Introduction
Erectile dysfunction, also known as impotence, is a common sexual problem among men. It is the inability to develop or maintain an erection of the penis during sexual performance. For years, men suffering from erectile dysfunction had limited treatment options with low success rates. However, the late 1990s saw the development of a drug that would revolutionize treatment - Sildenafil, more commonly known by its brand name Viagra. Here is an in-depth look at this ground breaking medication.

How Sildenafil Works
Sildenafil works by inhibiting an enzyme called phosphodiesterase type 5 (PDE5). This enzyme is found in the corpus cavernosum of the penis and is responsible for breaking down cyclic guanosine monophosphate (cGMP). cGMP plays a key role in achieving and maintaining an erection. When sexual stimulation occurs, cGMP levels in the penis rise, leading to smooth muscle relaxation and increased blood flow to the corpus cavernosum. However, PDE5 limits this natural process. Sildenafil Drug blocks PDE5, allowing higher levels of cGMP to accumulate. This results in improved blood flow to the penis and the ability to get and maintain an erection for intercourse.

Clinical Trials and Approval
Early clinical trials in the 1990s found Sildenafil to be effective and safe for treating erectile dysfunction. The largest trial involved over 1500 patients at 27 sites across 11 countries. Participants administered Sildenafil doses of 25mg, 50mg, or 100mg or a placebo about one hour prior to sexual activity. The drug demonstrated a statistically significant improvement in the ability to obtain and maintain erections versus the placebo. Common adverse effects were mild and included headaches, flushing, and dyspepsia. Based on these positive results, Sildenafil was approved for medical use by regulatory agencies worldwide starting in 1998. It quickly became the go-to treatment recommended by doctors.

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