Some gay and bisexual men pair recreational drugs (such as crystal methamphetamine) with sex in what is referred to as chemsex or party’n’play. Men may also take erectile dysfunction medications in this situation, often for purposes such as lengthening the time taken to reach orgasm, maintaining erections for prolonged periods or to counteract the loss of erections caused by chemsex drugs. For some men, using these medications can also serve to mask a lack of sexual confidence and self-esteem, or even low desire. It’s also possible to develop unreasonable expectations of your erectile performance.
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Vitamin D deficiency has been linked with rickets, cancer, cardiovascular disease, severe asthma in children and cognitive impairment in older adults. Causes include not ingesting enough of the vitamin over time, having limited exposure to sunlight, having dark skin, and obesity. Symptoms include bone pain and muscle weakness. Treatment for vitamin D deficiency involves obtaining more vitamin D through supplements, diet, or exposure to sunlight.
Some men experience symptoms of sexual disorders that are related to erectile dysfunction, including: Ejaculation happens too fast — this is called premature ejaculationEjaculation happens too slowly (a man needs stimulation for more than 30 minutes) — this is called delayed ejaculationEjaculation doesn’t happen, or a man doesn’t orgasm — this is called anorgasmia What Causes ED?
In many cases, erectile dysfunction is caused by something physical. Common causes include:
Alprostadil injections or suppositoriesInjections into penis of a combination of other medicationsTestosterone replacement therapy (for men with low testosterone levels)Vacuum erection devicesPenile implantsVascular surgical procedures
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.
It is recommend that the first trial of intraurethral prostaglandin be performed in the doctor's office due to the risk of hypotension with this medication.
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Hormone imbalance including abnormal levels of estrogen, testosterone, cortisol, progesterone, and other hormones may lead to symptoms like weight gain, fatigue, and mood swings. Hormonal imbalance may be due to natural states, like menopause, or other conditions. See your doctor for suspected imbalances in hormonal systems.
Men in generally good health who use terms such as “performance anxiety” usually suffer from stress-induced or substance-induced ED, which is caused by anxiety, distraction or too much drinking of alcoholic beverages. These patients often respond to such drugs as Cialis, Levitra and Viagra, all of which enhance the effects of nitric oxide, a natural chemical in the body that relaxes the penis muscles and increases blood flow.
Combination therapy for the treatment of erectile dysfunction has been under investigation. Most of these studies have been small trials, and long-term data regarding their effectiveness and safety are lacking. However, with thorough evaluation and counseling, there may be a use for combination therapy for certain individuals with ED.
The third and final exercise which may be of benefit if you have erectile dysfunction is pelvic floor exercise (Kegels).
Erectile dysfunction can be a difficult problem to discuss with your partner or even your doctor. However, it needn't be because erectile dysfunction, which causes sexual performance issues for men, is a very common and highly treatable condition.
Combination therapy for the treatment of erectile dysfunction has been under investigation. Most of these studies have been small trials, and long-term data regarding their effectiveness and safety are lacking. However, with thorough evaluation and counseling, there may be a use for combination therapy for certain individuals with ED.
Berookhim BM, Mulhall JP. Erectile dysfunction. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 191.
It is important to understand that ED is frequently, if not usually, directly related to endothelial dysfunction, and that the release of NO by the vasculature of the penile arteries is directly related to the function of intact, healthy endothelium. In the face of endothelial dysfunction, the process of erection fails to occur in a normal fashion.16