbsp;However, the true burden of the disease in the country cannot be established due to underreporting of cases. The stigma surrounding sexual health makes men hesitant to discuss their issues with a healthcare professional and at times even friends and family. Moreover, many are unaware that ED is a highly treatable condition. Thus, it not only affects one&#39;s sexual and mental health but also the overall quality of life. 
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Understanding Erectile Dysfunction Pills

Over the years, researchers have developed several treatment options for ED, ranging from pills and aids to surgical implants. However, oral pills such as phosphodiesterase (PDE) 5 inhibitors continue to be the first line of treatment for erectile dysfunction.<a href="#accordion">[6]</a>&nbsp;The widely popular pill, Viagra (sildenafil) was one of the first FDA-approved oral pills for ED.&nbsp;

PDE5 inhibitors relax the penile muscles during sexual arousal, thus increasing blood flow to the chambers and causing an erection. They are typically 60-80% effective at treating the symptoms of ED.<a href="#accordion">[7]</a>&nbsp;Although all are similar in safety and effectiveness, there is a difference in how long the drug&#39;s effect lasts and the side effects of the medication.&nbsp; 
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There are four FDA-approved PDE5 inhibitors for use against ED. They include:

<ol>
	<li>Viagra (Sildenafil) - The famous blue pill was the first PDE5 inhibitor approved for ED. It is typically taken at least an hour prior to sexual intercourse and has a quick onset of action (30 minutes). The recommended dosage is 50 milligrams(mg), and its effect typically lasts for 4-5 hours. For maximum absorption, it is advised to take the drug on an empty stomach.&nbsp;</li>
	<li>Cialis (Tadalafil) - Unlike other ED pills, tadalafil has an extremely long duration of action (36 hours). It is often prescribed as a daily 5mg dose in patients suffering from benign prostatic hyperplasia and ED. Although similar to Viagra in terms of onset and safety, people often prefer tadalafil because it improves sexual confidence.<a href="#accordion">[8]</a>&nbsp;Therefore, it is often prescribed for people with psychological factors causing ED.&nbsp;</li>
	<li>Stendra (Avanafil) - Avanafil is a newer class of PDE5 inhibitors and is typically taken 30 minutes before sexual intercourse. Compared to other ED pills, avanafil is preferred in people with cardiovascular disorders as it has fewer effects on blood pressure<a href="#reference" target="_blank">9</a>. Thus, making it safe to use in those taking anti-hypertensives.&nbsp;</li>
	<li>Levitra (Vardenafil) - This particular drug has the shortest onset of action (10 minutes) and is effective for 4-5 hours. However, it can lengthen the QTc interval and is not prescribed in patients with prolonged QTc or those taking antiarrhythmics.</li>
</ol>

Note: ED pills can have mild side effects, such as flushing, dizziness, headaches, diarrhea, and vision problems. Moreover, the medications are contraindicated in those taking nitrate drugs, or suffering from blood pressure-related problems, liver disease, or severe kidney disease. A more severe side effect of the drug is a painful, prolonged erection. In case of an erection lasting more than 4 hours, professional help should be sought. 
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As per a 2013 meta-analysis, all PDE5 inhibitors are more effective than a placebo for treating ED.<a href="#accordion">[7]</a>&nbsp;They have a similar safety profile; however, the study found tadalafil to be the most effective among other PDE5 inhibitors, followed by vardenafil.&nbsp;

If all are safe and effective, what is the best option? The truth is that the best option will vary from person to person. It will depend on your medical history, the underlying cause of ED, whether you want it for regular use or occasional use, and your lifestyle. Therefore, it is best to discuss all your options with a healthcare professional and then make a decision. 
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Conclusion

Sexual health has a huge impact on a person&#39;s quality of life. Letting societal pressures and social stigmas influence your decisions will only negatively affect your health. And while living with any form of sexual dysfunction can be frustrating, it is important to note that treatment is very much possible. And the presence of a sexual problem is in no way reflective of one&#39;s masculinity.&nbsp;

Therefore, if one suffers from ED or any other sexual dysfunction, seeking a healthcare professional can significantly improve the overall quality of life. Moreover, combining various treatment options such as oral pills. counselling and lifestyle changes can further improve one&#39;s sexual problems.&nbsp; 
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Key Points

<ul>
</ul>

<ul>
	<li>Erectile dysfunction is defined as an inability to maintain an erection firm enough for satisfactory sexual intercourse. It can result from a variety of physical (obesity, diabetes, cardiovascular disease) and psychological (anxiety, depression) conditions.</li>
	<li>Phosphodiesterase (PDE) 5 inhibitors are the first line of treatment for ED. There are currently four FDA-approved pills: sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra).&nbsp;</li>
	<li>All ED pills are similar in safety and efficacy; however, doctors prescribe the drugs based on your medical history, lifestyle, and underlying cause of ED. It is best to consult your doctor before starting any medication.</li>
	<li>Seeking professional help is an important step in treating ED and improving one&#39;s sexual health&nbsp;and overall quality of life.</li>
</ul>

[1] Rosen, R. C., 2000. Prevalence and risk factors of sexual dysfunction in men and women. Current Psychiatry Reports, Volume 2, pp. 189-195.

[2] Wincze, J. P. & Weisberg, R. B., 2015. Sexual Dysfunction: A Guide for Assessment And Treatment. 3rd Edition ed. s.l.:Guilford Press.

[3] Johannes, C. B. et al., 2000. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. The Journal of Urology, 163(2), pp. 460-3.

[4] McMahon, C. G., 2019. Current diagnosis and management of erectile dysfunction. Medical Journal of Australia, 210(10), pp. 469-476.

[5] Shaeer, K. Z. M. et al., 2003. Prevalence of erectile dysfunction and its correlates among men attending primary care clinics in three countries: Pakistan, Egypt, and Nigeria. International journal of impotence research, Volume 15.

[6] Kalsi, J. S. & Kell, P. D., 2004. Update on oral treatments for male erectile dysfunction. Journal of the European Academy of Dermatology and Venereology, 18(3), pp. 267-274.

[7] Yuan, J. et al., 2013. Comparative effectiveness and safety of oral phosphodiesterase type 5 inhibitors for erectile dysfunction: a systematic review and network meta-analysis. European Urology, 63(5), pp. 902-12.

[8] Gong, B. et al., 2017. Direct comparison of tadalafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysis. International Urology and Nephrology, 49(10).

[9] Katz, E. G., Tan, R. B., Rittenberg, D. & Hellstrom, W. J., 2014. Avanafil for erectile dysfunction in elderly and younger adults: differential pharmacology and clinical utility. Therapeutics and Clinical Risk Management, Volume 10, pp. 701-11.

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