The primary cause of the problem is considered to be a psychological problem. Any person suffering from anxiety, depression, stress, fear may find it hard to enjoy intimate moments. In some cases, smoking, drugs have also been considered a common cause of erectile Dysfunction.
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Getting an erection is a process that includes physical, hormonal, and psychological elements. The penis is made of soft, spongy, elastic tissue that fills with blood to make it grow in size and become rigid. Around the spongy tissue and the prostate, there are nerves that send signals so that the blood vessels supply the blood (Fig. 1). These signals are controlled by the male hormone testosterone.
If a man has nocturnal erections, it is likely that psychological issues are affecting his erectile function. The fact that he can have erections during the night shows that his body is working normally. Men might consider seeing a sex therapist or counselor at this point, although a physician should always be consulted for erection problems. Men’s Sexual Health Public Prev Next Clinical Policy Bulletins Medical Clinical Policy Bulletins Policy
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“We listen to the patient and partner, understand the cause of the problem and work with the couple to start treatment that works best for the patient,” says Dr. Honig. PDE-5 inhibitors (phosphodiesterase type 5 inhibitors): These are medicines which relax muscle cells in the penis and increase blood flow. Vacuum erection device: This pulls blood into the penis, causing an erection. The erection is maintained by placing an elastic ring at the base of the penis. Injection therapy: Doctors use a very small needle to inject medication directly into the side of the penis. This relaxes the muscle allowing for blood flow and is a highly successful. Minimally invasive penile implant surgery: which our experienced physicians routinely perform. Most patients recover full sexual function in six to eight weeks. Yale Medicine Urology has extensive experience in standard and complicated penile implant surgery.
Some information provided may not be valid for residents of other countries due to variations in medical practice and drug approval and indications.
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Where erectile dysfunction is predominantly due to a physical cause, patients may describe a gradual onset of symptoms, which may occur across a variety of settings and different stimuli. Where the psychological component is the main factor, patients may describe a sudden onset in symptoms with erectile dysfunction varying dependent on the situation.
Writing in the journal Physiotherapy, Mr Myers said 30 per cent of men suffer from premature ejaculation.
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Too much squeezing of your buttocks and thighsNot relaxing pelvic bones while doing kegel exercisesInappropriate postures while performing half bridges and cat and cow poses.Not breathing properly while holding the posturesExtensive workout can also be harmfulPilates Exercises
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• The inability to achieve or maintain an erection sufficient for sexual intercourse •Symptoms include erection problems, decreased desire, and psychological distress •Treatments include medications, injection therapy, a vacuum erection device, and penile implant•Involves urology
These drugs work by improving blood flow to the penis during arousal and are taken 30 to 60 minutes before sexual activity. They should not be used more than once a day. Cialis can be taken up to 36 hours before sexual activity and also comes in a lower, daily dose. Staxyn dissolves in the mouth. All require a doctor's prescription for safety.
Testosterone cypionate and testosterone enanthate injections are used for replacement therapy in patients with low testosterone. Other formulations, such as gels and patches, are recommended in older patients with chronic conditions.57 Serum prostate specific antigen should be measured before starting testosterone replacement, then 3–6 months after starting the treatment, followed by annual measurement.74
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The penile implant allows men to achieve an erection through an implanted device. These devices can be effective in restoring sexual activity for a man and his partner. At Yale Medicine, our doctors have specialized experience with placing the penile prosthesis.
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.
The third Princeton Consensus (Expert Panel) Conference recommends assessing cardiovascular risk in all patients with ED and CVD. This refers to estimating the risk of mortality and morbidity associated with sexual activity. The current recommendations classify patients into low-, intermediate- and high-risk, based on their New York Heart Association class.57 The consensus also recommended that all patients with ED and CVD should undergo lifestyle changes, such as exercise, smoking cessation, healthy diet and weight reduction. These measures are likely to reduce cardiovascular risk and improve erectile function.58
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In a study of 24 men with mild-to-moderate E.D. who took a placebo for one month followed by a month of L-citrulline, half of the men reported an improvement in erection hardness from mild E.D. to normal erectile function (Cormio et al., 2011).
Your doctor can provide you with specific details about the pros and cons of each of the following treatments: Lifestyle changes like stopping smoking, losing weight and eating healthier Vacuum Erection Devices
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Some men are hesitant to tell their doctors about their symptoms of ED because they’re embarrassed or afraid. You should know that your doctor is there to help you through this process and provide any support that you might need.
Erectile dysfunction refers specifically to problems achieving or maintaining an erection. Other forms of male sexual dysfunction include poor libido and problems with ejaculation. Men with erectile dysfunction often have a healthy libido, but their bodies fail to respond in the sexual encounter by producing an erection. Usually there is a physical basis for the problem.
Lifestyle choices can contribute to ED. Smoking, heavy drinking, and drug use disorder can damage the blood vessels and reduce blood flow to your penis. Being overweight and getting too little exercise also raise your odds. Studies show that men who exercise regularly have a lower risk of ED.
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6. Mix it up. Along with the longer pelvic floor exercises, try practising short contractions (two to three seconds) as well, to ensure pelvic muscles are regularly activated.
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Talk with your doctor before trying supplements for ED. They can contain 10 or more ingredients and could make other health conditions worse. Some men say alternative treatments help them get and keep an erection. Unfortunately, the long-term safety of these products isn’t known, so most doctors don’t recommend them.
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New research suggests that you might be able to reverse erectile dysfunction without medication.
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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?
The role of the endothelium in ED has been noted for a number of years and the overlapping of ED and other conditions, especially coronary heart disease, CVD, affecting endothelial function/dysfunction, is clearly present. The endothelial cell is now known to affect vascular tone and impact the process of atherosclerosis, and impacting ED, CVD and peripheral vascular disease.16
Background A growing body of evidence suggests that physical activity and exercise may improve erectile function.
To get an erection, your brain, nerves, hormones, and blood vessels all need to work together. If something gets in the way of these normal functions, it can lead to erection problems.
These erectile dysfunction treatments should not be used in patients with high blood pressure. If you do not know your blood pressure you can have it tested at a number of places, including:
PDE 5 inhibitors are broken down primarily by enzyme, cytochrome P450enzyme CYP3A4. Medications that decrease or increase the activity of CYP3A4 may affect levels and effectiveness of PDE 5 inhibitors. Such drugs include medications for the treatment of HIV (protease inhibitors) and the antifungal medications ketoconazole and itraconazole. Thus caution is recommended.
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Some men notice issues maintaining an erection after starting a new medication. Common medications that can contribute to erectile issues are:
The diagnosis of erectile dysfunction is made clinically, based on a patient’s symptoms. It therefore is important for patients to be evaluated by their GP in the first instance. At this appointment, a full history will be taken from the patient regarding the current symptoms and other medical issues. Regular medications will also be reviewed to ensure that there are no contributing factors. Questions regarding alcohol intake and smoking will also be asked. A general physical examination will be performed by the GP, which may include checking blood pressure and an examination of the genitals. Examination of the vascular system and peripheral nervous system may also be undertaken.
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Kegel exercises, or pelvic exercises, have proven to be effective in addressing erectile dysfunction, and it should be used as the first-line of treatment. The ischiocavernosus and bulbocavernosus muscles in the pelvic area surround the penis and are active during an erection. The following exercises aim to strengthen these muscles.
One rough-and-ready way of working out whether your ED has a physical cause is to see whether there any circumstances in which you get an erection. If you can produce one when masturbating but not with a partner, wake up with an erection, or have erections during the night, then there's a good chance that your ED has psychological causes. How can I prevent it? Have a healthy lifestyle. Quitting smoking and drinking alcohol in moderation will help. Regular aerobic exercise and a low-fat diet will also reduce the risks of atherosclerosis. If you have diabetes, ensure it's properly controlled. Should I see a doctor?
Erectile dysfunction itself is not inherited. However, some of the underlying physical causes may run in families (for example, type 2 diabetes has a genetic predisposition).
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Often, erectile dysfunction can be a symptom of a heart condition, diabetes, or high blood pressure. To address this, Yale Medicine established the Male Reproductive Health/Sexual Medicine Program, a collaboration between the specialties of cardiovascular medicine and urology.
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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.
Impotence treatments were discussed in the oldest Chinese text, The Yellow Emperor’s Classic of Internal Medicine, which describes traditional Chinese medicine during the time of the Yellow Emperor’s rule which ended around 2600 BC. One of the treatments for impotence discussed is a potion with 22 ingredients.4
Penile prostheses are very effective, and most patients who have a prosthesis placed are satisfied with the prosthesis. However, placement of a prosthesis causes scarring of the tissue within the corpora cavernosa, and if the prosthesis requires removal, other forms of therapy, except for the vacuum device, are often not effective. Thus, most physicians reserve placement of a prosthesis for men who have tried and failed or have contraindications to other therapies.
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Viagra was introduced in 1998 (the others in 2003) and revolutionized the way that men and their partners looked at ED.
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Erection problems are common. Almost all adult men have trouble getting or keeping an erection at one time or another. Often the problem goes away with little or no treatment. But for some men, it can be an ongoing problem. This is called erectile dysfunction (ED).
Blood in the semen (haematospermia) Blood in the urine (haematuria) Erectile dysfunction (impotence) Fertility problems Incontinence of urine Kidney stones Male menopause (androgen deficiency in the ageing male) Premature ejaculation Prostate symptoms (bladder outlet obstruction) Raised PSA Testicle missing Testicular lump Tight foreskin (phimosis) Urinary infection (adult) Urinary infection (child)
• Repeated feelings of doubt and failure or negative communication that reinforce the erection problems
The ability to achieve and sustain erections requires the following:A healthy nervous system that conducts nerve impulses from the brain, spinal column, and the penisHealthy arteries in and near the corpora cavernosa of the penis so that when stimulated there is an increase in blood flow to the penisHealthy smooth muscle and fibrous tissue within the corpora cavernosa so that it can fill with bloodAn adequate amount of nitric oxide (NO) in the penis to help with the stimulation of blood flow into the penisNormal functioning of the tunica albuginea, the layer of tissue surrounding the corpora cavernosa and responsible for the compression of the veins to keep blood in the penisAppropriate psychosocial interactions to enhance sexual stimulation/arousal and decrease anxiety/stress
According to the American Urological Association, ED affects as many as 30 million men in the United States.
Risk exposure is important to consider in the PDE5 inhibitors. Cardiovascular diseases may be a contraindication to treatment, as severely impaired patients may run the risk of a cardiac complication related to vigorous sexual activity. Likewise, patients actively taking nitrates, including nitroglycerine and other agents, are contraindicated from receiving prescriptions for PDE5 inhibitor. Relative contraindications to the use of PDE5 inhibitor include alpha-adrenergic antagonists. Visual disturbances can be seen with sildenafil (blue haze to the visual field) as a result of inhibition of the PDE6 enzyme.
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Low intensity shockwave therapy(LiST) is a groundbreaking “drug and surgery-free” procedure that uses acoustic waves to stimulate a cascade of biological actions that lead to the healing and regeneration of the sexual organs. Simply…LiST helps your body heal itself! Learn more about Low Intensity Shockwave Therapy. Oral medications for ED are called PDE-5 inhibitors. The drugs in this class include medications like Viagra, Levitra, Cialis, Stendra and more. This class of drugs is considered first line therapy for those men presenting with ED. Learn More About Oral Medications for ED. Penile injection therapy involves an injection of a medication into the shaft of the penis on an as needed basis to produce a rapid erection. It is commonly used by patients who have failed oral medications. Learn more about this very effective treatment. The same medicine used for penile injection may be used as a very small suppository placed into the tip of the penis to provoke an erection.
There is insufficient information on the safety of vardenafil in men with the following health disorders:
Erectile dysfunction (ED, impotence) is the failure to achieve or maintain an erection. There are many potential underlying causes of erectile dysfunction, including stress and emotional problems, brain dysfunction, problems with blood supply to the penis, and structural problems with the penis.
Quit smoking.Cut back on alcohol (no more than 2 drinks per day).DO NOT use illegal drugs.Get plenty of sleep and take time to relax.Stay at a healthy weight for your height.Exercise and eat a healthy diet to keep good blood circulation.If you have diabetes, keep blood sugar well-controlled.Talk openly with your partner about your relationship and sex life. Seek counseling if you and your partner have trouble communicating. References
Your urologist will perform a physical examination to check your health. They will examine your genitals (testes and scrotum) for any signs of injury or problems that point to erectile dysfunction. They will also check your heart rate and blood pressure to know about your cardiovascular health. They may even perform a rectal examination to check your prostate.
He discovered that exercises involving pelvic floor muscles were helpful to treat incontinence in women.
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To avoid ED problems before they start, regular exercise is essential. Find out what you need to add to your routine.
Kegel exercises, or pelvic exercises, have proven to be effective in addressing erectile dysfunction, and it should be used as the first-line of treatment. The ischiocavernosus and bulbocavernosus muscles in the pelvic area surround the penis and are active during an erection. The following exercises aim to strengthen these muscles.
The penis contains three cylinders, the two corpora cavernosa, which are on the top of the penis (see figure 1 below). These two cylinders are involved in erections. The third cylinder contains the urethra, the tube that the urine and ejaculate passes through, runs along the underside of the penis. The corpus spongiosum surrounds the urethra. Spongy tissue that has muscles, fibrous tissues, veins, and arteries within it makes up the corpora cavernosa. The inside of the corpora cavernosa is like a sponge, with potential spaces that can fill with blood and distend (known as sinusoids). A layer of tissue that is like Saran Wrap, called the tunica albuginea, surrounds the corpora. Veins located just under the tunica albuginea drain blood out of the penis. SLIDESHOW Erectile Dysfunction (ED) Causes and Treatment See Slideshow Readers Comments 5 Share Your Story
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.
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