Topical cream studied for erectile dysfunction

Scientists from Albert Einstein College of Medicine of Yeshiva University are working on a cream to rub on and treat erectile dysfunction (ED). The cream could prove to be safer than oral medications used to deliver nitric oxide to the cells that improves blood flow to treat impotency. Using encapsulated nanoparticles, the scientists have found a way to deliver nitric oxide and prescription drugs that penetrate the tissues to treat erectile dysfunction that affects tens of millions of men.

The study, published online in the Journal of Sexual Medicine, was performed on eighteen rats with age related erectile dysfunction. The cream, when applied topically, delivers drugs to treat erectile dysfunction in a controlled release fashion that eliminates the potential side effects when erectile dysfunction drugs are delivered systemically.

The researchers treated three groups of rats – one group received the topical nanoparticles erectile treatment with encapsulated nitric oxide. A second group received nanoparticles encapsulated with nitric oxide, plus an experimental erectile dysfunction drug called sialorphin. Sialorphin acts differently than PDE5 inhibitors currently on the market such as Viagra and Cialis. The third group was given the topical erectile dysfunction cream plus tadalafil (Cialis).

The nanoparticle, nitric oxide system, applied topically, combined with either sialorphin or tadalafil, significantly improved erectile dysfunction in five out of seven rats treated. Developer of the topical erectile dysfunction treatment and study co-author Joel M. Friedman, M.D., PhDs says, “Most of the animals, nearly 90 percent, showed a response to treatment with the nanoparticles.”

It only took thirty minutes for the rats to respond to the treatment says senior author Kelvin P. Davies, Ph.D., associate professor of urology at Einstein. “In both rats and humans, it can take 30 minutes to one hour for oral ED medications to take effect.”

Using a topical treatment for erectile dysfunction could prove safer for men with existing heart disease, and could also provide a more effective treatment for diabetics who have high rates of erectile dysfunction. So far, the erectile dysfunction cream looks safe. The scientists found no signs of systemic toxicity, local inflammation, or other undesirable side effects.

Gene Therapy Reverses Erectile Dysfunction

Erectile Dysfunction Treatment

Rats with erectile dysfunction, or ED, that were injected with a gene therapy vector containing either of two nerve growth factors were able to regain normal function after four weeks, according to a study conducted by University of Pittsburgh School of Medicine researchers. These findings are being presented at the 10th annual meeting of the American Society of Gene Therapy, which is convening May 30 to June 3 at the Washington State Convention & Trade Center, Seattle.

Erectile Dysfunction is the repeated inability to achieve or maintain an erection necessary for sexual intercourse. Because of the variability of symptoms, estimates of the incidence of erectile dysfunction vary but range from 15 million to 30 million affected men in the United States. Erectile dysfunction is frequently associated with damage to the cavernous nerve that results from surgery for prostate cancer. Even if a patient receives a nerve-sparing procedure during surgery, recovery from ED after radical prostatectomy may take a long time.

In this study, which was led by Joseph C. Glorioso, III, Ph.D., chair of the department of biochemistry and molecular genetics, and Joel Nelson, M.D., chair of the department of urology, University of Pittsburgh School of Medicine, researchers inserted either the gene for the glial cell line derived neurotrophic factor (GDNF) or the GDNF family ligand (neurturin) into a genetically engineered herpes simplex virus (HSV). They then injected either of the recombinant viruses into the damaged cavernous nerve of rats. GDNF is an important nerve growth promoter and has been shown in other studies to contribute to survival and regeneration of penile nerves. Neurturin also is a nerve growth factor closely related to GDNF. Control mice received only the virus without the GDNF or neurterin genes inserted.

Four weeks after the treatment, rats administered HSV-GDNF exhibited significant recovery of intracavernous pressure (ICP) and systemic arterial pressure (AP) compared with rats treated with the control virus or untreated mice with erectile dysfunction. Rats treated with HSV-neurturin also exhibited significant recovery of ICP and AP compared with the control or untreated mice at four weeks after treatment. Fluorescent protein studies also showed that the delivered genes had been effectively incorporated into the target nerve cells.

According to Dr. Glorioso, HSV delivery of GDNF or neurturin presents a potentially important new approach for the treatment of ED. “Because the herpes virus persists in the nerve cell for as long as it is alive and nerve cells typically do not reproduce, this represents the first-ever demonstration of a long-term treatment for erectile dysfunction that does not rely on the chronic administration of drugs that can have potentially harmful side effects,” he explained.

How is Erectile Dysfunction Treated?

Erectile Dysfunction and Impotence Treatment

Most physicians suggest that treatments or Erectile Dysfunction or Impotence� � proceed from least to most invasive. Cutting back on any drugs with harmful side effects is considered first. For example, drugs for high blood pressure work in different ways. If you think a particular drug is causing problems with erection, tell your doctor and ask whether you can try a different class of blood pressure medicine.

Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered.

Psychotherapy

Experts often treat psychologically based Erectile Dysfunction using techniques that decrease the anxiety associated with intercourse. The patient’s partner can help with the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when Erectile Dysfunction� � from physical causes is being treated.

Drug Therapy

Drugs for treating Erectile Dysfunction can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration (FDA) approved Viagra, the first pill to treat Erectile Dysfunction. In August 2003, the FDA gave approval to a second oral medicine, vardenafil hydrochloride (Levitra). Additional oral medicines are being tested for safety and effectiveness.

Taken an hour before sexual activity, Viagra and Levitra work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

While oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection as injections do. The recommended dose for Viagra is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for Levitra is 10 mg, and the physician may adjust this dose to 20 mg if 10 mg is insufficient. Lower doses of 5 mg and 2.5 mg are available for patients who take other medicines or have conditions that may decrease the body’s ability to use Levitra.

Neither Viagra nor Levitra should be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use either drug because the combination can cause a sudden drop in blood pressure. Also, Levitra should not be taken with any of the drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure.

Oral testosterone can reduce Erectile Dysfunction in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage. Patients also have claimed that other oral drugs–including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone–are effective, but the results of scientific studies to substantiate these claims have been inconsistent. Improvements observed following use of these drugs may be examples of the placebo effect, that is, a change that results simply from the patient’s believing that an improvement will occur.

Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, can sometimes enhance erection when rubbed on the penis.

A system for inserting a pellet of alprostadil into the urethra is marketed as Muse. The system uses a prefilled applicator to deliver the pellet about an inch deep into the urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness from increased blood flow to the penis; and minor urethral bleeding or spotting.

Research on drugs for treating Erectile Dysfunction is expanding rapidly. Patients should ask their doctor about the latest advances.

Vacuum Devices

Mechanical vacuum devices cause erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. The devices have three components: a plastic cylinder, into which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body (see figure 2).

 

Surgery

Surgery usually has one of three goals:

• to implant a device that can cause the penis to become erect
• to reconstruct arteries to increase flow of blood to the penis
• to block off veins that allow blood to leak from the penile tissues

Implanted devices, known as prostheses, can restore erection in many men with Erectile Dysfunction. Possible problems with implants include mechanical breakdown and infection, although mechanical problems have diminished in recent years because of technological advances.

Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.

Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.

 

Surgery to repair arteries can reduce Erectile Dysfunction caused by obstructions that block the flow of blood. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch or fracture of the pelvis. The procedure is almost never successful in older men with widespread blockage.

Surgery to veins that allow blood to leave the penis usually involves an opposite procedure–intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes the rigidity of the penis during erection. However, experts have raised questions about the long-term effectiveness of this procedure, and it is rarely done.

Pomegranate juice may improve erectile dysfunction

Pomegrante and Impotence

Research published in the International Journal of Impotence Research finds drinking 8 ounces of POM Wonderful 100% Pomegranate Juice daily may help the management erectile dysfunction and impotence.

According to a pilot study released in the International Journal of Impotence Research (www.nature.com/ijir), POM Wonderful 100% Pomegranate Juice was found to have beneficial effects on erectile dysfunction (ED), a disorder that affects 1 in 10 men worldwide and 10 to 30 million men in the United States alone.� � Erectile dysfunction can be caused by several factors, including arterial plaque, high blood pressure, heart disease, diabetes, nerve damage, endocrine imbalance or� � depression.Ultimately,� � erectile dysfunction is a condition that affects the blood flow to the penis during sexual stimulation.

This randomized, placebo-controlled, double-blind, crossover pilot study examined the efficacy of pomegranate juice versus placebo in improving erections in 61 male subjects. To qualify, participants had to experience mild to moderate ED for at least 3 months; be in a stable, monogamous relationship with a consenting female partner; and be willing to attempt sexual intercourse on at least one occasion per week during each study period.

Mild� � erectile dysfunction is defined as the mildly decreased ability to get and keep an erection, while moderate ED is the moderately decreased ability to get and keep an erection. The majority of men with ED have moderate erectile dysfunction.

For the first four weeks of the study, the subjects were assigned to drink either 8 oz. of POM Wonderful Pomegranate Juice or 8 oz. of placebo beverage daily with their evening meal or shortly after. After a two-week washout period during which the subjects did not consume any study beverage nor utilize any� � erectile dysfunction treatment, they were assigned to drink 8 oz. of the opposite study beverage every evening for another four weeks. At the end of each four week period, efficacy was assessed using the International Index of Erectile Function (IIEF) and Global Assessment Questionnaires (GAQ). The IIEF is a validated questionnaire that has been demonstrated to correlate with ED intensity. The GAQ elicits the patient’s self-evaluation of the study beverages’ effect on erectile activity.

Forty seven percent of the subjects reported that their erections improved with POM Wonderful Pomegranate Juice, while only 32% reported improved erections with the placebo (p=0.058). These results compare favorably to a recent 24-week study using a PDE5 inhibitor (such as Cialis), in which roughly 73% of subjects reported a benefit from the PDE5 inhibitor and 26% reported a “placebo effect” (i.e. experiencing improvement while on the placebo).

Although the study did not achieve overall statistical significance, the authors conclude that additional studies with more patients and longer treatment periods may in fact reach statistical significance. The strong directional results of this pilot study are encouraging because almost half of the test subjects experienced a benefit simply by adding pomegranate juice to their daily diet, without the use of� � erectile dysfunction drugs.

Researchers believe that the results might be due to the potent antioxidant content of pomegranate juice, which can prevent free radical molecules from disrupting proper circulatory function. In several previously published medical studies, pomegranate juice has been shown to enhance blood flow and to slow or reverse arterial plaque growth. Because an erection requires significant blood flow, these potent pomegranate antioxidants may provide benefit by mitigating arterial plaque and promoting blood vessel dilation.

According to study co-author Harin Padma-Nathan, MD, FACS, FRCS, Clinical Professor of Urology at the Keck School of Medicine, University of Southern California, “These findings are very encouraging as they suggest there is a non-invasive, non-drug way to potentially alleviate this quality of life issue that affects so many men. For men with erectile dysfunction, it is important to maintain a healthy diet and exercise. Drinking pomegranate juice daily could be an important addition to the diet in the management of this condition.”

Natural Therapies For Relieving Erectile Dysfunction (Impotence)

Impotence and Erectile Dysfunction

Until recently, the very mention of erectile dysfunction or impotence could bring about a blush to even the most manly of men.� � Embarrassing as it may be, erectile dysfunction affects more than 18 million men in America.� � It can vary in severity from an inability to achieve, maintain and sustain an erection, to an inability to achieve an orgasm, even though a healthy sexual desire exists.� � � � Because of the sensitive nature of� � the disorder of impotence, it often goes unreported.

Achieving a normal erection is a complex process.� � � � It involves psychological impulses from the brain, adequate levels of testosterone (male sex hormone), a functioning nervous system, and healthy vascular tissue of the penis.� � Electrical impulses from the brain, when stimulated, cause the nerves in the penis to release nitric oxide.� � This, in turn, increases the production of guanylate MonoPhosphate (cGMP) in the muscle cells of the corpora cavernosa (the tissue of the penis, consisting of smooth muscles, fibrous tissues, spaces, veins and arteries).� � The cGMP triggers the muscles of the corpora cavernosa to relax and fill with blood, which causes the penis to expand.

Because of the intricate nature of the physiological processes involved, a number of different factors can interfere with a man’s ability to achieve a normal and healthy erection.� � The most common of these is aging.� � As a man gets older, his ability to produce nitric oxide decreases, thus affecting the proper functioning of the corpora cavernosa.

A number of health issues can also underscore this disorder.� � The most frequently seen are diabetes mellitus and hypertension.� � Diabetes, for example, can damage the sensory nerves in the body.� � In turn, individuals who suffer from hypertension exhibit low nitric oxide production.� � Other factors that can contribute to erectile dysfunction include cardiovascular disease, nerve or spinal cord damage, cigarette smoking, low testosterone levels, prescription medications, depression, stress and anxiety.

Until recently, it was believed that little could be done to help a man who is suffering from erectile dysfunction, but there are a number of natural things that can be tried before having to rely on the “little blue pill.”

Recommendations For Wellness

If you think your stress, anxiety or depression is affecting you physically, perhaps psychological counseling, meditation, bio-feedback or hypnotherapy can help.

If you are taking prescription medications such as MAO inhibitors or anti-hypertensives, talk to your doctor about their possible side effects.

Have your hormone levels checked.� � You might be suffering from low testosterone levels.� � In some men, low levels of the hormone dehydroepiandrosterone (DHEA) have also been reported.� � DHEA is essential for the production of testosterone.

Quit smoking.

Try supplementing with the amino acid L-arginine.� � Nitric oxide formation depends on sufficient levels of L-arginine in the body and has been found particularly effective for men with abnormal nitric oxide metabolism.

Yohimbe bark has a history of helping men with erectile dysfunction.� � Yohimbe dilates blood vessels and may help regardless of the underlying cause.� � If you are on prescription medications, talk to your doctor before taking yohimbe.

Muria puama can be used to increase the libido and erectile strength.� � It works best when combined with yohimbe bark.� � This combination can be found in Nature’s Sunshine’s X-Action for Men.

In Mexico, the herb damiana is used as a male aphrodisiac and is an herb traditionally recommended for men with erectile dysfunction.

In Peru, maca is known as a potent aphrodisiac.� � Maca is often called the herbal “Viagra” and does not alter circulation.� � Instead it works to regulate hormones and bring the body back into balance.

Asian (panax) ginseng is an herb that has long been used to support male potency.

Sarsaparilla has a history of being used as a tonic for male sexual potency and is thought to assist in the production of testosterone.

Some men find relief when taking ginkgo biloba.� � Ginkgo biloba supports blood circulation and may help by increasing blood flow to the penis.� � This supplement is not recommended if you are taking any kind of prescription blood thinner.

Traditionally used to lessen the symptoms of an enlarged prostate, saw palmetto stimulates a low libido and increases sexual energy.

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