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Abstract Prevalence Pathophysiology Diagnosis and Evaluation Treatment Link to Cardiovascular Disease References.

Many men associate advancing age with declining sexual function and an overall decreased quality of life. ED affects up to one third of men throughout their lives, and the incidence increases with age. health professionals found the prevalence of sexual dysfunction in men to be 12 percent in those younger than 59 years, 22 percent in those 60 to 69 years of age, and 30 percent in those older than 69 years.3 Persons with

type

Abstract Prevalence Pathophysiology Diagnosis and Evaluation Treatment Link to Cardiovascular Disease References. ED may result from organic causes (e.g., vascular, neurogenic, hormonal, anatomic, drug-induced), psychological causes, or a combination of both. A normal sexual erectile response results from the interaction between neurotransmitter, biochemical, and vascular smooth muscle responses initiated by parasympathetic and sympathetic neuronal triggers that integrate physiologic stimuli of the penis with sexual perception and desire. Nitric oxide produced from endothelial cells after parasympathetic stimuli triggers a molecular cascade that results in smooth muscle relaxation and arterial influx of blood into the corpus cavernosum. This is followed by compression of venous return, which produces an erection.6. History of pelvic irradiation or surgery, including radical prostatectomy.

Hormonal disorders (e.g., hypogonadism, hypothyroidism, hyperprolactinemia) Illicit drug use (e.g., cocaine, methamphetamine) Medications (e.g., antihistamines, benzodiazepines, selective serotonin reuptake inhibitors) Neurologic conditions (e.g., Alzheimer disease, multiple sclerosis, Parkinson disease, paraplegia, quadriplegia, stroke) Psychological conditions (e.g., anxiety, depression, viagra for men buy online guilt, history of sexual abuse, marital or relationship problems, stress) Information from reference 9 . History of pelvic irradiation or surgery, including radical prostatectomy. Hormonal disorders (e.g., hypogonadism, hypothyroidism, hyperprolactinemia) Illicit drug use (e.g., cocaine, methamphetamine) Medications (e.g., antihistamines, benzodiazepines, selective serotonin reuptake inhibitors) Neurologic conditions (e.g., Alzheimer disease, multiple sclerosis, Parkinson disease, paraplegia, quadriplegia, stroke) Psychological conditions (e.g., anxiety, depression, guilt, history of sexual abuse, marital or relationship problems, stress) Information from reference 9 . Abstract Prevalence Pathophysiology Diagnosis and Evaluation Treatment Link to Cardiovascular Disease References. There is no preferred, first-line diagnostic test for ED, and routine screening is not recommended.

History and physical examination are sufficient in making an accurate diagnosis of ED in most cases. Penile duplex ultrasonography is not a useful diagnostic test for ED.7 The American Urological Association (AUA) recommends that the initial evaluation of ED include a complete medical, sexual, and psychosocial history.8 The medical history may reveal comorbid conditions, risk factors related to ED ( Table 1 ),9 or medications that contribute to ED ( Table 2 ).6 Sexual history should focus on erection adequacy, altered libido, quality and timing of orgasm, volume and appearance of ejaculate, presence of sexually-induced genital pain or penile curvature (Peyronie disease), and partner sexual function. The five-item version of the International Index of Erectile Function Questionnaire is a validated survey instrument that can be used to assess the severity of ED symptoms ( Table 3 ).10. Medications and Substances That May Cause or Contribute to Erectile viagra for men buy online Dysfunction.

Lithium, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, tricyclic antidepressants. Dimenhydrinate, diphenhydramine (Benadryl), hydroxyzine (Vistaril), meclizine (Antivert), promethazine (Phenergan) Alpha blockers, beta blockers, calcium channel blockers, clonidine (Catapres), methyldopa, reserpine. Bromocriptine (Parlodel), levodopa, trihexyphenidyl.

Digoxin, disopyramide (Norpace), gemfibrozil (Lopid) Spironolactone (Aldactone), thiazides.

5-alpha reductase inhibitors, corticosteroids, estrogens, luteinizing hormone-releasing hormone agonists, progesterone.

Amphetamines, barbiturates, cocaine, heroin, marijuana. Medications and Substances That May Cause or Contribute to Erectile Dysfunction. Lithium, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, tricyclic antidepressants.

Dimenhydrinate, diphenhydramine (Benadryl), hydroxyzine (Vistaril), meclizine (Antivert), promethazine (Phenergan) Alpha blockers, beta blockers, calcium channel blockers, clonidine (Catapres), methyldopa, reserpine. Bromocriptine (Parlodel), levodopa, trihexyphenidyl. Digoxin, disopyramide (Norpace), gemfibrozil (Lopid) Spironolactone (Aldactone), thiazides. 5-alpha reductase inhibitors, corticosteroids, estrogens, luteinizing hormone-releasing hormone agonists, progesterone.

Amphetamines, barbiturates, cocaine, heroin, marijuana.

Five-Item Version of the International Index of Erectile Function Questionnaire. How do you rate your confidence that you could get and keep an erection? When you had erections with sexual stimulation, how often were your erections hard enough for penetration?

During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

When you attempted sexual intercourse, how often was it satisfactory for you? note : The score is the sum of the above five question responses. Erectile dysfunction is classified based on these scores: 17 to 21 = mild; 12 to 16 = mild to moderate; 8 to 11 = moderate; 5 to 7 = severe . Adapted with permission from Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction . Five-Item Version of the International Index of Erectile Function Questionnaire.

How do you rate your confidence that you could get and keep an erection?

When you had erections with sexual stimulation, how often were your erections hard enough for penetration?

During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? When you attempted sexual intercourse, how often was it satisfactory for you? note : The score is the sum of the above five question responses.

Erectile dysfunction is classified based on these scores: 17 to 21 = mild; 12 to 16 = mild to moderate; 8 to 11 = moderate; 5 to 7 = severe . Adapted with permission from Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction .

The physical examination should assess blood pressure and heart rate; body habitus, for central obesity; and cardiovascular, neurologic, and genitourinary systems, including penile, testicular, and digital rectal examinations ( Figure 1 ).8 , 9 , 11 – 14 The AUA and World Health Organization recommend limited diagnostic testing in men with ED. This may include a fasting serum glucose level and lipid panel, thyroid-stimulating hormone test, and morning total testosterone level.8 , 11 Additional diagnostic testing and urologic evaluation may be warranted in cases of ED refractory to standard therapies ( Table 4 ).11 Clues to the diagnosis of ED are listed in Table 5 .

Algorithm for the diagnosis and treatment of erectile dysfunction. Algorithm for the diagnosis and treatment of erectile dysfunction. Additional Testing in the Workup of Erectile Dysfunction. Laboratory investigations (complete blood

count

Neurophysiologic testing (vibrometry; bulbocavernosus reflex latency; cavernosal electromyography; somatosensory evoked potential test; pudendal and sphincter electromyography) Nocturnal penile tumescence and rigidity assessment. Specialized endocrinologic testing (hypothalamic-pituitary-gonadal function studies; magnetic resonance imaging of the sella turcica) Vascular diagnostics (duplex ultrasonography; penile pharmacocavernosometry and pharmacocavernosography; penile arteriography; computed tomography or magnetic resonance imaging; nuclear imaging) Adapted with permission from Jardin A, Wagner G, Khoury S, et al.

Recommendations of the 1st International Consultation on Erectile Dysfunction.

Plymouth, U.K.: Health Publication Ltd, 2000:718–719 . Additional Testing in the Workup of Erectile Dysfunction.

Laboratory investigations (complete blood count; free testosterone, luteinizing hormone, and prolactin levels; sex hormone-binding globulin test; urinalysis) Psychological or psychiatric viagra for men buy online consultation. Neurophysiologic testing (vibrometry; bulbocavernosus reflex latency; cavernosal electromyography; somatosensory evoked potential test; pudendal and sphincter electromyography) Nocturnal penile tumescence and rigidity assessment.

Specialized endocrinologic testing (hypothalamic-pituitary-gonadal function studies; magnetic resonance imaging of the sella turcica) Vascular diagnostics (duplex ultrasonography; penile pharmacocavernosometry and pharmacocavernosography; penile arteriography; computed tomography or magnetic resonance imaging; nuclear imaging) Adapted with permission from Jardin A, Wagner G, Khoury S, et al. Recommendations of the 1st International Consultation on Erectile Dysfunction. Plymouth, U.K.: Health Publication Ltd, 2000:718–719 .

Abstract Prevalence Pathophysiology Diagnosis and Evaluation Treatment Link to Cardiovascular Disease References.

First-line therapy for ED is aimed at lifestyle changes and modifying pharmacotherapy that may contribute to ED8 ( Table 2 6). Sedentary lifestyle, a significant risk factor for cardiovascular disease, may also be a modifiable risk factor for ED.viagra for men buy online 15 Obesity nearly doubles the risk of ED3; one study determined that one third of men who were obese improved their ED with moderate weight loss and an increase in the amount and duration of regular exercise.14 The risk of moderate or total ED is almost double in men who smoke compared with nonsmokers.16 Patient education should be aimed at increasing exercise, losing weight to achieve a body mass index (BMI) less than viagra for men buy online 30 kg per m 2 , and stopping smoking.

Psychological causes (e.g., anxiety, depression, guilt, history of sexual abuse, marital or relationship problems, stress) Decreased appearance and volume of ejaculate.