A recent review and meta-analysis published in JAMA Network Open, conducted by Alexander Stridh et al, has shown some exciting findings related to placebo responses and erectile dysfunction (ED). It was reported that placebo administration on ED patients who were already on clinical trials with phosphor-diesterase 5 inhibitors therapy (PDE5Is) showed some promising results in specific ED groups, specifically in those associated with post-traumatic stress disorder (PTSD).
However, in ED group that had undergone prostate surgery or radiotherapy, no significant positive response of placebo was recorded.
Systematic review & meta-analysis including >12,000 individuals show significant placebo responses among men with erectile dysfunction treated with PDE5Is like Viagra. https://t.co/S3rwnnjeUF
— JAMA Network Open (@JAMANetworkOpen) March 20, 2020
Erectile dysfunction (ED) is the most common sexual problem that men face. Almost 30 million men are affected by it worldwide. It is defined as trouble getting a proper erection or sustaining it for a considerable period to perform sex in a normal way. Almost all men have erectile problems from time to time but if the problem persists and hinders with the routine sex activities, it should be treated.
ED can occur due to several reasons, including heart disease, hypertension, diabetes and obesity.
These findings are exceptional as previously no such systematic review and meta-analysis of the already available data on different resources has been conducted. ED trials data with PDE5Is of 12,564 men was collected from various databases, i.e., MEDLINE, Embase, Web of Science and Chocrane Library from January 1998 to December 2018. Only double blind, placebo controlled and randomized clinical trials were included in the analysis.
Out of 2,215 total studies, only 63 were selected based on statistical analysis. The relevant data from these studies was extracted according to PRISMA guidelines and assessment was performed using Jadad scale for systematic reviews and meta-analysis. The outcome of the analysis was improvement of ED in the placebo groups of the studies. The age range of men included in all the 63 studies was 36-68 years.
As a result the study found a significant link between placebo treatment and erectile function improvement in ED patients. Although the underlying mechanism is still unexplored, one possibility is an increased nervous tone in the particular tract due to arousal mechanisms or the release of endogenous cannabinoids and opioids to mediate the placebo effects.
However, the limitations of the meta-analysis were the inability to compare the improvements of the placebo data with no-treatment data from the included study groups.
Drugs to Treat ED
Oral pills belonging to class phosphodiestrase type-5 inhibitors (PDE5Is) are most commonly used drugs to treat ED in the US. Common examples are Viagra (sildenafil citrate), Cialis (tadalafil), Stendra (avanafil) and Levitra (vardenafil HCl). These drugs act by increasing the blood supply in the penile area. Men with ED should take these pills about an hour or two before having sex for best results.