Trials: Sildenafil (Viagra) and erectile dysfunction in MS

Xiao et al. Sildenafil citrate for erectile dysfunction in patients with multiple sclerosis. Cochrane Database Syst Rev. 2012 Apr 18;4:CD009427.

BACKGROUND: Erectile dysfunction (ED) is a common sexual disease in male MSers. Sildenafil citrate (Viagra) is considered as an effective drug in the treatment of male ED in the general population, but it has not been systematically reviewed in patients with MS.



OBJECTIVES: To assess the efficacy and safety of sildenafil citrate for ED in MSers.

MAIN RESULTS: Two randomised controlled trials involving a total of 420 MSers were identified. Both trials investigated the short-term efficacy and safety of sildenafil citrate for ED in MSers. MSers taking sildenafil citrate were more likely to improve their ability to achieve and maintain an erection measured by International Index of Erectile Function and achieve vaginal penetration ( (RR 1.28, 95%CI 0.92 to 1.78) and complete intercourse measured by Sexual Encounter Profile diary (RR RR 1.38, 95%CI 1.00 to 1.90). and receive A global well respond measured by Global Assessment Question (RR 2.72, 95%CI 1.40 to 5.28) was reported. One trial showed sildenafil citrate is effective in quality of life improvement, while the other trial did not find any significant difference between both groups. Both included trials were judged as high risk of attrition bias. Adverse events were also reported: the most common were headache, flushing, rhinitis, visual disturbances and dyspepsia. Two MSers suffered serious adverse events: one with coronary artery disease requiring triple bypass surgery and one with a cerebrovascular accident.

AUTHORS' CONCLUSIONS: There is limited evidence to support sildenafil citrate as an effective treatment for ED in MSers. Future well designed randomised, double blinded, placebo-controlled trials with long-term duration are needed.

"Sexual dysfunction in MS, in both woman and men, is one the hidden disabilities that is seldom discussed. It is very common and disabling. I have little doubt that viagra and viagra-like drugs have an effect and help male MSers, both physically and emotionally. The biggest problem is recognising sexual dysfunction as a problem; most MSers don't volunteer that they have a problem and most healthcare professionals avoid asking. We don't, but the clinic environment we work in is not conducive to open discussion. Interestingly, at MS Life last weekend the sexual dysfunction session was massively over subscribed indicating that sexual dysfunction in a major, and an under recognised problem in MS. Don't be embarrassed raise the issue with your MS nurse or neurologist."

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