Studies have shown that for men with stress-related ED, when the partner is involved in the therapy, the problem is resolved 50%–70% of the time. When the man must go through counselling alone, the results are less successful. Psychosexual counselling is unlikely to be effective if a man drops out of treatment after just one or two sessions.44
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When your question is: do I have erectile dysfunction? We can answer it by examining the risk factors of ED:
Certain side effects are common to all methods of alprostadil administration, although they may differ in severity depending on how the drug is given:
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What we treatErectile DysfunctionHair LossPremature EjaculationSleepAcneDaily Skin RoutineGenital HerpesCold Sores
When it comes to erectile dysfunction, there is a lot of misinformation out there. Understand the facts about Erectile Dysfunction in our Frequently Asked Questions section.
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A new study has found that hydrocarbon contaminants typically associated with oilsands operations are contributing to decreased penis bone strength among river otters.
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Diabetes is a major risk factor for ED. Damage to blood vessels and nerves is a common complication of diabetes. When the blood vessels or nerves of the penis are involved, ED can result. Diabetes is also associated with heart disease and chronic kidney disease, which are other risk factors for ED.
The doctor may also test for thyroid and adrenal gland dysfunction. For more sophisticated tests, the doctor may refer you to specialist such as an urologist or endocrinologist.
Many medications can cause or contribute to erectile dysfunction, including certain blood pressure drugs, antidepressants, and tranquilizers. Men with erectile dysfunction should talk with their doctor if they suspect a prescription or over-the-counter drug may be causing erectile problems. Born This Way? Physiology and Erectile Dysfunction
Without adequate blood flow, erection problems can occur. In some cases, the erection is weak. In others, the man is unable to have an erection at all.
Erectile dysfunction is the inability to either achieve or maintain an erection. This may happen either occasionally or regularly, but may occur only in certain situations depending on the cause (i.e. patients may still have early morning erections).
Physical examination. This might include careful examination of your penis and testicles and checking your nerves for sensation. If the penis does not reach erection, it might be caused by the endocrine.
AgingDiabetes High blood pressureAtherosclerosis (hardening of the arteries)Stress, anxiety, or depressionAlcohol or tobacco useSome prescription medicinesTirednessBrain or spinal cord damageLow testosteroneMultiple sclerosisParkinson’s diseaseRadiation therapy to the testiclesStrokeSome types of prostate or bladder surgery
The blood vessel processes that lead to an erection are controlled by your nervous system. Some medications can interfere with the nerve signals that make an erection happen. They include certain stimulants, sedatives, diuretics, antihistamines, and drugs to treat high blood pressure, cancer, or depression. But never stop taking a medication unless your doctor tells you to. Alcohol, tobacco, and illegal drugs, such as marijuana, may also contribute to ED.
Patient can inject medications directly into the corpora cavernosa to help attain and maintain erections. Medications such as papaverine hydrochloride, phentolamine, and prostaglandin E1 (alprostadil) can be used alone or in combinations to attain erections. All of these medications are vasodilators and work by increasing blood flow into the penis. Prostaglandin E1 (Caverject, Edex) is easier to obtain; however, it is associated with penile pain in some individuals. The use of combinations of two or three of these medications can decrease the risk of having penile pain.
Weight loss (calories are burned as a result of increases in lean body mass and basal metabolism)Prevention and management of diabetes (which is associated with ED)3. Pelvic floor exercises (aka Kegels)
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You may see many herbs and supplements that claim to help sexual performance or desire. However, none have been proven to successfully treat ED. Plus, they may not always be safe. DO NOT take anything without talking with your provider first.
Avanafil is the most recently FDA-approved PDE5 inhibitor to treat erectile dysfunction.
and men: A consensus statement from the fourth international consultation on sexual Our Doctors on the Radio When to Seek Treatment for Erectile Dysfunction: Jim Hotaling, MD, ESPN 700 Video: Erectile Dysfunction Explained, Past Seminar Hear From Our Patients Gene Miluk
DiabetesHigh blood pressureHeart or thyroid conditionsClogged arteries (atherosclerosis)DepressionNervous system disorders, such as multiple sclerosis or Parkinson disease
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Cancer and cancer treatments that involve the pelvic area including colon cancer surgery, prostate cancer surgery or radiation treatments may cause neurological as well as vascular damage which may lead to sexual dysfunction as well.
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Sildenafil (Viagra) is a medication prescribed for the treatment of impotence (erectile dysfunction, ED) caused by medical or psychological conditions. Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking any medication.
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Methods A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. We searched 6 electronic databases between January 1990 and July 2016 and hand-searched reference lists for randomised controlled trials. Only patients with a diagnosis of erectile dysfunction were included. The mean differences between intervention and control groups were calculated for meta-analysis.
Men can still have orgasms, even if they don’t have an erection. During sexual touching or stimulation, a man can still have an orgasm, even if the penis isn’t hard enough for intercourse. It’s normal for men to have difficulty with erections on occasion. Erectile dysfunction gets more common as men get older. blood vessel problems nerve problems heart disease diabetes smoking cancer treatments involving the pelvis (e.g., pelvic radiation therapy, pelvic surgery) depression, anxiety, or stress drinking too much alcohol
This maxim springs more from anecdotal observations than from scientific studies: Men who have erection problems tend not to have much sex, urologists noticed. And those who don’t, have plenty. Then again, anyone with a passing knowledge of the birds and the bees might have guessed as much.
Picture of penile tourniquet. This is one of many types of constricting devices placed at the base of the penis to diminish blood outflow and improve the quality and duration of the erection. These may be used in conjunction with oral drugs, injection therapy, and with vacuum devices.
Drug therapy with oral PDE5 inhibitors is the main treatment for ED. Sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis), and avanafil (Stendra) are the PDE5 inhibitor drugs approved for treating ED. In general, if a man is a candidate for PDE5 inhibitor therapy and is satisfied with the results, no further treatment is necessary.
Erectile dysfunction, also known as impotence or ED, is the inability to achieve or maintain an erection sufficient for sexual intercourse. Almost all cases of erectile dysfunction are treatable, says Dr. Honig.
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Eat a heart-healthy diet rich in fresh fruits and vegetables, whole grains, and fiber and low in saturated fats and sodium. Because ED is generally related to circulation problems, diets that benefit the heart are especially important.
Pelvic floor exercises tighten the muscles around the base of the penis. These muscles exert pressure on the blood vessels that drain the penis. Tightening these muscles can help keep blood in the penis longer and therefore help maintain an erection. Pelvic floor exercises (also called Kegel exercises) can tighten the muscles that sag and weaken as we age (Meldrum et al., 2014).
In general, there are three main pelvic floor muscles that are used when performing a kegel:
Why no pills? Testosterone is available as a pill but some experts believe long-term oral delivery of testosterone can have negative effects on the liver. These other delivery methods bypass the liver (as they don't involve a pill being absorbed through the stomach/intestine) and go directly into the blood stream. QUESTION Testosterone is a chemical found only in men. See Answer
Skeldon SC, Cheng L, Morgan SG, Detsky AS, Goldenberg SL, Law MR. Erectile dysfunction medications and treatment for cardiometabolic risk factors: a pharmacoepidemiologic study. J Sex Med. 2017;14(12):1597-1605. PMID: 29198514 pubmed.ncbi.nlm.nih.gov/29198514/.
If these fail to improve symptoms, second-line treatments include a topical cream (alprostadil, prostaglandin E1) which works by relaxing the blood vessels, improving blood supply to the penis, and so causing an erection. Alternatively, alprostadil (prostaglandin E1) may also be injected into the penis, to relax blood vessels
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A wide variety of treatments for ED are now available. Remember, however, that not all men are entitled to treatment through the NHS.
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The good news is that there’s a cure for ED. Depending on the underlying cause of the problem, your doctor can opt for one of these treatment options;
You get an erection when blood fills two chambers known as the corpora cavernosa. This causes your penis to expand and stiffen, much like a balloon as it is filled with water. Impulses from the brain and genital nerves start the process. Anything that blocks these impulses or restricts blood flow to the penis can cause ED.
Research in stem cell therapy and gene therapy for erectile dysfunction is also ongoing. Penis Curved When Erect Could I have CAD? Treat Bent Fingers Treat HR+, HER2- MBC Tired of Dandruff? Life with Cancer Cuzin, B. "Alprostadil cream in the treatment of erectile dysfunction: clinical evidence and experience." Ther Adv Urol 8.4 Aug. 2016: 249-256. Diamond, L.E., et al. "Co-administration of Low Doses of Intranasal PT-141, a Melanocortin Receptor Agonist, and Sildenafil to Men With Erectile Dysfunction Results in an Enhanced Erectile Response." Urology 65 (2005): 755. Jackson G., et al. "The second Princeton consensus on sexual dysfunction and cardiac risk: new guidelines for sexual medicine." Journal of Sexual Medicine 3 (2006): 28. Kim, E.D. "Erectile Dysfunction Treatment & Management." Medscape.com. Oct. 12, 2015. Matz, E.L., et al. "Stem cell therapy for erectile dysfunction." Sex Med Rev 2018 April 6 epub ahead of print. United States. Food and Drug Administration. "Hidden Risks of Erectile Dysfunction 'Treatments' Sold Online." Mar. 23, 2015. Yafi, F.A., et al. "Erectile dysfunction." Nat Rev Dis Primers 2 (2016): 16003.
It is important for clinicians prescribing these drugs to make the patient aware of the action of the drugs especially the fact that they do not result in an immediate erection, and that they do not cause an erection without sexual stimulation. There is frequently a great expectation when men begin using these drugs and it is wise to temper their enthusiasm and explain they do not work immediately, and may not work every time, but also let the patient know that if these drugs do not work, there are other options.
You can also inject drugs directly by inserting a tiny needle into the penis. Several drugs and drug combinations are available, including alprostadil (Edex, Caverject), phentolamine, and papavarine (usually given in combination as Bimix or Trimix).
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With 50% of all men between the ages of 40 and 70 likely to experience it to some degree, we look at how exercise can help to manage this condition.
Penile implant surgery can be very effective, provided that precautions are taken to avoid infection. Prosthesis surgery is contraindicated if systemic cutaneous or urinary infection is present. Antibiotics should be provided pre-operatively, and the surgical site should be shaved immediately prior to surgery. We use both Mentor and AMS penile implants with specialized antibiotic coats. Patients are hospitalized overnight for closed suction drainage, and sent home on seven days of post-operative antibiotics. Using these and other precautions, our implant infection rate is comparable to national averages (2-4%, 1-2% for antibiotic coated implants). Vascular surgery is recommended only in healthy individuals with recently acquired erectile dysfunction due to a focal arterial narrowing (usually related to trauma) and in the absence of generalized vascular disease. Sign up for Email Updates Click here Support Urology
Zinc is a micronutrient that plays a role in testosterone production. Low testosterone is associated with severe to moderate deficiency. The consequences of marginal levels are unknown (Prasad et al.,1996). Zinc is also important for immune function.
“And we know that the disease has caused a tremendous amount of stress on people,” he said, “and that can affect your ability to get erections.”
Your private physical examination happens with an ED specialist in a confidential men’s health clinic. Your blood pressure will be checked. Your testicles and penis will be examined, and a brief rectal exam may be recommended to check your prostate health.
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What are the biggest body health issues that plague men? Most men struggle with belly fat, back hair, sweating, erectile...
Sexual dysfunction refers to a problem that arises during any phase of the sexual response cycle, preventing an individual or couple from experiencing sexual satisfaction. Physical, medical, and psychological conditions may affect sexual functioning, resulting in inhibited sexual desire, inability to become aroused, lack of orgasm, and painful intercourse. Treating the underlying physical and psychological problems usually resolves most female sexual problems.
Want to lower your blood sugar? Learn to better control your glucose levels by preventing blood sugar spikes and swings to avoid neuropathy and other diabetes complications. Find foods that lower blood sugar, and identify foods and activities that raise high blood sugar risks.
However, low testosterone as the sole cause of ED likely affects only a small percentage of men. Hypogonadism is also associated with very small or shrinking testicles, loss of muscle mass, increased body fat, reduced bone density, fatigue, anemia, and declining sperm production. Many men with hypogonadism are infertile.
Hypertension (high blood pressure) is associated with ED and is seen more commonly among aging men. In addition, medications prescribed for hypertension, such as beta blockers and thiazide diuretics, have been shown to have detrimental effects on erectile function.
Sometimes, blood flow problems develop because of damage to the endothelium or penile smooth muscle – tissues in the penis that are important for normal erections. This damage may be the result of high blood pressure or smoking. It can also happen if a man has high cholesterol, triglyceride, or blood sugar levels.
Treatment options for ED have evolved considerably over the past decade to encompass psychological counseling; oral, topical, intraurethral, and intracavernosal vasoactive therapy; oral therapies with other or unknown mechanisms; hormone replacement; vacuum constriction devices; and surgery, including vascular bypass procedures and penile implants. The goal of treatment is to restore satisfactory erections with minimal adverse effects. Men have demonstrated a strong preference for oral treatments even if they have low efficacy.
All men receiving testosterone replacement need to have periodic measurement of haemoglobin and haematocrit to monitor for erythrocytosis. Feldman HA , Goldstein I , Hatzichristou DG , et al . Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994;151:54–61. Araujo AB , Esche GR , Kupelian V , et al . Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab 2007;92:4241–7. doi:10.1210/jc.2007-1245 Lindau ST , Schumm LP , Laumann EO , et al . A study of sexuality and health among older adults in the United States. N Engl J Med 2007;357:762–74. doi:10.1056/NEJMoa067423 Shah J . Erectile dysfunction through the ages. BJU Int 2002;90:433–41. doi:10.1046/j.1464-410X.2002.02911.x Mobley D . Early history of inflatable penile prosthesis surgery. Asian J Androl 2015;17:225–9. Roumeguère T , Wespes E , Carpentier Y , et al . Erectile Dysfunction is associated with a high prevalence of hyperlipidemia and coronary Heart Disease Risk European Urology.44:355–9. Klein R , Klein BE , Lee KE , et al . Prevalence of self-reported erectile dysfunction in people with long-term IDDM. Diabetes Care 1996;19:135–41. doi:10.2337/diacare.19.2.135 Larsen SH , Wagner G , Heitmann BL . Sexual function and obesity. Int J Obes 2007;31:1189–98. doi:10.1038/sj.ijo.0803604 McWaine DE , Procci WR . Drug-induced sexual dysfunction. Med Toxicol Adverse Drug Exp 1988;3:289–306. doi:10.1007/BF03259941 Croft H , Settle E , Houser T , et al . A placebo-controlled comparison of the antidepressant efficacy and effects on sexual functioning of sustained-release bupropion and sertraline. Clin Ther 1999;21(4):643–58. doi:10.1016/S0149-2918(00)88317-4 Janeway M , Baum N . Managing the enlarged prostate gland in elderly men. Clinical Geriatrics http://www.consultant360.com/articles/managing-enlarged-prostate-gland-elderly-men. Kumar RJ , Barqawi A , Crawford ED . Adverse events associated with hormonal therapy for prostate Cancer. Rev Urol 2005;7 Suppl 5:S37–S43. Aksam A , Yassin A , Saad F . Testosterone and erectile dysfunction. J Andrology 2008;29. Gades NM , Nehra A , Jacobson DJ , et al . Association between smoking and erectile dysfunction: a population-based study. Am J Epidemiol 2005;161:346–51. doi:10.1093/aje/kwi052 Mobley D , Baum N . Smoking: it’s impact on urologic conditions. Rev Urology 17 2015. Stein RA . Endothelial dysfunction, erectile dysfunction, and coronary heart disease: the pathophysiologic and clinical linkage. Rev Urol 2003;5(Suppl 7):S21–S27. Andersson K , Stief C . Penile erection and cardiac risk: pathophysiologic and pharmacologic mechanisms. Am J Cardiol 2000;86:23–6. doi:10.1016/S0002-9149(00)00887-0 Feldman HA , Johannes CB , Derby CA , et al . Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med 2000;30:328–38. doi:10.1006/pmed.2000.0643 Vlachopoulos C , Ioakeimidis N , Terentes-Printzios D , et al . The triad: erectile dysfunction-endothelial dysfunction-cardiovascular disease Curr Pharm Des. 2008;14:3700–14. Watts GF , Chew KK , Stuckey BG et al . The erectile-endothelial dysfunction nexus: new opportunities for cardiovascular risk prevention. Nat Clin Pract Cardiovasc Med 2007;4:263–73. doi:10.1038/ncpcardio0861 Montorsi F , Briganti A , Salonia A , et al . Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol 2003;44:360–5. doi:10.1016/S0302-2838(03)00305-1 Vlachopoulos C , Rokkas K , Ioakeimidis N , et al . Prevalence of asymptomatic coronary artery disease in men with vasculogenic erectile dysfunction: a prospective angiographic study. Eur Urol 2005;48:996–1003. doi:10.1016/j.eururo.2005.08.002 Mulhall J , Teloken P , Barnas J et al . Vasculogenic erectile dysfunction is a predictor of abnormal stress echocardiography. J Sex Med 2009;6:820–5. doi:10.1111/j.1743-6109.2008.01087.x Hodges LD , Kirby M , Solanki J , et al . The temporal relationship between erectile dysfunction and cardiovascular disease. Int J Clin Pract 2007;61:2019–25. doi:10.1111/j.1742-1241.2007.01629.x Inman BA , Sauver JL , Jacobson DJ , et al . A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc 2009;84:108–13. doi:10.4065/84.2.108 Ponholzer A , Temml C , Obermayr R , et al . Is erectile dysfunction an indicator for increased risk of coronary heart disease and stroke? Eur Urol 2005;48:512–8. doi:10.1016/j.eururo.2005.05.014 Thompson IM , Tangen CM , Goodman PJ , et al . Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005;294:2996–3002. doi:10.1001/jama.294.23.2996 Banks E , Joshy G , Abhayaratna WP , et al . Erectile dysfunction severity as a risk marker for cardiovascular disease hospitalisation and all-cause mortality: a prospective cohort study. PLoS Med 2013;10:e1001372. doi:10.1371/journal.pmed.1001372 Lewis RW , Fugl-Meyer KS , Corona G , et al . Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med 2010;7:1598–607. doi:10.1111/j.1743-6109.2010.01778.x Yaman O , Gulpinar O , Hasan T , et al . Erectile dysfunction may predict coronary artery disease: relationship between coronary artery calcium scoring and erectile dysfunction severity. Int Urol Nephrol 2008;40:117–23. doi:10.1007/s11255-007-9293-8 Montorsi P , Ravagnani PM , Galli S , et al . Association between erectile dysfunction and coronary artery disease. role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. 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Eur Urol 2006;49:806–15. doi:10.1016/j.eururo.2006.01.028
People with erectile dysfunction (ED) have difficulty getting and/or keeping an erection. The difficulty may be constant or occasional. While ED is sometimes called “impotence,” healthcare professionals have increasingly moved away from a term that can be perceived as pejorative or confused with nonmedical definitions of the word.
Secondary premature ejaculation can be caused by both psychological and physical factors and has been linked to drinking too much alcohol.
Other research has shown Black men may be less likely to report symptoms of moderate to severe ED.
Erectile dysfunction is a common condition and its frequency increases with age. Whilst for some men it may only occur occasionally, being related to fatigue, stress or alcohol intake, for others, it can occur more frequently. The male erection is the culmination of two aspects of sexual function – a reflex aspect, controlled by the nerves in the body, and a psychogenic aspect, which is the result of emotional or erotic stimuli, and involving the brain’s limbic system (which controls emotions and feelings).
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