That OF es a very frequent situation; it has been anticipated that it affects in major or minor grade half of the men between the 40 and 70 years. But it is not a topic that talks each other openly. Myths and cultural expectations of the masculine sexuality have prevented many men from looking for help for a disorder that can, in most cases, benefit from a medical treatment.

This way, the situations that more often produce powerlessness are:

• Illnesses that they affect to the blood glasses and restrict the blood flow towards the penis, like the diabetes, the hypertension (high arterial tension), the excess of cholesterol or the cardiac illnesses.
• " Situations that interrupt the connection between the nervous system and the penis, like the surgery of prostate or traumatic injuries in the area.
• " Many medicines (some of them used to treat the hypertension and the depressions), which they produce OF as not wished side effect.
• Nervous depression.
• Risk habits for OF: Nicotinism, alcohol, drugs, stress.

An indicator of the physical powerlessness, in contrast with the psychological one, is the incapability to experience or to support an erection on having woken up in the morning. The powerlessness that persists more than 3 months and that does not stem from a clear stressful event, from drugs, from alcohol or from transitory medical complaints that they cause OF, it points out the need to get medical attention for an urologist.

2. Physical examination. It includes an exploration of the genital area and a rectal tact (examination of the rectum with a finger enguantado). There must be looked evidences of other illnesses - hypertension, diabetes, ateroesclerosis, nervous damage...-

3. You try laboratory. Blood tests will be done to measure the testosterone levels and, if it is necessary, those of prolactina to determine if there are problems of the endocrine system. There can be necessary diverse specific examinations to detect that OF, like tests of erectile answer after injection of medicines that dilate the blood glasses of the penis, or detection of night erections by means of diverse devices.

The form of the treatment is dictated by the specific problem that causes the powerlessness. The first step is to define the cause, if it is possible, and then to try the simplest and less risky solution. In synthesis, the different therapeutic alternatives include one or several of the following ones.

1) To change the habits of life that they affect to the health of the arteries and veins: Not to smoke, to moderate the consumption of alcohol and of fats, to do something of exercise and to learn to relax.

2) To change or to reduce the medicines that cause powerlessness, like some antidepressants, diuretics and betabloqueantes...

3) Psychotherapy and behavioral therapy. Independently of the cause of that OF, there is recommended for all the patients some form of psychological, behavioral, sexual therapy or of combination, generally assisted by his couple.

4) Therapy transuretral and of injection. Medicines consist of being injected into the erectile textile, to relax the smooth muscles of the penis and to allow the erection to be able to take place. It is indicated in some cases of OF. The injected medicines are usually associations of papaverina-fentolamina, or alprostadil (prostaglandin E1). The adverse reactions are generally minor, but long and painful erections (priapismo) can incluír. An alternative to the injections is a plastic device to apply these medicines across the urethra. Although surer and less costly than the surgical treatments, these therapies have a high abandonments valuation, since the loss of spontaneity makes to lose interest in the procedure.

5) Oral medicines. The current methods are the therapy with medicines that improve the flow in the penis facilitating his erection, between them they are:

• SILDENAFIL (VIAGRA ®)
• Vardenafilo (Levitra ®)
• Tadalafilo (Cialis ®)
• Apomorfina Hidrocloruro (Uprima ®)
• Yohimbina. Employee as popular medicine for years, at present there exists evidence of which it can improve the potency in a third of the men with OF light, especially in combination with the antidepressant trazodone.
• Hormonal treatments. The therapy with testosterone is indicated only in men with hipogonadismo (low levels of masculine hormone). It can be used by oral route or in patches. The testosterone is never recommended for men at normal levels of masculine hormone; in these it can improve the sexual impulse, but at the cost of hurting on the prostate and the liver, sometimes irreversible. When the powerlessness owes at excessive levels of the hormone prolactina, the medicine can be useful bromocriptina.
• Others: They have been used, with different grades of success, medicines like pentoxifilina (Elorgan ®), naltrexona - an antidote of the heroine and the morphine - or the antihypertensive minoxidil.

The three first ones (CIALIS ®, Levitra ®, Viagra ®) acts of similar form being inhibiting of the PDE5.
When the penis is stimulated Guanosina secretes cyclical monophosphate (CGMP), and this substance produces the erection and supports it.
The PDE5 is the product that the cGMP degrades, then it annuls the erection.
All the products that inhibit the PDE5 increase the time of performance of the cGMP, and it stays better and more time the erection.
From here there are differences between these medicines for the dose, the beginning of performance, duration of the effect, and the need for readministration. Also the Cialis ® does not interact with food, yes others make it two.

Brief comparative table:

The side effects are similar: migraines, diarrheas, bad digestions, stomachache, photophobia and hallucinations of colors in the vision, sickness, facial flush, in more or less intensity. It is always necessary to be careful in patients with cardiopatías hypertense and with treatments with nitrites or with betabloqueantes.