Etiology of Erectile Dysfunction

Posted on April 20, 2012 by ED doctor

Etiology of Erectile Dysfunction

Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.1 The prevalence of ED is estimated at 35% in men over age 60 and in some studies as high as 50%.2,3 It has been estimated that globally, the number of patients with ED will exceed 330 million by 2030 .Despite recognition that ED is a common medical illness and not only psychogenic in origin – as historically described – patients and physicians alike often have difficulty communicating on this topic. In an international survey of more than 27,000 men and women, only 9% of respondents reported that their physician had inquired about their sexual health in the last three years.

Pharmacists – a trusted source of objective medical information are responsible for counseling and routinely dispensing medications for ED. This affords many opportunities to improve outcomes as well as provide valuable education on optimization of treatments – especially when a suboptimal response is experienced with phosphodiesterase type 5 (PDE-5) inhibitors. ED is an important patient care topic, as patients may associate sexual health with vitality and overall well-being. Furthermore, there are several treatment options, making this an amenable medical condition potentially responsive to both pharmacotherapy and nonpharmacologic measures.

Etiology of Erectile Dysfunction

A complex sequence of biochemical steps results in an erection during sexual stimulation.6 The principal mediator is nitric oxide (NO), which activates guanylyl cyclase, thereby increasing concentrations of cyclic guanosine monophosphate. The resulting relaxation of smooth muscle allows for engorgement of the penis to provide rigidity for intercourse.

ED has multiple etiologies including vascular, neurologic, and endocrine disorders. This highlights the importance of a proper physical exam and a thorough patient history. Many patients have specific modifiable vascular risk factors that can impact erectile function. Patients with vascular risk factors including hypertension, coronary artery disease (CAD), high cholesterol, and diabetes are at increased risk for ED compared to patients without these conditions.7,8 Smoking appears to further increase the risk of ED in patients with vascular risk factors, likely due to direct effects on endothelial function. Health care providers should routinely remind current smokers with ED of the beneficial effects of smoking cessation from both a cardiovascular and sexual health perspective. In regard to diabetes, poor glycemic control and duration of disease further increases risk, which highlights the need for prevention and vigilance in this patient population.

Obese patients are also at risk for ED, possibly due to increases in oxidative stress that may render NO inactive. In obese men, lifestyle changes including moderate weight loss and increased exercise can have a significant impact on retaining and improving erectile function. Additionally, ED is often the first sign of underlying, undiagnosed cardiovascular disease.

It is important that pharmacists recognize medication classes associated with ED and sexual dysfunction. For example, incidence of selective serotonin reuptake inhibitor (SSRI)–induced sexual dysfunction is estimated at 30% to 50%. In this situation, as well as in beta-blocker–induced ED, drug holidays to avoid sexual side effects should not be routinely recommended. Whenever possible, conversion to another agent within the same therapeutic class with a lower incidence of sexual side effects should be recommended. PDE-5 inhibitors may be appropriate and have been studied to improve specific causes of drug-induced sexual dysfunction.13,14 Other medications commonly associated with ED include antihypertensive agents such as calcium channel blockers, beta-blockers, and thiazide diuretics as well as miscellaneous agents including methotrexate, interferon-alpha, and 5-alpha reductase inhibitors.

Posted in Erectile Dysfunction | Tagged , , , , , , , | Comments Off

Proscar- Enlarged prostate treatment

Posted on October 21, 2011 by ED doctor

Enlarged prostate treatment

It may seem strange but enlarged prostate and male pattern baldness are two conditions that have more in common than you would expect. They are both caused by the same process in the male body and they can both be treated by the same medications, in this case Proscar.

The process that causes both the male pattern baldness and enlarged prostate, also known as benign prostatic hyperplasia (BPH) is the conversion of testosterone into a more potent hormone called dihydrotestosterone by an enzyme called type II 5-alpha reductase in the cells in the scalp and in the prostate, respectively.

Increased levels of dihydrotestosterone in the prostate cause benign prostatic hyperplasia, which is a common medical condition in men over the age of 50. Despite being a very common condition, BPH can also be a very serious condition that can have many adverse effects on the health of the individual. In about half of the people who suffer from some level of BPH, the symptoms and the complications call for medical attention and drug treatment.

Benign prostatic hyperplasia causes physical pressure on the urethra, the canal which leads the urine from the bladder to the genitals. By narrowing this passage, the flow of urine is compromised and this can lead to numerous symptoms, such as urinary retention, urinary hesitancy, painful urination, frequent urination and it also increases the risk of urinary infections. This happens due to the fact that more and more urine gets stored in the bladder, which results in increased amounts of bacteria which in turn increases the probability of infections.

There are other complications that might occur due to BPH and the two most common ones include bladder stones which form due to increased amounts of salts in the bladder and chronic urinary retention, which can lead to other complications, some of which are quite dangerous, such as renal failure.

Male pattern baldness is a much less serious condition and it involves thinning of the hair and loss of hair due to increased levels of dihydrotestosterone which has a detrimental effect on the hair follicles.

Proscar and its effects on these conditions
Proscar is a medication belonging to the class of drugs known as 5-alpha-reductase inhibitors. 5-alpha-reductase inhibitors works in such a way that it inhibits the conversion of testosterone into dihydrotestosterone which helps treat the two aforementioned conditions. However, you need to keep in mind several things about 5-alpha-reductase inhibitors treatment. If used for BPH, it can take a significant amount of time before 5-alpha-reductase inhibitors starts showing all the potential benefits. If used for male pattern baldness, the benefits are also many, from preventing further hair loss to even promoting growth of new hair. However, if the follicles have been completely destroyed by dihydrotestosterone, there is nothing 5-alpha-reductase inhibitors can do about it. You also need to keep in mind that pregnant women and children are not to come in any contact with this medication, as it can get absorbed via skin and then harm either the child handling it or the fetus.

There are other complications that might occur due to BPH and the two most common ones include bladder stones which form due to increased amounts of salts in the bladder and chronic urinary retention, which can lead to other complications, some of which are quite dangerous, such as renal failure.

Male pattern baldness is a much less serious condition and it involves thinning of the hair and loss of hair due to increased levels of dihydrotestosterone which has a detrimental effect on the hair follicles.

Posted in Erectile Dysfunction | Tagged , , , , , , | Comments Off

Confido

Posted on October 8, 2011 by ED doctor

Confido

Confido is a non-hormonal therapy acting on the higher centers of emotions in the brain and locally on the sex organs directly or indirectly. Confido reduces anxiety and calms the individual. By acting through the neuro-endocrine pathway, Confido regulates the process of ejaculation.

Confido tablets are useful when the following symptoms are displayed:

Spermatorrhea
Premature ejaculation
Nocturnal emission
Confido is a safe, non-hormonal ayurvedic formulation that acts on the higher centers of emotions in the brain and locally on the sex organs directly or indirectly. Confido reduces anxiety and calms the individual. By acting through the neuro-endocrine pathway, Confido regulates the process of ejaculation.
Benefits of Confido

Confido helps in maintaining normal sperm production
Confido inhibits premature ejaculation
Confido inhibits nocturnal emission
Himalaya Confido Composition

Each Himalaya Confido (Speman forte) tablet contains :

Salabmisri (Orchis mascula) – 78 mg
Kokilaksha (Astercantha longifolia Syn. Hygrophila auriculata) – 38 mg
Vanya kahu (Lactuca scariola Syn. L.serriola) – 20 mg
Kapikachchhu (Mucuna pruriens) – 20 mg
Suvarnavang – 20 mg
Sarpagandha (Rauwolfia serpentina)
(Standardised to contain 1.5mg of the total alkaloids)
Vriddadaru (Argyreia speciosa Syn. A.nervosa) – 38 mg
Gokshura (Tribulus terrestris) – 38 mg
Jeevanti (Leptadenia reticulata) – 38 mg
Shaileyam (Parmelia perlata) – 20 mg

Now more than ever before, guys libido is a big issue in found lifestyle.

Start up it today, and you really are certain to see commercials and advertising’s for doctor prescribed harmful drugs like The blue pill and Cialis. Relying on the trustworthiness of these remedies, you think the leading lovemaking disaster facing gents nowadays is Impotence problems (Erectile Dysfunction). There may be, though, one more sexual dysfunction facing men today.

Fast ejaculation has are a main damage to males, human relationships, and marriage during the entire globe.

In spite of how nurturing and totally determined a relationship is, using a nutritious and equitable sex romantic relationship is vital to your durability of any set. In addition, adult men as persons should feel as though they be capable to execute at a high level intimately so they can succeed and achieve in other elements in their lifetime.

What has induced this health issue to global? Research workers and professionals have reported a selection of causes, including practices, environment, and various healing difficulties. life style fears such as supplemental stress and negative slumbering patterns, enviromentally friendly components, like pollution and foodstuff superior, and healing negative effects using their company medications have most certain contributed to ejaculation problems staying as much of an issue as Edward.

Posted in Erectile Dysfunction | Tagged , , , , , , | Comments Off

Penis diseases

Posted on September 26, 2011 by ED doctor

Penis diseases

Men with penis problems usually only seek medical attention if they have painful erections and/or difficulty with intercourse. However, there are five other conditions believed to be common in most males.

Peyronie’s Disease
The most common and visible symptom of Peyronie’s disease is an extreme curving of the penis when erect. Other symptoms include pain set off by hardened, cord-like legions in the penis. The legions experience hardening as a result of the formation of hard plaque on either the upper or lower side of the penis in layers containing erectile tissue. Inflammation caused by the plaque eventually develops into a full scar with hard and inflexible scar tissue.

A penis with Peyronie’s disease will have an obvious bend in one direction, often with the angle of curvature in excess of 45 degrees. The extreme curvature of the penis can make sex difficult, and can result in serious pain during erection.

There is no need to worry about a curved penis unless the curve appeared suddenly, and/or your penis has experienced some sort of trauma.

Symptoms of Peyronie’s Disease can develop over time or overnight. Overnight appearances are usually due to some sort of serious penile injury, but not always.

Treatment is available, but may include surgery.

Hypospadias
Males born with Hypospadias have a urethral opening on the underside of the shaft of their penis (the orifice or opening in a penis used for urination and ejaculation) rather than at the end. Hypospadias affects up to one out of every 400 to 500 infants, and about 10 percent of boys born with this defect may also have undescended testicles.

Surgery is most often performed before the child reaches school age and puberty. The surgery involves creating a tube to extend the urethra to the end of the penis. The original hole is most often left as is since the urethra now bypasses it. Although the penis has two holes, only one is functional. Otherwise it will be a normal functioning penis.

Priapism
Priapism is an involuntary prolonged or painful erection that can persist for hours or days, and is not associated with sexual arousal. It can occur at any age and is a true emergency with risks of subsequent impotency. Primary priapism is the result of trauma or infection. Secondary causes include sickle cell disease, spinal cord injury and stroke. Various medications can also contribute to this condition.

Phimosis
Phimosis refers to a tightening of the foreskin that prevents the full retraction of the foreskin from the head of the penis. There are two typical forms of Phimosis, infant Phimosis and acquired Phimosis.
An infant Phimosis has an easily recognizable tubular form. This is common and healthy in infants.

The adult, or acquired, Phimosis is a thin contour of skin tissue located towards the front of the inner foreskin that narrows the opening of the foreskin. A phimotic ring can make retraction of the foreskin over and behind the glans impossible, painful and/or difficult, and the foreskin may even get stuck behind the glans. This condition is often treated by circumcision, although there are less extreme procedures depending upon the degree of Phimosis. For ‘simple’ Phimosis, stretching of the foreskin may be a method for treatment. Steroids and surgery are other options.

Large Penis Veins
It’s normal for men to have prominent veins on their penis. For some men, the appearance or change in color of veins is a result of poorly functioning valves in their testicles.

Posted in Erectile Dysfunction | Tagged , , , , , , , , , , , , , , , , , , , , , , | Comments Off

Prostatitis

Posted on September 10, 2011 by ED doctor

What is prostatitis?

Prostatitis is an inflammation of the prostate gland. Prostatitis can cause many symptoms, including the following:

Difficult or painful urination
Frequent urination
Fever
Low-back pain
Pain in the penis, testicles or perineum (the area between the testicles and the anus)
Inability to get an erection
Decreased interest in sex

Prostatitis may be easily confused with other infections in the urinary tract. If you think you have prostatitis, see your doctor.

What is the prostate gland?
Prostatitis
The prostate is a gland that lies just below a man’s urinary bladder. It surrounds the urethra and is in front of the rectum. The urethra is the tube that carries urine out of the bladder, through the penis and out of the body.

What causes prostatitis?
There are 2 kinds of prostatitis: acute prostatitis and chronic bacterial prostatitis. Both are caused by an infection of the prostate. Some kinds of prostatitis may be a result of the muscles of the pelvis or the bladder not working correctly.

How is prostatitis treated?
The treatment is based on the cause. Your doctor may do a rectal exam and test urine samples to find out the cause. During a rectal exam, your doctor may check your prostate by putting a gloved, lubricated finger into your rectum to feel the back of your prostate gland.

Antibiotics are used to treat prostatitis that is caused by an infection. You might have to take antibiotics for several weeks or a few months. If prostatitis is severe, you might have to go to a hospital for treatment with fluids and antibiotics.

What if my prostatitis is not caused by infection?
Because doctors do not yet understand what causes prostatitis without infection, it can be hard to treat. Your doctor might try an antibiotic to treat a hidden infection. Other treatments are aimed at making you feel better.

Nonsteroidal anti-inflammatory medicines, such as ibuprofen (two brand names: Advil, Motrin) or naproxen (one brand name: Aleve), and hot soaking baths may help you feel better. Some men get better by taking medicines that help the way the bladder or prostate gland work.

Can prostatitis be passed on during sex?
Sometimes prostatitis is caused by a sexually transmitted organism, such as chlamydia. However, most cases of prostatitis are caused by infections that are not sexually transmitted. These infections can’t be passed on to sexual partners.

Can prostatitis come back?
Men who have had prostatitis once are more likely to get it again. Antibiotics may not get into the prostate gland well.

Small amounts of bacteria might “hide” in the prostate and not be killed by antibiotics. Once you stop taking the antibiotic, the infection can get bad again. If this happens, you might have to take antibiotics for a longer period of time to prevent another infection. Prostatitis that is not caused by infection is often chronic. If you have this kind of prostatitis, you might have to take medicine for a long time.

Should I have my prostate gland taken out if I have prostatitis?
Prostatitis can usually be treated with medicine. Most of the time, surgery is not needed.

Does prostatitis cause cancer?
Although prostatitis can cause you discomfort, it does not cause cancer. Some doctors use a blood test called the prostate-specific antigen (PSA) to test for prostate cancer. If you have prostatitis, your PSA level might go up. This does not mean you have cancer. Your doctor will treat your prostatitis and may check your PSA level again.

Posted in Erectile Dysfunction | Tagged , , , , , , , , , , , , , , , , | Comments Off

Erectile Dysfunction and heart disease

Posted on June 25, 2011 by ED doctor

New Facts about Erectile Dysfunction

Erectile dysfunction may be a sign of heart disease

Erectile dysfunction (ED) affects approximately one in five American men, appears to be associated with cardiovascular and other chronic diseases and may predict severity and a poor prognosis among those with heart disease, according to three studies in the January 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

New medications for Erectile dysfunction, introduced in 1998, prompted a 50 percent increase in physician visits related to the condition from 1996 to 2000, according to background information in one of the articles. Most previous estimates of the impact of ED have either excluded some men based on age, ethnicity or profession or were compiled before these medications became available. This led the National Institutes of Health Consensus Development Panel on Impotence to call for national epidemiological data to provide information about prevalence and risk factors for ED, the authors write.

Doctors at the Urologic Diseases in America Project analyzed data from the 2001-2002 National Health and Nutrition Examinational Survey (NHANES). A total of 2,126 men age 20 years and older responded to the study, answered questions about sexual function and underwent a physical examination. Men who said they were sometimes or never able to maintain an erection adequate for sexual intercourse were defined as having ED.

Overall prevalence of ED was 18.4 percent, the authors report. ED occurred more often as men aged, affecting 6.5 percent of men aged 20 to 29 years and 77.5 of those aged 75 years and older. When considering other factors that might contribute to ED, including age and other medical conditions, Hispanic men had almost twice the risk of ED as white men. Obesity, hypertension, smoking and diabetes also were associated with risk of ED. “Mitigation of these risk factors may ameliorate the burden of ED,” the authors write.

Severe Heart Disease, Poor Prognosis Linked to Erectile dysfunction

In another study, researchers report that men with ED may have more severe cases of coronary heart disease and more risk factors for adverse outcomes than those without ED.

Doctors from the University of Chicago Hospitals evaluated 221 men with an average age of 58.6 years who were referred for nuclear stress testing, a noninvasive diagnostic test for evolution of heart disease. The researchers screened the men for ED and then compared their results on the tests.

Of the 221 men, 121 (54.8 percent) reported ED. Patients with ED were older than men without ED and more likely to have heart disease, diabetes and hypertension and have undergone previous procedures to restore blood flow to the heart. They also were more likely to have results on the stress test that indicated they were at high cardiovascular risk, and more of them had already developed severe heart disease.

In patients referred for stress testing, “the presence of Erectile dysfunction is common and is a strong predictor of clinically significant coronary heart disease and established markers of an adverse cardiovascular prognosis” as indicated by several tests, the authors write. “Erectile dysfunction is a stronger predictor than traditional coronary heart disease risk factors in this population,” they conclude. “Sexual function questioning may be useful to stratify risk in patients suspected to have coronary heart disease. Further studies are needed to establish whether patients with ED but no cardiac symptoms should be screened for overt coronary heart disease.”

Erectile dysfunction Common in Primary Care Patients

A third study of Canadian men visiting primary care physicians indicates that about half of them report having ED, and that it is linked with cardiovascular disease, diabetes, future heart disease risk and increased fasting blood sugar levels.

“Primary care physicians are uniquely positioned to inquire about a patient’s sexual function during a routine office visit,” the authors write. “They can also screen for modifiable risk factors and treatable comorbidities. However, there is little information available regarding the prevalence of ED among patients seen in this clinical setting.”

Specialists from Montreal General Hospital and McGill University, Montreal, Quebec surveyed 3,921 men aged 40 to 88 years who visited one of 75 primary care physicians between July 20, 2001, and Nov. 13, 2002. Participants gave medical histories and received physical examinations, including measurements of fasting blood sugar and lipid levels.

Almost half (49.4 percent) of the men reported ED during the previous four weeks or were taking medication for ED, the authors report. Men with cardiovascular disease and diabetes were most likely to have ED. Among men without cardiovascular disease or diabetes, the calculated future risk of developing these conditions was linked to likelihood of having ED. “These data demonstrate that primary care physicians may find that taking a sexual history provides important clinical information beyond the detection of ED,” the authors conclude.

Posted in Erectile Dysfunction | Tagged , , , , , , | Comments Off

Erectile Dysfunction

Posted on May 30, 2011 by ED doctor

Erectile dysfunction

(impotence)

The outlook for men with erectile dysfunction (ED) has improved enormously in the first 11 years of this century – so much so that almost all patients nowadays can be assured of a return to successful intercourse.

A lot of men feel that the new treatments for erection difficulty (formerly known as ‘impotence’ or ‘impotency’) have transformed their lives.

What is erectile dysfunction?

First, let’s understand, what is the problem. ED means an inability to get a good enough erection to achieve satisfactory intercourse.

Some patients can’t get a ‘hard-on’ at all. Others get one, but it isn’t firm enough to penetrate the partner. And others can manage penetration for a bit, but then they lose it.

Why does Erectile dysfunction occur?

Erectile dysfunction is very common, and it occurs for a variety of reasons and at different ages.

Erectile dysfunction in Teenagers and young men

In younger men, the most frequent cause is anxiety – particularly nervousness about having sex, about causing a pregnancy or about using a condom or any other reasons.

A lot of young men complain that they ‘can’t get on with a condom’ because as soon as they try to put it on, they lose their ‘stiffy’.

Erectile dysfunction inMiddle age

Common causes in this age group are overwork, stress, guilt and bereavement (ED often happens when a widowed man tries to form a new sexual relationship). A few cases are due to diabetes.
Post-middle age

In this group of men, Erectile dysfunction gets commoner with increasing age. Nonetheless, 70 percent of all 70-year-olds are sexually potent.

It is now clear that in a high proportion of cases, the problem of Erectile dysfunction is due to narrowing of the blood vessels that carry blood into the penis.

Research, which was carried out in 2007, suggests that in some older men who have erection difficulties, there may also be deterioration in the arteries of the brain or the heart.

In Oct 2008, leading sex expert Dr Geoffrey Hackett said in the British Medical Journal, ‘Erectile dysfunction is the manifestation of vascular disease in smaller arteries and can give a two to three year early warning of heart attack.’

This doesn’t mean that if you have erection problems, you’re about to have a stroke or a ‘coronary’.

But older men with Erectile dysfunction should take care to protect themselves against strokes and heart attacks – for example by keeping their blood pressure and cholesterol down and getting an adequate amount of exercise. Also, at all costs they should avoid smoking.

You may be surprised to see that I have not listed ‘lack of hormones’ as a common cause of Erectile dysfunction. In fact, lack of male hormone is pretty rare. However, it can occur particularly after severe injuries to the testicles or to the base of the brain.

If you are tempted to go to one of the many private doctors that make a habit of diagnosing ‘male hormone deficiency’, and then charging huge sums of money for testosterone treatment, I suggest you think twice.
What is an erection?

An erection occurs when blood is pumped into the penis and stays there, making it hard. It generally happens because a guy is thinking about sex or because his penis is being stimulated – or both.

The result is that signals go down the nerves that lead from his spinal cord to his genitals. They tell the blood vessels which supply the penis to open up. Blood flows in and the organ ‘blows up’ like a balloon. A valve mechanism near the base of the penis keeps the blood from flowing out again – a least, until sex is over.

As you can see, getting an erection is a complex process. It’s awfully easy for various factors to interfere with it – for instance, worry, tiredness, too much alcohol or in later life, narrowing of the blood vessels.

Nicotine is now known to narrow those vital blood vessels – which is why ED is much commoner in smokers. But often, there is nothing physically wrong with men who develop ED.
Are many cases due to psychological causes?

Yes, particularly in the young. In general, ED is quite likely to be psychological rather than physical if the man:

* is still waking with morning erections
* can still get a good erection by masturbation.

Common psychological causes of erection difficulties include:

* nerves – especially about performing
* guilt – notably if you’re trying to have sex with somebody else’s wife
* relationship problems – especially if you’re no longer keen on your partner
* latent gayness – for instance, if you’re a basically gay guy, trying to have sex with a woman
* depression
* exhaustion.

In a lot of cases, ED turns out to be due to a mixture of psychological and physical causes.
What physical causes are there?

Common physical causes of erectile dysfunction include:

* deterioration of the arteries – this is a physical change which is common in older men, including those with high blood pressure
* diabetes
* smoking
* excessive drinking (hence the phrase ‘Brewer’s droop’)
* being obese and out-of-condition
* side-effects of certain drugs, notably ones for blood pressure and depression
* effects of recreational drugs, like cocaine.

Less common physical causes of erectile dysfunction include:

* excessive drainage of blood from the veins of the penis (‘venous leak’)
* diseases of the nervous system
* injury to the spinal cord or brain
* major surgery in the abdomen, particularly prostate operations
* hormone problems, including excess production of a pituitary hormone called prolactin (this is rare).

What to do if I’m having potency problems?

If you have difficulty getting an erection, seek help. Don’t suffer in silence – as so the majority of men do!

Also, don’t hide it from your sexual partner. A lot of guys behave like this, and very often the result is that the other person decides that she is being scorned, or that ‘he doesn’t love me any more’.

Your first move should be to consult your doctor.

If for any reason you don’t want to do that, then contact another medical/relationships agency, such as the ones listed at the end of this article.

Don’t make common mistakes like:

* buying yourself some pills or potion off the Internet
* signing up with some clinic that asks you for £1,000 deposit
* going to a prostitute to see if she can cure you
* deciding that your life is over (it isn’t).

What will happen when I see a doctor or therapist?

If you go to a doctor, he should take a full history of your problem and then examine you to see if there are any physical causes for your erectile dysfunction.

A therapist or counsellor may be very useful, but they aren’t able to do physical examinations, nor can they prescribe drugs.

The doctor should also do a test for diabetes and possibly other lab tests as well.

After that, he may well be able to give you some indication of the likely cause of your ED. If he can’t, then ask if can refer you to someone who can give you further help.

Once the cause(s) of your erectile dysfunction has been identified, you can get treatment.
What treatments are now available?

Treatment of ED depends on the cause of the erectile dysfunction. For instance, psychological causes may require:

* commonsense advice to one or both partners
* counselling
* psychotherapy
* relationship counselling.

Personally, I feel that in some cases of psychologically-induced ED, it’s worth trying erection-aiding drugs to help ‘kick-start’ the man back into action and boost his confidence. Not all doctors agree with me.

The treatments for ED that have a physical origin are listed below.

Erection-aiding drugs

Oral drugs, which help produce an erection in response to sexual stimulation, have revolutionised the treatment of ED over the last 12 years.

They don’t work for everybody, but they do work for the majority – even in diabetes. They can also help people with neurological and spinal problems.

Also, the choice of available drugs means that if one particular drug doesn’t suit you, it’s well worth trying one of the others.

There are now only three orally-administered drugs available in the UK. They all have side-effects, only a few of which we can list here. For more information, read the package insert leaflet, and if in doubt ask your doctor.

It is not safe for some people to use these drugs, and some medications interact dangerously with them. Therefore, before going on any of these pills you should always see a doctor, talk things over with him, and have a physical check-up.

Do not buy erection drugs by mail-order, or from chaps you meet in pubs! They may not be the right thing.

The oral drugs currently available are:

* Viagra tablets (sildenafil)
* Cialis tablets (tadalafil)
* Levitra tablets (vardenafil).

Viagra (sildenafil)

It widens the bloods vessels, so giving an erection – provided there is some sexual stimulation.

In most men, it works within an hour. The effect lasts for about four hours. (This doesn’t mean the erection lasts for four hours, rather that an erection can be produced for up to four hours after taking a tablet.) It’s easily blocked by food in the stomach.

Viagra still remains the world’s most popular ED drug.

At the Vienna International Sexology conference of December 2006, which we attended, it was claimed that its continuing popularity is due to the ‘hardness‘ of the erections it produces.

And it certainly does give you excellent stiffness. However, we’re not convinced that it produces greater hardness than the other two drugs.

The most common side-effects are headache, visual disturbances, blocked nose, flushed face, indigestion, palpitations – and dizziness after getting out of bed too quickly! Blue vision occurs at higher doses.

Viagra is dangerous with certain heart drugs. It interacts with many medications. Do not drink grapefruit juice on the day of use, because that pushes up the blood level of the drug.

In April 2005, a report from the University of Minnesota suggested that a small group of men have suffered blindness as a result of Viagra use. It was claimed that the drug may rarely cause a serious eye condition called non-arteritic ischaemic optic neuropathy (NAION).

It’s apparent that a very small number of British men have suffered similar eye problems. If you are taking Viagra, you should ask your doctor to keep you informed of any further research on this development.

Cialis (tadalafil)

Works in the same way as Viagra. Now popular with a lot of men, because its effects last so long – at least 12 hours in most cases, which means sex can be more spontaneous. Manufacturers claim it is not blocked by food.

Side-effects are similar to those of Viagra, but it can also cause back pain and muscle pain.

Interactions with other drugs and with grapefruit juice are similar to those of Viagra but also clashes with the antibiotic clarithromycin and the sedative phenobarbital.

Cialis is very similar in structure to Viagra and there have been several reports of blindness occurring while on it.
Levitra (vardenafil)

Works in same way. Side-effects and interactions are similar to those of Viagra. Not as long-lasting as Cialis. There have been a few reports of blindness.

Please note the alleged relationship between these three drugs and blindness is still the subject of litigation. A ’cause and effect’ has still not been proved.

Posted in Erectile Dysfunction | Tagged , , , , , , , , , , , , , , , , , , , | Comments Off

Impotence

Posted on May 4, 2011 by ED doctor

What is Impotence

Impotence is a consistent inability to sustain an erection enough for sexual contact. Medical professionals often use the term “erectile dysfunction(ED)” to describe this disorder and to differentiate it from other problems that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. This fact sheet focuses on impotence defined as erectile dysfunction.

Impotence usually has a physical cause, such as disease, injury, or drug side-effects. Any disorder that impairs blood flow in the penis has the potential to cause impotence. Incidence rises with age: about 5 percent of men at the age of 40 and between 15 and 25 percent of men at the age of 65 experience impotence. Yet, it is not an inevitable part of aging.

Impotence can be a total inability to achieve erection, an inconsistent ability to do it, or a tendency to sustain only brief erections. These variations make defining impotence and estimating its incidence difficult. Experts believe impotence affects between 10 and 15 million American men. In 1985, the National Ambulatory Medical Care Survey counted 525,000 doctor-office visits for erectile dysfunction.

Impotence is treatable in different age groups, and awareness of this fact has been growing. More men have been seeking help and returning to near-normal sexual activity because of improved, successful treatments for impotence. Urologists, who specialize in problems of the urinary tract, have traditionally treated impotence–especially complications of any kinds ofimpotence.

How Does an Erection Come?

Male penis contains two chambers, called the corpora cavernosa, which run the length of the organ. A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa.

Erection starts with sensory and mental stimulation. Impulses from your brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the open spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps to trap the blood in the corpora cavernosa, thereby sustaining erection. Erection is reversed when muscles in the penis contract, stopping the inflow of blood and opening outflow channels.

What Can Cause erectile dysfunction?

Since an erection requires a sequence of events, impotence can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area of the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Damage to arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of impotence. Diseases–including diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, and vascular disease–account for about 70 percent of cases of impotence. Between 35 and 50 percent of men with diabetes experience impotence.

Surgery (for example, prostate surgery) can injure nerves and arteries near the penis, causing impotence. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to impotence by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

Also, many common drugs produce impotence as a side effect. These include high blood pressure drugs, tranquilizers, antihistamines, antidepressants, appetite suppressants, and cimetidine (an ulcer drug).

Experts believe that psychological factors cause 10 to 20 percent of cases of impotence. These factors can include guilt, stress, low self-esteem, anxiety, depression, and fear of sexual failure. Such factors are broadly associated with more than 80 percent of cases of impotence, usually as secondary reactions to underlying physical causes.

Other possible causes of impotence are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as insufficient testosterone.

How to Diagnose Impotence?

Patient History

Medical and sexual histories help define the degree and nature of impotence. A medical history can disclose diseases that lead to impotence. A simple recounting of sexual activity might distinguish between problems with erection, ejaculation, orgasm, or sexual desire.

A history of using certain prescription drugs or illegal drugs can suggest a chemical cause. Drug effects account for 25 percent of cases of impotence. Cutting back on or substituting certain medications often can alleviate the problem.

Physical Examination

A physical examination can give clues for systemic problems. For example, if the penis does not respond as expected to certain touching, a problem in the nervous system may be a cause. Abnormal secondary sex characteristics, such as hair pattern, can point to hormonal problems, which would mean the endocrine system is involved. A circulatory problem might be indicated by, for example, an aneurysm in the abdomen. And unusual characteristics of the penis itself could suggest the root of the impotence–for example, bending of the penis during erection could be the result of Peyronie’s disease.

Laboratory Tests

Several laboratory tests can help diagnose impotence. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. For cases of low sexual desire, measurement of testosterone in the blood can yield information about problems with the endocrine system.

Other Tests

Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out certain psychological causes of impotence. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then the cause of impotence is likely to be physical rather than psychological. Tests of nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be applied for best results.

Psychosocial Examination

A psychosocial examination, using an interview and questionnaire, reveals psychological factors. The man’s sexual partner also may be interviewed to determine expectations and perceptions encountered during sexual intercourse.

How Is Impotence Treated?

Most physicians suggest that treatments for impotence proceed along a path moving from least invasive to most invasive. This means cutting back on any harmful drugs is considered first. Psychotherapy and behavior modifications are considered next, followed by vacuum devices, oral drugs, locally injected drugs, and surgically implanted devices (and, in rare cases, surgery involving veins or arteries).

Psychotherapy

Experts often treat psychologically based impotence using techniques that decrease anxiety associated with intercourse. The patient’s partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical impotence is being treated.

Drug Therapy

Drugs for treating impotence can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration approved sildenafil citrate (marketed as Viagra), the first oral pill to treat impotence. Taken 1 hour before sexual activity, sildenafil works by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation, allowing increased blood flow. While sildenafil improves the response to sexual stimulation, it does not trigger an automatic erection as injection drugs do. The recommended dose is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the needs of the patient. The drug should not be used more than once a day.

Oral testosterone can reduce impotence in some men with low levels of natural testosterone. Patients also have claimed effectiveness of other oral drugs–including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone–but no scientific studies have proved the effectiveness of these drugs in relieving impotence. Some observed improvements following their use may be examples of the placebo effect, that is, a change that results simply from the patient’s believing that an improvement will occur.

Many men gain potency by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marked as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, sometimes can enhance erection when rubbed on the surface of the penis.

A system for inserting a pellet of alprostadil into the urethra is marketed as MUSE. The system uses a pre-filled applicator to deliver the pellet about an inch deep into the urethra at the tip of the penis. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects of the preparation are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness of the penis due to increased blood flow; and minor urethral bleeding or spotting.

Research on drugs for treating impotence is expanding rapidly. Patients should ask their doctors about the latest advances.

Vacuum Devices

Mechanical vacuum devices cause erection by creating a partial vacuum around the penis, which draws blood into the penis, engorging it and expanding it. The devices have three components: a plastic cylinder, in which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body (see figure 2).

One variation of the vacuum device involves a semirigid rubber sheath that is placed on the penis and remains there after attaining erection and during intercourse.

Surgery

Surgery usually has one of three goals:

1. to implant a device that can cause the penis to become erect;
2. to reconstruct arteries to increase flow of blood to the penis;
3. to block off veins that allow blood to leak from the penile tissues.

Implanted devices, known as prostheses, can restore erection in many men with impotence. Possible problems with implants include mechanical breakdown and infection. Mechanical problems have diminished in recent years because of technological advances.

Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa, the twin chambers running the length of the penis. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.

Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and pump, which also are surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.

Surgery to repair arteries can reduce impotence caused by obstructions that block the flow of blood to the penis. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch area or fracture of the pelvis. The procedure is less successful in older men with widespread blockage.

Surgery to veins that allow blood to leave the penis usually involves an opposite procedure–
intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes rigidity of the penis during erection. However, experts have raised questions about this procedure’s long-term effectiveness.

What Will the Future Bring?

Advances in suppositories, injectable medications, implants, and vacuum devices have expanded the options for men seeking treatment for impotence. These advances also have helped increase the number of men seeking treatment.

An oral form of the drug phentolamine may soon join sildenafil in the armamentarium of noninvasive treatments for impotence. Other treatments in the experimental stages include reconstruction surgery for damaged veins and arteries in the penis. Whether or not this method proves to be safe and effective, ongoing improvements in traditional methods should continue to create more successful and widespread treatment of impotence.

Posted in Erectile Dysfunction | Tagged , , , , , , , , | Comments Off