Erectile dysfunction (ED) is a term used when you can’t get or sustain an erection, and it can affect both men and their sexual partners. The Male Infertility & Sexual Health Program at University Hospitals offers advanced treatments and an experienced, multidisciplinary team to address many of the symptoms and causes of erectile dysfunction.
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What is the role of testosterone therapy in the treatment of erectile dysfunction?
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These tests are only done in certain patients who have not responded to initial therapies, and may include: Ultrasonography (penile Doppler) to check blood flow in the penis A special injection into the penis to check erection Arteriography (an imaging test that uses X-rays and a special dye to see inside the arteries) Magnetic resonance imaging (MRI) or computed tomography (CT) scan Nocturnal penile tumescence or NPT (using a special electronic device to monitor nocturnal erections)
Vacuum Erection Device is one such external device that is FDA approved and is easy and safe to use. At IASH, we explain step by step procedure for the safe and competent use of this device.
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The side effects of ED medicine are mostly the same. Sildenafil and vardenafil can cause: Headache. Flushing (face and upper body turning red and warm). Stomach upset. Runny nose (sniffles). vision changes (things look blue).
Another second-line therapy is the use of alprostadil, either intracavernosal or intraurethral. Two products are available for direct injection, Caverject (Pfizer) or Edex (Actient). A small needle is used to inject the medication into the lateral aspect of the penis through a small-gauge needle.
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Also talk to the doctor if it's painful to get an erection or difficult because your penis is curved (a condition called Peyronie's disease).
Studies have shown that for men with stress-related ED, when the partner is involved in the therapy, the problem is resolved 50%–70% of the time. When the man must go through counselling alone, the results are less successful. Psychosexual counselling is unlikely to be effective if a man drops out of treatment after just one or two sessions.44
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Erectile Dysfunction is one of the most commonly seen sexual issues in males. The point to note is that if occasional erection issues are there, then there is no point of concern, but getting frequent ones can actually destroy your sexual life and your relationship as well.
While its true medications can help improve blood flow and hormone levels, dietary changes and simple exercises can also help improve erectile function by supporting overall cardiovascular health. That being said, your first step should be to contact your doctor in order to determine the cause of your E.D. symptoms. In some men, E.D. is an early warning sign of cardiovascular disease.
Men with a known hypersensitivity to alprostadil should not use intraurethral prostaglandin E1.
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It is recommended that prior to proceeding with other therapies, patients reporting failure of their PDE5 inhibitors should be evaluated to determine whether the trial was adequate. This would include discussion of fatty food ingestion, which is important with sildenafil, and specific patient population such as prostatectomy and diabetes. Furthermore, patients should be encouraged to continue attempts at intercourse up to the eighth to tenth dose of PDE5 inhibitor as improvements in success rate are seen up to the eighth to tenth dose.
“ED can definitely be a standalone issue,” Dr. Baumgarten says. “Erections are complicated, involving nerves, blood vessels, and the brain.” When the brain triggers anxiety or doesn’t trigger sexual desire, it can impact erectile function. “For example, patients may have performance anxiety, and sometimes they can benefit from sex therapy.”
AntidepressantsBlood pressure medicines (especially beta-blockers)Heart medicines, such as digoxinSleeping pillsSome peptic ulcer medicines
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Once you feel comfortable with this feeling, you can incorporate this into a daily routine of performing pelvic floor exercises. It won't take long, and will soon feel like second nature.
Men with a rare heart condition known as long QT syndrome should not take vardenafil since this may lead to abnormal heart rhythms. The QT interval is the time it takes for the heart's muscle to recover after it has contracted and is measured on an electrocardiogram (EKG). In addition, vardenafil is not recommended for men taking medications that can affect the QT interval such as quinidine, procainamide, amiodarone, and sotalol.
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ED is most commonly caused by medical conditions such as diabetes and high blood pressure or pelvic surgeries. Age related decline in erectile function is also thought to occur. An injury A disease (e.g. diabetes, high blood pressure, or high cholesterol) Various studies have estimated that between 20% – 71% of individuals with diabetes suffer from erectile dysfunction. An operation (e.g. prostate gland removal) Substance use (e.g. tobacco, drugs, alcohol or medications) Stress, anxiety, depression, psychological trauma Approximately 30 million American men suffer from erectile dysfunction. Most men with erectile dysfunction still have the ability to have an orgasm and father a child, but often have difficulty doing these things because they can’t get or sustain an erection. Erectile dysfunction is not normal, and is by no means an inevitable consequence of aging. Most men at one time or another during their sexual lives are unable to get or keep an erection. This is normal and does not indicate a problem. However, millions of men of all ages experience this inability as a continuing problem. In most cases, erectile dysfunction can be overcome using medical or surgical options. We typically start with questionnaires such as the International Index of Erectile Function (IIEF) to determine the severity. Penile injections such as Trimix may be used to assess the quality of your erection and to differentiate among the many causes. Occasionally a penile duplex ultrasound is indicated if there is concern for disease in the blood vessels or penile scarring. Treatment Options for Erectile Dysfunction
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On the horizon is gene therapy that would deliver genes that produce products or proteins that may not be functioning properly in the penile tissue of men with ED. Replacement of these proteins may result in improvement in erectile function. Experimental animal models have demonstrated improvement in erectile function with gene therapy. Human studies may also demonstrate success with this therapy. Gene therapy may take a long time for regulatory approval and public acceptance.
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Are you taking any medicines, including over-the counter medicines and supplements?Do you drink, smoke, or use recreational drugs?What is your state of mind? Are you stressed, depressed, or anxious?Are you having relationship problems?
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Kegels exercises can be helpful in maintaining the blood flow and strengthen the muscles of the pelvic- region thus enabling a normal erection.
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I have severe erectile dysfunction, and it’s really affecting my self-esteem and marriage. I’ve been too embarrassed to seek help, but my wife has put her foot down and demanded I seek treatment for impotence. What is the treatment for severe ED?
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Typically, the medication is taken 1-4 hours prior to sexual activity and no more than once per day. Sildenafil and tadalafil are available in generic form, making the pills significantly less expensive than the brand-name versions.
While ED medications are safe for most men, some people should not take them. Men who are taking nitrite medications – usually for chest pain, congestive heart failure, or pulmonary hypertension – should avoid ED pills, as they can cause a severe drop in blood pressure.
This asana is also known as the standing forward bend Uttansana is mentioned in many popular yoga routines. Doing this erectile dysfunction exercise will help you deal with stress and anxiety. Doctors even say that Uttanasana can treat infertility and improve digestion and organ stimulation of the abdomen.
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The first step in the medical management of erectile dysfunction is taking a thorough sexual, medical, and psychosocial history. This is a delicate topic, and your doctor should be sensitive and caring to make you comfortable about sharing these intimate details of your private life.
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Guide For Naturally Erectile Dysfunction Exercises : How They Work?HomeMens HealthGuide For Naturally Erectile Dysfunction Exercises : How They Work?
Tadalafil (Cialis) is the third oral medicine approved by the U.S. FDA for the treatment of erectile dysfunction. Like sildenafil (Viagra) and vardenafil (Levitra), tadalafil inhibits PDE5 (as described earlier). Unlike the other PDE 5 inhibitors, patients should take tadalafil once daily and is approved for the treatment of BPH (benign enlargement of the prostate).
PRP is an injection of your own body’s platelet growth factors to stimulate cellular regeneration and tissue repair of the penis. Learn More about the P-Shot®
Carter et al. Interventions to address sexual problems in people with cancer: American Society of Clinical Oncology clinical practice guideline adaptation of Cancer Care Ontario guideline. Journal of Clinical Oncology. 2018;36(5):492-513.
ED is a complex condition that can be caused by a variety of factors. Often, there’s more than one issue that’s responsible for ED.
ED that’s caused by psychological factors, hormone issues, or injuries to the penis can usually be effectively treated.
Metabolism (breakdown) of vardenafil can be slowed by aging, liver disease, and concurrent use of certain medications (such as erythromycin [an antibiotic], ketoconazole [Nizoral, a medication for fungal/yeast infections], and protease inhibitors [medications used to treat AIDS]). Slowed breakdown allows vardenafil to accumulate in the body and potentially increase the risk for side effects. Therefore, in men over 65 years of age with liver disease, or who are also taking medication(s) that can slow the breakdown of vardenafil, the doctor will initiate vardenafil at low doses to avoid its accumulation. For example,
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Psychosexual counselling, or sex therapy, is an appropriate recommendation especially for men who are experiencing discord with their partner especially if the conflict is related to the man’s ED. Counselling usually consists of 5–20 sessions with counsellor. It is our recommendation that referral doctors treating men with ED make a referral to a psychotherapist or sex therapist who is certified by AASECT (American Association of Sexuality Educators, Counselors and Therapists) of certified sexuality educator.43
Avanafil shares the common PDE5 inhibitor side effects, contraindications, and cautions. No changes in dose are need for men with mild or moderate kidney disease. Individuals with severe kidney disease, severe liver disease, or those on kidney dialysis should not use avanafil.
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Trouble getting an erectionTrouble keeping an erectionHaving an erection that is not firm enough for intercourseLess interest in sex
Despite conflicting findings in clinical studies, men should monitor the effects of alcohol use on erectile function. Alcohol can lower testosterone levels, decrease blood flow into the penis, and cause fatigue. At least in some men, alcohol can exacerbate symptoms of E.D.
In the past, erectile dysfunction was commonly believed to be caused by psychological problems. Performance anxiety or depression can cause ED, but it's now known that for most men, erectile dysfunction is an organic problem – usually related to blood supply to the penis. Many advances have occurred in both diagnosis and treatment of erectile dysfunction.
Similar to injections, studies show that about half of men discontinue use of this treatment within six to eight months. Side effects can include pain, bleeding at the injection site, urethral pain or burning, low blood pressure, and dizziness.
Algorithm for evaluating and managing the patient with ED. CV, cardiovascular; CVD, cardiovascular disease; ED, erectile dysfunction.
ALSO READ |Should you trust the search engine for a medical diagnosis? Here’s what doctors say * The condition also leads to stress, anxiety, or depression, and you must consult a psychologist or counsellor.
Picture of the three components of inflatable penile implant. This inflatable penile device has three major components. The two cylinders are placed within the penis, a reservoir is placed beneath the rectus muscle, and the pump is placed in the scrotum. When the pump is squeezed, fluid from the reservoir is transferred into the two cylinders, producing a firm erection. Squeezing the top of the pump causes a reversal of flow of the fluid from the cylinders back into the reservoir.
Erectile Dysfunction generally occurs due to the insufficient blood flow in the arteries and the male reproductive part. And ED is caused due to the same factor that in the future gives rise to various heart diseases. So it can be said that Erectile Dysfunction can be an early sign of heart diseases that can be seen in the future.
If your erection problems have a medical cause, your doctor can explain the treatment options, the techniques needed to make them work and their suitability for your needs based on your overall health.
Erection problems usually produce a significant psychological and emotional reaction in most men. This is often described as a pattern of anxiety, low self-esteem, and stress that can further interfere with normal sexual performance. This "performance anxiety" needs to be recognized and addressed by your health care provider.
Men can have several types of issues including poor sex drive and problems with ejaculation. But ED refers specifically to trouble getting or keeping an erection. You might have a healthy sex drive, but a body that won’t respond. Most of the time there is a physical basis for the problem.
Where erectile dysfunction is predominantly due to a physical cause, patients may describe a gradual onset of symptoms, which may occur across a variety of settings and different stimuli. Where the psychological component is the main factor, patients may describe a sudden onset in symptoms with erectile dysfunction varying dependent on the situation.
Yes, ED can also be a sign for prostate cancer as the Erectile Dysfunction symptoms include urinating issues, weak urinary stream, and urine blood. All these symptoms are also the early signs of prostate cancer in a body.
Squats can also be done as exercises to help erectile dysfunction, because they not only strengthen the thigh and buttock muscles, but increase the blood flow and circulation to the groin area. To do a proper squat, feet should be planted flat on the ground, roughly shoulder-width apart. Keeping the back straight, the upper body can then be lowered down slowly by bending the knees. To finish the exercise, the body is lifted back up. These exercises can be repeated ten to 30 times. Kegel exercises can be used to treat impotence in aging men.
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Did you know that around 5% of men aged 40, and 15% of men aged 70 have complete erectile dysfunction?
In addition, hormones and other substances determine how your nerves transmit ‘sexual signals’ and how blood vessels respond to the received signals. Arousing thoughts or nervous-system mechanisms such as touch reflexes are 2 ways you can get an erection.
“People shy away from consulting an expert and instead opt for products like supplements, creams etc., available in the market. But, it may not be safe. Before using any such products, check with your doctor, especially if you have chronic health conditions,” the doctor concludes.
Your doctor may ask you to fill out questionnaires, which are used to assess different aspects of your sexual health. The most common are: The International Index for Erectile Function (IIEF) The Sexual Health Inventory for Men (SHIM) The International Prostate Symptom Score (IPSS) The Clinical Depression Questionnaire
A duplex ultrasound is a diagnostic technique that uses painless, high frequency sound waves to measure blood flow in structures such as the penis.The procedure itself is painless. It is usually performed before and after injection of a smooth muscle relaxing medication into the penis, which should significantly increase the diameter of the penile arteries.A duplex ultrasound is most useful in evaluating possible penile arterial disorders. Further studies of the venous drainage system as well as arterial imaging are usually recommended if vascular reconstructive surgery is anticipated.
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