Hi, Boxcar;
There’s no question that injected prostaglandin and especially Trimix compounds give very powerful erectile benefits. Although I don’t need this (yet), my urologist knows that I admin a couple of impotence boards on the net and allowed me to use Trimix myself. He also knows I’ve tried nearly everything else that’s commercially available and that I don’t mis-use these drugs.
Trimix, which is a compound of three potent vasodilators, can be a near perfect solution for men on whom drugs like Viagra, Levitra, and Cialis don’t give satisfactory results. It is relatively inexpensive (for me about US $1.80 per event; far cheaper than Caverject), easy to use once you learn to self-inject safely, and one can regulate the duration of the erectile effect - a half hour to a couple of hours. It also acts quickly - a few minutes for most.
You raise an excellent point: Until recently, little study has been devoted to the impotence potential of many over-the-counter drugs - prime offenders among them being sinus/cold remedies like Sudafed (which incidently is used when Trimix or Caverject gives too long a response, to dampen an erection and prevent priapism) and many common prescription meds.
The generally acknowledged causes of impotence are:
Vascular 40%
Diabetes 30%
Medications taken 15%
Pelvic surgery, radiation
or trauma 6%
Neurological issues 5%
Hormonal imbalences 3%
Other 1%
I suspect that the medication and vascular categories are underestimated because they should include alcohol, caffeine, drugs you mention, and a few more.
What is often overlooked is the effect that medications, including the erectile drugs, can have on ejaculation. It’s one thing to get it up, and another to get off. Viagra, for example, has an established reputation for causing delayed ejaculation and/or anorgasmia in a significant number of users. This is often a dosage-related problem - the higher the dosage you take, the more difficult to cum for guys affected this way. The SRRI class of anti-depressants depress libido and can delay ejaculation and cause impotence.
All sexually active men who require medications need to become very savvy consumers, learning about side effects before they launch themselves into any medication program, either prescribed or OTC.