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In men who did not respond to PDE-5 inhibitors, alprostadil injections were successful in 85 out of 100 men.

Alprostadil inserted into the urethra is successful for up to two-thirds of men. Alprostadil should not be used: in men at risk of priapism (a painful erection that lasts for several hours) – for example, those with sickle cell anaemia alongside other erectile dysfunction medications if you have a penile implant or if you have been advised to avoid sexual activity. Urethral application may also not be used in: some men who have anatomical problems with their penis (conditions that affect the physical structure of the penis) men who have infections of their penis, such as balantis (inflammation of the head of the penis) Side effects.

Alprostadil can cause some side effects including: changes in your blood pressure dizziness headache pain in your penis urethral burning or bleeding reactions at the site of the injection, such as swelling. As with PDE-5 inhibitors, NHS prescriptions for alprostadil may only be available for men with particular health conditions or those receiving some types of medical treatments.

If you need to pay the full prescription cost, a single injection of alprostadil costs around ?8 to ?22, depending on the dose. A single dose of alprostadil for urethral application is around ?10.

If a hormonal condition is causing erectile dysfunction, you may be referred to an endocrinologist (who specialises in the treatment of hormonal conditions). Many hormonal conditions can be treated using injections of synthetic (man-made) hormones to restore normal hormone levels.

Surgery for erectile dysfunction is usually only recommended if all other treatment methods have failed. It may also be considered in: younger men who have experienced serious injury to their pelvic area – for example, in a car accident men with a significant anatomical problem with their penis.

In the past, surgery was used if there was clear evidence of a blockage to the blood supply of the penis.

The surgeon could unblock the blood vessels to restore a normal supply of blood.

However, research now suggests that the long-term results of this type of surgery are poor, so it's unlikely to be used.

Penile implants

are

Penile implants are not usually available on the NHS and inflatable implants may be very expensive. However, around three-quarters of men report being satisfied with the results of this type of surgery.

As with all types of surgery, having penile implants inserted carries a risk of infection.

If you take preventative antibiotics, the rate of infection is around two or three in 100.

Mechanical problems with the implants may occur within five years in five per cent of cases. If your erectile dysfunction has an underlying psychological cause then you may benefit from a type of treatment called sensate focus.

If conditions such as anxiety or depression are causing your erectile dysfunction, you may benefit from counselling (a talking therapy).

Sensate focus is a type of sex therapy that you and your partner complete together. It starts with you both agreeing not to have sex for a number of weeks or months.

During this time, you can still touch each other, but not in the genital area (or a woman’s breasts).

The idea is to explore your bodies knowing that you will not have sex.

After the agreed period of time has passed, you can gradually begin touching each other’s genital areas.

You can also begin to use your mouth to touch your partner, for example, licking or kissing, them. You can find out more about sensate focus from the College of Sexual and Relationship Therapists (COSRT). Psychosexual counselling is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues that may be contributing to your erectile dysfunction.

By talking about the issues, you may be able to reduce any anxiety that you have and overcome your erectile dysfunction. The counsellor can also provide you with some practical advice about sex, such as how to make effective use of other treatments for erectile dysfunction to improve your sex life. Psychosexual counselling may take time to work and the results achieved have been mixed. Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (CBT) is another form of counselling that may be useful if you have erectile dysfunction. CBT is based on the principle that the way you feel is partly dependent on the way you think about things. CBT helps you realise that your problems are often created by your mindset. It is not the situation itself that is making you unhappy, but how you think about it and react to it. Your CBT therapist can help you to identify any unhelpful or unrealistic thoughts that may be contributing to your erectile dysfunction – for example, to do with: your self-esteem (the way you feel about yourself) your sexuality your personal relationships. Your CBT therapist will be able to help you to adopt more realistic and helpful thoughts about these issues. Some studies have suggested that, in a few cases, it may be beneficial to exercise your pelvic floor muscles.

These are a group of muscles around the underside of the bladder and rectum, as well as at the base of the penis. Pelvic floor muscle exercise involves strengthening and training the muscles used to control

the

Some complementary therapies, such as acupuncture, have claimed to treat erectile dysfunction. In some cases, they may even include ingredients that could interact with other medications and cause side effects.

Always speak to your GP before using any complementary therapies. Healthdirect Free Australian health advice you can count on. If you need urgent medical help, call triple zero immediately. healthdirect Australia is a free service where you can talk to a nurse or doctor who can help you know what to do.

Erectile dysfunction, or impotence, means not being able to get or keep an erection that is sufficient for sexual intercourse. Many men have erectile dysfunction at some time in their lives. It is estimated erectile dysfunction affects about 1 million men in Australia. Erectile dysfunction can have a range of causes, both physical generic pharmacy cialis and psychological.

Physical factors that can cause erectile dysfunction include: general ageing health problems that affect your nerves, like spinal cord injury, multiple sclerosis (MS), diabetes, surgery that affects the pelvic area or spinal cord (prostate or bowel surgery), Parkinson’s disease and Alzheimer’s disease reduced blood flow to the penis, caused by atherosclerosis (clogging of the arteries) conditions like prostate disease, high blood pressure, underactive thyroid gland (hypothyroidism), cardiovascular disease, obesity or sleep disorders alcohol, some medicines, smoking or substance abuse Peyronie's disease (scar tissue inside the penis) treatments for prostate cancer or an enlarged prostate.

Psychological factors that can cause erectile dysfunction include: unresolved problems, conflicts or issues within a sexual and emotional relationship anxiety about sexual performance (this is most common at the start of a new relationship, especially if a man has had previous problems

with

Your doctor will first treat any health conditions that may be causing your erectile dysfunction. You may need treatment for both physical and psychological causes of erectile dysfunction.

Although it usually can’t be completely cured, there are treatments that will allow you to get an erection so you can have sex.

For physical causes, your doctor will usually suggest medicine. Other treatment options include a penis pump, implants, injections or surgery.

Treating erectile dysfunction that is caused by psychological factors could involve counselling, such as cognitive behavioural therapy, or sex therapy undertaken with your partner. Medicines for erection problems should be obtained only from an authorised Australian prescriber, such as your doctor, specialist nurse or erectile specialist.

Medicines bought on the internet may be of poor quality and may contain ingredients that are not safe when taken in combination with other medicines you are on. They may also be unsafe due to other health problems you have.

If you are worried that you might have been sold counterfeit (fake) medicines, then report it to the Therapeutic Goods Administration.

If you are still concerned about your erectile dysfunction, check your symptoms with healthdirect's online Symptom Checker to get advice on when to seek medical attention.

The Symptom Checker guides you to the next appropriate healthcare steps, whether it's self-care, talking to a health professional, going to a hospital or calling triple zero (000). Penis Erectile dysfunction medicines Testosterone Test Sexual Health. These trusted information partners have more on this topic.

If you have impotence (erectile dysfunction), the treatment your doctor recommends will depend on the severity of your symptoms and the underlying cause of your impotence.

Find out the physical and psychological causes of impotence, also called erectile dysfunction or ED.

Erectile dysfunction: visiting your doctor - myDr.com.au.

Find out what questions a doctor may ask when discussing erectile dysfunction (ED, or impotence). Erectile Dysfunction - Causes & Treatment | Healthy Male. Your doctor’s appointment Resources and videos Resources Filter resources Type: Information guide Fact sheet Clinical summary guide Video Video Video Video Video Video RESET Information guide Erectile dysfunction information guide Download PDF Fact sheet Erectile dysfunction fact sheet Download PDF Clinical summary guide Erectile dysfunction clinical summary guide (#9) Download PDF Video Erectile dysfunction and general men's health WATCH VIDEO Video Erectile dysfunction: A comprehensive guide WATCH VIDEO Video What are the causes of erectile dysfunction? WATCH VIDEO Video What are the causes of erectile dysfunction?

WATCH VIDEO Video What are the treatment options for erectile dysfunction? WATCH VIDEO Video Erectile dysfunction WATCH VIDEO SEE ALL RESOURCES. Read more on Healthy Male - Andrology Australia website.

Erectile dysfunction is the inability to develop or maintain an erection rigid enough to allow penetration of the vagina, and therefore functional sexual

intercourse

Read more on myVMC – Virtual Medical Centre website. Erectile Dysfunction: Impact on Other Diseases and Conditions | myVMC.

Erectile dysfunction is associated with many systemic health conditions, which affect a man's physical health, can impact negatively on the treatment of erectile dysfunction, and in some cases are life-threatening.

Read more on myVMC – Virtual Medical Centre website.

How do stress and anxiety affect sexual performance and erectile dysfunction?

During the COVID-19 pandemic, it is completely normal and expected to feel a certain level of stress and anxiety.

The current situation may impact our mental and generic pharmacy cialis physical health in different ways.

Read more on Healthy Male - Andrology Australia website.

Diabetes and erectile dysfunction Diabetes and low testosterone Diabetes and low sex drive Diabetes and retrograde ejaculation Diabetes and balanitis Resources and videos Resources Filter resources Type: Fact sheet Video Video RESET Fact sheet Diabetes and reproductive health fact sheet Download PDF Video Diabetes and androgens WATCH VIDEO Video Diabetes and reproductive health WATCH VIDEO SEE ALL RESOURCES.

Read more on Healthy Male - Andrology Australia website.

Sexual health A healthy sexual relationship can be an important part of someone's life. Sex therapy refers to a group of treatments which are used to resolve sexual difficulties, for example difficulties relating to sexual desire, arousal and ability to orgasm. Read more on myVMC – Virtual Medical Centre website. Finasteride provides relief of symptoms related to benign prostatic hyperplasia.

Authors' conclusions: Finasteride improves long-term urinary symptoms versus placebo, but is less effective than doxazosin.

Read more on Cochrane (Australasian Centre) website.

Drugs for benign prostatic hypertrophy - NPS MedicineWise. Alpha1a adrenergic receptor inhibition with selective (tamsulosin, silodosin, terazosin, alfuzosin) or non-selective (prazosin) drugs treat the dynamic component of benign prostatic hyperplasia by relaxing smooth muscle in the prostate and bladder neck.

Sexual difficulties in the menopause - Australasian Menopause Society.

Sexual difficulties can be life-long or recently acquired, but they are a common presentation at the menopause. Read more on Australasian Menopause Society website. Adverse effects of sports supplements in men | Australian Prescriber. Up to 1 in 5 sports supplements contain banned substances. Find out what to look for and how to manage patients with adverse effects.

Medical management of chronic stable angina | Issue 4 | Volume 38 | Australian Prescriber.

Stable angina pectoris is characterised by typical exertional chest pain that is relieved by rest or nitrates.Risk stratification of patients is important to.

Low testosterone in men | Issue 6 | Volume 37 | Australian Prescriber.

Male hypogonadism is a clinical syndrome of symptoms and signs confirmed by the presence of low testosterone.

Chronic heart failure | Issue 4 | Volume 40 | Australian Prescriber | Australian Prescriber.

Managing chronic heart failure which drugs should be used in which patients?

Healthdirect Australia is not responsible for the content and advertising on the external website you are now entering. Erectile dysfunction (male impotence) You may find it embarrassing if you are having difficulty maintaining an erection, or finding it hard to ejaculate, but you are not alone.

As many as two and a half million men around the UK may have some sort of sexual dysfunction at any one time.

Although it may not be something you want to discuss with your friends, it is important that you get some advice if you are worried about it. The most common cause of erectile dysfunction for young men is anxiety.

This may include concerns about getting someone pregnant, not wanting to appear inexperienced, or worrying about using a condom without embarrassment or losing your erection while putting a condom on. Common causes of erectile dysfunction for middle aged men may include stress, guilt, or having sex with a new partner after many years of monogamy.

Although 70% of men over the age of 70 are still sexually active, erectile dysfunction does get more likely as you get older. This may be linked to the deterioration to the blood vessels that carry blood to the penis, and also to the deterioration of heart or brain arteries. Both men and women can – and do - have problems that affect their sex lives. You may have lost interest in sex, or been unable to maintain an erection, or have difficulty with premature ejaculation, or be having difficulty having an orgasm.

There are many reasons why men may experience sexual problems.

Physical reasons for erectile dysfunction may include: Side effects from medication (mainly medication for blood pressure or depression) Other illness or infection Diabetes Smoking and or excessive drinking Being unfit or overweight Deterioration of the arteries, common in older men especially those with high blood pressure Use of recreational drugs such as cocaine. Psychological reasons for erectile dysfunction may include: Stress, which may be related to sex and or other parts of your life Concerns about your current sexual relationship(s) Depression and related fatigue Any feelings of guilt about your sexual performance or your sexual health. And although it is not an easy thing to talk about, there are trained professionals who can give you good advice about what may be the cause of your current predicament. Many men like to talk about sex, but like women, they may find it harder to talk about sex when it is not going well. We are here to help you with

some

And be aware that the vast majority of physical or psychological causes of erectile dysfunction are temporary. But if anything is bothering you or your partner, you should seek out confidential, professional advice.

There is no point in worrying and not doing anything about it. Treatment for erectile dysfunction has improved a great deal over the last 10 years. The vast majority of men – and women – can look forward to a return to sexual activity after advice and or treatment.

Indeed many men say that treatment has transformed their lives.

Treatment for erectile dysfunction is available from Dr Fox and Doctor4U. Most commonly, diagnosis will be the result of your doctor asking you about your symptoms and medical history, in association with a physical exam. Naturally, during the discussion, expect questions about the frequency, quality, and duration of your erections.

Other tests that can assist the diagnosis are as follows: Nocturnal Penile Tumescence Testing.

If you have erectile dysfunction but have normal erections during sleep, the problem may be emotional. If you have problems with an erection even while you sleep, the problem may be physical. The test is done to check for blood flow in the penis. It will also look for blockage in the arteries or veins that supply the penis.

Whereas erectile dysfunction is a man’s inability to attain or maintain an erection sufficient for satisfactory sexual performance, premature ejaculation is ejaculation which occurs sooner than desired and typically before or shortly after penetration. This is persistent, diminishes the satisfaction related to the sexual encounter and causes substantial distress to the patient and his partner. Premature ejaculation is the most common sexual dysfunction reported by men.

Differentiating between erectile dysfunction and premature ejaculation is crucial in determining an appropriate treatment strategy. Treatment options include behavioral, topical, and oral therapies and can be selected following a discussion with your provider. Your doctor may prescribe: Phosphodiesterase inhibitors. (Do not take these medications if you are also taking nitrates.) Oral testosterone , if you have low testosterone levels. Alprostadil , either injected into the penis or inserted into the urethra as a suppository.

Popular medications such as Sildenafil (Viagra) or Tadalafil (Cialis).

Use caution and talk to your doctor before taking any over-the-counter medications for erectile dysfunction.

Prior to sexual activity, a vacuum device pulls blood into the penis. A band is then placed around the penis to keep the erection.

Most vacuum devices include: A plastic cylinder for the penis.

An elastic band for holding the erection after removal of the cylinder.

Prior to sexual activity, the implants are then inflated via fluid pumped from a small reservoir near the implants, thus creating an erection.

After sexual activity, the fluid then returns to the reservoir, thus deflating the implants and allowing the penis to return to non-erect size. (See associated illustration.) Vascular surgery is done to repair blood vessel leaks in the penis.

Sex therapy with a qualified counselor may help erectile dysfunction resulting from: Ineffective sexual techniques.

To reduce your future chance of having erectile dysfunction: Take medications to manage your blood pressure and diabetes.

Ask your doctor about changing medications Maintain a healthy weight and eat a healthful diet. Smoking is significantly associated with erectile dysfunction in older men.

If you have anxiety, stress, or emotional difficulty in your life, consider talking to a therapist or counselor.

Definition Prevalence Pathophysiology Signs and Symptoms Diagnosis. Since the 1990s, erectile dysfunction (ED) has been recognized as a common problem.

Higher rates of reporting, diagnosis, and treatment of ED have been driven by effective treatments, direct to consumer advertising, and screening by health care providers. Erectile dysfunction or disorder (ED) is the inability to develop and maintain an erection for satisfactory sexual intercourse or activity. Erectile dysfunction or erectile disorder are the preferred terms as opposed to impotence . There are no uniform criteria defining how consistent the problem has to be and for what duration it must be present to considered ED. The Diagnostic and Statistical Manual of Mental Disorder-5 specifies a duration of at least 6 months in its definition of ED.

The Massachusetts Male Aging Study reported a prevalence of 52%.

2 The study demonstrated that ED is increasingly prevalent with age: approximately 40% of men are affected at age 40 and nearly 70% of men are affected at age 70. The prevalence of complete ED increased from 5% at age 40 to 15% at age 70.

2 Age was the variable most strongly associated with ED. Incidence estimates have been published using data compiled from the Massachusetts Male Aging Study. 3 Incidence data are necessary to assess risk and plan treatment and prevention strategies. The Massachusetts study data suggest there will be approximately 17,781 new cases of ED in Massachusetts and 617,715 in the United States annually.

A larger national study, the National Health and Social Life Survey, looked at sexual function in men and women.

4 This study surveyed 1,410 men aged 18 to 59 and also documented an increase in ED with age.