Erectile Dysfunction!

Erectile Dysfunction

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Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. It’s sometimes referred to as impotence, although this term is now used less often. Occasional ED isn’t uncommon. Many people experience it during times of stress

Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. It’s sometimes referred to as impotence, although this term is now used less often. Occasional ED isn’t uncommon. Many people experience it during times of stress

  • Prostate problems
  • Type 2 diabetes
  • Hypogonadism in association with a number of endocrinologic conditions
  • Hypertension (high blood pressure)
  • Vascular disease and vascular surgery
  • High levels of blood cholesterol
  • Low levels of HDL (high-density lipoprotein)
  • Chronic sleep disorders (obstructive sleep apnea, insomnia)
  • Drugs
  • Neurogenic disorders
  • Peyronie’s disease (distortion or curvature of the penis)
  • Priapism (inflammation of the penis)
  • Depression
  • Alcohol use
  • Lack of sexual knowledge
  • Poor sexual techniques
  • Inadequate interpersonal relationships
  • Many chronic diseases, especially renal failure and dialysis.
  • Smoking, which exacerbates the effects of other risk factors, such as vascular disease or hypertension

Age appears to be a strong indirect risk factor in that it is associated with increased likelihood of direct risk factors, some of which are listed above.

Accurate risk factor identification and characterization are essential for prevention or treatment of erectile dysfunction.

Premature ejaculation is a male sexual dysfunction characterized by:

  • Ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration.
  • Inability to delay ejaculation on all or nearly all vaginal penetrations; and, negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.

Premature ejaculation is divided into lifelong and acquired categories:

  • Lifelong premature ejaculation. With lifelong premature ejaculation, the patient has experienced premature ejaculation since first beginning coitus.
  • Acquired premature ejaculation. With acquired premature ejaculation, the patient previously had successful coital relationships and only now has developed premature ejaculation.
  • Performance anxiety. Performance anxiety is a form of psychogenic ED, usually caused by stress. 
  • Sildenafil. A prescription medication taken orally for the treatment of ED. This drug works best when taken on an empty stomach and many men can get an erection 30 to 60 minutes after taking the medication. Sexual stimulation is required for sildenafil citrate to have the best efficacy. 
  • Vardenafil. This drug has a similar chemical structure to sildenafil citrate and works in a similar manner.
  • Tadalafil. Studies have indicated that tadalafil citrate stays in the body longer than other medications in its class. Most men who take this medication find that an erection occurs within 4 to 5 hours after taking the pill (slow absorption) and the effects of the medication may last up to 24 to 36 hours.
  • Avanafil,The FDA recommends that men follow general precautions before taking a medication for ED. Men who are taking medications that contain nitrates, such as nitroglycerin, should NOT use these medications. Taking nitrates with one of these medications can lower blood pressure too much. In addition, men who take tadalafil or vardenfil should use alpha blockers with care and only as instructed by their physician, as they could result in hypotension (abnormally low blood pressure). Experts recommend that men have a complete medical history and physical examination to determine the cause of ED. Men should tell their doctor about all the medications they are taking, including over-the-counter medications.

Men with medical conditions that may cause a sustained erection, such as sickle cell anemia, leukemia, or multiple myeloma, or a man who has an abnormally-shaped penis, may not benefit from these medications. Also, men with liver diseases or a disease of the retina, such as macular degeneration or retinitis pigmentosa, may not be able to take these medications, or may need to take the lowest dosage.

These medical treatments should NOT be used by women or children. Elderly men are especially sensitive to the effects of these medical treatments, which may increase their chance of having side effects.

Hormone replacement therapy

Testosterone replacement therapy may improve energy, mood, and bone density, increase muscle mass and weight, and heighten sexual interest in older men who may have deficient levels of testosterone. Testosterone supplementation is not recommended for men who have normal testosterone levels for their age group due to the risk of prostate enlargement and other side effects. Testosterone replacement therapy is available as a cream or gel, topical solution, skin patch, injectable form and pellet form placed under the skin.

Alprostadil 

Alprostadil urethral Gel is used to treat men who have erectile dysfunction (also called sexual impotence). It belongs to a group of medicines called vasodilators that can increase blood flow by expanding blood vessels. This medicine causes an erection because it increases the blood flow to the penis.

Penile implants

Two types of implants are used to treat ED, including:

  • Inflatable Penile Prosthesis (3-piece hydraulic pump). A pump and two cylinders are placed within the erection chambers of the penis, which causes an erection by releasing a saline solution; it can also remove the solution to deflate the penis. 

  • Semi-rigid Penile Prosthesis. Two semi-rigid but bendable rods are placed within the erection chambers of the penis, which allows manipulation into an erect or non-erect position.

Infection is the most common cause of penile implant failure and occurs less that 2 percent of the time. Implants are usually not considered until other methods of treatment have been tried but they have a very high patient satisfaction rate and are an excellent treatment choice in the appropriate patient.

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