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Conditions: Erectile Dysfunction

Overview - Erectile Dysfunction

What is erectile dysfunction (ED)?

Erectile dysfunction (ED) occurs when a consistent inability to get or maintain an erection prevents you from having satisfying sex. A man with ED either loses his erection before intercourse, gets only a partial erection, or gets no erection at all. ED is sometimes called impotence, but the preferred term is ED.

How common is ED?

Because ED is somewhat open to definition, it is tough to accurately estimate the number of sufferers. There is no universally agreed-upon criteria for how consistent an erection problem has to be and for how long it has to continue in order for it to qualify as ED. Plus, it can be hard to determine the number accurately because many men don't like to about it.

But some studies suggest that 20% of men in their 50s, and about 18 million Americans between the ages of 40 and 70, have ED to some degree. Worldwide, it's estimated that ED affects about 100 million men. And ED need not be chronic to make its presence felt. Other studies suggest that almost all men experience occasional difficulty getting or maintaining an erection. In many cases, it's just temporary and needs only short term treatment.

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Conditions: Erectile Dysfunction

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Materials viewable in this section of SexHealthMatters have been contributed by Sponsors of the SMSNA Foundation and reviewed by SMSNA Website Committee for the purposes of patient education. SMSNA requires that medications and prosthetics discussed are FDA approved for use in the United States. The SMSNA Foundation and SMSNA are not endorsing the medications or prosthetics displayed. Investigational Procedures and Therapeutics are not shown. Patients are advised to consult an expert in sexual medicine or surgery to enhance their understanding of risks and benefits of treating their sexual dysfunctions – link for Find a Provider.

Conditions: Erectile Dysfunction

Estrogen, Metabolic Syndrome, and Erectile Function

Estrogen, Metabolic Syndrome, and Erectile FunctionWhen we think of major sex hormones, estrogen and testosterone usually come to mind first. And even though we know that men’s and women’s bodies make both, it’s easy to automatically associate estrogen with women and testosterone with men. After all, these hormones drive secondary sex characteristics.

However, estrogen might be more involved with erectile function than scientists thought. A new study has shown that erectile function in rabbits that have been fed a high-fat diet is affected more by high levels of estradiol (E2) than low testosterone.

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Conditions: Erectile Dysfunction

Seed Brachytherapy and Erectile Function

Seed Brachytherapy and Erectile FunctionMen with prostate cancer have several treatment options, including surgery, hormonal therapy, and radiation. All of these treatments have their pros and cons and sexual issues, such as erectile function, are a common concern for patients.

One type of radiation treatment is prostate brachytherapy, which involves placing radiation as close as possible to the prostate cancer cells. The radiation may be delivered through wires (temporary brachytherapy) or with radioactive seeds that remain in the prostate (permanent brachytherapy).

Brachytherapy may be used alone or in conjunction with other treatments. Side effects include problems with urination, blood in the urine or stool, and diarrhea.

Erectile dysfunction (ED) is another possibility. But to what extent might brachytherapy patients experience ED? And what factors could make a man more or less likely to develop ED after treatment?

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Conditions: Erectile Dysfunction

Peyronie’s Disease and Erectile Dysfunction

Peyronie’s Disease and Erectile DysfunctionPeyronie’s disease (PD), a condition marked by plaques that form just below the skin of the penis, can affect men in different ways. The most notable symptom is curvature of the penis, but men may also have pain or penile shortening. Psychological and emotional issues are also common, especially if the man is unable to have intercourse.

Erectile dysfunction (ED) is another common problem for men with PD. Studies have shown that between 22% to 54% of men with PD also have problems getting an erection firm enough for sex. (The wide range is due to the variety of ED definitions and criteria used by researchers.)

Unfortunately, scientists aren’t sure why so many men with PD also have ED. It’s also difficult to assess given the many factors that affect erectile function, such as aging and comorbid conditions like diabetes and heart disease.

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Conditions: Erectile Dysfunction

Erection Hardness Score

Erection Hardness ScoreAs clinicians, we know that there can be several ways to assess symptoms and conditions. This is true for sexual function, too.

The Erection Hardness Score (EHS) can be a helpful tool to evaluate erectile dysfunction (ED) – a man’s inability to get or maintain an erection firm enough for sex.

Developed in 1998, the EHS is a single-item Likert scale that men can use on their own. The tool asks them to consider the question “How would you rate the hardness of your erection?” and select one of the following options:

·         0 – Penis does not enlarge.

·         1 – Penis is larger, but not hard.

·         2 – Penis is hard, but not hard enough for penetration.

·         3 – Penis is hard enough for penetration, but not completely hard.

·         4 – Penis is completely hard and fully rigid.

Like most assessment tools, the EHS does have its advantages and disadvantages. Let’s take a look at these aspects more closely.

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Conditions: Erectile Dysfunction

Possible Causes of Early Onset Erectile Dysfunction (ED)

Possible Causes of Early Onset EDWe often associate erectile dysfunction (ED) with older men and for logical reasons. After all, erection problems become more common as men age, especially as they develop age-related conditions like diabetes and cardiovascular disease.

However, younger men develop ED, too. And the causes for this population might be different from those affecting their older counterparts.

To understand such causes, it’s helpful to review the physiology of erection. When a man is sexually stimulated, smooth muscle tissue relaxes and arteries expand, allowing the penis to fill with blood. Once this occurs, smooth muscle tissue works to trap the blood in the penis until the stimulation ends or the man ejaculates. This “trapping” is called veno-occulsion.

Some men develop ED because they have problems with the arterial inflow. For example, the may have atherosclerosis, or hardening of the arteries, which impairs the flow of blood in to the penis.

Over the last decade or so, endothelial dysfunction, considered a precursor to atherosclerosis, has been linked to ED. Endothelial dysfunction involves the endothelium – the lining of blood vessels. Problems with the endothelium can also restrict blood flow to the penis.

But do younger men with ED tend to have arterial inflow problems and endothelial dysfunction? Scientists from UCLA decided to take a closer look at this question and published their results last fall in the International Journal of Impotence Research.

Their study involved 23 patients between the ages of 18 and 49. All of the men had had ED for at least six months. Their average age was 33 years. Each man had a duplex ultrasound scan of his penis.

The researchers found abnormal arterial responses in just 4 – 13% of the men, depending on the criteria used. Based on these data, they suggested that most cases of ED in younger men are not the result of problems with penile arteries.

They added that when their patients described their erectile difficulties, most said they had trouble keeping an erection after it started. “This inability to maintain an erection once the erection has occurred is clinically very suggestive of [cavernosal veno-occlusive dysfunction (CVOD)] rather than an arterial inflow issue.” Another term for CVOD is “venous leakage.”

“The conclusion from these observations is that the arterial system does not seem to be severely impacted in young men who present with ED, and as such does not appear to be the primary cause of ED in this age group,” they wrote, adding that their data suggest “that if there is going to be a vascular component in this age group, it is most likely going to reside on the veno-occlusive side.”

Why might this happen? It could be related to aging, the researchers said. It might also be explained by genetics.

They suggested that clinicians should not be so quick to blame ED on endothelial dysfunction. Past research has usually involved men over age 50 and men with hypertension and diabetes, which makes the connection to endothelial dysfunction more prominent. But for men younger than 50, the role of corporal smooth muscle tissue should be considered as well, the authors noted.


Print this article or view it as a PDF file here: Possible Causes of Early Onset ED


Resources

International Journal of Impotence Research

Rajfer, J., et al.

“Early onset erectile dysfunction is usually not associated with abnormal cavernosal arterial inflow”

(Full-text. November/December 2013)

http://www.nature.com/ijir/journal/v25/n6/full/ijir201317a.html

Conditions: Erectile Dysfunction

Men with Infertility

Tony just didn’t know what to do anymore. He and his wife Rebecca had always planned to have a family, a large one. But after a year of trying, they were losing hope that they’d ever conceive a child. They were confused about their next steps. Should they give up? Keep trying? Try in vitro fertilization? Adopt?

Making matters worse, Tony was starting to have some problems in the bedroom. He’d never had trouble getting an erection before, but now he couldn’t count on being able to perform. And since this ability was crucial for starting a pregnancy, he felt like a failure. Rebecca tried to understand, but deep down, Tony knew she was as frustrated and disappointed as he was. Lately, they had started avoiding the subject of sex altogether and he knew that wasn’t good for their relationship. He missed the intimacy they shared.

There are lots of men like Tony. Infertility takes a huge toll on couples, emotionally and sexually.

Unfortunately, it’s fairly common for infertile men to develop sexual problems. Some have erectile dysfunction (ED), the inability to achieve and maintain an erection suitable for intercourse. Others may have premature ejaculation (PE), which occurs when a man ejaculates before he and his partner wish it to happen.

Depression and anxiety often accompany sexual problems. In Tony’s case, he missed the intimacy he once had with his wife. He might feel anxious about pleasing her. The fact that they’re trying to conceive adds even more pressure.

Today, we’ll take a closer look at the extent of sexual problems affecting men with infertility. We’ll also discuss some ways that we, as professionals, might help them.

Recent Research

A study published online in May in theJournal of Sexual Medicine has shed some light on the incidence of sexual and psychological problems among infertile men in China.

Researchers collected data from 1,468 infertile men and 942 fertile men who ranged in age from 23 to 45.

They found that the infertile men had higher rates of erectile dysfunction, premature ejaculation, depression, and anxiety than the fertile men. These rates were as follows:

 

 

Infertile Men

Fertile Men

Premature Ejaculation

19.01%

10.93%

Erectile Dysfunction

18.05%

8.28%

Depression

15.74%

10.08%

Anxiety

38.01%

26.65%

As you can see, infertile men were almost twice as likely to have premature ejaculation when compared to the fertile men. And they were more than twice as likely to have erectile dysfunction.

The study authors noted that their results coincide with the results of other studies that have found higher incidence of sexual and psychological problems among infertile men. However, they also pointed out that cultural and religious factors should be considered when comparing Chinese and Western patient populations. What may be true in one part of the world may not necessarily apply to another.

How Can Practitioners Help?

Still, the results are a worthwhile reminder of issues our patients and clients could be struggling with. So how can healthcare providers help men like Tony?

  • Have compassion. Sexual problems and infertility are difficult enough on their own and can put tremendous strain on relationships. Adding the two together creates an even tougher situation. Keep this in mind when talking to your patient or client.
  • Ask. A lot of men are reluctant to discuss sexual problems with a clinician. Try giving them the opportunity to do so. For example, you might say, “A lot of men dealing with infertility develop sexual problems. Fortunately, there are treatments available. Is this something you’d like to talk about?”
  • Be prepared to make referrals. If sexual problems and infertility are outside your area of expertise, have a list of referrals ready. Men may benefit from counseling, either by themselves or with their partner. Urologists may be able to help with erectile dysfunction. Sex therapists can offer strategies for dealing with premature ejaculation. If these specialists are not part of your practice, ask your colleagues for recommendations.

Even if our patients don’t volunteer much information, being aware of the sexual implications of infertility can help us understand the deeper struggles that may be part of their relationships.

Resources

The Journal of Sexual Medicine

Gao, Jingjing, MM, et al.

“Relationship between Sexual Dysfunction and Psychological Burden in Men with Infertility: A Large Observational Study in China”

(Full-text. First published online: May 20, 2013)

http://onlinelibrary.wiley.com/doi/10.1111/jsm.12207/abstract

Conditions: Erectile Dysfunction

Men’s Adherence to Erectile Dysfunction (ED) Drugs

It’s been fifteen years since the FDA approved sildenafil (Viagra) as the first drug to treat erectile dysfunction (ED). Since then, other drugs such as tadalafil (Cialis) and vardenafil (Levitra), have been developed. Together, these drugs often serve as first-line therapy for men with ED and generally work well in that role.

Sildenafil, tadalafil, and vardenafil are all phosphodiesterase type 5 inhibitors and work in similar ways to enhance blood flow to the penis so a man with ED can get an erection firm enough for sex.

Given the success of these drugs for men who can take them, we may think that men would be eager to comply with therapy. But this is not always the case. The drugs aren’t effective for every man and their length of effectiveness can vary. Some men are dissatisfied with their results or have unrealistic expectations.

How can we help patients adhere to their medication plan? To answer this question, it’s helpful to consider reasons why they don’t.

Men’s Adherence Study

In a recent study published in The Journal of Sexual Medicine, European scientists examined men’s adherence to three different types of ED medication regimens: tadalafil taken once daily, tadalafil taken on demand, and sildenafil taken on demand. (Vardenafil was not included in this study.)

Seven hundred seventy patients were randomly assigned to one of the three treatment plans. For eight weeks, the patients took their designated medication with no changes, except for adjustments in dosage when necessary. After this period, the men were allowed to continue their current treatment, switch to another regimen, or stop treatment completely.

Men who took tadalafil (once a day or on demand) tended to stay with their treatment plan longer than the men taking sildenafil. Overall, 44% of the men continued with their assigned plan. Forty-two percent switched plans at least once.

Why? Efficacy played a role in the two most common reasons. Men either felt that their erections were not hard enough or did not last long enough. Some men did not like taking a pill every day; others did not like taking medication on demand.

Helping Patients Choose an ED Drug

When choosing an ED drug, much depends on a man’s preferences. Some helpful questions to ask include the following:

·         How do you feel about taking an ED drug? Some men in the above study cited “feel medication controls my sexual life” as their reason for switching or discontinuing a regimen. Men with this concern may want to choose a different approach to treating ED.

·         How do you prefer to take this drug? Some men prefer once a day because it’s easier to remember. Others may not like the idea of taking a daily pill and choose the on-demand route.

·         How important is spontaneity? In some regimens, the drug must be taken 30-60 minutes before sex. But often, a couple may not know when they’ll feel inspired. They may prefer to take advantage of unplanned moments, which might make another regimen more suitable for them.

·         How important is length of effectiveness?  Each drug is effective for a different amount of time. According to the Mayo Clinic, sildenafil and vardenafil may be effective for up to 5 hours. Tadalafil may last up to 36 hours. This can be an important factor.

Being Realistic About Adherence and Usage

Advertising often portrays happy couples whose sexual problems are solved by a pill. But patients need to know that the situation can be more complicated than that.

Sometimes, adjustments are needed. The dose may need to be increased or decreased. Or the drug itself may need to be changed because of side effects. What works for one man may not work for another. It can take some time to find the right fit.

Helping patients and their partners understand their options is just one step. They may also need to think about their relationship and talk openly about their expectations. It often takes time, effort, patience, and understanding to work through ED.

Resources

The Journal of Sexual Medicine

Buvat, Jacques, MD, et al.

“Adherence to Initial PDE-5 Inhibitor Treatment: Randomized Open-Label Study Comparing Tadalafil Once a Day, Tadalafil on Demand, and Sildenafil on Demand in Patients with Erectile Dysfunction”

(Full-text. First published online: April 2, 2013)

http://onlinelibrary.wiley.com/doi/10.1111/jsm.12130/references

Mayo Clinic

“Erectile dysfunction: Viagra and other oral medications”

(June 6, 2012)

http://www.mayoclinic.com/health/erectile-dysfunction/MC00029

Conditions: Erectile Dysfunction

MUSE® (aprostadil) Local Erectile Dysfunction Therapy

While there are several treatment options for erectile dysfunction, some of them are more effective or tolerable than others. MUSE (Medicated Urethral System for Erection) helps many men who do not respond well to oral medications or prefer not to give themselves injections.

The following short video gives an overview of MUSE and explains the following: 
 
  • The active ingredient in MUSE, alprostadil
  • The procedure for taking MUSE, using an applicator
  • The ways MUSE works in the penis to create an erection
  • Risk information, safety precautions that doctors consider before prescribing MUSE, and warnings and side effects of MUSE

 A man’s urologist can help him decide whether MUSE is right for him.

INDICATION: MUSE (alprostadil) is indicated for the treatment of erectile dysfunction. Studies that established benefit demonstrated improvements in success rates for sexual intercourse compared with similarly administered placebo.

Warning: Do not drive or do other hazardous activities after taking MUSE because low blood pressure or fainting may occur. Fainting within 1 hour of taking MUSE has been reported.

Important Risk Information

Because sex is a vigorous physical activity and increases heart rate and work, make certain that your doctor determines that you are healthy enough for sex before you use MUSE. If you have chest pain, nausea or other discomforts during sex, seek immediate medical help.

The first time you use MUSE should be in your doctor's office so that your doctor can find the dose that is right for you and so that you can be monitored for low blood pressure, which may cause you to faint.

Make sure your doctor knows about any drugs you are using to lower blood pressure before you start using MUSE. Tell your doctor if you have any symptoms indicating that blood pressure may be too low (e.g., lightheadedness) when you use MUSE.

Carefully follow your doctor's instructions for inserting MUSE in the urethra to avoid scratching the inside of your urethra (the channel that urine and semen pass through), which could result in minor bleeding. If you are on anti-coagulant (blood thinning) medicine, or have a bleeding disorder, you may be at higher risk of bleeding.

If you have an erection lasting more than 4 hours, seek immediate medical help to avoid long-term injury.

Use a condom if your partner is pregnant, or could become pregnant.

MUSE does not protect against sexually transmitted diseases.

The most common side effects of MUSE are penis pain, burning in the urethral opening, urethral bleeding, pain in testicles, low blood pressure, and dizziness.

Do not use MUSE if:
1. Your penis is severely curved, or you have a narrow urethra, or your penis is otherwise abnormally shaped.
2. The head of your penis is inflamed or you have an infection of the urethra, or regularly get infections of the urethra.
3. You have sickle cell anemia or trait, any disorder of the red blood cells or platelets, multiple myeloma, or are prone to blood clots or have an abnormal thickening of the blood, because these things can mean you have an increased risk of priapism (rigid erection lasting 6 or more hours).
4. You are allergic to alprostadil.

MUSE has not been studied in men who have penile implants. There is no experience in homosexual men and no experience with other than vaginal intercourse.

You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see Patient Information.

MUS-13-0005

Conditions: Erectile Dysfunction

Questions to ask your provider about ED

Many men find it awkward to talk about their erectile dysfunction for the first time. It can therefore be helpful to write down a few questions to ask your health care provider. We've provided a few common questions about ED to give you a head start. 

Conditions: Erectile Dysfunction

Penile Implants - Erectile Dysfunction

What are penile implants (prostheses)?

Penile prostheses, or penile implants, are an important treatment option for men with ED who have an established medical cause for ED, fail to respond to nonsurgical treatments (such as oral medications, vacuum devices, injection therapy, etc.) and who are motivated to have surgery to improve erectile function. Penile implant requires a permanent surgical procedure that cannot be reversed. It is important that men talk to their doctor about the advantages and possible drawbacks of having the procedure.

This procedure replaces the spongy tissue (corpora cavernosum) inside the penis with rigid, semi-rigid, or inflatable cylinders (depending on which type of penile implant is chosen). In all penile prostheses, the surgically inserted components are totally concealed within the body. After a penile implant, when a man desires an erection, he is able to produce a rigid erection on demand that enables him to have sexual relations. Penile implants do not typically lengthen the penis.

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Conditions: Erectile Dysfunction

Identifying ED - Erectile Dysfunction

What tests can help identify the causes of ED?

The diagnosis of ED is easy. Determining why ED is occurring, on the other hand, can be more difficult. Identifying the cause of ED usually begins with a structured interview, followed by a physical examination, and possibly laboratory testing.

Determining whether a person suffers from ED rather than other sexual problems of ejaculation, orgasm, or sexual desire is an essential first step. Once ED is established, a doctor will determine the nature of ED. Finding the cause begins by asking many of the previous questions in order to obtain a medical, sexual and psychological history. These questions can be helpful in determining the severity of ED and revealing possible medical conditions or diseases that may be causing, or merely complicating, a man's ED. Sometimes a doctor may also ask their patient to complete a questionnaire regarding their sexual function which can confirm the presence of ED.

  • After this structured interview, a physical examination is performed in order to help identify physical problems that may be causing ED. A simple physical examination often includes a check for abnormalities in the penis and testicles.
  • Pulse examination - including lower extremity pulses that may indicate circulatory problems.
  • Neurological examination - including gait and postural instability, testing sensations of touch, and reflexes.
  • Rectal exam - checking sphincter tone and evaluating the prostate.
  • Abdominal examination - looking for signs of liver or kidney disease.

Some simple laboratory tests may be performed. These tests include:

  • Blood tests
    • Testosterone: Deficiency in this sex hormone can be linked to sexual dysfunction
    • Blood sugar levels - screening for diabetes.
    • Lipid profiles - determines cholesterol and triglyceride levels, possibly indicating arteriosclerosis (which can reduce blood flow to the penis).
    • Liver and kidney function - disease to either the liver or kidney can create hormonal imbalances. Enzyme and serum creatinine level analysis for liver function are indicators of kidney efficiency.
    • Thyroid function - production of sex hormones and regulation of metabolism is done by thyroid hormones.
  • Urinalysis - also analyzes sugar and hormone levels that may indicate diabetes, as well as kidney dysfunction and testosterone deficiency. In some men, further tests may be required in order to help identify the cause of ED. These include erectile function tests, such as:
    • Vascular testing: the most commonly performed tests
    • Injection testing - Agents that cause increased blood flow are injected into the erectile chamber of the penis to cause an erection. The response to the medication may aid the physician in defining the cause of the problem.
    • Duplex ultrasound - Also called Doppler color-flow mapping or Doppler ultrasound - It is a form of ultrasound that allows physicians to see the structure and blood flow through blood vessels.
    • Dynamic infusion cavernosometry/cavernosography (DICC) - A sophisticated penile blood flow test conducted in some men with ED and penile abnormalities, Usually done at major medical centers or by ED experts.
  • Neurological testing: these tests are rarely done these days.
    • Penile biothesiometry - Electromagnetic vibration is used to evaluate penile sensitivity and nerve function.
    • Somatosensory evoked potentials - Electrical, tactile or another type of stimulation of the nerves to determine nerve damage and function.
    • Pudendal electromyography - The pudendal nerve is the main nerve supplying the pelvis, bladder and urethra. Damage to this nerve can cause ED. Electromyography is a test that doctors use to detect nerve function and measure the electrical activity generated by muscles. Therefore this test can determine if damage to the pudendal nerve is the cause of ED.
  • Nocturnal penile tumescence - Men normally have erections when asleep at night, if not, this may be indicative of a problem with nerve function, hormones or blood supply to the penis.

Conditions: Erectile Dysfunction

Vascular Surgery - Erectile Dysfunction

What is vascular surgery?

Vascular surgery attempts to restore penile blood flow that has been reduced by correcting a blockage or leakage in blood flow to the penis in order to improve a man's ability to get and maintain a natural erection.

Vascular surgeries can include:

  • Repairing leaking veins that prevent a man from keeping an erection
  • Bypass operations to re-route blood past blocked arteries to the penis
  • Blocking off veins that allow blood to leave penile tissue.
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Conditions: Erectile Dysfunction

Vacuum Devices - Erectile Dysfunction

What are vacuum devices and how do they work to treat ED?

Vacuum erection devices (VED), also called vacuum constriction devices (VCD), are commonly used, have been FDA approved and have been utilized for nearly a century. Several medical equipment companies have created specially designed devices to limit the amount of pressure that is built up in the cylinder, reducing the chance of pressure-induced penile injury. Some devices have been developed and are available (mainly via the Internet) that are not FDA approved and should not be used without consulting a doctor.

The basic units of FDA approved VED/VCD are:

  • a clear plastic cylinder with an opening at one end that is placed over the penis.
  • a pump that is connected to the cylinder that draws air out to create a vacuum. The pump may be hand or battery operated. The vacuum reduces air pressure in the cylinder and an increase in blood flow to the penis. FDA approved cylinders have pop-off valves, which limit the amount of pressure.
  • an elastic ring. Once an erection is achieved, an elastic ring is placed around the base of the penis. The elastic helps maintain the erection by reducing blood flow out of the penis. The rings come in different shapes, sizes, and most importantly tightness for individual fit. Most manufacturers recommend use of the elastic ring for no more than 30 minutes to minimize the risk of injury.

VEDs/VCDs are effective, but some men find them to be cumbersome and that they get in the way of sexual spontaneity. With proper instruction, roughly 80 percent of men who use.
VEDs/VCDs achieve a functional erection.

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Conditions: Erectile Dysfunction

Transurethral Agents - Erectile Dysfunction

What is a "transurethral agent"?

Transurethral agents, also called intra-urethral agents, are erectile dysfunction (ED) treatments whose mode of administration is insertion into the urine channel, known as the urethra. The only FDA-approved urethral suppository is called MUSE® (Medicated Urethral System for Erection), which contains the drug alprostadil (also used in the injectable drugs, Caverject and Edex).

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Conditions: Erectile Dysfunction

Self-Injection - Erectile Dysfunction

What types of injections are used to treat ED?

Oral medications don't work for everyone. Many men may be prescribed medicines that go directly, via injection, into the penis. Injection therapy may use a single drug or a combination of drugs. Single drug injection therapy uses alprostadil, a type of prostaglandinE1 (PGE1), and is called either Caverject® or Edex®. Combination therapies, called "bi-mix" (for 2 drugs mixtures) or "tri-mix" (for 3 drugs mixtures), are a mixture of either two, or all three, of the following most commonly used drugs: papaverine, phentolamine and/or alprostadil. Not all bi-mix or tri-mix medications are identical - the amount of the individual drugs may vary from pharmacy to pharmacy.

Alprostadil is a vasoactive agent that is a synthetic version of the chemical prostaglandin E. This chemical helps relax the smooth muscle tissue in the penis to enhance blood flow needed for an erection.

Papaverine and phentolamine also belong to this group of medicines called vasodilators (drugs that relax smooth muscle tissue, causing arteries to open and allowing an influx of blood flow).

Most men who do not respond to oral drug therapies used to treat ED find injection therapies to be effective. Success rates with self-injection are roughly 85 percent of patients. Injections may also be helpful for men who are taking other medications, such as oral nitrates, that should not be used at the same time as some oral medications for ED.

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Conditions: Erectile Dysfunction

Questions Used in Diagnosing ED - Erectile Dysfunction

Diagnosing ED

How is ED diagnosed?

What questions do doctors ask when discussing ED with patients?

The kinds of questions a doctor might ask about ED are:

A. Questions relating to the specific erectile complaint:

1. How long have these symptoms been present? Did they begin gradually or suddenly?

  • Your doctor needs to know if this is a new problem or one that has been ongoing for some time.

2. Do you wake up with an erection? How about in the evening?

  • Men naturally have erections while they sleep and when they wake up in the morning. This is one way your doctor might determine the severity or cause of the problem.

3. If you do have erections, how firm are they? Is penetration difficult?

  • The doctor needs to get a sense of how severe ED is since dissatisfaction can vary.

4. How consistent is the problem: Is penetration difficult 50%, 75% or 100% of time?

5. Do your erections change under at different times such as with different partners, oral stimulation, or masturbation?

  • Does ED vary from one circumstance to another, or is it consistent throughout all sexual experiences?

6. Are there any difficulties with sexual desire (libido), arousal, ejaculation, or orgasm (climax)? If so, did these difficulties occur before or after the onset of the ED, or are they separate issues?

  • It is possible that your ED is due to, or occurring in conjunction with, a different sexual dysfunction?

7.What effect is this problem having on your sexual satisfaction, your sexual confidence, or your relationship (if you are in one)?

B. Questions relating to medical factors that could be contributing to ED:

1. What medical conditions do you have?

  • ED is strongly linked to a number of other common diseases in men such as: diabetes, heart disease, high blood pressure, high cholesterol, vascular disease, neurologic conditions, chronic liver or kidney disease.

2. What medications are you currently taking?

  • There are a number of medications that may cause, or contribute to ED.

3. If and how much do you smoke, drink, or use other drugs?

  • Certain lifestyle habits increase a man's likelihood of having ED. Alcohol or drug abuse can contribute to heart disease, hardening of the arteries and hypertension, all of which can lead to ED.

4. Is there a new curve or bend to the penis? If curvature is present, is it painful? What is the location and severity of the curvature?

  • Peyronie's disease, which is an inflammatory condition that produces scarring within the penis, causing it to curve or bend, can also contribute to ED.

5. Any previous history of surgery or radiation therapy, particularly in the pelvic region?

  • For example, treatments for prostate disease may also cause ED.

6. Any history of pelvic, genital, or spinal cord trauma?

  • Injury to these areas can sometimes interfere with the body's ability to develop and maintain an erection.

7. Do you experience urinary problems?

  • ED may also be caused by urinary tract problems, such as irritation or problems in voiding (such as urinary frequency, urgency, and dysuria [pain or burning during urination]).

C. Questions relating to psychosocial factors that could be contributing to ED:

1. How is your relationship with your partner? Has anything changed recently?

  • ED can sometimes be a result of marital (or relationship) problems.

2. What is your sex life like? Has anything changed recently?

  • This sometimes leads to questions about the quality of your sexual relationships and sexual intimacy, such as frequency, sexual expectations from you and your partner, or any performance anxiety that may exist.

3. In general, are you under a lot of stress? Or has anything particularly upsetting happened to you?

  • Excessive stress from any aspect of life - work, relationship, financial, etc. may lead to ED

4. Have you been feeling down and depressed a lot? Do you have any psychological illnesses or have you considered seeing a psychologist?

  • Depression or other mental illnesses can contribute to ED.

D. Questions relating to prior evaluation or treatment:

1. What testing have you have done to date?

2. Have you used any treatments for ED? What kind or response have you obtained? Have you been using them properly?

3. Did you experience any side effects from the medications?

Conditions: Erectile Dysfunction

Radical Prostatectomy - Erectile Dysfunction

What is the prostate?

The prostate is a donut shaped gland found only in men. It is roughly the size of a walnut. It is located just below the bladder. The prostate surrounds the urethra, which is the tube that carries urine from the bladder to the outside during urination or semen during ejaculation. The prostate produces about a quarter of the semen, the milky substance that comes out during ejaculation.

What is prostate disease?

The three most common problems that can develop in the prostate gland are:

  • Inflammation, also known as prostatitis - this can be due to infectious or non-infectious causes. Infections can be treated with with antibiotics. Non-infectious inflammation is more difficult to treat.
  • Prostate enlargement or benign prostatic hyperplasia (BPH) - BPH frequently occurs in men over the age of 50. It is a natural part of the aging process. BPH can result in a gradual squeezing of the urethra, sometimes making it hard to urinate. The symptoms associated with BPH are called lower urinary tract symptoms (LUTS).
  • Prostate cancer -This is the most common cancer in older men and the second leading cause of cancer deaths in the US. Researchers estimate that about 225,000 men are diagnosed with prostate cancer and about 30,000 die of prostate cancer in the United States each year.

How does prostate disease cause ED?

Men with lower urinary tract symptoms (LUTS) are more likely to have ED. The more severe the LUTS, the more severe the ED. These difficulties may include getting up to urinate at night, having to urinate often and urgently and trouble urinating. Such symptoms can be due to BPH, studies have shown a strong and consistent link between LUTS, BPH and ED.

Surgical removal of the entire prostate gland for the treatment of benign prostate enlargement or prostate cancer, or surgical removal of the bladder and prostate for the treatment of bladder cancer often injure the nerves and arteries leading to the penis. This usually causes at least temporary ED. ED can also result from the various forms of radiation therapy that are used to treat prostate cancer. Also, hormone treatment for advanced prostate cancer, which occurs when prostate cancer has spread outside of the prostate to other organs, reduces a man's sexual desire and erection function.

Why is prostate surgery (radical prostatectomy) associated with ED?

In 2003, about 225,000 men were diagnosed with prostate cancer in the United States. Of these men, 45% received treatment by surgical removal of the prostate gland (radical prostatectomy.) The majority of those men who have had this surgery will experience temporary or permanent ED.

Radical prostatectomy is an operation that completely removes the prostate and the surrounding tissue. Prostate surgery can be:

  • Nerve-sparing (keeping intact the nerves which lead to the erection chambers and provide the stimulation for erection)
  • Non nerve-sparing (not preserving these nerves)

Even if the majority of the nerves are preserved in the surgery, temporary ED is common.

When the nerve-sparing technique is used, particularly bilateral nerve-sparing, permanent ED is less common than with non-nerve sparing surgery and recovery often occurs within the first year or two following the procedure.

ED from a non-nerve-sparing procedure is common and recovery of erectile function after a non-nerve-sparing technique is unlikely though not impossible.

Erectile function following surgery depends on an individual patient's age, anatomy, extent of cancer and preoperative sexual function.5 Most studies report that 50-80% of men who have a radical prostatectomy have some degree of ED for the first year after surgery even if the surgeon is able to spare all or part of the nerves.6 Even in bilateral nerve-sparing surgery, return of erectile function may take up to 12-24 months. Eventually though, erections adequate for vaginal penetration return in 40-80% of men. Unilateral nerve sparing technique produces results that are intermediate between bilateral and non-nerve sparing surgery. Also, duration of time from the surgery to treatment for ED can play a role in the effectiveness of different therapeutic options.

Other sexual complications following radical prostatectomy include the absence of ejaculation or dry orgasm (orgasm without discharge of semen) in all cases, and loss of penile length in some men.

Do men respond to PDE5 inhibitors after having prostate surgery?

The first line of treatment for ED following prostate surgery is oral medications, such as phosphodiesterase-5 inhibitors (PDE5i) - sildenafil (Viagra®), vardenafil (Levitra®) and tadalafil (Cialis®). About 70% of men respond in some fashion to oral drug therapy in the post-operative setting.

Since these drugs are designed to increase blood flow to the penis upon sexual stimulation, they require intact nerves and arteries. Men receiving the nerve-sparing prostatectomy generally have a better response.

Does self-injection therapy used after prostate surgery help erectile function?

Penile self-injections provide very effective treatment of ED after prostate cancer surgery. Some studies report that penile self-injections can achieve a 95% success rate. Self-injection therapy is usually used after trying oral medications because of the convenience of oral therapy.

The role of oral, self-injection, intraurethral and vacuum therapies after treatment for prostate cancer:

For men who have had surgical or radiation treatment for prostate cancer, evidence suggests that oral, self-injection treatments started soon after treatment may improve the chances for later recovery of natural spontaneous erections. Oral therapy can be used with any of the three PDE5 inhibitor drugs. There are three vasodilator drugs used for self-injection therapy:

  • papaverine
  • phentolamine
  • Alprostadil, a type of prostaglandin E1

Injection of Alprostadil may cause penile pain. If this occurs, lowering the dose of Alprostadil and/or mixing Alprostadil with papaverine and phentolamine may reduce or eliminate the pain. The prescription drug called MUSE is used in intraurethral therapy.

Penile implants are a third line therapy, with a success rate of about 80-90%. They are the single most reliable form of treatment for erectile dysfunction, and they provide an excellent solution to the problem of erectile dysfunction.

(will have a link here to our section on each of these treatments that provides readers with their basic information)

Is prostate surgery associated with penile shortening?

Decreased penile length is commonly experienced following radical prostatectomy. In one study, loss of penile length ranging from 0.5 to 4 cm (about 1/4 to 1½ inches) was experienced in 71% of men, although only 48% of men reported a loss over 1cm (about ½ inch). Some experts believe that penile shortening can be reduced by starting oral, self-injection, intraurethral and/or vacuum therapy a few weeks after surgery.

Is it normal for men to leak urine during an orgasm?

Some men may leak urine during sexual activity and/or orgasm following prostate surgery, but the amount and frequency of leakage usually decrease over time. One way to help avoid leaking is to empty the bladder completely before sexual intimacy. Strategies used to minimize this problem have included wearing condoms, certain medications (the antidepressant imipramine, for example) and the use of a constriction band after the achievement of an erection (like the ACTIS tension band).

Conditions: Erectile Dysfunction

Radiation Therapy - Erectile Dysfunction

How does radiation therapy cause ED?

Radiation therapy is a well-known cause of ED. Radiation therapy uses high levels of radiation to damage cancer cells' DNA in an effort to destroy them or keep them from growing and dividing, while minimizing damage to the surrounding healthy cells. Both pelvic external beam radiotherapy and seed implants (brachytherapy) are used to treat prostate cancer.

Radiation therapy in the pelvis area of men can cause ED in 3 possible ways:

  • Arterial damage may block blood flow and/or damage the lining of the blood vessels that carry blood to the penis
  • Nerves in the pelvic area may become permanently damaged
  • Erectile tissue may be damaged, reducing blood flow to the penis and/or causing leakage of blood from erectile tissue (venous leak) during an erection

Some of the sexual side effects after radiation therapy are:

  • Inability to achieve or maintain an erection (erectile dysfunction)
  • Weaker, less satisfying orgasms
  • Pain during ejaculation (although this usually goes away within several weeks)
  • Dry orgasm or retrograde ejaculation (orgasm without the discharge of semen)
  • Less semen ejaculated

There are three main factors that determine the extent of vascular damage that occurs following radiation exposure:

  • Dose of radiation
  • The higher the dose the greater the degree of vascular damage
  • The amount of area exposed to radiation; the wider the area exposed, the more significant the damage
  • The existence of vascular risk factors

How common is it for men to experience ED following radiation therapy?

Radiation therapy is a well-known cause of ED. Although ED may begin about six months after treatment, and progress gradually, it is the most common long-term complication of radiation therapy.

There is a 20 - 80% chance of ED from radiation therapy. There seems to be an increase in sexual dysfunction rates as time goes by following radiation therapy. One study revealed that two years after radiation therapy, 61.5% of men reported they had ED.

Other predictors of ED can include patient age, pre-treatment erectile function, method and dose of radiation delivery, the use of neoadjuvant (pre-surgery) hormone deprivation and the duration following radiation at which the patient is assessed by a physician. Also, men who smoke or who have a history of heart disease, high blood pressure or diabetes also may be at a higher risk of ED. These conditions may have already caused some artery damage which becomes further damaged by the radiation, Older men (especially those over 60) may find that treatment accelerates the sexual side effects associated with normal aging.

Radiation specialists have developed new techniques that target just the prostate and avoid surrounding tissue, nerves and blood vessels essential in erectile function.

How soon after having radiation therapy are men likely to have ED?

Even with the most precise radiation therapy, men may experience some ED for the first few months after treatment. Many of the sexual side effects of radiation are slow and gradual, and may take as long as six months to several years to appear. Unfortunately, radiation-induced ED is usually permanent.

There are a number of treatments available. These include early post-treatment evaluation and early institution of a trial of drug treatment as soon as the patient experiences any trouble with his erectile function. Men are encouraged to develop regular erections with or without sexual relations and they are followed up on a regular basis to ensure appropriate early treatment.

First line therapy includes management of related medical conditions and psychological support combined with oral therapy. Second line includes vacuum erection device therapy, penile injection therapy, and transurethral prostaglandin suppository administration. Third line therapy is penile implant surgery.

Does anti-androgen therapy make ED either better or worse?

Hormone treatment (also called androgen deprivation therapy or androgen suppression therapy) for prostate cancer attempts to stop, block or remove the production of testosterone and all androgens to slow down or stop the progression of cancer. When hormone therapy is used, it is common for sexual problems to occur within the month following the beginning of therapy.10 In addition to causing ED, hormone therapy can also reduce a man’s sex drive.

Other common sexual side effects with hormone treatment include:

  • Inability to get or keep an erection (ED)
  • Difficulty climaxing
  • Orgasm without discharge of semen (dry orgasm)
  • Weaker, less satisfying orgasms

Younger men tend to have fewer side effects from hormone therapy.

Conditions: Erectile Dysfunction

Health Problems - Erectile Dysfunction

What health problems are associated with ED?

Impaired blood flow, either to or from the penis, is the most common cause of ED. Various diseases, such as diabetes, high blood pressure and hardening of the arteries (atherosclerosis), can affect the flow of blood. In fact, atherosclerosis causes roughly 40% of ED in men older than 50 years.

Diseases affecting the nervous system can interfere with the body's ability to process sexual stimulation signals, also causing ED. Nerve damage from strokes or spinal injuries, and other neurological disorders, like multiple sclerosis and Parkinson's, change the brain's ability to respond to sexual stimulation, potentially preventing an erection.

Diabetes is a disease that affects both the vascular and nervous systems. Approximately 50% of diabetic patients, irrespective of type, have ED.

ED can also result from a fractured or crushed pelvis that leaves the man's nerves or arteries damaged, inhibiting the flow of blood to the penis.

Likewise, some types of pelvic surgeries and radiation therapies, such as those used in the treatment of prostate, bladder or rectal cancer, can cause ED.

Endocrine disorders such as low levels of testosterone, or thyroid or pituitary gland problems, can also cause a hormone imbalance and erectile problems.

Diseases such as Peyronie's disease, an inflammatory condition that produces scarring within the penis, causing it to curve or bend, can also contribute to ED.

Sometimes, medications taken to treat illnesses are behind ED. Blood pressure therapies like beta-blockers, some heart medications, some peptic ulcer medications, sleeping pills, and antidepressants fall into this classification.

Lifestyle choices may also contribute. Alcohol or other drug abuse, a poor diet and smoking may be associated with vascular disease, hardening of the arteries and high blood pressure--all of which are, in turn, associated with ED.

Other chronic-disease states associated with ED include: chronic renal failure; hepatic failure; Alzheimer's disease; sleep apnea; and chronic obstructive pulmonary disease.

Very often, a combination of several factors causes ED. As the number of risk factors or conditions often leading to ED increase, the man's risk of ED rises correspondingly.

Conditions: Erectile Dysfunction

Common Causes - Erectile Dysfunction

What are the common causes of ED?

Erections reflect the brain's complex interaction with the penis/pelvic area. Nerves and chemicals cause the penis muscles to relax and allow blood flow to the penis to increase, resulting in an erection. Anything that interferes with this intricate process can cause ED.

Common causes of ED include:

  • Physiological disorders: diabetes, high blood pressure, cholesterol elevation and some cardiovascular conditions can block blood vessels and impair blood flow to the penis. Certain hormone problems and medications can also cause ED.
  • A stroke or multiple sclerosis, for example, can interfere with the brain's ability to communicate with the rest of the body. Such miscommunication during sexual functioning could cause ED. If different areas of the brain, nerves, or spinal cord are damaged, proper messages will not be relayed to the penis.
  • Psychological: ED can stem from relationship problems, performance anxiety, stress (job, family, financial), a history of sexual abuse, guilt or fear associated with sexual behavior, and depression or other mental illnesses.

Conditions: Erectile Dysfunction

Diabetes - Erectile Dysfunction

How often do men with diabetes experience ED?

Erectile dysfunction is a common issue in diabetic men -- in fact, research indicates that men with diabetes are four times more likely to experience erectile dysfunction as men without diabetes.

Erectile dysfunction occurs 10-to-15 years earlier in men with diabetes than in men without diabetes and diabetic men with ED may also suffer more severe ED than men without diabetes. The severity of their ED also increases with age, length of time and poor diabetes control. ED may also worsen with the presence of cardiovascular complications and therapy.

Understand that, with proper treatment of diabetes, the chances of diabetic men being affected by ED are reduced, but not eliminated.

Why does diabetes cause ED?

Diabetes has to do with the body's metabolism. Most of the food we eat is broken down into glucose, a type of sugar in the blood. After digestion, glucose moves into the blood stream to help cell growth and energy. A hormone, called insulin, changes glucose into the energy the body needs for daily life. In people with diabetes, though, the body produces either too little or no insulin. People with diabetes may experience frequent changes of high and low blood sugar levels.

Very high levels of blood sugar associated with diabetes can affect the penis in a variety of ways, and lead to ED. The effects include blood vessel damage, nerve damage and damage to erection tissue itself. This nerve and blood vessel damage can disrupt normal sexual function.

Diabetes can cause neuropathy, or damage to nerves, throughout the body, including the penis. These damaged nerves cannot communicate properly, meaning that the proper information is not being relayed from the brain to the penis making it difficult to have an erection firm enough for intercourse.

Additionally, poor blood sugar control in diabetic men can slow the creation of certain chemicals in the penis that enable erections, such as nitric oxide. Nitric oxide is the major neurotransmitter involved in the development and maintenance of an erection. A lack of nitric oxide can prevent the pressure of blood from rising enough to close off the valve mechanism which allows blood to flow out of the penis, preventing the man from keeping his erection.

In diabetes, chemicals known as advanced glycation end-products (AGE) are associated with stiffening of certain tissues including erectile tissue. Stiffening of these tissues can lead to a defective valve mechanism inside the corpora cavernosa. Such a defect, known as 'venous leak,' can result in severe ED and poor response to erection drugs, in particular drugs like Viagra®, Levitra® and Cialis®.

Diabetes is associated with accelerated atherosclerosis, the hardening and narrowing of blood vessels. If the blood vessels become too narrow or hard, it can result in poor circulation of blood and oxygen into the penis. This, too, can affect pressure inside the penis and lead to ED.

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Conditions: Erectile Dysfunction

Causes - Erectile Dysfunction

Introduction

Conditions of Erectile Dysfunction vary over a wide variety of health complications. Principally, ED occurs frequently in those that suffer from:

  • Obesity
  • Diabetes
  • Heart attacks
  • Radical prostatectomy

Of course, ED is not limited to these health conditions and can result from a variety of medical and non-medical related concerns.

Conditions: Erectile Dysfunction

Treating Erectile Dysfunction

What factors determine which treatment a doctor recommends for ED patients?

Erectile dysfunction has many causes, both physical and psychological. Initial management for ED depends on the possible cause of the disorder in each individual patient. Treatment options for ED have significantly improved over the past few years and new research and medications continue to increase treatment choices. Treatments offered depend on the expertise of the physician you see. For example, a urologist may offer you a greater scope of treatments than a family physician.

Deciding which treatment is best depends on a number of factors, including:

  • Whether the cause of a patient's ED is physical, psychological or both
  • The presence of other medical conditions
  • The possibility of interaction with other medications
  • Which option is most likely to be effective for a particular patient
  • The preferences of the man and his partner

Physical issues that may cause varying degrees of sexual dysfunction include: injury or surgery; underlying medical conditions, such as diabetes and/or cardiovascular disease; lifestyle issues, such as smoking and the use of alcohol or other substances; and side effects of medications used to treat other conditions. Psychological issues that can lead to ED include performance anxiety, stress or secondary sexual dysfunctions (premature, delayed and/or retrograde ejaculation).

While the first step of good medical practice is to alter controllable risk factors (such as smoking, obesity, and alcohol abuse; stress, fatigue, depression; the adjustment of prescription medications etc.), most patients with ED will need an additional form of treatment. Therapies currently available include: sexual counseling and education, oral medications, injection therapy, vacuum devices and surgical treatments.

To determine an optimal treatment plan, physicians, patients and partners must have open and honest discussions of all available options. The process of care model outlines the general approach to treatment. First-line therapy includes (1) an attempt to correct controllable risk factors (2) addressing overt psychological issues (For example, if ED commences during the first relationship after a divorce, after being widowed or where obvious confidence issues are not being helped by medical therapies, such as a sex psychologist) (3) oral therapy (pills), which at this time is limited to the use of PDE5 inhibitors, such as sildenafil citrate (Viagra®), vardenafil hydrochloride (Levitra®) and tadalafil (Cialis®).

Second-line treatment includes the use of vacuum devices, intra-urethral (urine channel) suppositories and penile injection (intracavernosal) therapy and is typically reserved for men who have failed pills or have significant side effects and cannot tolerate these medications. Third-line therapy is for patients who have explored first- and second-line therapy and includes vascular surgery for very specific populations of men and penile implant (prosthesis) surgery.

Is treatment for ED covered by insurance? Are the medicines covered?

Treatment and medicine coverage by healthcare insurance varies from one insurance provider to the next, as well as from one plan to the next. It is best to contact the individual provider in order to determine whether the prescribed treatment(s) for ED is covered by insurance.

What non-surgical treatments are available for ED?

The most common non-surgical treatments for ED include:

  • Counseling/Psychotherapy/Sex Therapy
  • Oral medications
  • Penile (intracavernosal) injections
  • Vacuum devices
  • Intra-urethral suppositories

What is involved in Counseling/Psychotherapy/Sex Therapy?

Seeking psychological treatment is very common in the treatment of ED since ED can be both due to, and the cause of, psychological stress, sexual anxiety and/or other mental health and personal issues.

Psychological treatments often involve counseling or talk therapy and include talking about relationships and experiences with a mental or sexual health professional. Therapists can help find effective ways of coping with many of these problems. Therapists can offer practical strategies that can help reduce sexual anxiety and encourage communication around sexual issues. Often, meeting with a therapist, as few as three or four times, can be very helpful. For many couples affected by ED, talking with a therapist together may produce the best results, as good communication among partners can also help solve problems in an intimate relationship that might be contributing to ED and increasing sexual anxiety.

The risks and benefits of all treatment options should be discussed with a doctor before any mode of treatment is chosen, as patient and partner satisfaction is the primary goal.

Does taking vitamins or other dietary supplements help treat or prevent ED?

Many dietary supplements, such as herbs, vitamins, and minerals, have become increasingly popular as ways to treat medical conditions and improve health. Some are even labeled and marketed as promoting sexual health and improving ED. Don't assume "natural" products are safe and effective to use, as they are not usually reviewed and/or approved by regulatory health agencies such as the U.S. Food and Drug Administration (FDA). There is very little clinical evidence to determine whether dietary supplements provide benefits to people with ED. It is best to discuss the individual risks and benefits of any dietary supplements with your physician before taking them, as some may interact with current prescriptions or complicate current medical conditions.

It is worth noting that in ED drug trials, there is a 30% placebo response rate, meaning that 30% of men on a placebo (sugar pill) claim an improvement in their erectile function. Two important caveats: first, some male health supplements contain androgens (testosterone, DHEA, androstenedione), which may be inappropriate for some men, and second, it has been shown that some of these "all natural" supplements actually contain drugs such as sildenafil citrate (Viagra®) and tadalafil (Cialis®). One of the reasons many men choose to try such supplements is that they are not permitted to use the prescription medications sildenafil citrate (Viagra®), vardenafil hydrochloride (Levitra®) and tadalafil (Cialis®), because they use or possess nitroglycerin-containing medications. Combining these two types of medications may result in life-threatening blood pressure changes. So be cautious when purchasing or using 'all natural' supplements, as they may actually not be 'all natural.'

Conditions: Erectile Dysfunction

Diagnosing Erectile Dysfunction

Introduction

The diagnosis of ED is fairly easy. Determining why ED is occurring, on the other hand, can be more difficult. To accurately identify why a patient is suffering from ED, a medical professional will usually conduct a comprehensive patient interview, followed by a physical examination, and possibly laboratory testing.

The interview may include the following types of questions:

  • Questions relating to the specific erectile complaint
  • Questions relating to medical factors that could be contributing to ED
  • Questions relating to psychosocial factors that could be contributing to ED
  • Questions relating to prior evaluation or treatment

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