Barriers to Treatment Success

Approximately 90% of men who seek assistance for ED are treated with PDE-5s, all of which are reasonably safe (15). All are completely contraindicated with concomitant nitrate use; with some additional warnings and/or contraindications attached to use of alpha-blockers. Generally, PDE-5 inhibitors are highly effective, restoring erections in ^70% of men, yet there is a growing body of evidence suggesting that the frequently quoted 20-50% drop-out rate for medical treatments is true for PDE-5 treatment as well (15). Why? The adverse event profile is excellent for all three PDE-5s, with few patients terminating treatment, because of adverse events. Of course, not all discontinuation of sexual pharmaceuticals are due to failure or complications. There are some who tried the medications out of curiosity and never intended to continue using a PDE-5. There are some reported cases of men with psychogenic ED experiencing a "cure" after temporary use of a PDE-5 (16).

Reciprocally, some people will discontinue PDE-5 because of the severity of their ED. For these individuals, the pharmaceuticals simply do not work. Regardless of the mode of administration, a certain percentage of the population will not experience restored capacity, because the degree of organicity is so profound as to overwhelm the salutary effects of the drug. In particular, some diabetics and radical prostatectomy survivors may need more powerful medical treatments.

Importantly, PDE-5 treatments do have significant psychosocial limitations and consequences which have created "born-again" roles for sex therapists, albeit more complex and sophisticated ones (17). Previously, many presumed that high discontinuation rates were due to the objectionable nature a specific treatment, such as self-injecting the penis. They thought that the introduction of efficacious and safe oral agents would decrease this high drop-out rate (18). However, there is great complexity to the barriers to success story. Although definitely improving, the reported success rate, the ensuing publicity (following PDE-5 launches) still resulted in just a small percentage of people worldwide receiving pharmaceutical therapy. ED treatment, even with its juggernaut of publicity and advertising has penetrated < 15% of the estimated market place. In fact, industry information suggested that a geometrically small number of individuals were actually successfully treated and satisfied repeat "customers" (19). Apparently, a limited number of men were treated and a large percentage of those who tried it, apparently discontinued rather abruptly (19). There was also a high relapse rate when medication was stopped. The model for all three PDE-5s, as well as ICI and IUI treatments for ED, was chronic pharmaceutical use in order to relieve symptoms. To date, very little was written about "weaning" patients from pharmaceuticals or effectively maintaining them on lower doses. Concepts of "weaning" and relapse prevention offer opportunities for MHPs (20).

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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