title: Pharmacotherapy for erectile dysfunction.
abstract: BACKGROUND
  Advances in understanding of the biochemistry and physiology of penile erection have led to breakthroughs in pharmacotherapy of erectile dysfunction.
  
  
  OBJECTIVE
  To provide recommendations/guidelines concerning state-of-the-art knowledge for the putative molecular and cellular mechanisms of action of centrally and peripherally acting drugs currently utilized in pharmacotherapy of erectile dysfunction.
  
  
  METHODS
  An international consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a two-year period. Concerning the Pharmacotherapy for Erectile Dysfunction Committee there were 25 experts from 10 countries.
  
  
  METHODS
  Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.
  
  
  RESULTS
  Selective and potent oral PDE5 inhibitors have significantly more affinity than cGMP and form broader molecular interactions with multiple amino acids, thereby blocking access to cGMP in the catalytic sites of the PDE5 enzyme. PDE5 inhibitors, which vary as to biochemical potency, selectivity and pharmacokinetics, lead to cGMP elevation and relaxation facilitation of penile corpus cavernosum smooth muscle cells following sexual stimulation. Various centrally acting drugs influence sexual behaviour. In particular, the dopaminergic substance apomorphine is a central enhancer that acts in the paraventricular nucleus of the hypothalamus as a dopamine (D2) receptor agonist, induces and increases penile erection responses via disinhibition, following sexual stimulation.
  
  
  CONCLUSIONS
  There is a need for more research in the pharmacotherapeutic development of central and peripheral agents for safe and effective erectile dysfunction treatment.
authors.affiliation: hpn@insyght.com
authors.forename: Harin
authors.initials: H
authors.lastname: Padma-Nathan
authors.forename: George
authors.initials: G
authors.lastname: Christ
authors.forename: Ganesan
authors.initials: G
authors.lastname: Adaikan
authors.forename: Edgardo
authors.initials: E
authors.lastname: Becher
authors.forename: Gerald
authors.initials: G
authors.lastname: Brock
authors.forename: Serge
authors.initials: S
authors.lastname: Carrier
authors.forename: Culley
authors.initials: C
authors.lastname: Carson
authors.forename: Jackie
authors.initials: J
authors.lastname: Corbin
authors.forename: Sharon
authors.initials: S
authors.lastname: Francis
authors.forename: Robert
authors.initials: R
authors.lastname: DeBusk
authors.forename: Ian
authors.initials: I
authors.lastname: Eardley
authors.forename: Hans
authors.initials: H
authors.lastname: Hedlund
authors.forename: Adolph
authors.initials: A
authors.lastname: Hutter
authors.forename: Graham
authors.initials: G
authors.lastname: Jackson
authors.forename: Robert
authors.initials: R
authors.lastname: Kloner
authors.forename: Ching-Shwun
authors.initials: CS
authors.lastname: Lin
authors.forename: Shin
authors.initials: S
authors.lastname: Lin
authors.forename: Kevin
authors.initials: K
authors.lastname: McVary
authors.forename: Andrew
authors.initials: A
authors.lastname: McCullough
authors.forename: Ajay
authors.initials: A
authors.lastname: Nehra
authors.forename: Hartmut
authors.initials: H
authors.lastname: Porst
authors.forename: Claude
authors.initials: C
authors.lastname: Schulman
authors.forename: Allen
authors.initials: A
authors.lastname: Seftel
authors.forename: Ira
authors.initials: I
authors.lastname: Sharlip
authors.forename: Christian
authors.initials: C
authors.lastname: Stief
authors.forename: Claude
authors.initials: C
authors.lastname: Teloken
mesh_terms: D001058:Apomorphine / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D007546:Isoquinolines; D008297:Male; D009271:Naltrexone / Q000031:analogs & derivatives / Q000627:therapeutic use; D009287:Naphthyridines / Q000627:therapeutic use; D018696:Neuroprotective Agents / Q000627:therapeutic use; D010456:Peptides, Cyclic / Q000627:therapeutic use; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012725:Sexual Behavior / Q000187:drug effects* / Q000502:physiology / Q000523:psychology; D014196:Trazodone / Q000627:therapeutic use; D000521:alpha-MSH / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D001058:Apomorphine; D018491:Dopamine Agonists; D007546:Isoquinolines; D009271:Naltrexone; D009287:Naphthyridines; D018696:Neuroprotective Agents; D010456:Peptides, Cyclic; D010726:Phosphodiesterase Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors; D014196:Trazodone; D000521:alpha-MSH; C079282:melanotan-II; C060956:Delequamine; C038981:nalmefene