Jacob
Welcome, readers, to our exploration of the historical development of erectile function therapy over the past century. In this blog post, we will delve into the significant milestones and advancements that have revolutionized the treatment landscape for erectile dysfunction (ED). From early remedies to modern innovations, join us on this fascinating journey through time.
Ancient Remedies and Beliefs
Historical Beliefs and Remedies
Similarly, in ancient Greece and Rome, ED was viewed as a physical ailment with potential psychological factors. Greek physician Hippocrates believed that ED was caused by an imbalance of bodily humor, while Roman physician Galen attributed it to a defect in the seed and reproductive organs. Traditional herbal concoctions, like the famous Greek aphrodisiac blend “Hippocras,” were used to address the issue.
Psychological Perspectives
During the time of Sigmund Freud and his psychoanalytic theory, psychological explanations for ED gained prominence. Freud proposed that unresolved childhood traumas and repressed sexual desires could lead to sexual dysfunctions, including ED. He specifically hypothesized that the Oedipus complex, where a child has unconscious sexual desires for the parent of the opposite sex, could contribute to later sexual difficulties.
Psychotherapy, particularly psychoanalysis, became the dominant approach to ED treatment during this period. Therapy sessions aimed to uncover and address unconscious conflicts, providing patients with insight and potential resolution for their underlying psychological issues.
Cultural Factors and Societal Norms
Outside of medical explanations, cultural and societal factors also played a significant role in shaping perceptions of ED. In many societies, including Victorian England, discussions of sexual matters were considered taboo. This led to a culture of silence and shame surrounding sexual problems, making it difficult for individuals to seek help or openly address issues related to ED.
Additionally, religious beliefs, particularly those espoused by conservative institutions, often portrayed sexual activities and desires as sinful or immoral. Such attitudes could compound feelings of guilt or shame for individuals experiencing ED, further hindering their ability to seek appropriate medical assistance.
Early Medical Interventions
The Emergence of Yohimbine
Yohimbe is an evergreen tree native to the central region of Africa. According to rumors, the locals soaked yohimbe leaves in their tea as food, and as a result, the local people’s genitals were particularly developed and their reproductive ability was particularly strong.
In 1896, L. Spiegel extracted the main alkaloid from the bark of this tree and named it yohimbine. It promotes the release of norepinephrine, reduces venous return to the penis, and facilitates a congested erection.
Yohimbine was first used in combination with papaverine to treat erectile dysfunction (ED) in 1923. Before the emergence of phosphodiesterase type 5 (PDE5) inhibitors, yohimbine was the most used ED treatment drug worldwide, and was even described as “the most satisfying African aphrodisiac”.
However, its effectiveness has not been well established and is not included in guideline recommendations.
Penile Prosthesis Implantation
In 1936, Soviet doctor Bogoraz got inspiration from the existence of reproductive bones in animal penises. Using costal cartilage as a prosthesis implanted in the reconstructed skin tube, the first penile reconstruction was performed and used in ED patients, opening the precedent for penile prosthesis implantation. Unfortunately, due to the natural absorption of costal cartilage, no long-term effect can be obtained.
After World War II, many pilots and soldiers had their genitals disabled by burns and blasts, which accelerated the development of penile reconstructive surgery.
In 1949, a penile prosthesis using allogeneic materials—acrylic subcutaneous penile prosthesis implantation was successfully implemented.
Since then, the Egyptian doctor Beheri put the acrylic rod into the penile cavernous body for the first time, which opened the great attempt at modern penile prosthesis implantation. Finally, in 1973, Scott designed the modern three-piece expandable penile prosthesis. Currently, inflatable penile prosthesis is the “ultimate weapon” in the treatment of ED.
Medications and Mechanical Devices
A vacuum erection device comes out
As early as 1874, American doctor John King proposed to use a small vacuum pump to act on the penis to improve erection. This is also the prototype of the vacuum device for treating ED.
In 1982, Erec-Aid, a vacuum erection device designed and developed by American Geddings Osbon, was approved by the FDA. Since then, various vacuum erection devices have come out one after another, the principle of which is to use negative pressure to attract blood flow into the cavernous body of the penis, thereby promoting penile erection.
Intracavernosal Injections
In 1975, Karim first reported that prostaglandin E1 could relax the smooth muscle of the corpus cavernosum in the penis. In 1977, Virag et al. accidentally discovered that papaverine was injected into the cavernous body during penile vascular surgery, and the penile erection lasted for 2 hours.
In 1982, the injection of vasoactive drugs into the cavernous body of the penis was officially reported for the treatment of ED, which can relax vascular smooth muscle and increase penile blood flow. Papaverine was the first drug for intracavernous injection, opening a new avenue for the treatment of ED patients. In 1983, phentolamine also began to be used in penile cavernous injections.
Intracavernosal injections became the treatment of choice for ED at the time and were widely accepted as an effective treatment for ED, although they required one injection before each intercourse. Intracavernosal injections are currently the second-line treatment for ED.
Alprostadil is the first and only drug approved for intracavernous injection in the treatment of ED. In 1990, Goldstein first reported the combination of papaverine/phentolamine/prostaglandin E1 for intracavernous injection. Although the effective rate improved, it was not officially approved.
Since intracavernosal injection needs to be injected directly at the root of the penis, many patients have difficulty persisting for a long time due to fear of pain. In 1994, intraurethral injection of alprostadil (MUSE) was successfully used clinically. Although the efficacy was slightly less invasive, it provided an alternative method for patients who feared intracavernosal injection.
PDE5 Inhibitors and Beyond
The Revolutionary Impact of PDE5 Inhibitors
In 1991, Pfizer’s R&D personnel developed a drug for the treatment of cardiovascular disease – sildenafil. However, the clinical trials did not achieve the desired goals. So the R&D staff decided to recall this batch of drugs. Strangely, none of the subjects were willing to hand in the rest of the medication. After questioning, it turns out that many patients have frequent erections because of taking this pill. Therefore, the researchers conducted research on the effect of sildenafil on the smooth muscle of the cavernous body of the penis.
In March 1998, the US FDA approved the first PDE5 inhibitor, Viagra (sildenafil), which became a revolutionary drug for the treatment of ED.
Since then, various PDE5 inhibitors have sprung up. Most of the PDE5 inhibitors are on-demand, which is commonly referred to as “eat once and take once”. Currently, oral PDE5 inhibitors have become the preferred modality for the treatment of ED.
In 2008, the U.S. FDA approved tadalafil as a once-a-day treatment mode to treat ED. This regular treatment mode has a preventive effect, eliminating “scheduled sexual intercourse” and avoiding the “direct dependence” of erection and drug treatment, to become a new breakthrough in ED treatment mode.
Extracorporeal shock wave therapy
In 2010, Vardi et al. recognized the close association between erectile dysfunction (ED) and cardiovascular diseases. Building upon the success of extracorporeal shock wave therapy (ESWT) in treating cardiovascular conditions, they began applying low-intensity extracorporeal shock waves to ED treatment. The results of their studies demonstrated significant improvement in erectile function and penile hemodynamics.
Animal studies have also supported the use of low-intensity extracorporeal shock waves in promoting the regeneration and recovery of penile nerve cells, endothelial cells, and smooth muscle cells. This therapy has been shown to enhance penile endothelial function and improve penile hemodynamics.
While there is limited research on the specific mechanism of action for low-intensity extracorporeal shock wave therapy in treating ED, its efficacy does not surpass that of oral PDE5 inhibitors. However, this therapy is safe, non-invasive, and carries the potential to repair or protect endothelial cell function. It holds promise as a novel and encouraging approach to ED treatment, deserving further investigation and research.
Over the past century, the treatment landscape for erectile dysfunction has undergone significant transformations. From early remedies rooted in ancient beliefs to the breakthrough of PDE5 inhibitors and non-invasive therapies, medical advancements have greatly improved the management of ED. As our understanding continues to evolve, it is essential to explore new frontiers in order to provide optimal care and enhance the quality of life for individuals affected by ED.
Source:
[1]Capozza M, et al. Erectile Dysfunction in Ancient Roman Literature: Looking for Clues in the Past. J Sex Med. 2020;17(3):529-534.
[2]Wespes E, et al. What Is New in the Management of Erectile Dysfunction? Part 1: Advances in Medical Treatments. Eur Urol. 2016;70(4):699-709.
[3]Hatzimouratidis K, et al. EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature, and Priapism. European Association of Urology. 2019.
[4]Hellstrom WJ, Montague DK, Moncada I, et al. Implants, mechanical devices, and vascular surgery for erectile dysfunction. J Sex Med.2010; 7: 501-23.
[5]Vardi Y, Appel B, Jacob G, et al. Can low-intensity extracorporeal shockwave therapy improve erectile dysfunction? A 6-month follow-up pilot study in patients with organic erectile dysfunction. Eur Urol. 2010; 58(2):243-8.
