Weidmann P
Hospital Europa, Marbella.
Ther Umsch. 1998 Jun;55(6):384-8.
Erectile dysfunction may have psychological as well as a variety of organic causes. This necessitates in each case a careful medical evaluation. Various commonly used drugs, as well as alcohol and narcotics, may interfere with erection and should, whenever possible, be discontinued before starting treatment. Organic diseases should be identified and, if feasible, specially treated. In the remaining majority of afflicted men, psychological treatment and partner counseling may produce an improvement, but ultimately what is necessary remains an effective and safe medication. The drug, Sildenafil, introduces a new therapeutic principle. During sexual nerve stimulation, nitric oxide (NO) is released from nerves into the cells of the penile erectile bodies. NO activates in turn its "second messenger", the substance cyclic GMP, and the latter induces the vasorelaxation and blood filling of the erectile bodies. Orally administered Sildenafil competitively inhibits phosphodiesterase type 5, which physiologically inactivates cyclic GMP in the erectile bodies. Thus, Sildenafil increases in men with erectile dysfunction the NO-stimulated cyclic GMP concentration and, thereby, improves erection. This new therapy is attractive because 1. Sildenafil is the first pill (for oral use) with established efficacy that benefits most men with insufficient erection; 2. compared with previous therapeutic approaches (such as drug injections in the penis, instillations into the urinary duct, vacuum pumps or even prostheses), Sildenafil is at least as effective, is easy to take and appears well tolerated with no risk of a prolonged erection; 3. remarkably, this medication stimulates erection only during sexual arousal and, thus, has a rather "natural" effect, and 4. side effects (including headache, facial flushing and dyspepsia or epigastric discomfort) were mostly of mild degree and transient, so that only 4% of men interrupted treatment for this reason. Sildenafil does not need to be taken daily, but may be taken, when needed, 1 hour before a planned sexual activity. The new pill has the potential to enliven the boys "wunder horn" with fresh sound.
勃起功能障碍可能有心理原因以及多种器质性病因。因此，每种情况都需要进行仔细的医学评估。各种常用药物以及酒精和麻醉品都可能干扰勃起，应尽可能在开始治疗前停用。应识别出器质性疾病，如有可能，进行针对性治疗。在其余大多数患病男性中，心理治疗和性伴侣咨询可能会有所改善，但最终仍需要一种有效且安全的药物。西地那非这种药物引入了一种新的治疗原理。在性神经刺激过程中，一氧化氮（NO）从神经释放到阴茎勃起组织的细胞中。NO继而激活其“第二信使”——环磷酸鸟苷（cGMP），后者诱导勃起组织血管舒张和充血。口服西地那非可竞争性抑制5型磷酸二酯酶，该酶在生理状态下会使勃起组织中的cGMP失活。因此，西地那非可提高勃起功能障碍男性中由NO刺激产生的cGMP浓度，从而改善勃起功能。这种新疗法具有吸引力，原因如下：1. 西地那非是第一种经证实对大多数勃起功能不足的男性有效的口服药物；2. 与先前的治疗方法（如阴茎药物注射、尿道灌注、真空装置甚至假体植入）相比，西地那非至少同样有效，服用方便，耐受性良好，且无持续性勃起风险；3. 值得注意的是，这种药物仅在性唤起时刺激勃起，因此具有相当“自然”的效果；4. 副作用（包括头痛、面部潮红、消化不良或上腹部不适）大多程度较轻且为一过性，因此只有4%的男性因此中断治疗。西地那非无需每日服用，可在需要时于计划的性活动前1小时服用。这种新药有可能让男孩们的“魔角”焕发出新的活力。
