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NO is one of the key molecules involved in getting an erection. It works by dilating (widening) blood vessels in the penis, allowing more blood to flow into it, which is how an erection takes place. Anything that disrupts its production is bad news for strong erections.

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Like it or not, the majority of men will develop sexual dysfunction at some point in their lives. Whether it is mild or severe, chronic or intermittent, sexual dysfunction can be extremely frustrating and can take a toll on your confidence, relationship, and overall well-being. Fortunately, the sweeping advances in medicine and technology give men more options now than ever before for treating a wide range of sexual dysfunction conditions, including ED. The acclaimed team at Kasraeian Urology, led by board-certified urologists Drs. Ahmad and Ali Kasraeian, understands the complex and disruptive nature of male sexual dysfunction and is proud to offer the newest and most effective erectile dysfunction treatment options available in 2021.
If your doctor doesn't take your problem seriously, ask to be referred to a specialist. Don't let yourself be fobbed off with comments like "What do you expect at your age?" .

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Kegel exercises are one of the most effective ways to eliminate ED. For curing ED, it is very important to strengthen your muscles and bones of the pelvic areas. And for getting better and strengthful muscles, Kegels are ideal for a body.

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The benefits of exercise for your blood vessels last only as long as you keep exercising on a regular basis. Experts recommend that men who want to prevent impotence make a long-term commitment to exercise. Here are some tips to remember:
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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The doctor will perform a complete physical examination, to check for abnormalities in the penis, scrotum, and testicles. To check for heart disease the doctor will take your blood pressure, measure your heart rate, and order a blood test to check your level of cholesterol. Your doctor will do a digital rectal examination to feel the size, shape, and consistency of the prostate, and if necessary check the level of prostate-specific antigen (PSA) in your blood. To check for diabetes the doctor may order a test to measure the level of glucose in your blood. It could also be necessary to assess your testosterone levels in the morning. This is also done with a blood test.

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Reimplantation of a penile implant is considered medically necessary for persons who meet medical necessity criteria above for a penile implant and whose prior prosthesis was removed for medically necessary indications.

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    Intracavernosal and intraurethral injections are second-line therapy for patients with ED. Alprostadil is the agent most commonly used for intracavernosal injections. The main adverse effects of intracavernosal injections are painful erection, priapism and development of scarring at the injection site.73 Alprostadil is also available as a topical cream in patients who cannot tolerate injections.75

    By asking about your sexual history -- your relationships, sex drive, if you ever get erections -- they can begin to figure out whether the problem is more likely to be physical or mental. Be honest with your doctor; they can’t help you if you withhold information.
    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

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    There have been rare reports of priapism (prolonged and painful erections lasting six or more hours) with the use of PDE5 inhibitors. Patients with blood cell diseases such as sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks of developing priapism. Untreated priapism can cause injury to the penis and lead to permanent impotence. Therefore, if your erection lasts four hours, you should seek emergency care.

    What erectile dysfunction studies are under way? What are future treatment options?
    Since endothelial dysfunction, CVD and ED are closely associated in epidemiological studies, the question for clinicians is whether to recommend the man presenting with ED undergo a cardiovascular (CV) evaluation. Clearly, based on numerous studies, ED can be considered at least a ‘marker’ for possible further vascular disease or CVD.15 In their report, Vlachopoulos and coworkers make the point that the man presenting with ED, the clinician, is offered an opportunity to attempt to improve the health of the man by addressing lifestyle modification, and consider further vascular evaluation owing to the clear relationship between endothelial dysfunction, ED and CVD.19

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    Your GP should work through a recommended scheme of assessment for men with erectile dysfunction (impotence). This will normally include some or all of the following:

    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.
    The main causes could be due to stress, tiredness, anxiety or drinking too much alcohol. If it happens often, it could be due to physical or emotional problems.

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    ED is defined as the inability to achieve a full erection or the inability to maintain an erection adequate for sexual intimacy. Other types of sexual dysfunction such as premature ejaculation and low libido may occur; however, the most common and disruptive problem in men is ED. Although most men will experience periodic episodes of ED, these episodes tend to become more frequent with advancing age.

    Often men with erectile dysfunction are able to improve sexual function by making a few lifestyle changes. Stopping smoking, losing weight, and exercising regularly can help by improving blood flow. If you suspect a medication could be contributing to erectile dysfunction, talk to your doctor about it.
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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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Erectile dysfunction is very common, affecting about 30 million men in the United States. It can be an uncomfortable subject for people. However, a healthy sex life positively impacts quality of life and health. Your doctor is trained to discuss sensitive material and may be able to help you address the issue when consulted.

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Swimming is a cardiovascular exercise that has been proven to be beneficial in overcoming erectile dysfunction. Q&A Rachel Baxter 13 April 2015

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Monitoring erections that occur during sleep (nocturnal penile tumescence) can help you and your doctor to understand if the erectile dysfunction is due to psychological or physical causes. The nocturnal penile tumescence test is a study to evaluate erections at night. Normally men have three to five erections per eight hours of sleep. The test can be performed at home or in a sleep lab. The most accurate way to perform the test involves a special device that is connected to two rings. The rings are placed around the penis, one at the tip of the penis and the other at the bottom (base) of the penis. The device records how many erections occur, how long they last, and how rigid they are. The test is limited in that it does not assess the ability to penetrate.

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