Erectile dysfunction: a brief history

Whilst erectile dysfunction has been a major issue to men for millennia having been described since the beginning of written history in India, Ancient Egypt, Ancient Greece, even the New Testament and its treatment has evolved over the centuries.  It is defined as “the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance” (National Institute of Health 1992) snd although the disease is considered to be a benign disorder it may affect a person’s quality of life detrimentally, often leading to depression, anxiety and poor self-esteem which in turn can exacerbate the problem.

 

Early treatments

A rather gruesome, if an important person, in the early treatment of erectile dysfunction is Regnier de Graaf.  In 1668 he discovered that if he injected saline into the blood vessels in the penis of a cadaver could result in an erection.

Peyronie’s disease was first described by Francois de la Peyronie in 1743; this is a condition where the penis is bent, often as a result of trauma and so is more likely to suffer erectile dysfunction.

The first studies of electrically induced induce erections were published by Eckhard in dogs in 1863

Then came Charles Edouard Brown-Sequard, the French neurologist who first suggested the link between hormones and the ageing process and these investigations led to the idea of using androgens in modern medicine.  It wasn’t until the 1940’s that the source of testosterone moved away from animal sources and the human version of the hormone was first purified

In 1908 Frank Lydston reported more than 100 dorsal vein ligation procedures and so illustrating the first understanding of the circulatory system in penile erection.

 

Dr John R. Brinkley

The first attempts to cure erectile function with medication were carried out in the US by Dr John R. Brinkley in the 1920s and 1930s.  He used goat gland implants and injections of  “mercurochrome” alongside surgeries performed by Serge Voronoff, a French - Russian surgeon.

Brinkley had his medical licence revoked and he moved from Texas to Mexico to continue his practice.

 

Surgical Procedures for ED

Inflatable surgical implants were introduced in the 1970s.

In addition, the first vacuum pump for erectile dysfunction was introduced by Geddings Osbon in 1960; they are still used today

Progress with drug treatment was very slow and it wasn’t until 1983 that light appeared at the end of the tunnel.  English physiologist Giles Brindley PhD demonstrated to an American Urological Association audience how he had injected a non-specific vasodilator and an alpha-blocking agent into the veins of his own penis which led to his having an erection.  This inevitably resulted in further research into vasodilators and alpha-blocking medication to be used for oral management of erectile dysfunction.

Finally, the first drug to be used for oral treatment of ED was patented in 1996  in the UK.  Its brand name is Viagra, active ingredient sildenafil.

 

Lifestyle changes to help with ED

  1. Lose weight
  2. Exercise regularly
  3. Eat a healthy diet
  4. Avoid stress
  5. Stop smoking

 

Drug therapy for erectile dysfunction

 For the last twenty years or so we have had more drug options available for treating erectile dysfunction, however, we need to understand the causes of the ED in each patient before we can consider which drug would be most useful:

 

Causes

High cholesterol or hypertension.

If the ED is caused by either of these conditions, then drugs to treat the specific  problems should be considered as a first option

Hormone problems

Hormone replacement therapy should be considered (eg. testosterone)

Side effects of prescribed medication

Consult the GP to consider changing to another form of medication

Finally, we can consider sildenafil (Viagra), tadalafil (Cialis), Vardenafil (Levitra, Staxyn ODT) and avanafil (Stendra). 

These drugs encourage the engorgement of the penis with blood which in turn creates the erection

 

Sources

Erectile Dysfunction: A Review of Historical Treatments With a Focus on the Development of the Inflatable Penile Prosthesis https://www.nature.com/articles/3900717.pdf?origin=ppub#:~:text=An%20important%20figure%20in%20the,cadavers%20could%20induce%20an%20erection.

The history of erectile dysfunction management https://www.nature.com/articles/3900717.pdf?origin=ppub#:~:text=An%20important%20figure%20in%20the,cadavers%20could%20induce%20an%20erection.

Impotence (Erectile Dysfunction) History https://www.news-medical.net/health/Impotence-(Erectile-Dysfunction)-History.aspx

Treatment for erection problems depends on the cause https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/#treatments-other

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