Sexual enhancers

from Wikipedia, the free encyclopedia

As Potency (also erection aids ) is colloquially known agents and actions in addressing the erectile dysfunction are intended (impotence).

Overview

In addition to historically known popular potency drugs (e.g. Spanish fly ) and mostly ineffective dubious drugs that are offered in magazines or advertised through spam mail , the pharmaceutical industry has developed various therapeutically effective potency drugs that can be taken orally (tablets, capsules) or can use topically (creams, injections, “mini suppositories”).

A distinction is made between the peroral agents

  • Initiators (with erection-inducing effect),
  • Conditioner (supporting the conditions for an erection).

The topical therapy ( p. U. ) Involves administration of the vasodilator hormone tissue alprostadil means

  • Corporal injection directly into the penis
  • Insertion of preparations such as sticks ("mini suppositories") or cream into the urethra

Non-drug measures are:

A promising form of therapy always depends on the cause of the erectile dysfunction. An effective preventive measure is aerobics or fitness training, which is also being investigated as a form of therapy. The forms of therapy of choice are oral pharmacotherapy and physical vacuum therapy, followed by drug injections into the penis and finally implants. Surgical interventions are only considered as a last resort for erectile dysfunction (see article: Penis Enlargement ). These include the implantation of hydraulic penile prostheses and so-called penile augmentation . These methods are also used if the penis - at least subjectively - is generally too small.

Erectile dysfunction are often symptoms of other diseases and often require treatment to rule out consequential damage. The most common causes of erectile dysfunction include drug side effects (antidepressants from the SSRI group , nicotine ), neurogenic disorders, Peyronie's disease , surgical complications, and mental disorders.

Medicinal sexual enhancers

Overview of potency-increasing drugs:

Oral medication

PDE-5 inhibitors

The PDE-5 inhibitors include the newer generation of “sexual enhancers” such as the drugs Sildenafil , Vardenafil , Tadalafil and Avanafil . Phosphodiesterase exists in various molecular forms that are unevenly distributed throughout the body. The enzyme promotes the breakdown of cGMP , one of whose effects is the widening of vessels. Phosphodiesterase-5 occurs in increased concentrations in the area of ​​the erectile tissue of the penis, which is why an inhibition of this enzyme causes an almost isolated increase in cGMP in the penis and thus an increased blood flow.

The orally active PDE-5 inhibitors used therapeutically in the therapy of ED are shown comparatively in the table:

Sildenafil Tadalafil Vardenafil Avanafil
Onset of action within 30 to 60 minutes within 30 to 60 minutes within 15 to 25 minutes from about 15 minutes
Duration of action up to 4 to 5 hours up to 36 hours up to 4 to 5 hours
Mean plasma half-life 4 hours 17.5 hours 4–5 hours 6-17 hours
Available single doses 25, 50 and 100 mg 5, 10 and 20 mg 5, 10 and 20 mg 50, 100 and 200 mg
Original preparation Viagra ( Pfizer ) Cialis ( Eli Lilly ) Levitra ( Bayer ) Spedra ( Menarini )

As the first representative of the active ingredient group, Sildenafil has the longest experience in therapeutic use. There are also positive experiences with problem groups. Sildenafil (like the other PDE-5 inhibitors) in combination with medication containing nitrates can lead to life-threatening conditions.

A pack of Viagra

In general, the spectrum and strength of side effects are comparable for all four active ingredients. A longer duration of action is associated with a longer duration of side effects.

Yohimbine

Yohimbine , which is extracted from the bark of the yohimbine tree and used orally , is also used for erectile dysfunction . Its effect is said to be due on the one hand to the blockade of α 2 -adrenoceptors on blood vessels in the male sexual organs and on the other hand to the blockage of α 2 -adrenoceptors in the central nervous system . In higher doses, yohimbine also acts on serotonin (5-HT) receptors . With the advent of the effective PDE-5 inhibitors for the treatment of erectile dysfunction, the importance of the weak and unreliable yohimbine has declined.

Local medication

Local therapies are used when PDE-5 inhibitors fail, systemically acting agents are undesirable or contraindicated . The contraindications to PDE-5 inhibitors include severe heart disease, heart failure, heart attack or stroke in the last six months and, above all, the use of nitrates or alpha blockers .

The prostaglandin-E1 analogue alprostadil is most frequently used in local therapy . Alprostadil is a vasoactive tissue hormone (prostaglandin E 1 ), which causes the muscle cells of the arteries to relax. As a result, these blood vessels expand and the surrounding tissue is supplied with more blood. In Canada, alprostadil is the preferred therapy for erectile dysfunction. The antispasmodic papaverine or the alpha blocker phentolamine can also be used.

Cavernous injection

With penile injection (also known as penile autoinjection therapy (SKAT) or penis injection ), alprostadil is injected into the erectile tissue. Alprostadil is contained as an active ingredient in the common preparations Caverject and Viridal . This therapy has been around since the 1980s. The correct dosage must be determined in several sessions with the specialist. The correct application (puncture site, puncture technique, frequency of application and minimum time interval) is learned, as there is a risk of painful permanent erection lasting several hours if used incorrectly . Injuries to the urethra, blood vessels or nerves can also occur. The active ingredient is injected directly into the erectile tissue. Because the needle is very thin, the injection is almost painless.

The most common side effects, even when used properly, are penile pain and scarring at the injection site. With the correct dosage, an erection occurs after a few minutes and lasts for about an hour. The success rate is around 70 to 80%.

Transurethral administration

In addition to the injection, there is also the - not quite as successful - possibility of applying the active ingredient alprostadil via a stick ("mini suppository") inserted into the urethra ("Medicated Urethral System for Erection" = MUSE ® ).

cream

When Alprostadil cream ( Vitaros ) is introduced into the urethral orifice ( meatus urethrae ), the active substance reaches the erectile tissue of the penis via the small blood vessels in the urethral wall, and some of it penetrates the venous pelvic circulation. Sufficient penetration and absorption of the alprostadil is made possible by the dodecyl ( N , N -dimethyl- DL- alaninate) hydrochloride (DDAIP) contained in the cream . Alprostadil causes the muscle cells of the arteries to relax, causing blood to flow into the erectile tissue and an erection within 5 to 30 minutes .

Dietetic substances and nutritional supplements

Proteinogenic amino acids

The proteinogenic amino acids L-arginine and L-aspartic acid are both considered biogenic alternatives to PDE-5 inhibitors. However, potency and erectile function increase only slowly within a few days after ingestion. L-arginine is usually produced industrially, while L-aspartic acid is also found in the seedlings of vegetable asparagus. Proteinogenic amino acids are also used in combination with other substances such as pycnogenol and taurine as dietary supplements .

Herbal preparations

The procyanidin extract from the bark of the French maritime pine ( Pinus pinaster , ssp. Atlantica), trade name z. B. Pycnogenol , is considered an effective antioxidant and bioenhancer . It is also used for erectile dysfunction , also in combination with other substances.

Preparations made from maca are marketed as dietary supplements in Europe and the USA as a natural sexual enhancer. As with other remedies of this type, these effects have only been partially scientifically proven.

Mechanical erection aids

Vacuum erection aids

A plastic cock ring

The idea of ​​treating erectile dysfunction using a vacuum pump in conjunction with erection rings originated from D. Osbon in the 1960s. Vacuum erection aid systems have been used successfully as a mechanical, non-invasive aid to produce an erection since 1982. The vacuum erection aid system is listed as a recognized aid in the aid catalog; If there is a corresponding medical indication, the costs for the therapy i. d. Usually covered by the health insurance.

Working principle: A vacuum erection aid system is an electrically or manually operated vacuum pump that creates a negative pressure in a plastic cylinder. This plastic cylinder is first slipped over the penis. In order to create a vacuum in this cylinder, the pumping process is then started. This leads blood to the erectile tissue. The limb stiffness is obtained by an erection ring that has previously been applied to the bottom of the cylinder and then transferred to the base of the penis.

The overall clinical success rate of vacuum therapy is around 90%. It ensures an increased supply of oxygen to the erectile tissue and thus effectively counteracts shrinkage processes in the circumference and length of the limb as well as reduced limb stiffness. The latest findings even suggest that vacuum therapy has positive effects on synaptic facilitation in the area of ​​neural lesions (e.g. after radical prostatectomy). These approaches suggest the possibility of complete restoration of erectile function through the use of a vacuum erection support system.

Squeezing and massaging

Exercises, which essentially consist of forcing blood from the pelvis into the penis by hand, should be repeated regularly. These exercises can quickly overload the erectile tissue. Irreparable vascular damage cannot be ruled out either. There are no scientific studies that confirm its effectiveness.

Illicit drugs

The sale of potency-increasing drugs is a lucrative billion-dollar market for the pharmaceutical industry , as the costs for the active ingredient only make up a negligible part of the retail price. For example, in 2004 the raw material for Viagra, sildenafil citrate, cost 650 euros per kilogram. This could be used to produce 20,000 tablets with a sales value of 240,000 euros. Compared to the original preparation, black market prices are low for generics, e.g. B. from India, where it is still not the requirements of the WTO corresponding patent law is for pharmaceuticals. The import of prescription drugs is prohibited in Germany under both customs and pharmaceutical law and is subject to the VuB rules .

"Natural" erection aids are offered on the roadside (Turkey, 2006)
Confiscated forgeries of Viagrat tablets

Fraudsters also sell counterfeit drugs on the Internet. Corresponding plant-based drops are advertised on a large scale on the Internet, for example through spam emails . The proven very effective prescription drugs Viagra and Cialis are the meistbeworbenen products. Taking prescription medication without a doctor's prescription is fraught with health risks, as the failure to diagnose certain underlying diseases such as B. cardiovascular diseases, liver insufficiency, degenerative retinal diseases, diseases predisposing to priapism and penile malformations can lead to serious adverse effects. Prescription drugs that are illegally sold over the counter are often counterfeited on a large scale. Counterfeits of Viagra are many times more profitable than the trade of certain illegal drugs.

In 2003, analyzes by the “Flora Research” test laboratory in California and the University of Maryland identified various harmful substances in dietary supplements sold to increase potency , including yeasts, Escherichia coli bacteria, pesticides and lead . An American company that had sold such preparations was shut down by the authorities and brought to justice for selling ineffective tablets. However, the company was mainly noticed when customers complained about credit card fraud. So far, similar companies have hardly been prosecuted.

Web links

Wiktionary: Potency means  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ a b c d Hatzimouratidis Konstantinos, Edouard Amar, Ian Eardley, Francois Giuliano, Dimitrios Hatzichristou, Francesco Montorsi, Yoram Vardi, Eric Wespes: Guidelines on Male Sexual Dysfunction: Erectile Dysfunction and Premature Ejaculation . In: European Urology . tape 57 , no. 5 , 2010, p. 804–814 , doi : 10.1016 / j.eururo.2010.02.020 .
  2. ↑ PL Delgado, SK Brannan, CH Mallinckrodt, PV Tran, RK McNamara, F. Wang, JG Watkin, MJ Detke: Sexual functioning assessed in 4 double-blind placebo- and paroxetine-controlled trials of duloxetine for major depressive disorder . In: The Journal of clinical psychiatry . tape 66 , no. 6 , 2005, p. 686-692 , doi : 10.4088 / JCP.v66n0603 .
  3. ↑ Nerogenic Sexual Dysfunction in Men and Women. ( Memento from December 20, 2014 in the Internet Archive ) (PDF) In: Neurologic Bladder, Bowel and Sexual Dysfunction. Retrieved December 20, 2014.
  4. ↑ Male Sexual Dysfunction Epidemiology. Retrieved December 20, 2014.
  5. ↑ Causes of Erectile Dysfunction. Retrieved December 20, 2014.
  6. ↑ Erectile Dysfunction (ED) Causes. Retrieved December 20, 2014.
  7. ↑ a b c Technical information available on the European Medicines Agency website; see EPAR Viagra , EPAR Cialis , EPAR Levitra , EPAR Spedra .
  8. ↑ a b G. Geisslinger et al .: Mutschler drug effects . 11th edition. WVG, Stuttgart 2019, p. 414 f .
  9. ↑ Sildenafil Citrate. Retrieved December 20, 2014.
  10. ↑ H. Kuhlmann: Yohimbin: Potency from the equator . In: Pharmaceutical newspaper. 47/1999.
  11. ↑ I. Knebel: Tadalafil and Vardenafil. In: Pharmaceutical newspaper. 11, 2004.
  12. ↑ C. Leiber, U. Wetterauer: Individual therapy for secret suffering. In: Pharmaceutical newspaper. 37, 2005.
  13. ↑ New Topical Erectile Dysfunction Drug Approved Vitaros in Canada; Approved Topical Drug Testim Proves Helpful for Erectile Dysfunction. Retrieved December 20, 2014.
  14. ^ RW Lewis, R. Witherington: External vacuum therapy for erectile dysfunction: use and results. In: World J Urol . 15, 1997, pp. 78-82.
  15. ↑ a b H. Derouet, D. Caspari, V. Rohde, G. Rommel, M. Ziegler: The treatment of erectile dysfunction using vacuum pumps. In: Urogynaecology. 1999; 6 (2) (edition for Austria), pp. 55–62.
  16. ^ RW Lewis, R. Witherington: External vacuum therapy for erectile dysfunction: use and results. In: World J Urol. 15, 1997, pp. 78-82.
  17. ↑ RJ Bosshardt, R. Farwerk, R. Sikora u. a .: Objective measurement of the effectiveness, therapeutic success and dynamic mechanisms of the vacuum device. In: Br J Urol . 75, 1995, pp. 786-791.
  18. ↑ C. Zippe, G. Pahlajani: Vacuum erection devices to treat erectile dysfunction and early penile rehabilitation following radical prostatectomy. In: Current Urology Reports. 9, 2008, pp. 506-513.
  19. ^ J. Yuan, AN Hoang, CA Romero, H. Lin, Y. Dai, R. Wang: Vacuum therapy in erectile dysfunction - science and clinical evidence. In: International Journal of Impotence Research. 22, 2010, pp. 211-219.
  20. ↑ Beware of penis-enlargement scams. CNN, May 2007, archived from the original on July 26, 2003 ; accessed on January 31, 2011 .
  21. ^ Kurt Langbein , Hans-Peter Martin , Hans Weiss : Bitter Pills . 77., additional u. corr. Output. 2005, ISBN 3-462-03467-7 , p. 35 f.
  22. ↑ Types of Spam. ( Memento from July 13, 2009 in the Internet Archive )
  23. ↑ Sildenafil 50mg film-coated tablets - Public Consultation - Proposal to make available from Pharmacies (PDF) MHRA, March 2017.
  24. ↑ Sigrid Averesch: Viagra is also often counterfeited . In: Berliner Zeitung , September 27, 2007
  25. ↑ Uta Grossmann: A kilo of fake Viagra brings 90,000 euros. In: Pharmaceutical newspaper. 24/2008.
  26. ↑ 'Performance' pills offer men something unexpected. ( Memento from June 28, 2009 in the Internet Archive )
  27. ^ Anatomy of a penis pill swindle. (No longer available online.) MSNBC June 5, 2003, archived from the original January 22, 2011 ; accessed on January 31, 2011 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / msnbc.msn.com