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All men receiving testosterone replacement need to have periodic measurement of haemoglobin and haematocrit to monitor for erythrocytosis.

False (both groups have endothelial dysfunction) Erectile Dysfunction: Management and Treatment.

The type of medical specialist who treats ED will depend on the cause of the problem. Based on your family's medical history, as well as your own medical history and current health, your doctor may treat you with oral medications (Viagra®, Levitra®, Cialis®). If these options fail, you may be referred to a urologist who can assist with other non-surgical options such as vacuum device or injections or surgical treatment options.

If needed, your doctor may also refer you to a psychologist specializing in sexual dysfunction. ED can be treated in many ways, including: Oral medications.

Discuss your options with your doctor to determine the best treatment for you.

The first step to treating ED is to find the underlying cause. There are a number of non-surgical and surgical options that can help a man regain normal sexual function.

What non-surgical treatments are there for erectile dysfunction (ED)?

Education about sex, sexual behaviors, and sexual responses may help a man overcome his anxieties about sexual dysfunction. Talking honestly with your partner about your needs and concerns may also help to overcome many barriers to a healthy sex life. Medications such as sildenafil (Viagra®), vardenafil (Levitra®), or tadalafil (Cialis®) may help improve sexual function in men by increasing blood flow to the penis. Men who are on medicines that contain nitrates such as nitroglycerine should not take oral ED medications. The combination of nitrates and these specific medications can cause low blood pressure (hypotension). The most common side effects of these medications are indigestion, nasal congestion, flushing, headaches and a temporary visual disturbance. Aids such as vacuum devices and penile constriction rings serve as erectile aids for some men.

A vacuum constriction device (above) is a cylinder that is placed over the penis. The air is pumped out of the cylinder, which draws blood into the penis and causes an erection. The erection is maintained by slipping a band off of the base of the cylinder and onto the base of the penis. The vacuum device can be safely used to treat most causes of erectile failure. Lack of spontaneity, discomfort, and cumbersomeness of the device seem to be the biggest concerns of patients. Penile injection therapy (intracavernosal injection therapy) Men are taught how to inject medications directly into the erection chambers of the penis to create an erection.

Injection therapy is effective in treating a wide variety of erection issues caused by blood vessel, nerve and psychological conditions. Using a tiny needle and syringe, the man injects a small amount of medicine into the side of his penis. The medicine relaxes the blood vessels, allowing blood to flow into the penis.

This treatment has been widely used and accepted since the early 1980s. The three most common medicines are prostaglandin E1 (alprostadil), papaverine (Papacon®), and phentolamine (Regitine®). The most common side effects are pain and penile scarring (fibrosis).

In extremely rare cases, patients with cerebral and vascular disease or severe cardiovascular diseases might not be able to tolerate the dizziness and high blood pressure occasionally caused by injection therapy.

A painful erection that lasts longer than two to three hours is called priapism and may occur with injection therapy. This can be lessened with proper dosing and by following the treatment guidelines. Psychological causes may contribute to erectile failure even when there is a clear organic cause. Therapy with a trained counselor can help a person address feelings of anxiety, fear or guilt that may have an impact on sexual dysfunction.

Sex therapy can be beneficial to most men when viagra no prescription fast counseling is provided by a skilled sex therapist.

Sex therapy also helps a man's partner accept and cope with the problems. A patient whose ED has a clear psychological cause should receive sex therapy counseling before any invasive treatments are pursued.

Hormone replacement in the form of topical gels, creams, patches, injections and pellets are only used after physician evaluation. What are surgical treatment options for erectile dysfunction (ED)? Inflatable penile prostheses are implanted during outpatient surgery.

Once they are part of a man's body, they enable him to have an erection whenever he desires. The use of a prosthesis preserves penile sensation, orgasm and ejaculation for most men. The most commonly used penile implant consists of a pair of inflatable cylinders that are surgically implanted in the erection chambers of the penis.

The cylinders are connected through tubing to a reservoir of fluid under the lower abdominal muscles, and to a pump inside the scrotal sac.

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fluid from the reservoir to the cylinders. When inflated, the prosthesis makes the penis stiff and thick, which is very similar to a natural erection. A penile prosthesis does not change the sensation on the skin of the penis or a man's ability to achieve orgasm or ejaculate. Pressing on a deflation valve attached to the pump returns the fluid to the reservoir, which returns the penis to a flaccid state.

The surgical procedure is performed through one or two small incisions


are generally well hidden.

Other people will be unable to tell that a man has an inflatable penile prosthesis. Complications following surgery are not common, but primarily include infection and mechanical device failure. Approximately 95% of penile implant surgeries are successful in producing erections that enable men to have sexual intercourse.

Moreover, patient satisfaction questionnaires show that up to 90% of men who have undergone penile implants say they would choose the surgery again, and overall satisfaction ratings are higher than those reported by men using oral medication or penile injection therapy.

Last reviewed by a Cleveland Clinic medical professional on 10/14/2019.

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Is There a Space to Improve the Treatment of Erectile Dysfunction in the Next Years? 1 online prescription ed Executive Director, Center for Marital and Sexual Health of South Florida.

2 Professor Emeritus, Case Western Reserve University School of Medicine. Keywords: Erectile Dysfunction; Therapeutics; PDE-5 Inhibitors. Prior to the US approval of sildenafil in 1998, the available treatment options for erectile dyfunction (ED) included: intraurethral alprostadil (MUSE), intracavernosal injections (tri mix, alprostadil), vacuum pump therapy, placement of a penile prosthesis, hormone replacement therapy and individual or couples psychotherapy ( 1 – 7 ).

The approval of sildenafil, a phosphodiesterase type 5 inhibitor (PDE5i), dramatically changed the treatment and research landscape. By utilizing sildenafil millions of men with ED could reliably and safely restore their erectile function. In addition to sildenafil, three other PDE5i medications have been approved in the US for the treatment of ED; they are: tadalafil (daily and as needed), vardenafil and avanafil. While the PDE5i medications are successful in restoring erectile function in the majority of men, they are not as effective in men whose cavernous nerve has been damaged from a radical prostatectomy or in men with diabetes mellitus.

Additionally, some men may not respond to PDE5i's because their vascular disease is too severe, they take concomitant medications that interfere with ED restoration, or they harbor severe psychological and/or interpersonal issues that overwhelm the prosexual effect of the drug. For men who utilize nitrate medications, PDE5i's are contraindicated because of their synergistic hypotensive effects, therefore these men must find other treatment options. For all the above reasons clinicians would welcome new agents that could overcome the limitations of the current PDE5i drugs.

I am certain that we will see new and better options for men suffering from ED.

The introduction of the PDE5i's drugs revolutionized the manner in which we currently treat ED patients and opened the pathway for further research into the biological underpinnings of ED. One important limitation of the PED5i's is that they only provide short-term solutions to the chronic vascular issues that cause the ED. Treatments that would cure or reverse the underlying precipitating and maintaining factors would move us beyond the current standard of care.

Stem cell therapy is an exciting new treatment option that in theory offers the potential to reverse the underlying causes of ED and reduce patient reliance on the tran sient effects of the PDE5i drugs.

It is also targeted at men with cavernous nerve injury or diabetic men whose response to PDE5i drugs is suboptimal.

Stem cell therapy was initially based on the theoretical rationale that stem cells can differentiate into a range of cell types such as endothelial, smooth muscle, Schwann cells, and neurons8. Stem cells were delivered via intracorporal penile injections to replenish the depleted endothelial cells and/or caveronous smooth muscle cells. A different theoretical understanding is that stem cell therapy results in the host's regeneration, as opposed to simply replenishment, of endothelial and cavernous smooth muscle cells and is able to restore the interactions between these structures ( 8 ).

The vast majority of published studies focus on animal models with only one study in humans and one ongoing clinical trial in humans.

Lin reports that intracavernous injected stem cells can escape the penis and hone into the bone marrow possibly accounting for systemic antidiabetic effects and prolonged restoration of erectile function ( 8 ).


and promising therapies for ED continue to evolve. The PDE5i's significantly advanced our understanding and ability to treat men suffering from ED. However, stem cell therapy may become the next generation of ED treatment offering the field of sexual medicine and our patients new possibilities.

While it will take time to conduct the necessary human trials and obtain regulatory and ethical approvals, stem cell therapy may move us into the next wave of treatment options for ED.

Psychotherapy for erectile dysfunction: now more relevant than ever.

Dean JD, McMahon CG, Guay AT, Morgentaler A, Althof SE, Becher ER et al. The International Society for Sexual Medicine's Process of Care for the Assessment and Management of Testosterone Deficiency in Adult Men. Male sexual function: A guide to clinical management.

Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA.

Oral sildenafil in the treatment of erectile dysfunction.

Padma-Nathan H, Hellstrom WJ, Kaiser FE, Labasky RR Lue TR Nolten WE, et al.

Treatment of men sildenafil citrate 200 mg online with erectile dysfunction with transurethral alprostadil.

Medicated Urethral System for Erection (MUSE) Study Group. Shabsigh R, Padma-Nathan H, Gittleman M, McMurray J, Kaufman J, Goldstein I. Intracavernous alprostadil alfadex (EDEX/VIRIDAL) is effective and safe in patients with erectile dysfunction after failing sildenafil (Viagra).

Penile prostheses for the treatment for erectile dysfunction. Lin CS, Xin ZC, Wang Z, Deng C, Huang YC, Un G, et al.

Stem cell therapy for erectile dysfunction: a critical review. Althof , Executive Director, Center for Marital and Sexual Health of South Florida, Professor Emeritus, Case Western Reserve University School of Medicine, 1515 North Flagler Drive, Suite 540, West Palm Beach, Florida 33401, Fax: + 1 561 822-5458, E-mail: sxa6@case.edu. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Rua Bambina, 153 22251-050 Rio de Janeiro RJ Brazil Tel. Erectile Dysfunction (ED) The UW Health Men’s Health program offers comprehensive and compassionate expertise for a wide array of men’s urological needs, including erectile dysfunction, hypogonadism (low testosterone) and urinary problems.

Erectile dysfunction can encompass several different conditions of reproductive health and sexual dysfunction. It is a very common condition, but is also a very emotional and sensitive topic to discuss. Erectile dysfunction is defined as the inability to maintain an erection sufficient for sexual intercourse. Achieving an erection is a complex process involving the brain, hormones, nerves, muscles and blood circulation.

If something interferes with this process, the result may be erectile dysfunction. In some cases, erectile dysfunction is the first sign of other serious underlying health conditions, such as cardiovascular problems, that need treatment because erectile dysfunction can share the same risk factors for heart attacks and strokes.

About 5 percent of men that are 40 years old have complete erectile dysfunction, and that number increases to about 15 percent of men at age 70. Mild and moderate erectile dysfunction affects approximately 10 percent of men per decade of life (i.e., 50 percent of men in their 50s, 60 percent of men in their 60s).

Erectile dysfunction


occur at any age, but it is more common in men that are older.

Older men are more likely to have health conditions that require medication, which can interfere with


function. Additionally, as men age, they may need more stimulation to get an erection and more time between erections.

There are three essential components of male sexual function: Interest and desire for sexual activity (libido) The ability to obtain and maintain an erection Ejaculation and climax (orgasm) During an initial visit, the urologist will help to differentiate which components of the male sexual function are affected.

This is an important step because treatment options for differ depending on the affected components. There are many possible causes of erectile dysfunction, both physical and psychological, including: Psychological/Environmental. There are several steps men can take to reduce their risk for erectile dysfunction, including: Quit smoking Exercise regularly Maintain a healthy weight and healthy diet Limit or avoid the use of alcohol Reduce stress Get help for anxiety or depression Discontinue drugs with harmful side effects Have regular check-ups with a primary care physician to monitor blood pressure, blood sugar and cholesterol levels. UW Health urologists with advanced training offer suhagra tablet online medical and surgical treatment options for men and their partners affected by erectile dysfunction.

There are several different ways that erectile dysfunction can be treated.

For some men, making a few healthy lifestyle changes may solve the problem. Your urologist will help determine the most effective course of treatment for your condition. Erectile dysfunction (ED) is when a man has persistent problems achieving and/or sustaining an erection. Erectile dysfunction can make sexual intercourse impossible without treatment.

Erectile dysfunction can first emerge in a man as early as 40 according to the Massachusetts Male Aging Study on sexual dysfunction. They also found that an estimated 18 to 30 million men are affected by erectile dysfunction. Erectile online prescription ed online prescription ed dysfunction refers specifically to problems achieving or maintaining an erection.

Other forms of male sexual dysfunction include poor libido and problems with ejaculation.

Men with erectile dysfunction often have a healthy libido, but their bodies fail to respond in the sexual encounter by producing an erection.

Can Low Testosterone (Low T) Cause Erectile Dysfunction?

While low T isn't the only cause of erectile dysfunction, the two do seem to be connected. However, the connection between low testosterone and erectile dysfunction is complicated.

Researchers believe two are connected because they both seem to coincide as a man ages.

However, some men with low testosterone continue to produce healthy erections. Symptoms of erectile dysfunction include erections that are too soft for sexual intercourse, erections that last only briefly, and an inability to achieve erections. Men who cannot have or maintain an erection at least 75% of the time that they attempt sex are considered to have erectile dysfunction.

According to the Massachusetts Male Aging Study, about 40% of men experience some degree of inability to have or maintain an erection at age 40 compared with 70% of men at age 70.

And the percentage of men with erectile dysfunction increases from 5% to 15% as age increases from 40 to 70 years.

When blood fills two chambers in the penis (known as the corpora cavernosa) an erection occurs. This causes the penis to expand and stiffen, much like a balloon as it is filled with water. The process is triggered by nerve impulses from the brain and genital area.

Anything that interferes with these impulses or restricts blood flow to the penis can result in erectile dysfunction.

The link between underlying chronic disease and erectile dysfunction is most striking with diabetes.

Approximately half of the men with diabetes experience erectile dysfunction.

Nevertheless, good blood sugar control can minimize this risk. In addition, the following four diseases can lead to erectile dysfunction by interfering with blood flow or nerve impulses throughout the body. Cardiovascular disease Atherosclerosis (hardening of the arteries) Kidney disease Multiple sclerosis. Lifestyle choices, such as smoking, alcohol abuse, and obesity can impair blood circulation and lead to erectile dysfunction.

Smoking, excessive drinking, and drug abuse may damage the blood vessels and reduce blood flow to the penis. Smoking makes men with atherosclerosis even more vulnerable to erectile dysfunction. Smokers have almost twice the risk of erectile dysfunction compared with nonsmokers.

Being overweight and getting too little exercise also contribute to erectile dysfunction. Men who exercise regularly have a lower risk of erectile dysfunction.

Surgical or radiation treatments for prostate cancer, bladder cancer, or prostate enlargement (BPH) can sometimes damage nerves and blood vessels near the penis. Occasionally, the nerve damage is permanent and the patient requires treatment to achieve an erection. Sometimes, surgery causes temporary erectile dysfunction that improves on its own after 6 to 18 months.

Many medications can cause or contribute to erectile dysfunction, including certain blood pressure drugs, antidepressants, and tranquilizers. Men with erectile dysfunction should talk with their doctor if they suspect a prescription online prescription ed or over-the-counter drug may be causing erectile problems. It is common for men with erectile dysfunction to have an underlying physical basis for it, particularly in older men. However, psychological factors may be present in 10% to 20% of men with erectile dysfunction.

Experts say stress, depression, poor self-esteem, and performance anxiety can impair the ability to have an erection.

These factors can also make erectile dysfunction worse in men whose sexual dysfunction stems from something physical.

Avid cyclists suffer more erectile dysfunction than other athletes because the shape of some bicycle seats causes pressure on the nerves that are vital to sexual arousal.

Cyclists who ride for many hours each week may benefit from seats designed to protect the perineum. To diagnose erectile dysfunction, the doctor will ask questions about the symptoms and medical history. A complete physical exam is done to detect poor circulation or nerve trouble. The physician will look for abnormalities of the genital area that could cause problems with erections. Many lab tests can be helpful in diagnosing male sexual problems.

Measuring testosterone levels can determine whether there is a hormonal imbalance, which is often linked to decreased desire.

These tests may reveal underlying medical causes of ED: Blood cell counts Cholesterol levels Blood sugar levels Liver function tests.

Erectile dysfunction can be a warning sign of serious underlying disease. Research has found that erectile dysfunction is a strong predictor of heart attack, stroke, and even death from cardiovascular disease.

All men with erectile dysfunction should be evaluated for cardiovascular disease.

Notably, this does not mean every man with erectile dysfunction will develop heart disease, get viagra prescription doctor or that every man with heart disease has erectile dysfunction; however, erectile dysfunction patients should be aware of the link. 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.

While popularized in the media, Viagra is not the only erectile dysfunction drug.

Other erectile dysfunction drugs include: Cialis Levitra Staxyn Stendra. These drugs work by improving blood flow to the penis during arousal and are taken 30 to 60 minutes before sexual activity.

Cialis can be taken up to 36 hours before sexual activity and also comes in a lower, daily dose. There are also injectable drugs for erectile dysfunction.

Some men sustain stronger erections by injecting these medications directly into the penis. These drugs work by widening the blood vessels, causing the penis to become engorged with blood.

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