Erectile Dysfunction: PDE5 inhibitors 

Erectile dysfunction (ED) is surprisingly common, can cause serious issues with self-esteem and can ruin relationships. 
While the great majority of problems are due to psychosocial issues ("performance anxiety"), occasionally ED can be an early warning sign of future cardiovascular disease. Viagra (Sildenafil), Levitra (Vardenafil) Cialis (Tadalafil) and Spedra (Avanafil) are drugs known as phosphodiesterase type 5 inhibitors (PDE5I). 
They are used in treatment of ED, either alone or in conjunction with testosterone replacement therapy/TRT. The general action of PDE5Is is to relax the blood vessels in the penis; this enables blood flow into the penis when sexual arousal occurs, helping to cause and/or maintain an erection. Sexual stimulation is needed for the drug to work. 
A full history and assessment should be made before prescribing. You should inform your doctor about any medicines you are taking, including over-the-counter treatments, herbal remedies etc. Lifestyle (diet, exercise, smoking, alcohol and drug misuse) will be discussed, as will a family history of heart disease. Blood tests are sometimes indicated.  
Occasionally, other investigations, eg penile ultrasound, will be needed.Treatment depends on individual needs. Spedra or Levitra have the more rapid onset of action and will work for about 8 hours. Cialis 20mg stays in the system for up to 72 hours (the French call it "Le weekend"). There is also Cialis 5mg available for daily use. Sildenafil and tadalafil are now available in generic form, resulting in significant price reduction. 
Alprostadil injections are sometimes indicated where PDE5I medication does not work. 
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