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Psychotherapy can be beneficial for men with erectile dysfunction even when erectile dysfunction has a known physical cause. The therapist can instruct the man and his partner in techniques to reduce performance anxiety and improve intimacy.

Therapy can also help couples adjust to the use of vacuum devices and implants. Erectile Dysfunction Treatment: Alternative Therapies. Men with erectile dysfunction should talk with their doctors before trying supplements for erectile dysfunction.

They can contain 10 or more ingredients and may complicate other health conditions.

Asian ginseng and ginkgo biloba (seen here) are popular, but there isn't a lot of good research on their effectiveness.

Some men find that taking a DHEA supplement improves their ability to have an erection. Unfortunately, the long-term safety of DHEA supplements is unknown. There are dozens of "dietary supplements" that claim to treat erectile dysfunction, but the FDA warns that many of these are not what they seem. One investigation discovered that supplements for erectile dysfunction can often contain prescription drugs not listed on the label, including the active ingredient in Viagra.

These can put the man at risk for dangerous drug interactions.

To reduce your sildenafil buy online risk of erectile dysfunction, exercise and maintain a healthy weight, stop smoking, avoid alcohol and substance abuse, and keep your diabetes under control, if you have it. It's natural to feel angry or embarrassed when confronted with erectile dysfunction.

Talking openly about erectile dysfunction with your partner will help them understand the diagnosis and treatment options (and will reassure your partner that you haven't lost interest).

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Reviews in Urology Journal: "Relationship Between Testosterone and Erectile Dysfunction" 3 ways to treat erectile dysfunction without Viagra. Erectile dysfunction occurs when you can't get an erection or can't keep a firm enough erection to have sex.

Having mild or moderate erectile dysfunction is common — it affects about half of men at age 50 and becomes increasingly more prevalent beyond 50.

Being unable to keep an erection can cause issues in your relationships or your self-confidence, but there are ways to treat or even cure the condition. Though there are drugs like Viagra on the market, some people would prefer a more natural approach.

Here are a few methods you can try at home to help treat erectile dysfunction. "Kegel exercises help strengthen the muscles that keep the erection full and hard," says William Brant, MD, a urologist at Granger Medical Clinic in Utah.

These muscles, called your pelvic floor muscles, sit beneath your prostate and rectum and their strength can affect your ability to keep an erection.

This is because when you flex your

pelvic

You can find your pelvic floor muscles by acting as if you are trying to stop peeing mid-flow or keep yourself from passing gas.

The muscles that you feel moving are the ones you will use in kegel exercises. Here is how to do a kegel workout: Tighten your pelvic floor muscles – sitting or lying down may make this easier. To get positive results, you should aim to do 3 sets of 10 repetitions per day.

Though more research is needed, there is some evidence that Korean red ginseng can help treat erectile dysfunction. Ginseng works by helping the muscles in the penis relax, Brant says, "it is this relaxation that allows blood to fill the penis and create an erection." A 2008 review of several studies found that taking 600 milligrams of red ginseng helped men get and keep erections.

However, many of these studies were on small groups and larger studies are still needed to see if these results apply to a general population.

You can find red ginseng sold as capsules or as a tea, but Brant cautions that these supplements are not always reliable. Because supplements are not regulated by the FDA, the dosages on the labels may not be accurate or they may contain other unlisted ingredients. It is important to talk to your doctor before trying over-the-counter remedies for erectile dysfunction to make sure that you are not putting your health at risk.

Getting an erection involves many of the systems in your body including your nerves, your blood circulation, and your muscles. For this reason, conditions linked to an unhealthy lifestyle, like heart disease and obesity, can put you at greater risk for erectile dysfunction.

"Don't think of the penis in isolation," Brant says, "penis issues may represent general health issues." To improve erectile functioning, it's important to make lifestyle changes that will improve the health of your blood vessels, the channels that carry blood to all parts of your body, including your penis.

Brant recommends three lifestyle shifts that can help treat erectile dysfunction: Exercise more. When you exercise, your body produces more nitric oxide, a compound that causes the muscles in your blood vessels to relax, allowing blood to flow more freely.

This allows your penis to more easily become erect and stay erect.

A 2018 review found that physical activity can significantly improve erectile dysfunction, and experts recommend doing 40 minutes of exercise four times per week for best results. If you smoke cigarettes, you are almost twice as likely as nonsmokers to experience erectile dysfunction. This is because the chemicals in cigarettes damage the lining of your blood vessels, known as the endothelium.

The endothelium is what produces nitric oxide and without enough of it, it is much more difficult for blood to flow into your penis. Drinking a low to moderate amount – fewer than 14 drinks per week for men – is not likely to increase your risk for erectile dysfunction. However, if you drink more than this, especially over a long period of time, you may have a harder time keeping an erection.

This is because alcohol dilates your blood vessels, allowing blood to flow into your penis, but also allowing it to flow out, leaving your penis flaccid. Erectile dysfunction is a common issue for men, particularly as you grow older, but there are several ways to treat it at home. If none of these methods work for you, reach out to your doctor to discuss other options like prescription medication.

When your erec­tion falls flat, you need real and hon­est infor­ma­tion on what to do. Ignore those mir­a­cle cures and ran­dom Google search­es; get seri­ous about fix­ing your prob­lem and talk to a doctor.

Erec­tile dys­func­tion ( ED ), or male impo­tence, is the per­sis­tent inabil­i­ty to achieve or main­tain an erec­tion firm enough to have sex­u­al inter­course and occurs for more than a few weeks or months.

The Nation­al Insti­tutes of Health esti­mates that erec­tile dys­func­tion strikes rough­ly 30 mil­lion men in the Unit­ed States, so you are not alone.

Erec­tile dys­func­tion pri­mar­i­ly affects men over the age of 20 , but preva­lence does increase with age.

The Jour­nal of Sex­u­al Med­i­cine reports that one of out every four new ED patients is less than 40 years old.

There are many dif­fer­ent rea­sons you expe­ri­ence impo­tence rang­ing from health prob­lems like high blood pres­sure to psy­cho­log­i­cal and emo­tion­al issues, or even side effects from a med­ica­tion.

It is impor­tant to talk to your doc­tor about this con­di­tion because erec­tile dys­func­tion may be a sign of addi­tion­al health problems.

Every per­son is dif­fer­ent, so your physi­cian will focus on the spe­cif­ic con­di­tion that could be caus­ing your erec­tile dys­func­tion. Read more about five treat­ment options for erec­tile dysfunction.

Oral Med­ica­tions There are a num­ber of pre­scrip­tion med­ica­tions avail­able (Via­gra, Lev­i­t­ra, Cialis) that may improve blood flow to the penis.

Com­bined with sex­u­al stim­u­la­tion, this can pro­duce an erec­tion.

These med­ica­tions all work sim­i­lar­ly to each oth­er; how­ev­er, there are some dif­fer­ences in effec­tive­ness and how quick­ly they begin to work. Com­mon side effects may include headache, facial flush­ing, stuffy nose and an upset stomach.

These med­ica­tions can NOT be tak­en if you use Nitrates for chest pain or oth­er med­ical prob­lems.

This com­bi­na­tion can cause dan­ger­ous­ly low blood pressure. Vac­u­um Erec­tile Device (Penile Pump) A vac­u­um erec­tile device ( VED ) is a device that con­sists of a hol­low

plas­tic

The tube, placed over the penis, cre­ates a vac­u­um that pulls blood into the penis.

Once an erec­tion is achieved, an elas­tic ten­sion ring is placed at the base of the penis to help main­tain the erec­tion.

Since effec­tive oral med­ica­tion came onto the mar­ket, VEDs are used less to achieve erec­tion since they can be cum­ber­some and less effective.

Intrau­rethral Suppository/?Medicated Ure­thral Sys­tem for Erec­tion ( MUSE ) Med­icat­ed Ure­thral Sys­tem for Erec­tion ( MUSE ) uses an appli­ca­tor con­tain­ing a small pel­let with a med­ica­tion that is insert­ed into the ure­thra.

Once the pel­let is released, the med­ica­tion dis­solves inside the ure­thra and helps to increase blood flow to the penis to achieve an erec­tion.

Patients admin­is­ter the med­ica­tion them­selves as need­ed before intercourse. Penile Self-Injec­tion Therapy Injec­tion ther­a­py was the first FDA-approved med­ica­tion for the treat­ment of ED and uses a tiny nee­dle to inject med­ica­tion direct­ly into the base or side of the penis. The inject­ed med­ica­tion can cre­ate an erec­tion by improv­ing blood to flow into the penis direct­ly.

Patients can admin­is­ter the injec­tion them­selves as need­ed before intercourse. Penile Implant Surgery In use since the 1970 s, a penile implant is a med­ical device that is implant­ed into the penis dur­ing an out­pa­tient or overnight-stay sur­gi­cal pro­ce­dure.

The device is entire­ly con­tained with­in the body, so it is dis­crete. The device allows for an arti­fi­cial erec­tion to be achieved at any time the patient desires by oper­at­ing a con­cealed pump in the scrotum.

If you are expe­ri­enc­ing erec­tile dys­func­tion, talk to your pri­ma­ry care physi­cian or urol­o­gist to help find the best solu­tion for you.

HEIDELBAUGH, MD, University of Michigan Medical School, Ann Arbor, Michigan. Patient information : See related handout on erectile dysfunction, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Abstract Diagnosis Causes and Related Conditions History and Physical Examination Laboratory Evaluation Treatment Managing Psychogenic ED References. Abstract Diagnosis Causes and Related Conditions History and Physical Examination Laboratory Evaluation Treatment Managing Psychogenic ED References. Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.

The five-question International Index of Erectile Function allows rapid clinical assessment of ED. The condition can be caused by vascular, neurologic, psychological, and hormonal factors.

Common conditions related to ED include diabetes mellitus, hypertension, hyperlipidemia,

obesity

ED is associated with an increased risk of cardiovascular disease, particularly in men with metabolic syndrome.

Tobacco cessation, regular exercise, weight loss, and improved control of diabetes, hypertension, and hyperlipidemia are recommended initial lifestyle interventions.

Oral phosphodiesterase-5 inhibitors are the first-line treatments for ED. Second-line treatments include alprostadil and vacuum devices.

Surgically implanted penile prostheses are an option when other treatments have been ineffective.

Counseling is recommended for men with psychogenic ED. Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.1 ED becomes more common as men age ( Figure 1 ) .2 At least 12 million U.S. Current smoking is significantly associated with ED, and smoking cessation has a beneficial effect on the restoration of erectile function. Men with metabolic syndrome should be counseled to make lifestyle modifications to reduce the risk of cardiovascular events and ED.

Phosphodiesterase-5 inhibitors are the first-line treatment for ED. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort . Current smoking is significantly associated with ED, and smoking cessation has a beneficial effect on the restoration of erectile function. Men with metabolic syndrome should be counseled to make lifestyle modifications to reduce the risk of cardiovascular events and ED.

Phosphodiesterase-5 inhibitors are the first-line treatment for ED.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort . BEST PRACTICES IN UROLOGY: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN. Do not prescribe testosterone to men with erectile dysfunction who have normal testosterone levels.

Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org.

For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see https://www.aafp.org/afp/recommendations/search.htm .

BEST PRACTICES IN UROLOGY: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN.

Do not prescribe testosterone to men with erectile dysfunction who have normal testosterone levels.

Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org.

For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see https://www.aafp.org/afp/recommendations/search.htm . The prevalence of erectile dysfunction increases with age. The prevalence of erectile dysfunction increases with age. Abstract Diagnosis Causes and Related Conditions History and Physical Examination Laboratory Evaluation Treatment Managing Psychogenic ED References. The five-question International Index of Erectile Function (IIEF-5) allows rapid clinical assessment of ED and can measure the effectiveness of ED treatments (see https://www.aafp.org/afp/2010/0201/p305.html#afp20100201p305-t3). Other diagnostic options include a single-question self-assessment (Table 1) 4 and the Brief Male Sexual Function Inventory.5.

Single-Question Assessment of sildenafil buy online Erectile Dysfunction. Impotence means not

being

Moderately impotent: sometimes able to get and keep an erection good enough for sexual intercourse. Completely impotent: never able to get and keep an erection good enough for sexual intercourse.

Single-Question Assessment of Erectile Dysfunction. Impotence means not being able to get and keep an erection that is rigid enough for satisfactory

sexual

Minimally impotent: usually able to get and keep an erection good enough for sexual intercourse. Moderately impotent: sometimes able to get and keep an erection good enough for sexual intercourse. Completely impotent: never able sildenafil buy online to get and keep an erection good enough for sexual intercourse. Abstract Diagnosis Causes and Related Conditions History and Physical Examination Laboratory Evaluation Treatment Managing Psychogenic ED References. ED has vascular, neurologic, psychological, and hormonal causes.

Conditions commonly associated with ED include diabetes mellitus, hypertension, hyperlipidemia, obesity, testosterone deficiency, and prostate cancer treatment (Table 2) .6 – 8 Performance anxiety and relationship issues are common psychological causes. Erectile Dysfunction: Related Conditions and Approaches to Evaluation. Endocrine disorders (e.g., hypogonadism, hyperprolactinemia, thyroid disorders) History and physical examination; if an endocrine disorder is suspected, consider laboratory testing.

Blood pressure; fasting glucose, high-density lipoprotein, and triglyceride levels; waist circumference.

Neurologic conditions (e.g., multiple sclerosis, Parkinson disease, spinal cord injury, stroke) History and physical examination.

Prostate cancer treatment (e.g., surgery, radiation, hormone therapy) Psychological conditions (e.g., anxiety, depression, guilt, history of sexual abuse, marital or relationship problems, stress) History and physical examination; if venous leakage is suspected, consider urology consultation for venous flow testing. Erectile Dysfunction: Related Conditions and Approaches to Evaluation. Endocrine disorders (e.g., hypogonadism, hyperprolactinemia, thyroid disorders) History and physical examination; if an endocrine disorder is suspected, consider laboratory testing.

Blood pressure; fasting glucose, high-density lipoprotein, and triglyceride levels; waist circumference. Neurologic conditions (e.g., multiple sclerosis, Parkinson disease, spinal cord injury, stroke) History and physical examination.

Prostate cancer treatment (e.g., surgery, radiation, hormone therapy) Psychological conditions (e.g., anxiety, depression, guilt, history of sexual abuse, marital or relationship problems, stress) History and physical examination; if venous leakage is suspected, consider urology consultation for venous flow testing. Many medications cause or exacerbate ED (Table 3) .9 – 12 Antidepressants are a common cause, especially the selective serotonin reuptake inhibitors citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), and the serotonin-norepinephrine reuptake inhibitor venlafaxine.

Bupropion (Wellbutrin), mirtazapine (Remeron), and fluvoxamine are less likely to cause ED.11 Tobacco, alcohol, and illicit

drugs

methotrexate

androgen

§— Thresholds for white patients differ significantly according to the recommending organization.

Thresholds listed are from the International Diabetes Federation. However, the American Heart Association and National Heart, Lung, and Blood Institute set thresholds of 40 inches (102 cm) for U.S. women, noting that there is increased risk at the lower International Diabetes Federation values . Metabolic syndrome: insulin resistance and prediabetes . ? 100 mg per dL (5.6 mmol per L) High-density lipoprotein level† *— Criteria listed are the harmonized criteria proposed by the joint statement from the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. At least three criteria must be present to diagnose metabolic syndrome .

†— Patients currently receiving drugs to manage lipid disorders or high blood pressure are considered positive for these criteria .

‡— Thresholds according to International Diabetes Federation recommendations . §— Thresholds for white patients differ significantly according to the recommending organization. Thresholds listed are from the International Diabetes Federation. However, the American Heart Association and National Heart, Lung, and Blood Institute set thresholds of 40

inches

women, noting that there is increased risk at the lower International Diabetes Federation values .

Metabolic syndrome: insulin resistance and prediabetes .

Low serum testosterone levels are one factor that may explain the relationship between metabolic syndrome and ED.23 The adipose tissue enzyme aromatase prevalent in obese men converts testosterone into estradiol, a significant cause of hypogonadism.24 – 26 Adipocytes also generate inflammatory cytokines associated with impaired endothelial function, cardiovascular events, and ED.27 – 29. Patients with diabetes are three times more likely to develop ED, and a longer duration of diabetes is strongly associated with ED.18 , 30 , 31 Metabolic syndrome is associated with a 2.6-fold increase in the incidence of ED, and the fasting blood glucose level is the component associated with the highest risk of ED.32 , 33 The probability of having undiagnosed diabetes is one in 50 among men 40 sildenafil 50 mg buy online to 59 years of age who do not have ED, but increases to one in 10 sildenafil buy online for those with ED.34.

ED and CVD share similar risk factors, including older age, hypertension, dyslipidemia, smoking, obesity, and diabetes.

ED is associated with an increased risk of CVD, coronary artery disease (CAD), stroke, and all-cause mortality, and it is probably an independent risk factor for CVD.35. ED typically occurs two to five years before CAD, providing a potential window during which men diagnosed with ED can make lifestyle changes to prevent CAD.36 Men with ED are at higher risk of angina, myocardial infarction, stroke, transient ischemic attack, congestive heart failure, and cardiac arrhythmias compared with men who do not have ED.37 Men with ED have a 75% increased risk of developing peripheral vascular disease.38.

ED has a positive predictive value for the development of CVD that is equal to or greater than that for

smoking