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Diagnostic testing for erectile dysfunction kubat pharmacy sildenafil should usually be limited to obtaining a fasting serum glucose level and lipid panel, thyroid-stimulating hormone test, and morning total testosterone level.

First-line therapy for erectile dysfunction should consist of oral phosphodiesterase type 5 inhibitors. Phosphodiesterase type 5 inhibitors are most effective in the treatment of erectile dysfunction associated with diabetes mellitus and spinal cord injury, and of sexual dysfunction associated with antidepressants. Additional therapy for erectile dysfunction may consist of psychosocial therapy and testosterone supplementation in men with hypogonadism. Testosterone supplementation in men with hypogonadism

improves

erectile dysfunction and libido.

Screening for cardiovascular risk factors should be considered in men with erectile dysfunction. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.

For information about sildenafil cheap the SORT evidence rating system, go to https://www.aafp.org/afpsort.xml .

Diagnostic testing for erectile dysfunction should usually be limited to obtaining a fasting serum glucose level and lipid panel, thyroid-stimulating hormone test, and morning total testosterone level. First-line therapy for erectile dysfunction should consist of oral phosphodiesterase type 5 inhibitors.

Phosphodiesterase type 5 inhibitors are most effective in the treatment of erectile dysfunction associated with diabetes mellitus and spinal cord injury, and of sexual dysfunction associated with antidepressants.

Additional therapy for erectile dysfunction may consist of psychosocial therapy and testosterone supplementation in men with hypogonadism.

Testosterone supplementation in men with hypogonadism improves erectile dysfunction and libido. Screening for cardiovascular risk factors should be considered in men with erectile dysfunction.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.

For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.xml .

Abstract Prevalence Pathophysiology Diagnosis and Evaluation Treatment Link to Cardiovascular Disease References.

Many men associate advancing age with declining sexual function and an overall decreased quality of life. ED affects up to one third of men throughout their lives, and the incidence increases with age. health professionals found the prevalence of sexual dysfunction in men to be 12 percent in those younger than 59 years, 22 percent in those 60 to 69 years of

age

, and 30 percent in those older than 69 years.3 Persons with type 2 diabetes mellitus have a threefold

greater

risk of ED compared with the general population.4 Depression increases the risk of ED, but it is not clear if this relationship is causal.5.

Abstract Prevalence Pathophysiology Diagnosis and Evaluation Treatment Link to Cardiovascular Disease References.

ED may result from organic causes (e.g., vascular, neurogenic, hormonal, anatomic, drug-induced), psychological causes, or a combination of both.

A normal sexual erectile response results from the interaction between neurotransmitter, biochemical, and vascular smooth muscle

responses

initiated by parasympathetic and sympathetic neuronal triggers that integrate physiologic stimuli of the penis with sexual perception and desire.

Nitric oxide produced from endothelial cells after parasympathetic stimuli triggers a molecular cascade that results in smooth muscle relaxation and arterial influx of blood into the corpus cavernosum.

This is followed by compression of venous return, which produces an erection.6. History of pelvic irradiation or surgery, including radical prostatectomy.

Hormonal disorders (e.g., hypogonadism, hypothyroidism, hyperprolactinemia) Illicit drug use (e.g., cocaine,

methamphetamine

) Medications (e.g., antihistamines, benzodiazepines, selective serotonin reuptake inhibitors) Neurologic conditions (e.g., Alzheimer disease, multiple sclerosis, Parkinson disease, paraplegia, quadriplegia, stroke) Psychological conditions (e.g., curexa pharmacy sildenafil anxiety, depression, guilt, history of sexual abuse, marital or relationship problems, stress) Information from reference 9 .

History of pelvic irradiation or surgery, including radical prostatectomy. Hormonal disorders (e.g., hypogonadism, hypothyroidism, hyperprolactinemia) Illicit drug use (e.g., cocaine, methamphetamine) Medications (e.g., antihistamines, benzodiazepines, selective serotonin reuptake inhibitors) Neurologic conditions (e.g., Alzheimer disease, multiple sclerosis, Parkinson disease, paraplegia, quadriplegia, stroke) Psychological conditions (e.g., anxiety, depression, guilt, history of sexual abuse, marital or relationship problems, stress) Information from reference 9 . Abstract Prevalence Pathophysiology Diagnosis and Evaluation Treatment Link to Cardiovascular Disease References. There is no preferred, first-line diagnostic

test

for ED, and routine screening is not recommended.

History and physical examination are sufficient in making an accurate diagnosis of ED in most cases.

Penile duplex ultrasonography is not a useful diagnostic test for ED.7 The American Urological Association (AUA) recommends that the initial evaluation of ED include a complete medical, sexual, and psychosocial history.8 The medical history may reveal comorbid conditions, risk factors related to ED ( Table 1 ),9 or medications that contribute to ED ( Table 2 ).6 Sexual history should focus on erection adequacy, altered libido, quality and timing of orgasm, volume and appearance of ejaculate, presence of sexually-induced genital pain or penile curvature (Peyronie disease), and partner sexual function. The five-item version of the International Index of Erectile Function Questionnaire is a validated survey instrument that can be used to assess the severity of ED symptoms ( Table 3 ).10. Medications and Substances That May Cause or Contribute to Erectile Dysfunction.

Lithium, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, tricyclic antidepressants.

Dimenhydrinate, diphenhydramine (Benadryl), hydroxyzine (Vistaril), meclizine (Antivert), promethazine (Phenergan) Alpha blockers, beta blockers, calcium channel blockers, clonidine (Catapres), methyldopa, reserpine. Bromocriptine (Parlodel), levodopa, trihexyphenidyl.

Digoxin, disopyramide (Norpace), gemfibrozil (Lopid) Spironolactone (Aldactone), thiazides. 5-alpha sildenafil cheap reductase inhibitors, corticosteroids, estrogens, luteinizing hormone-releasing hormone agonists, progesterone. Amphetamines, barbiturates, cocaine, heroin, marijuana. Medications and Substances That May Cause or Contribute to Erectile Dysfunction.

Lithium, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, tricyclic antidepressants. Dimenhydrinate, diphenhydramine (Benadryl), hydroxyzine (Vistaril), meclizine (Antivert), promethazine (Phenergan) Alpha blockers, beta blockers, calcium channel blockers, clonidine (Catapres), methyldopa, reserpine.

Bromocriptine (Parlodel), levodopa, trihexyphenidyl.

Digoxin, disopyramide (Norpace), gemfibrozil (Lopid) Spironolactone (Aldactone), thiazides. 5-alpha reductase inhibitors, corticosteroids, estrogens, luteinizing hormone-releasing hormone agonists, progesterone.

Amphetamines, barbiturates, cocaine, heroin, marijuana. Five-Item Version of the International Index of Erectile Function Questionnaire.

How do you rate your confidence that you could get and keep an erection?

When you had erections with sexual stimulation, how often were your erections hard enough for penetration? During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? When you attempted sexual intercourse, how often was it satisfactory for you? note : The score is the sum of the above five question responses. Erectile dysfunction is classified based on these scores: 17 to 21 = mild; 12 to 16 = mild to moderate; 8 to 11 = moderate; 5 to 7 = severe .

Adapted with permission from Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development otc sildenafil cvs and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction .

Five-Item Version of the International Index of Erectile Function Questionnaire. How do you rate your confidence that you could get and keep an erection? When you had erections with sexual stimulation, how often were your erections hard enough for

penetration

? During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? When you attempted sexual intercourse, how often was it satisfactory for you? note : The score is the sum of the above

five

question responses.

Erectile dysfunction is classified based on these scores: 17 to 21 = mild; 12 to 16 = mild to moderate; 8 to 11 = moderate; 5 to 7 = severe . Adapted with permission from Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction .

The physical examination should assess blood pressure and heart rate; body habitus, for central obesity; and cardiovascular, neurologic, and genitourinary systems, including penile, testicular, and digital rectal examinations ( Figure 1 ).8 , 9 , 11 – 14 The AUA and World Health Organization recommend limited diagnostic testing in men with ED. This may include a fasting serum glucose level and lipid panel, thyroid-stimulating hormone test, and morning total testosterone level.8 , 11 Additional diagnostic testing and urologic evaluation may be warranted in cases of ED refractory to standard therapies ( Table 4 ).11 Clues to the diagnosis of ED are listed in Table 5 .



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