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With acquired premature ejaculation, the patient previously had successful coital relationships and only now has developed premature ejaculation.

Performance anxiety is a form of psychogenic ED, usually caused by stress. Diagnostic procedures for ED may include the following: Patient medical or sexual history.

This may reveal conditions or diseases that lead to impotence and help distinguish among problems with erection, ejaculation, orgasm, or sexual desire.

To look for evidence of systemic problems, such as the following: A problem in the nervous system may be involved if the penis does not respond as expected to certain touching.

Secondary sex characteristics, such as hair pattern, can point to hormonal problems, which involve the endocrine system. Circulatory problems could be indicated by an aneurysm. Unusual characteristics of the penis itself could suggest the basis of the impotence. These can include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes.

Measurement of testosterone in the blood is often done in men with ED, especially with a history of decreased libido or diabetes.

This is done to help reveal psychological factors that may be affecting performance.

The sexual partner may also be interviewed to determine expectations and perceptions encountered during sexual intercourse. Specific treatment for erectile dysfunction will be determined by your doctor based on: Your age, overall health, and medical history. Your tolerance for specific medications, procedures, or therapies. Some of the treatments available for ED include: Medical treatments: 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.

This drug has a similar chemical structure to sildenafil citrate and works in a similar manner.

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. 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. 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.

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.

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

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.

Many times, men will avoid sexual situations due to the emotional pain associated with ED, causing their partner to feel rejected or inadequate. It is important to communicate openly with your partner. Some couples consider seeking treatment for ED together, while other men prefer to seek treatment without their partner's knowledge.

A lack of communication is the primary barrier for seeking treatment and can prolong the suffering. The loss of erectile capacity can have a profound effect on a man.

The good news is that ED can usually be treated safely and effectively. Feeling embarrassed about sexual health problems may prevent many men from seeking the medical attention they need, which can delay diagnosis and treatment of more serious underlying conditions.

Erectile Dysfunction itself is often related to an underlying problem, such as heart disease, diabetes, liver disease, or other medical conditions.

Since ED can be a forewarning symptom of progressive coronary disease, doctors should be more direct when questioning patients about their health.

By

asking

Most men have

occasionally

However, erectile dysfunction (ED) is only considered a concern if satisfactory sexual performance has been impossible on a number of occasions for some time. Since the discovery that the drug sildenafil, or Viagra, affected penile erections, most people have become aware that ED is a treatable medical condition.

Men who have a problem with their sexual performance may be reluctant to talk with their doctor, seeing it can be an embarrassing issue. However, ED is now well understood, and there are various treatments available. This MNT Knowledge Center article offers helpful information for people experiencing this problem, or those close to them. Fast facts on erectile dysfunction: Erectile dysfunction (ED) is defined as persistent difficulty achieving and maintaining an erection sufficient to have sex. Causes are usually medical but can also be psychological. Organic causes are usually the result of an underlying medical condition affecting the blood vessels or nerves supplying the penis.

Numerous prescription drugs, recreational drugs, alcohol, and smoking, can all cause ED. Normal erectile function can be affected by problems with any of the following systems: blood flow nerve supply hormones.

Share on Pinterest Erectile dysfunction can cause embarrassment.

It is always worth consulting a physician about persistent erection problems, as it could be caused by a serious medical condition.

Whether the cause is simple or serious, a proper diagnosis can help to address any underlying medical issues and help resolve sexual difficulties. The following list summarizes many of the most common physical or organic causes of ED: heart disease and narrowing of blood vessels diabetes high blood pressure high cholesterol obesity and metabolic syndrome Parkinson’s disease multiple sclerosis hormonal disorders including thyroid conditions and testosterone deficiency structural or anatomical disorder of the penis, such as Peyronie disease smoking, alcoholism, and substance abuse, including cocaine use treatments for prostate disease surgical complications injuries in the pelvic area or spinal cord radiation therapy to the pelvic region.

Atherosclerosis is a common cause of blood flow problems. Atherosclerosis causes a narrowing or clogging of arteries in the penis, preventing the necessary blood

flow

Anyone taking prescription medications should consult their doctor before stopping or changing their medications: drugs to control high blood pressure heart medications such as digoxin some diuretics drugs that act on the central nervous system, including some sleeping pills and amphetamines anxiety treatments antidepressants, including monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants opioid painkillers some cancer drugs, including chemotherapeutic agents prostate treatment drugs anticholinergics hormone drugs the peptic ulcer medication cimetidine. Physical causes account for 90 percent of ED cases, with psychological causes much less common. In rare cases, a man may always have had ED and may never have achieved an erection.

This is called primary ED, and the cause is almost always psychological if there is no obvious anatomical deformity or physiological issue.

Such psychological factors can include: guilt fear of intimacy depression severe anxiety.

Most cases of ED are ‘secondary.’ This means that erectile function has been normal, but becomes problematic.

Causes of a new and persistent problem are usually physical.

Less commonly, psychological factors cause or contribute to ED, with factors ranging from treatable mental health illnesses to everyday emotional states that most people experience at some time. It is important to note that there can be overlap between medical and psychosocial causes.

For instance, if a man is obese, blood flow changes can affect his ability to maintain an erection, which is a physical cause. However, he may also have low self-esteem, which can impact erectile function and is a psychosocial cause. Questions remain about the effects on men’s health of riding a bicycle.

Some research has raised buy the blue pill online concerns that men who regularly cycle for

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The most recent study to investigate this found that there was no link between riding a bike and ED, but it did find an association between longer hours of cycling and the risk of prostate cancer.

However, prostate surgery to remove the cancer and radiation therapy to treat prostate cancer can cause ED.

Treatment of non-cancerous, benign prostate disease can also cause the condition.

ED isn’t just a natural part of aging that you’re stuck accepting. Guys with ED have several erectile dysfunction treatment options to consider, depending on the reason for their ED.

The sooner you learn about ED treatment alternatives, the sooner you can go back to sharing and enjoying intimate moments with your significant other.

There are many different body parts that play an essential role for a man to get and maintain an erection during sexual intercourse. Beyond the physical causes that can lead to ED, it has been reported that 20% of ED is related to psychological causes. 2 With so many possibilities leading to erectile dysfunction, it becomes particularly important to find a specialist who can correctly diagnosis the direct cause of your ED and find a treatment option that is right for you. Often, a physical exam and a discussion regarding medical history will be enough to diagnosis erectile dysfunction and start you on your treatment pathway.

22 As discussed in the “Causes of ED” page; however, there can be many different underlying reasons that have led to ED, and additional tests may be needed to determine the exact cause.

Physical Exam – an examination of the testicles and penis while also checking nerves for sensation.

Blood Tests – Can help to identify signs of heart disease, diabetes, low testosterone, and other health issues. Urine Tests – Similar to a blood test, a urine test can help identify diabetes or other potential causes.

Ultra Sound – This test is usually conducted by a specialist to determine if there is a lack of blood flow which is preventing you from getting an erection. There are many different treatment options for erectile dysfunction, but your diagnosis will determine which treatment option is right for you. It is important to realize that not all treatment options will work for everyone. A doctor who has specialized in men’s sexual health (typically a urologist) will be the most qualified to discuss all of your treatment options with you. Many specialists will often encourage you to schedule additional follow up appointments to review how your treatment is working for you or if a different option may be more beneficial.

When you make an appointment to discuss ED with your doctor, he’ll go over your options and help you decide what’s best for your unique situation. He might suggest making lifestyle changes, trying drug therapy, or getting a penile implant.

The same healthy lifestyle tips your doctor has been recommending for years may also help treat your ED: 21.

Quitting smoking Reducing alcohol consumption Losing weight Exercising regularly Reducing stress. These steps aren’t an instant fix, but they may improve your blood flow and nerve functioning.

If you’re having trouble sticking to these goals, ask your spouse or partner to join you.

Getting healthy together and trying new things as a couple can be a great bonding experience and can strengthen your relationship.

When lifestyle changes alone don’t work, drug therapy is normally the next step. Most of these medications work similarly to enhance a natural chemical in your body that relaxes the muscles in your penis. The goal of this medication is to increase your response to sexual stimulation by increasing the blood flow in your penis allowing you to get an erection.

With drug therapy, there’s a risk of side effects such as headaches, back pain or an upset stomach.

Before taking any medication for erectile dysfunction, it is important to ensure your doctor is ok with that decision. Medication may not work for all men, for instance, if you have diabetes or have previously had prostate surgery. ED medication might also have serious risks if you’re currently taking nitrates (commonly prescribed for chest pain), have heart disease or have low blood pressure. In addition to pills, injections can be used to treat ED.

Erections usually occur within

5-20

Urethral suppositories can also be used to treat ED. An applicator containing a small pellet (suppository) is inserted in the urethra, and the pellet is released.

Common side effects include pain or minor bleeding in the urethra.

Also called vacuum devices, penile pumps are devices that are placed over the penis to draw blood into the shaft.

Once the vacuum creates an erection, the retaining band is slid down to the lower end of the penis, and the pump is removed. An erection typically will

last

When other treatments haven’t helped, a penile implant may be the right solution. A penile implant is a medical device that is surgically placed into a penis to mimic the look and performance of a natural erection 9 . Sensitivity and the ability to ejaculate aren’t typically affected either, so you’ll be able to have an orgasm normally (unless you have a medical condition that prevents this) 7 .

To learn about erectile dysfunction alternatives like the Coloplast Titan® penile implant, visit our Penile Implants page. To arrange to speak with a man who has had the procedure about the impact of having an implant, head over to our Patient Educator page. Every policy is a little different, but most insurance providers do offer some form of coverage for ED treatment. Penile implants, for example, are covered by most insurers and Medicare when they are determined to be medically necessary for a man who has not responded to other treatment alternatives. Our Insurance page outlines some of the steps you can take to learn more about the out-of-pocket cost for treating ED. The reimbursement specialist at your urologist’s office might also be able to help you sort out the specifics of your coverage.

As you consider your treatment options make sure you and your doctor consider all of the options. These physicians specialize in the treatments for erectile dysfunction and urinary incontinence. They can be an excellent source of information about the risks and benefits of each treatment. By working with a physical therapist, you can find out if kegel exercises may help relieve your erectile dysfunction. Learn more on our Physical Activity and Exercise page.

There are a number of prescription medications available that may improve blood flow to the penis. Commonly used medications are Viagra, Cialis, and Levitra.

Combined with sexual stimulation, this can produce an erection. They can interfere with other medications you are taking and negatively impact your health. With injection therapy a needle is used to inject medication directly into the base or side of the penis. The medication allows blood to flow into the penis, creating an erection.

A plastic cylinder is placed over the penis, and a pump (either manual or battery operated) creates a vacuum suction within the cylinder, drawing blood into the penis to create an erection. A stretchable tension band is placed at the base of the penis to help maintain the erection. An applicator containing a small medicated pellet or suppository is inserted and released into the urethra through the opening at the tip of the penis.

The pellet is about the size of a grain of rice and dissolves to increase blood flow to the penis, creating an erection. Entirely contained within the body, a pump fills two cylinders and. Once activated you can maintain an erection as long as you desire. Penile implants require a surgical procedure by a physician, typically a urologist who has been trained and is skilled in penile prosthetics. There are three different types of penile implants: 3-piece inflatable implant, 2-piece inflatable implant, and a 1-piece bendable (malleable) implant.

Because each type of implant offers unique features, the risks and benefits should be discussed with the physician to help choose the most appropriate option.

Erectile dysfunction (ED) is one of the most common conditions affecting middle-aged and older men. Nearly every primary care physician, internist and geriatrician will be called upon to manage this condition or to make referrals to urologists, endocrinologists and cardiologists who will assist in the treatment of ED. This article will briefly discuss the diagnosis and management of ED.

In addition,

emerging

Finally, future potential therapies for ED will be discussed.

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Nearly every

primary

Some primary care physicians think that sexual potency in older men is the norm, and that if it is lacking, it is ‘all in the head.’ This viewpoint has not been supported by current literature. The Massachusetts Male Aging Study (MMAS) found that 52% of men between 40 and 70 years old reported having some form of erectile dysfunction (ED).1 The reality is that ED is a natural part of ageing and that the prevalence increases with age.

In the MMAS, they found that roughly 50% of men at 50 years old, 60% of men at 60 years old and 70% of men at 70 years old had ED.

Thus, nearly all men who live long enough should develop ED.

The myths that surround the problems of impotence or ED confound the attempts of patients to receive treatment and the attempts of physicians to help them.1.

Many factors can contribute to sexual dysfunction in older men, including physical and psychological conditions, comorbidities and the medications used to treat them.

Aspects of an ageing man’s lifestyle and behaviour and androgen deficiency, most often decreasing testosterone

levels

A study of men between the ages of 30 and 79 years showed that 24% had testosterone levels below 300 ng/dL and 5.6% had symptomatic androgen deficiency.2.

The percentage of men who engage in some form of sexual activity decreases from 73% for men aged 57–64 years to 26% for men aged 75–85 years.3 For some men, this constitutes a problem, but for others it does not. The aetiology for this decline in sexual activity is multifactorial and is in part due to the fact that most of the female partners undergo menopause at 52 years of age with a significant decline in their libido and desire to engage in sexual activity.

A study by Lindau and colleagues3 that examined sexuality in older Americans showed that 50% of the men in a probability sample of more than 3000 US adults reported at least one bothersome sexual problem and 33% had at least two such problems.3 This article will review the normal changes that occur with ageing, factors that influence these changes, individual variations and perspectives, and the available treatment options for ED and androgen deficiency.