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The role of the endothelium in erectile function became clearer with the observation that the phosphodiesterase type 5 (PDE5) inhibitor, sildenafil, enhanced erectile function. Erection occurs with the release of nitric oxide (NO) from the vascular endothelial cells.17 The reduction in endothelial cell production of NO results in the negative impact on the smooth muscles in the corporal bodies and results in less relaxation of the smooth muscle cells with decrease in blood supply and resulting ED. A similar phenomenon is well known to impact the coronary arterial system resulting in CVD.
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In addition, your doctor may address underlying conditions. They may suggest counseling or medication changes. They also may suggest lifestyle changes, including increased exercise or dietary changes. It is also a good idea to avoid drugs, alcohol, and cigarettes. American Urological Association: “Erectile Dysfunction (ED).” Andrologia: “Erectile dysfunction, physical activity and physical exercise: Recommendations for clinical practice.” Coronary Artery Disease: “A Home-Based Walking Program Improves Erectile Dysfunction in Men with an Acute Myocardial Infarction.” Memorial Sloan Kettering Cancer Center: “Pelvic Floor Muscle (Kegel) Exercises for Men.” National Institute of Diabetes and Digestive and Kidney Diseases: “Erectile Dysfunction (ED).”
Erectile dysfunction can be caused by many factors and may have a gradual or sudden onset. It can be very upsetting and result in a lot of stress and worry. It can feel embarassing to discuss this with your doctor but it is important that you do, so that you can receive the appropriate help. Erectile dysfunction can also be a sign of other illnesses such as heart disease or diabetes, so it is important that you seek medical advice. What are the facts about impotence? Erectile dysfunction becomes commoner with increasing age and is seen in 50 - 55% of men between 40 and 70 years old; It is often associated with obesity, high blood pressure, high cholesterol & diabetes which are all significant risks to health; Investigation is only indicated if both partners wish to pursue treatment; Most treatable causes can be identified by a clinical history, physical examination and routine blood tests; If there is no treatable cause, treatment with tablets is the first option for most men; Other methods of treatment are only indicated if medication proves ineffective, causes side-effects or cannot be used because of specific medical conditions. What should I expect when I visit my GP?
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Tadalafil shares the common side effects of the PDE5 inhibitors, however, due to its effect on PDE11, another phosphodiesterase located in muscle, tadalafil has been associated with muscle aches. Back pain and muscle aches occur in less than 7% of men taking tadalafil and in most patients will go away without treatment within 48 hours. When treatment was necessary, acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) or naproxen (Aleve) were effective. Rarely do the muscle aches and back pain cause men to stop using tadalafil.
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By giving yourself the given points and by comparing it with the details given below you can determine the extent of your ED issues
Quitting smoking, exercising regularly, losing excess weight, curtailing excessive alcohol consumption, controlling hypertension, and optimizing blood glucose levels in patients with diabetes are not only important for maintaining good health but also may improve or even prevent progression of erectile dysfunction. It is unclear if such lifestyle changes can reverse erectile dysfunction. However, lifestyle improvements may prevent progression of the erectile dysfunction. Some studies suggest that men who have made lifestyle improvements experience increased rates of success with oral medications.
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The copyright in this work belongs to Radcliffe Medical Media. Only articles clearly marked with the CC BY-NC logo are published with the Creative Commons by Attribution Licence. The CC BY-NC option was not available for Radcliffe journals before 1 January 2019. Articles marked ‘Open Access’ but not marked ‘CC BY-NC’ are made freely accessible at the time of publication but are subject to standard copyright law regarding reproduction and distribution. Permission is required for reuse of this content.
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Aetna considers topical cream or gel containing vasodilators, such as verapamil cream, experimental and investigational for the treatment of erectile dysfunction because their effectiveness for this indication has not been established.
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Copenhagen: c/o Videnskab.dk, Carl Jacobsens Vej 16, Entr. 16, 2500 Valby, Denmark. Phone +45 707 01 788 About Menu Toggle What is GAINSWave ? What to Expect? How it Works? Comparing Treatments FAQs Medical Advisory Board Expected Results Menu Toggle Erectile Dysfunction Treatment Peyronie’s Disease Treatment Sexual Enhancement Clinical Research Testimonials Am I a Candidate? Testimonials Resources Menu Toggle Men’s Health Guide Provider Resources Magazine Press Become a Provider Find A Provider
There are hundreds of medications that have the side effect of ED and/or decreased libido. Examples of drugs implicated as a cause of ED include hydrochlorothiazides and beta-blocking agents. Medications used to treat depression, particularly the SSRIs such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly, Sarafem), fluvoxamine (Luvox, Luvox CR), paroxetine (Paxil, Paxil CR, Pexeva) and sertraline (Zoloft), may also contribute to ED.9 Bupropion (Wellbutrin) which has a predominant effect on blocking the reuptake of dopamine is an antidepressant with lower incidence of ED.10 The side effects of 5ARIs occurring in fewer than 5% of patients can include gynaecomastia, ED, loss of libido and ejaculatory dysfunction.11
Half of men with diabetes will experience ED within 10 years of their diagnosis. High blood sugar levels can damage the nerves that control sexual stimulation. They can also damage the blood vessels needed to provide adequate blood flow to the penis in order to have and maintain an erection.
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These exercises, when combined into a regimen that you do on a daily basis, help strengthen the muscles that are used to achieve and maintain an erection. Pharmaceuticals are always going to be popular, but if you set aside some time everyday for the above erectile dysfunction exercises, you will targeting the root cause of the problem and improving your chances of better erectile health.
If you’re wondering about these tests, please don’t be concerned. This testing is covered under OHIP at certified labs.
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Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633-641. PMID: 29746858 pubmed.ncbi.nlm.nih.gov/29746858. Version Info
Dr. Chirag Bhandari promotes sex education in the urge to cultivate sexual awareness among youth and even among the blocked mindset of Indian people. Subscribe to his interactive youtube chat show, “Mans are from mars and women are from venus“, to earn some amazing facts about the sexual problem and natural treatments.
Several studies support the conclusion that following a Mediterranean-style diet can decrease the risk of E.D. The link between diet and improved erectile function was stronger in men under the age of 60, but it was found in all age groups (Bauer et al., 2020).
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NIH, National Institute of Diabetes and Digestive and Kidney Issues: “Erectile Dysfunction.” Erectile Dysfunction Guide Overview Symptoms & Risk Factors Testing &Treatment Living & Managing
There is insufficient information on the safety of vardenafil in men with the following health disorders:
Chrichton-Stuart, C. (2018). “Do erectile dysfunction exercises help?” Medical News Today. Retrieved from: http://www.medicalnewstoday.com/articles/322600.php
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Penile self-injection therapy is a shot that is inserted into the penis and produces an erection for up to an hour or more. This injection is mostly used to treat erectile dysfunction, but can help with other penile conditions as well.
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Certain feelings can interfere with normal sexual function, including feeling nervous about or self-conscious about sex, feeling stressed either at home or at work, or feeling troubled in your current sexual relationship. In these cases, treatment incorporating psychological counseling with you and your sexual partner may be successful. One episode of failure, regardless of cause, may propagate further psychological distress, leading to further erectile failure. Individuals suffering from psychogenic ED may benefit from psychotherapy, treatment of the ED, or a combination of the two. Also, medications used to treat psychologic troubles may cause ED; however, it is best to consult with your physician prior to stopping any medications that you are taking. Althof, S.E., E.W. Corty, S.B. Levine, et al. "EDITS: development of questionnaires for evaluating satisfaction with treatments for erectile dysfunction." Urology 53.4 April 1999: 793-799. American Foundation for Urologic Disease. American Foundation for Urologic Disease. American Urological Association. "Erectile Dysfunction." 2011. . Andersson, K.E., and G. Wagner. "Physiology of Penile Erection." Physiol Rev 75.1 January 1995: 191-236. Cheitlin, M.D., A.M. Hutter Jr., R.G. Brindis, et al. "ACC/AHA Expert Consensus Document. Use of Sildenafil (Viagra) in Patients With Cardiovascular Disease. American College of Cardiology/American Heart Association." J Am Coll Cardiol 33.1 January 1999: 273-282. The European Alprostadil Study Group. "The Long-Term Safety of Alprostadil (Prostaglandin-E1) in Patients With Erectile Dysfunction. Br J Urol 82.4 October 1998: 538-543. Feldman, H.A., I. Goldstein, D.G. Hatzichristou, et al. "Impotence and Its Medical and Psychosocial Correlates: Results of the Massachusetts Male Aging Study." J Urol 151.1 January 1994: 54-61. Laumann, E.O., A. Paik, and R.C. Rosen. "Sexual Dysfunction in the United States: Prevalence and Predictors." JAMA 281.6 Feb. 10, 1999: 537-544. National Kidney and Urologic Diseases Clearinghouse. National Kidney and Urologic Diseases Clearinghouse. Available at http://kidney.niddk.nih.gov/. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA 270.1 July 7, 1993: 83-90. The Process of Care Consensus Panel. "The Process of Care Model for Evaluation and Treatment of Erectile Dysfunction." Int J Impot Res 11.2 April 1999: 59-70; discussion 70-74. Segraves, R.T., M. Bari, K. Segraves, and P. Spirnak. "Effect of Apomorphine on Penile Tumescence in Men With Psychogenic Impotence." J Urol 145.6 June 1991: 1174-1175. United States. FDA Center for Drug Evaluation and Research. FDA Center for Drug Evaluation and Research. Available at http://www.fda.gov/cder/.
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Artery size also explains the onset of ED before occurrence of CAD. Coronary arteries are 3–4 mm in diameter, while the penile artery is 1–2 mm in diameter.17 Endothelial dysfunction and plaque burden in the small arteries may cause symptoms of ED before they affect blood flow in large arteries. Also, an asymptomatic lipid-rich plaque in the coronary arteries carries the risk of rupture that leads to acute coronary syndrome or death, so ED may be predictive of these serious events without warning cardiac symptoms.17
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Your doctor might perform a combination of different exams to determine if you have erectile dysfunction (ED).
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If you have a problem getting or keeping an erection hard enough for you to have sex with your partner, you may have erectile dysfunction. The condition is common in men over 40 years of age, although it can affect men of all ages. Symptoms may differ from person to person. Some men do not get an erection at all, others may be able to get an erection but can’t maintain it long enough for sex and some men get an erection, but it is not hard enough for sex. Lose weight if you are overweight Stop smoking, as it damages blood vessels Don’t drink more than 14 units of alcohol per week Eat a healthy, balanced diet Exercise regularly Try to reduce your stress levels
There's an excellent chance that your erections can be restored through one of the increasingly wide range of treatments now available but the psychological scars may take longer, and be more difficult, to heal.
Response is dose related and usually occurs within 10–15 min, and does not require stimulation. The intraurethral preparation, medicated urethral suppository for erection (MUSE), consists of a tiny pellet of drug inserted into the urethral meatus. Response is also dose related, and onset similar to the cavernosal preparations.
erectile DysfunctionFAQ to erectile dysfunction and impotenceWhat is erectile dysfunction?Self-testHow do erections occur?CausesDiagnosisDrug therapyPDE5 inhibitorsStent implantationShock wave therapyself-testAbout UsProf. Dr. Nicolas DiehmDr. Martin C. SchumacherPD Dr. Hak Hong KeoDr. Christian RegliDr. Dagmar SchumacherProf. Dr. Markus BéchirNewsContact erectile DysfunctionFAQ to erectile dysfunction and impotenceWhat is erectile dysfunction?Self-testHow do erections occur?CausesDiagnosisDrug therapyPDE5 inhibitorsStent implantationShock wave therapyself-testAbout UsProf. Dr. Nicolas DiehmDr. Martin C. SchumacherPD Dr. Hak Hong KeoDr. Christian RegliDr. Dagmar SchumacherProf. Dr. Markus BéchirNewsContact
When you choose to use this service to inform one or more sexual partners that you’ve been diagnosed with an STI, you are acting privately and anonymously, as well as individually and of your own volition, in a spirit of goodwill and respect, and with full knowledge of the potential consequences.
Erectile dysfunction can result from a number of factors such as medical conditions, psychological conditions, certain medical treatments, injuries and drug and alcohol use. While most cases of erectile dysfunction are caused by physical issues, sometimes a combination of physical and psychological issues can contribute to developing the condition.
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Risks associated with injection therapy including bleeding, pain with injection, penile pain, priapism, and corporal fibrosis (scarring inside of the corpora cavernosa). There is also concern that repetitive injections in the same area could cause scar tissue to build up in the tunica albuginea that could create penile curvature. Thus, doctors recommended that one alternate sides with injection and perform injections no more frequent than every other day.
American association of sexuality educators,counselors and therapists https://www.aasect.org/certification Randrup E , Wilson S , Mobley D , et al . Clinical experience with Mentor Alpha I inflatable penile prosthesis. Report on 333 cases. Urology 1993;42:305–8. doi:10.1016/0090-4295(93)90620-P Khera M , Albersen M , Mulhall JP . Mesenchymal stem cell therapy for the treatment of erectile dysfunction. J Sex Med 2015;12:1105–6. doi:10.1111/jsm.12871 Frey A , Sønksen J , Fode M . Low-intensity extracorporeal shockwave therapy in the treatment of postprostatectomy erectile dysfunction: a pilot study. Scand J Urol 2016;50:1–5. doi:10.3109/21681805.2015.1100675 Soni SD , Song W , West JL , et al . Nitric oxide-releasing polymeric microspheres improve diabetes-related erectile dysfunction. J Sex Med 2013;10:1915–25. doi:10.1111/jsm.12216
The key to all of this is the endothelium, the inner lining of blood vessels that helps blood flow smoothly. Regular exercise has been shown to improve the way the endothelium works. The endothelium lines the blood vessels in the heart and the penis, explains Dr. Hellstrom, but the blood vessels in the penis are about one-third the size of those in the heart. So if you fail to have erections due to vascular problems, that indicates that you’re at risk for heart problems as well.
Erythrocytosis has been noted in men on TRT, and should be monitored every 6–12 months depending upon the patients’ response to changes in haematocrit levels. For mild elevations, the dosage of testosterone can be decreased or the interval of using the medication can be increased. With the haematocrit greater than 50%, decisions to temporarily discontinue the medication or periodic phlebotomy may be indicated.38
There are several different types of injection therapy ranging from injection of a single chemical (monotherapy) to a combination of chemicals, Bimix and Trimix. The selection of which therapy to use will vary with the severity of your erectile dysfunction and whether or not you tried and had pain with MUSE.
Book a free consultation with us at Oakwood Health Network, our specialists will evaluate your case and build a custom plan for diagnosis and treatment if needed. Previous Post Men’s Mental Health Month 2021 Next Post COVID-19 and Erectile Dysfunction: 6 Factors August 13, 2021 Dr. Manisha Sharma Dr. Manisha Sharma attended medical school at Queens University in Kingston, Ontario in 2007 before returning to her roots in Toronto to complete her residency in Family Medicine at the University of Toronto. Categories ED Diagnosis ED Prevention ED Treatment ED Treatment Specials Men's Health Mental Health Peyronie's Disease Prostate Cancer Tags
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What is erectile dysfunction, and what are the signs and symptoms? Learn about the risks and causes of erectile dysfunction and what treatments are available for erectile dysfunction.
Of course, the test cannot and will not replace a medical examination and diagnosis. For each form of erectile dysfunction a medical examination is advisable. This is all the more true as even mild erectile dysfunctions can be an early warning sign for circulatory disorders such as coronary heart disease or peripheral arterial occlusive disease. Please answer the following 15 questions completely, otherwise an appraisal is not possible. You receive the test result at the end. It is only visible to you. 1. How often have you managed to get an erection during sexual activity in the last month? no sexual activity almost always or always most times (much more than half the time) sometimes (about half the time) a few times (much less than half the time) almost never or never 2. When you had erections with sexual stimulation in the last month, how often were your erections hard enough for penetration? no sexual activity almost always or always most times (much more than half the time) sometimes (about half the time) a few times (much less than half the time) almost never or never 3. When you attempted sexual intercourse in the last month, how often were you able to penetrate your partner? no attempt almost always or always most times (much more than half the time) sometimes (about half the time) a few times (much less than half the time) almost never or never 4. During sexual intercourse in the last month, how often were you able to maintain your erection after you had penetrated your partner? no attempt almost always or always most times (much more than half the time) sometimes (about half the time) a few times (much less than half the time) almost never or never 5. During sexual intercourse in the last month, how difficult was it to maintain your erection to completion of intercourse? no attempt extremely difficult very difficult difficult slightly difficult not difficult 6. How often have you attempted sexual intercourse in the last month? no attempts 1-2 attempts 2-3 attempts 5-6 attempts 7-10 attempts 11-20 attempts 7. When you attempted sexual intercourse, how often was it satisfactory for you? no attempt almost always or always most times (much more than half the time) sometimes (about half the time) a few times (much less than half the time) almost never or never 8. How much did you like your sexual intercourse in the last month? no sexual intercourse very well liked well liked it was all right. not much liked not liked 9. When you have had sexual stimulation or intercourse during the last month, how often have you ejaculated? no sexual stimulation or intercourse almost always or always most times (much more than half the time) sometimes (about half the time) a few times (much less than half the time) almost never or never 10. When you have had sexual stimulation or intercourse during the last month, how often have you had the feeling of orgasm (with or without ejaculation)? 11. How often did you feel sexual desire during the last month? almost always or always most times (much more than half the time) sometimes (about half the time) a few times (much less than half the time) almost never or never 12. How high would you rate your sexual desire during the last month? very high high moderate low very low to no desire 13. How satisfied have you been with your overall sex life during the last month? very satisfied quite satisfied about equally satisfied quite unsatisfied very unsatisfied 14. How satisfied have you been with your sexual relationship with your partner during the last month? very satisfied quite satisfied about equally satisfied quite unsatisfied very unsatisfied 15. How do you rate your confidence with regard to the last month that you could get and keep an erection? very high high moderate low very low
One of the most important causes for ED is vascular disease; examples include diabetes (Types I and II), high blood-pressure, high cholesterol/lipids, tobacco use, obesity, and lack of exercise. All of these conditions can lead to impaired response of the blood vessels responsible for controlling penile erection. There is evidence that men who have vascular disease and make healthy lifestyle changes (e.g. increasing exercise, losing weight, quitting smoking) may experience improvement in erectile function. It is important to remember that whatever is good for the heart is also good for the penis.
If you are experiencing erectile issues, it is important to speak with your physician. There could be a health condition contributing to your erectile dysfunction. A men’s health specialist will play an active role in your health and treatment plan for ED. Top 5 Common Causes of ED Vascular disease Endocrine disorders Medications Pelvic surgery Neurological disorders ED & Vascular Disease
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In general, there are three main pelvic floor muscles that are used when performing a kegel:
Erectile dysfunction can be a warning sign of current or future heart disease sometimes. In fact, ED can precede coronary artery disease in almost 70 percent of cases.
The Mayo Clinic is a go-to resource for data about ED. From diagnosis to treatment, this site can help you learn about your options when it comes to your sexual health.
What causes low testosterone (low T)? Learn about low testosterone symptoms in men. Discover low testosterone treatment and the signs of low testosterone.
In most healthy men, some of the drug will remain in the body for more than two days after a single dose of tadalafil. Metabolism (clearing of the drug from the body) of tadalafil can be slowed by liver disease, kidney disease, and concurrent use of certain medications (such as erythromycin, ketoconazole, and protease inhibitors). Slowed breakdown allows tadalafil to stay in the body longer and potentially increase the risk for side effects. Therefore, doctors have to lower the dose and frequency of tadalafil in the following examples:
High blood pressure can damage blood vessels, and this damage may lead to cardiovascular disease – the leading cause of erectile dysfunction.
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The academic team, from James Cook University in Australia, found 47 of patients with ED admitted the exercises helped.
Improvements in your lifestyle, such as a eating healthy diet, reducing alcohol intake, losing weight and increasing your exercise can dramatically improve erectile dysfunction. More specific treatment usually involves: weight loss and increased exercise (this may reduced the risk of erectile dysfunction by up to 70%) treatment of any hormone abnormality (testosterone treatment is only indicated if your testosterone levels are low and may be harmful if your the levels are normal); lifestyle modification (e.g. reduce stress, stop smoking, reduce alcohol consumption & stop illicit drugs); treatment of any anatomical abnormality if present (e.g. circumcision, frenuloplasty, penile straightening); psychological support if necessary.
• Nerve damage from pelvic surgery or radiation (e.g. treatment of prostate, bladder, or rectal cancer) or from conditions known to lead to neuropathy (e.g. HIV, diabetes)
While these reasons may seem convincing they should not prevent you from seeking help and improving your quality of life.
Injections do require training and it may be tricky to get the right dose initially. We always do the first injection in the office to show you how to do it and to give us a good idea about the proper dose. Our patients are usually anxious about injecting their penis but are almost always surprised by how painless the process is. Pros Cons Very effective (85%) Mimics normal erection Discreet Risk of prolonged erection (priapism) Risk of penile scarring Pain with injection (usually mild) Bruising or bleeding Hard to use if have tremor or poor vision or severe obesity Poor long-term satisfaction (less than 40%)
The placement of a penile prosthesis is typically an outpatient procedure and is typically performed through a single incision. All of the parts of the prosthesis are hidden under the skin. Antibiotics are given to decrease the risk of an infection. A catheter may be left in the penis in some men for a short period. After placement, there will be a time period of healing prior to the ability to use the prosthesis.
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