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Visit https://www.coloradouro.com/specialties/axol-softwave-therapy/ or call 888-401-7149. Colorado Urology, an affiliate of United Urology Group, is Eastern Colorado's premier urology practice, which was formed when Advanced Urology, Alpine Urology, and Foothills Urology became one urology group in April 2019. The group provides a broad array of urologic services, and its integrated approach to urologic care provides patients with access to experienced specialists, a comprehensive support team of healthcare professionals, innovative diagnostic tools, and highly advanced treatments and therapies.

Colorado Urology operates 12 medical offices throughout the Denver metro and Boulder area, has 18 urologists, 9 advanced practice providers, and more than 130 employees. United Urology Group is a national management services organization whose member groups of urology practices include : Arizona Urology Specialists with locations across the greater Phoenix area; Chesapeake Urology, with offices located throughout Maryland and Delaware ; Tennessee Urology, based in Knoxville, TN ; and Colorado Urology, located in the greater Denver , Boulder and Front Range areas.

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Media Contact: Patricia Schnably , Senior Vice President, Marketing & Communications United Urology Group 25 Crossroads Drive, Suite 306, Owings Mills, MD 21117 443-738-8107 [email protected] Erectile Dysfunction (ED, Impotence) Medical Author: Pamela I. Ellsworth, MD Medical Editor: Melissa Conrad Stoppler, MD. Erectile dysfunction (ED), also known as impotence, is the persistent inability to have an erection that is hard enough online shopping viagra tablet for penetration and/or a hard erection that lasts long enough for completion of sexual activity.

ED may have a significant effect on the sex life of a man and his partner.

Symptoms of erectile dysfunction include lack of an erection hard enough for penetration and/or lasting long enough for completion of sexual activity.

ED may occur with or without other sexual dysfunction, including decreased libido (decreased interest in sexual activity), orgasmic dysfunction (troubles achieving an orgasm/climax), and ejaculatory dysfunction (problems with the fluid released during sex, including lack of ejaculation [anejaculation], small volume ejaculate, ejaculation that occurs too quickly [premature ejaculation], ejaculate that goes backward into the bladder [retrograde ejaculation] and pain with ejaculation). Erectile dysfunction is common, and the risk of developing ED increases with age.

Experts have estimated that erectile dysfunction affects 30 million men in

the

United States.

The causes of erectile dysfunction include aging, high blood pressure, diabetes mellitus, cigarette smoking, online shopping viagra tablet atherosclerosis (hardening of the arteries), depression, nerve or spinal cord damage, medication side effects, alcoholism or other substance (drug) abuse, pelvic surgery including radical prostatectomy, pelvic radiation, penile/perineal/pelvic trauma such as pelvic fracture, Peyronie's disease (a disorder that causes curvature of the penis and sometimes painful erections), and low testosterone levels. Erectile dysfunction is treatable in all age groups.

Treatments include psychotherapy, adopting a healthy lifestyle, oral phosphodiesterase type V (PDE5) inhibitors (Viagra, Levitra, Cialis, Stendra, and Staxyn), intraurethral prostaglandin E1 (MUSE), intracavernosal injections (prostaglandin E1 [Caverject, Edex], Bimix and Trimix), vacuum devices, penile prosthesis and vascular surgery, and (in some cases) changes in medications when appropriate. Discuss over-the-counter products and/or supplements with a doctor before using them. New research is ongoing in the field of erectile dysfunction to find improved and effective therapies. No matter what erectile dysfunction treatment or treatments (whether herbal remedies or not) a man ultimately decides upon, experts say it's important to eat healthily and to avoid smoking and heavy drinking. Moreover, adequate exercise, stress reduction, and sleep can improve erectile dysfunction in many. Erectile dysfunction (ED), also known as impotence, is the inability to achieve or sustain a hard enough erection for satisfactory completion of sexual activity. Erectile dysfunction is different from other health conditions that interfere with male sexual function, such as lack of sexual desire (decreased libido) and problems with ejaculation release of the fluid from the penis (ejaculatory dysfunction) and orgasm/climax (orgasmic dysfunction), and penile curvature (Peyronie's disease), although these problems may also be present. This article focuses on the evaluation and treatment of erectile dysfunction. The penis contains three cylinders, the two corpora cavernosa, which are on the top of the penis (see figure 1 below).

The third cylinder contains the urethra, the tube that the urine and ejaculate passes through, runs along the underside of the penis.

Spongy tissue that has muscles, fibrous tissues, veins, and arteries within it makes up the corpora cavernosa.

The inside of the corpora cavernosa is like a sponge, with potential spaces that can fill with blood and distend (known as sinusoids).

A layer of tissue that is like Saran Wrap, called the tunica albuginea, surrounds the corpora.

Veins located just under the tunica albuginea drain blood out of the penis.

Erectile dysfunction (ED, impotence) varies in severity; some cannot have an erection at all, whereas other men sometimes have troubles getting a hard erection, and others get a hard erection but it only lasts for a short period of time.

Approximately 50% of men over the age of 40 have troubles with erectile dysfunction.

While erectile dysfunction can occur at any age, the risk of developing erectile dysfunction increases with age.

According to the Massachusetts Male Aging Study, the prevalence of erectile dysfunction was 52% in men 40-70 years of age. The prevalence of complete erectile dysfunction increases from 5% at 40 years of age to 15% among men 70 years of age and older.

Erections are neurovascular events, meaning that nerves and blood vessels (arteries and veins) are involved in the process of an erection and all must work properly to develop a hard erection that lasts long enough.

Sexual stimulation can be tactile (for example, by a partner touching the penis or by masturbation) or mental (for example, by having sexual fantasies, viewing porn).

Sexual stimulation or sexual arousal causes the nerves going to the penis to release a chemical, nitric oxide.

Nitric oxide increases the production of another chemical, cyclic GMP (cGMP), in the muscle of the corpora cavernosa.

The cGMP causes the muscles of the corpora cavernosa to relax, and this allows more blood to flow into the penis. The incoming blood fills the corpora cavernosa, making the penis expand.

As blood flows into the penis, the corpora cavernosa swell, and this swelling compresses the veins (blood vessels that drain the blood out of the penis) against the tunica albuginea. Compression of the veins prevents blood from leaving the penis. When the amount of cGMP decreases by the action of a chemical called phosphodiesterase type 5 (PDE5), the muscles in the penis tighten, and the blood flow into the penis decreases. With less blood coming into the penis, the veins are not compressed, allowing blood to drain out of the penis, and the erection goes down.

Women's Bodies Can Impede Less Desirable Sperm Will a Pill Cure Gonorrhea? New Test Can Tell A New 'Spin' on How Sperm Swim HPV Shots: Safe and Effective, But Many Hesitate Want More News? Restaurants, Bars Are COVID Hotspots Hope Against Dyslexia How Reliable Are COVID-19 Tests? Wildfires, COVID, and Lung Health More Health News » Trending on MedicineNet. Cold Stages of Lyme Disease Flu Shot Alopecia Areata Chiggers Bites. Read Doctor's View Readers Comments 2 Share Your Story. The ability to achieve and sustain erections requires the following: A healthy nervous system that conducts nerve impulses in the brain, spinal column, and penis Healthy arteries in and near the corpora cavernosa that when stimulated can bring increased blood flow into the penis Healthy muscles and fibrous tissues within the corpora cavernosa, which can distend to allow the penis to fill with blood Adequate levels of nitric oxide in the penis Normal-functioning tunica albuginea that allows for compression of the veins Appropriate psychosocial interactions.

Erectile dysfunction can occur if a man doesn't meet one or more of these requirements. The following are causes of erectile dysfunction, and many men have more than one potential cause: Aging : There are two reasons why older men are more likely to experience erectile dysfunction than younger men. First, older men are more likely to develop diseases (such as heart attacks, angina, cardiovascular disease, strokes, diabetes mellitus, and high blood pressure) that are associated with erectile dysfunction.

Second, the aging process alone can cause erectile dysfunction in some men by causing changes in the muscle and tissue within the penis. Diabetes mellitus : Erectile dysfunction tends to develop 10 to 15 years earlier in diabetic men than among nondiabetic men.

The increased risk of erectile dysfunction among men with diabetes mellitus may be due to the earlier onset and greater severity of atherosclerosis (hardening of the arteries) that narrows the arteries and thereby reduces the delivery of blood to the penis. Atherosclerosis can affect the arteries in the penis, as well as the arteries in the pelvis that supply the penile arteries.

Diabetes mellitus also causes erectile dysfunction by damaging nerves that go to the penis, much like the effect of diabetes on nerves in other areas of the body (diabetic neuropathy). Diabetes can also affect the muscles in the penis, leading to troubles with erections. Smoking cigarettes, obesity, poor control of blood glucose levels, and having diabetes mellitus for a long time further increase the risk of erectile dysfunction in people with diabetes. Hypertension (high blood pressure) : Men with high blood pressure have an increased risk of developing erectile dysfunction. Hypertension can cause troubles with erections related to atherosclerosis or from low levels of nitric oxide production from the arteries in the penis.

Medications to treat hypertension may cause erectile dysfunction.

Cardiovascular diseases : The most common cause of cardiovascular diseases in the United States is atherosclerosis, the narrowing and hardening of arteries that reduces blood flow.

Atherosclerosis (a type of vascular disease) typically affects arteries throughout the body; hypertension, high blood cholesterol levels, cigarette smoking, and diabetes mellitus aggravate atherosclerosis.

Hardening of the arteries to the penis and pelvic organs, atherosclerosis, causes insufficient blood flow into the penis.

There is a close correlation between the severity of atherosclerosis in the coronary arteries and erectile dysfunction.

For example, men with more severe coronary artery atherosclerosis (hardening of the arteries in the heart) also tend to have more erectile dysfunction than men with mild or no coronary artery atherosclerosis.

Some doctors suggest that men with new onset erectile dysfunction undergo evaluation for silent coronary artery diseases (advanced coronary artery atherosclerosis that has not yet caused angina or heart attacks).

Metabolic syndrome is associated online shopping viagra tablet with multiple risk factors for erectile dysfunction including diabetes, abnormal lipid profile, hypertension, and obesity. Cigarette smoking : Cigarettesmoking aggravates atherosclerosis and can cause vasospasm (spasms of the arteries) and thereby increases the risk for erectile dysfunction. Nerve or spinal cord damage : Damage to the spinal cord and nerves in the pelvis can cause erectile dysfunction. Nerve damage can be due to disease, trauma, or surgical procedures. Examples include injury to the spinal cord from automobile accidents, injury to the pelvic nerves from prostate surgery for cancer (prostatectomy), and some surgeries for colorectal cancer, radiation to the prostate, surgery for benign prostatic enlargement, multiple sclerosis (a neurological disease with the potential to cause widespread damage to nerves), and long-term diabetes mellitus. BPH : Benign enlargement of the prostate is associated with erectile dysfunction.

Trauma : Trauma to the pelvis, including pelvic fracture, may cause erectile dysfunction, and an untreated penile fracture may result in erectile dysfunction. Substance abuse : Marijuana, heroin, cocaine, methamphetamines, crystal meth, and narcotic and alcohol abuse contribute to erectile dysfunction. Alcoholism, in addition to causing nerve damage, can lead to atrophy (shrinking) of the testicles and lower testosterone levels.

Low testosterone levels : Testosterone (the primary sex hormone in men) is not only necessary for sex drive (libido) but also is necessary to maintain nitric oxide levels in the penis.

Therefore, men with hypogonadism (low testosterone with

symptoms

) can have low sex drive and erectile dysfunction. Medications : Many common medicines produce erectile dysfunction as a side effect.

Medicines that can cause erectile dysfunction include many used to treat high blood pressure, antihistamines, antidepressants, tranquilizers, and appetite suppressants.

Examples of common medicines that can cause erectile dysfunction include propranolol (Inderal) or other beta-blockers, hydrochlorothiazide, digoxin (Lanoxin), amitriptyline (Elavil), famotidine (Pepcid), cimetidine (Tagamet), metoclopramide (Reglan), naproxen, indomethacin (Indocin), lithium (Eskalith, Lithobid), verapamil (Calan, Verelan, Isoptin), phenytoin (Dilantin), gemfibrozil (Lopid), amphetamine/dextroamphetamine (Adderall), and phentermine.

Prostate cancer medications that lower testosterone levels such as leuprolide (Lupron) may affect erectile function. Some chemotherapies such as cyclophosphamide (Cytoxan) may affect erectile function. Recreational drugs : Recreational drugs, including alcohol, amphetamines, barbiturates, marijuana, nicotine, heroin and cocaine, are associated with erectile dysfunction.

Depression and anxiety : Psychological factors may be responsible for erectile dysfunction. These factors include stress, anxiety, guilt, depression, widower syndrome, low self-esteem, posttraumatic stress disorder, and fear of sexual failure (performance anxiety).

It is also worth noting that many medications used for treatment of depression and other psychiatric disorders may cause erectile dysfunction or ejaculatory problems.

The common risk factors for ED include the following: Advanced age Cardiovascular disease Hypertension Diabetes mellitus High cholesterol Cigarette smoking Recreational drug use Depression or other psychiatric disorders Pelvic surgery, including radical prostatectomy and colorectal surgery Pelvic radiation, such as for prostate cancer and some colorectal cancers Trauma to the pelvis (pelvic fracture), penis (penile fracture), and perineum. Signs and symptoms of erectile dysfunction may include the following: Penile erection occurs, but the penis does not remain hard enough for completion of sex.

Penile erections are not hard enough for penetration. One can still achieve an orgasm and ejaculate with erectile dysfunction. Subscribe to MedicineNet's Men's Health Newsletter. By clicking "Submit," I agree to the MedicineNet Terms and Conditions and Privacy Policy.

I also agree to receive emails from MedicineNet and I understand that I may opt out of MedicineNet subscriptions at any time. How do health care professionals diagnose erectile dysfunction? Physicians make a diagnosis of erectile dysfunction in men who complain of troubles having a hard enough erection or a hard erection that does not last long enough. It is important as you talk with your doctor that you be candid in terms of when your troubles started, how bothersome your erectile dysfunction is, how severe it is, and discuss all your medical conditions along with all prescribed and nonprescribed medications that you are taking. Your doctor will ask several questions to determine if your symptoms are suggestive of erectile dysfunction and to assess its severity and possible causes.

Your doctor will try to get information to answer the following questions: Is the patient suffering from erectile dysfunction or from some other form of sexual dysfunction such as loss of libido or a disorder of ejaculation (for example, premature ejaculation) or orgasm, or problems with penile curvature/pain (Peyronie's disease)?

Is your erectile dysfunction due to psychological (stress, relationship problems, etc.) or physical factors? Your doctor may ask if you note erections at night or in the early morning.

Men have involuntary erections in the early morning and during REM sleep (a stage in the sleep cycle with rapid eye canadian viagra cost movements).

Men with psychogenic erectile dysfunction (erectile dysfunction due to psychological factors such as stress and anxiety rather than physical factors) usually maintain these involuntary erections.

Men with physical causes of erectile dysfunction (for example, atherosclerosis, smoking, and diabetes) usually do not have these involuntary erections. Men with psychogenic erectile dysfunction may relate the onset of problems to a "stressor," such as failed relationship.

Your doctor may suggest a test to determine if you have erections during sleep, which may suggest that there may be a psychological cause of the erectile dysfunction.

Erectile dysfunction may be a symptom of underlying medical conditions, which if not detected may cause further medical problems.

A prior history of cigarette smoking, heart attacks, strokes, and poor circulation in the extremities (for example, intermittent claudication or cramping in your leg[s] when you walk) suggest atherosclerosis as the cause of the erectile dysfunction. Loss of sexual desire and drive, lack of sexual fantasies, gynecomastia (enlargement of breasts), and diminished facial hair suggest low testosterone levels.

A prior history of pelvic surgery or radiation and trauma to the penis/pelvis/perineum can cause problems with the nerves and blood vessels. Symptoms of intermittent claudication of the lower extremities with exercise may suggest a vascular problem as a cause of the erectile dysfunction.

Is the patient taking medications that can contribute to erectile dysfunction (see causes above), including prescribed, over-the-counter, or recreational drugs? It is important to discuss your prescribed medications, as well as over-the-counter medications and drugs of abuse such as opiates, alcohol, etc. The physical examination can reveal clues for physical causes of erectile dysfunction.

A doctor will perform an assessment of BMI and waist circumference to evaluate for abdominal obesity.

A genital examination is part of the evaluation of erectile dysfunction. The examination will focus on the penis and testes.

The doctor will ask you about penile curvature and will examine the penis to see if there are any plaques (hard areas) palpable. The doctor will examine the testes to make sure they are in the proper location in the scrotum and are normal in size.

Small testicles, lack of facial hair, and enlarged breasts (gynecomastia) can point to hormonal problems such as hypogonadism with low testosterone levels.

A health care provider may check pulses in your groin and feet to determine if there is a suggestion of hardening of sildenafil 200 mg online the arteries that could also affect the arteries to the penis. The lab testing obtained for the evaluation of erectile dysfunction may vary with the information obtained on the health history, physical examination, and recent lab testing. A testosterone level is not necessary in all men; however, a physician will order labs to determine a patient's testosterone level if other signs and symptoms of hypogonadism (low testosterone) such as decreased libido, loss of body hair, muscle loss, breast enlargement, osteoporosis, infertility, and decreased penile/testicular size are present.



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