Guidelines recommend that phosphodiesterase type 5 (PDE5) inhibitors are the first-line drug for the treatment of ED (Table 1). Sildenafil citrate was the first oral drug approved for ED in the US.59 The newer PDE5 inhibitors include vardenafil, tadalafil and avanafil. The inhibition of PDE5 enhances cyclic guanosine monophosphate (cGMP)-NO-mediated vasodilatation by preventing PDE5 catabolism of cGMP and so delaying detumescence. PDE5 inhibitors increase the number and duration of erections, as well as the percentage of successful sexual intercourse.60
Erectile dysfunction or impotence is a man's inability to achieve and maintain a penile erection suitable for sexual intercourse. .
You can buy extract of the bark of the yohimbe tree – long used as an aphrodisiac in western Africa -- as a dietary supplement. Its promoters claim it can help erectile dysfunction. But the science shows mixed results.
Penile prosthesis is the primary form of surgical therapy and is reserved for those men who fail, are intolerant of, or have contraindications to other forms of therapy. Currently, there are several different types of penile prostheses. The simplest is the malleable penile prosthesis, and the most complex is the three-piece inflatable penile prosthesis.
Many conditions are closely related to ED and may contribute to symptoms, including the following:
Some commonly prescribed cardiovascular drugs (beta-blockers, diuretics, angiotensin-converting enzyme inhibitors, etc.) contribute to ED.18 Previous studies have shown a strong association between ED and diuretics in patients treated with hydrochlorothiazide or chlorthalidone.19,20 It has also been shown that patients treated with first-generation non-selective beta-blockers, such as propranolol, had more frequent ED than those treated with a placebo.21
A common misconception is that erectile dysfunction only occurs in older men. While that is mostly true, it doesn’t mean that ED isn’t common among younger men. Lifestyle choices among younger men has led to a sharp increase in the number of young men suffering from erectile dysfunction. A 2013 study published by the Journal of Sexual Medicine found that 1 in every 4 men who were newly diagnosed with ED were below the age of 40, and roughly 50% of them were suffering from severe ED. Causes of Erectile Dysfunction Obesity Fatigue Excessive smokingAlcoholism Substance abuse Diabetes Prostate cancer Cardiovascular disease Treatment for Erectile Dysfunction
The nerves that control an erection lie very close to the prostate. These nerves may be injured during treatment. If the surgeon uses nerve-sparing procedures, some men may regain their previous level of erectile function. This typically takes a year or two.
Mayo Clinic: Erectile Dysfunction: Diagnosis and Treatment.UCSF Medical Center: Erectile Dysfunction Diagnosis.Urology Care Foundation: How is ED Diagnosed?National Institute of Diabetes and Digestive and Kidney Diseases (NIH): Diagnosis of Erectile Dysfunction.Cleveland Clinic: Erectile Dysfunction (ED): Diagnosing.
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Erectile dysfunction can be caused by any number of medical and psychological conditions. In general, ED is divided into organic (having to do with a bodily organ or organ system) and psychogenic (mental) impotence. Interestingly, and not surprisingly, most men with organic causes have a mental or psychological component, as well.
“Street” drugs can dampen a man’s feelings of arousal as well as other sensations. Illicit drugs can take away the pleasure of sex and make a man impotent. Some men use drugs to cope with other issues that could be the root of their penile dysfunction. Using drugs only compounds a man’s difficulty in achieving and maintaining erections.
With the increasing interest in more natural and holistic therapies for erectile dysfunction, many men are choosing nonsurgical shockwave therapy. This breakthrough treatment delivers virtually painless ultrasonic waves to the penis in order to remodel tissues, strengthen blood vessels, and increase blood flow to the penis. In the days and weeks following a quick shockwave ED treatment, which typically lasts 30 minutes or less and requires no downtime, patients will begin to develop stronger, firmer, longer-lasting erections.
Penile re-vascularization is considered experimental and investigational for other indications because its effectiveness for indications other than the one listed above has not been established. Consistent with clinical guidelines of the American Urological Association, Aetna considers arterial reconstructive procedures, dorsal vein arterialization procedures, or penile venous occlusive surgery (e.g., venous ligation, dorsal vein ligation) in men with erectile dysfunction secondary to arteriosclerotic occlusive disease experimental and investigational because such procedures have not been proven to be effective.
Aetna considers the following diagnostic workup of erectile dysfunction medically necessary: Comprehensive history and physical examination (including medical and sexual history and psychosocial evaluation) Duplexscan (Doppler and ultrasound) in conjunction with intracorporeal papaverine Dynamic infusion cavernosometry and cavernosography only for members who are to undergo re-vascularization procedures and meet medical necessity criteria for penile re-vascularization (see below) Pharmacological response test for erectile dysfunction (using vasoactive drugs, e.g., papaverine HCl, phentolamine mesylate, prostaglandin E1) Pudendal arteriography (angiography) only for members who are to undergo penile re-vascularization and meet the medical necessity criteria for penile revascularization (see below).
If you have erectile dysfunction, there are many ways your doctor can help you treat it. But you may want to consider complementary or alternative therapies, such as nutritional supplements, herbal remedies, acupuncture, and talk therapy. Just be sure to talk to your doctor first.
You must remember that these are prescription-only medications. Do NOT share these medications with your friends or family as they may have medical conditions that would prevent them from taking this medicine. What if ED Pills Don't Work?