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Congestive heart failure with borderline low blood pressure and borderline low blood volume is a contraindication to PDE5 inhibitors, as is high blood pressure requiring multiple medications to treat the blood pressure as PDE5 inhibitors could lead to lowering of the blood pressure and medical problems.

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ED is most commonly caused by medical conditions such as diabetes and high blood pressure or pelvic surgeries. Age related decline in erectile function is also thought to occur. An injury A disease (e.g. diabetes, high blood pressure, or high cholesterol) Various studies have estimated that between 20% – 71% of individuals with diabetes suffer from erectile dysfunction. An operation (e.g. prostate gland removal) Substance use (e.g. tobacco, drugs, alcohol or medications) Stress, anxiety, depression, psychological trauma Approximately 30 million American men suffer from erectile dysfunction. Most men with erectile dysfunction still have the ability to have an orgasm and father a child, but often have difficulty doing these things because they can’t get or sustain an erection. Erectile dysfunction is not normal, and is by no means an inevitable consequence of aging. Most men at one time or another during their sexual lives are unable to get or keep an erection. This is normal and does not indicate a problem. However, millions of men of all ages experience this inability as a continuing problem. In most cases, erectile dysfunction can be overcome using medical or surgical options. We typically start with questionnaires such as the International Index of Erectile Function (IIEF) to determine the severity. Penile injections such as Trimix may be used to assess the quality of your erection and to differentiate among the many causes. Occasionally a penile duplex ultrasound is indicated if there is concern for disease in the blood vessels or penile scarring. Treatment Options for Erectile Dysfunction
Depending on the symptoms elicited, further investigations including blood tests will be performed. These blood tests will include a check of testosterone (which is best checked first thing in the morning, preferably after fasting), as well checking other hormones, including thyroid function and blood sugar (or glycosylated haemoglobin, HbA1c, which may be used to check for diabetes). .

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Exercises should not cause any pain whatsoever. If you do experience pain, stop the exercises immediately, and seek medical help.
If you develop any side effects, including erectile dysfunction, after taking certain medications, consult your doctor. Do not stop taking the medications unless your doctor tells you to do so. SLIDESHOW Sex-Drive Killers: The Causes of Low Libido See Slideshow Medscape: "Erectile Dysfunction." https://emedicine.medscape.com/article/444220-overview

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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. Eur Heart J 2006;27:2632–9. doi:10.1093/eurheartj/ehl142 Montorsi P , Ravagnani PM , Galli S , et al . Association between erectile dysfunction and coronary artery disease:matching the right target with the right test in the right patient. Eur Urol 2006;50:721–31. doi:10.1016/j.eururo.2006.07.015 Yassin AA , Saad F . Testosterone and erectile dysfunction. J Androl 2008;29:593–604. doi:10.2164/jandrol.107.004630 Khera M . Androgens and erectile function: a case for early androgen use in postprostatectomy hypogonadal men. J Sex Med 2009;6:234–8. doi:10.1111/j.1743-6109.2008.01159.x Aversa A , Isidori AM , De Martino MU , et al . Androgens and penile erection: evidence for a direct relationship between free testosterone and cavernous vasodilation in men with erectile dysfunction. Clin Endocrinol 2000;53:517–22. doi:10.1046/j.1365-2265.2000.01118.x Wespes E , Amar E , Hatzichristou D , et al . EAU guidelines on erectile dysfunction: an update. Eur Urol 2006;49:806–15. doi:10.1016/j.eururo.2006.01.028
Erectile dysfunction (ED) happens when a man has ongoing problems getting and keeping an erection. Without treatment, ED can make sex difficult. The problem is reported by 1 in 5 men, and that number gets bigger with age.

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More than 30 million men in the U.S. have erectile dysfunction (ED), or the inability to achieve or keep an erection. If this condition affects you, our experienced urologists can help.

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For some people, this is a delicate talking point to go about asking our friends, neighbours, family members or even the doctor! I believe that the first step we should do when facing a situation like this is to bear in mind that this is quite normal and to get informed. For this reason, I believe that this reader is helpful. Nevertheless, I am of the opinion that apart from reading this book, an appointment with the doctor is a must for those people going through this type of situation.

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    If the lining of the blood vessels (known as the endothelium) becomes damaged and inflamed, this can also disrupt nitric oxide (NO) production.

    Pilates are another great group of erectile dysfunction exercises because hey challenge you to use your pelvic floor strength while moving. Prostate experts recommend men take advantage of pilates exercises for a wide range of benefits, including, among other things, improved erectile dysfunction. Lying on the floor with your knees bent and your arms at your side. You will see that, in this position, your lower back does not quite touch the ground. Next, flex your hips so that your back does make contact with the floor, so that your pelvic muscles rotate upward and contract. Hold this position for 3-5 seconds and then release, repeating for sets of 10-12. Pelvic Rock This erectile dysfunction exercises starts from the same position as the pelvic tilt. Next: Flatten your lower back against the groundAs you do this, position your legs slightly to one side. Make sure your legs are together, and your feet firmly on the floor as you do this.Return to your starting position and then lower your back again, this time moving your legs to the other side. The Zip and Hollow Place a mat or a blanket on the floor, lie down, and fully extend your legs on the ground.Place your hands on your lower abdomen with your thumbs pointing towards your belly button, your fingers towards your feet, and your hands on your pelvic bone Inhale and contract your abdominal muscles so that your navel drops down towards your spinal cord
    Doctors are more and more convinced that sexual health is directly correlated to overall health. A recent study showed that 44% of men who suffer from erectile dysfunction experience this problem because of health complications like diabetes and hypertension (high blood pressure).

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    The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater.

    A doctor may ask for the following laboratory tests in the evaluation of erectile dysfunction:
    This depends on whether you know what it is causing your ED. There are some things you can do that may help prevent ED, including: Avoid drinking too much alcohol, smoking, or abusing drugs. Ask your doctor if ED is a side effect of a new or current medicine you are taking. He or she may have an alternative medicine. Control your blood sugar and blood pressure. Try to relax and avoid stress.

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    Erectile dysfunction (E.D.) is often caused by blood vessel damage or suboptimal hormone levels; however, it can also be caused by stress or poor lifestyle choices such as smoking, an unhealthy diet, or not making time for physical activity.

    Lycopene can be found in a variety of bright red fruits and vegetables. It is a carotenoid that acts as an antioxidant and helps the body scavenge free radicals that can damage DNA. Lycopene may also reduce LDL (bad) cholesterol, a risk factor for high blood pressure and reduced blood flow (Arab & Steck, 2000).
    Get the most from your doctor’s visit Cancer survivorship An improved approach to prostate cancer Anxiety and Depression Sexual health European Code Against Cancer PRESS RELEASE: Alarmingly Low Awareness of Urology Across Europe

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    Here are some diet tips to follow while doing these exercises for erectile dysfunction for maximum results. Diet and weight loss are important aspects of erectile dysfunction treatment. People suffering are more likely to be overweight and inactive. Consumption of alcohol also plays a vital role in erectile dysfunction.

    The Sexual Advice Association has factsheets on medicines and other treatments for erectile dysfunction.
    Aetna considers penile re-vascularization for vasculogenic erectile dysfunction medically necessary only in men less than 55 years old who meet all of the following criteria: A focal blockage of arterial inflow is demonstrated by duplex Doppler ultrasonography or arteriography; and Diagnostic work-up reveals normal corporeal venous function; and Member is not actively smoking; and Member is not diabetic and has no evidence of systemic vascular occlusive disease; and The erectile dysfunction is the direct result of an arterial injury caused by blunt trauma to the pelvis and/or perineum.

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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.

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Second-generation cardioselective beta-blockers (atenolol, metoprolol, bisoprolol, etc.) can also lead to ED. Atenolol was shown to cause significant reduction of sexual activity compared with placebo in a double-blind, parallel-arm study.22 The same study also showed a significant reduction in testosterone levels with atenolol versus valsartan. An open, prospective study of hypertensive men treated with atenolol, metoprolol and bisoprolol for at least 6 months showed high prevalence of ED – approaching 66 % – in these patients.23

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Erectile disfunction often is caused by poor blood flow to the penis, related to a number of reasons, including: Age Underlying medical conditions, such as diabetes or heart problems Medications, such as antidepressants and antihistamines Excessive drug, alcohol or tobacco use Peyronie’s disease Stress, anxiety, depression or other emotional or psychological conditions Diagnosing Erectile Dysfunction

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An enlarged prostate, or benign prostatic hyperplasia, is a common condition affecting men over 50. While uncomfortable, BPH is not life threatening.

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