Oral pharmacotherapy for erectile dysfunction: current perspectives

The range of therapies for treating erectile dysfunction has expanded rapidly in recent years, with a trend toward understanding the scientific basis of erectile function and implementing therapies that are strategically based on this new knowledge. Treatment options in the field have evolved from penile prostheses that unnaturally provide a rigid erectile organ for sexual intercourse to various pharmacotherapies that are designed to restore or promote the biochemical mechanisms required for natural erectile function. As pharmacotherapies have evolved, their routes of administration have also been advanced ranging from local (eg, intracavernosal, intraurethral, and topical) to systemic (eg, subcutaneous and oral) forms. Among these, the oral route has consistently been highly attractive, particularly since this form offers a noninvasive route of delivery. The patient preference for oral forms of therapy for erectile dysfunction has been well demonstrated, with recent treatment outcome analyses revealing that patients persist in their preferences for some traditional oral therapies despite the poor efficacies and hence cause for significant dissatisfaction.1,2 This dilemma highlights the difficulty confronting specialists in this field who recognize that patients seek therapies that are convenient to deliver, cause minimal or no side effects, and are affordable while they expect them also to be consistently and immediately effective.3 Although erectile dysfunction specialists have been charged with providing treatments that fulfill all the prerequisites for ideal treatment, the new science of penile erection is indeed evolving to provide therapeutic options that are increasingly good prospects in this regard.