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Medications called PDE5 inhibitors like (tadalafil(cialis®), or sildenafil(viagra®) can help relax the smooth muscle in the penis by vasodilating those blood vessels causing you to achieve an erection. Having erectile dysfunction is actually very common around there are estimated to be around 15-30 million men who suffer from it. As you age erectile dysfunction becomes more common and on average 15-25% of men over the age of 65 experience problems maintaining an erection. Unable to get an erection with stimulation Weak or soft erections Short lasting erections lead to unsatisfactory sexual experience Change in Angle of erection Penis has decreased sensitivity (feels like you are wearing 5 condoms) Erections are less girthy. There are many men suffering from ED in the world, and the reasons behind ED are wide and varied. Below we have listed the more common causes for suffering from ED. Cardiovascular disease affecting the flow of blood to the penis Nerve damage affecting the penis Smoking, alcohol abuse, lack of exercise Diabetes High Blood Pressure Certain medications including SSRIs, and beta-blockers Stress Depression Performance Anxiety- Psychosomatic Low Testosterone Hormone imbalance Damage to the penis Peyronie’s disease (plaques causing a curvature of the penis) Nerve Sleep disorders or sleep apnea Damage to pelvic area Obesity High cholesterol Kidney disease Anxiety Loss of Penile Sensitivity and erections due to excessive aromatisation inhibition Stress. Testosterone PDE5 Inhibitors Prostaglandin Analogues injected into the penis before sexual activity (alprostadil, caverject) Prostaglandin Analogues inserted into the urethra with insertion device (aloprostadil Muse device) PRP-Platelet Rich Plasma Treatment (unapproved use) Stem Cells- (unapproved use as not approved by regulatory agencies but data to demonstrate effectiveness in small studies) Bremelanotide , sold under the brand name Vyleesi e for women(unapproved use and difficult to titrate) also can improve sexual desire (libido). Shockwave therapy at clinic The Rocket- home shockwave therapy device (pending approval, CE) PDE5 inhibitors and low testosterone. If you have low testosterone and you have tried viagra and cialis, chances are it may not have worked for you. PED5 inhibitors work best with an adequate amount of free testosterone. Some men who have tried PDE5s like cialis or viagra who are unable to maintain a desired erection with testosterone alone will often dismiss adding a PDE5 to treatment because of treatment failures in the past when they have had low testosterone. As mentioned earlier PDE5s work best when there is an optimal amount of testosterone present. So you may want to reconsider and ask your doctor if adding a PDE5 is right for you. ED can be caused by several factors as described above, if you would like us to check your testosterone levels please use the form below to get in touch with us. Erectile dysfunction, which is also known as impotence, is the inability to achieve and/or maintain an erection. It is a common condition that affects millions of men; it is estimated that half of men in the UK aged between 40 and 70 have erectile dysfunction to some degree, but it can affect men viagra tablet 50 mg price of all ages. Although the risk does increase with age, erectile dysfunction shouldn’t be seen as a consequence of ageing. There are many causes for erectile dysfunction ranging from underlining health conditions (high blood pressure, diabetes and high cholesterol), hormonal problems, previous surgery and injury through to psychological problems such as anxiety, depression and relationship issues. It is important to get an accurate diagnosis and identify the cause in order for the appropriate treatment or procedure to be recommended. An erection is a direct result of increased blood flow into your penis. This blood flow is stimulated by sexual thoughts and arousal, or direct contact with your penis. When a man becomes sexually aroused, all the muscles in the penis relax, allowing the blood flow to increase into the penile arteries. The blood then fills the two chambers that are inside the penis, called the Corpora Cavernosa. When these chambers fill with blood, the penis becomes rigid and erect. The erection ends when the muscles finally contract, and the blood can flow back out the penile veins. Giulio Garaffa, an award-winning Consultant Uro-Andrologist with over 20 years’ international medical experience in this field. Mr Garaffa has a global reputation for his excellence in urology and andrology and is one of the leading experts in the fields of erectile dysfunction, congenital penile curvature, complex penile reconstruction, phalloplasty, Peyronie’s disease, male infertility and microsurgery. + You have trouble maintaining an erection during sexual acts OR. If you experience any of these symptoms for more than 2-3 months, speak to your doctor. To determine if you have erectile dysfunction, your doctor will inquire about your symptoms and your health history. They will do tests if necessary to determine whether or not those symptoms are caused by an underlying health issue. This may include a physical exam, blood pressure work, and examination of your penis and testicles. This may also include a rectal exam to check on your prostate. If surgery is needed, your doctor will go over the best method for you and give you your options. The most common oral medications prescribed in patients with erectile dysfunction are Sildenafil, Tadalafil and Vardenafil. All these medications help to enhance erections and therefore do not trigger automatic erections as injections instead do. Therefore sexual stimulation is necessary for these medications to work. The most common side effects of these medications are headache, facial blushing, upset stomach and mild temporal visual effects (only for Sildenafil).In most cases, the side effects are minor and tend to reduce with time. Therefore only very few patients decide to discontinue the treatment due to side effects. Approximately 40% of men at the age of 50 suffer from erectile dysfunction and this prevalence increases around 10% each decade. Although prevalence of erectile dysfunction increases with age, erectile dysfunction should not be seen as an inevitable consequence of ageing. Erectile dysfunction can be subdivided in psychogenic and organic. Psychogenic erectile dysfunction, which is more common in younger men, cannot trace his origin to a physical problem or disease and is due to performance anxiety. Organic erectile dysfunction is much more common than psychogenic erectile dysfunction and in most cases the causes can be easily identified. Once identified, proper treatment can be recommended to help patients return to a satisfying sexual life. Organic erectile dysfunction is usually caused by an injury (to the brain, spinal cord, peripheral nerves or arteries), by a disease (diabetes, high blood pressure or high cholesterol), by an operation (prostate gland removal, urinary bladder removal, surgery to the rectum, spinal surgery) and by substance abuse (tobacco, drugs, alcohol and some medications). A thorough examination and history taking is necessary to understand the nature of erectile dysfunction. Patients with psychogenic erectile dysfunction may be further investigated with a nocturnal penile tumescence test to confirm that the nocturnal erections are preserved. The confirmation of the presence of normal nocturnal erections excludes the presence of an organic cause of erectile dysfunction and the patients should be therefore reassured and offered psychosexual counselling. When organic erectile dysfunction is suspected and an underlying cause is not obvious from the examination and history, efforts should be made towards the identification of any underlying condition, since erectile dysfunction may represent the first sign of diffuse cardiovascular disease. A prompt identification of any of the cardiovascular risk factors such as diabetes, high blood pressure and high cholesterol levels is paramount to set up an adequate treatment plan and prevent further progression of the cardiovascular disease. The Doppler Ultrasound scan of the penis is a relatively simple investigation but it provides very important information on the blood supply to the penis. The management of the patient with erectile dysfunction is tailored to the underlying cause of erectile dysfunction and to patients’ preferences. Various drugs are now available for the treatment of erectile dysfunction. Some medications are administered orally, some are injected directly into the penis while other are inserted into the urethra at the tip of the penis. When medical treatment is ineffective and contraindicated, the vacuum constriction device or penile prosthesis implantation guarantee the rigidity necessary for sexual intercourse. Injections are indicated in these patients who do not respond to oral medications or when oral medications are contraindicated. Injection therapy induces an erection even without the need of sexual stimulation. The main advantage of injections is that it can be easily self-administered while the main risk is to induce a prolonged erection and may occur if an excessive dose of the medication has been injected. The main reasons why patients quit injections are inadequate response, fear of needles, desire for a permanent treatment alternative and concerns over side effects. The vacuum pump is a tube, which is sealed around the flaccid penis. With the creation of a negative pressure, blood is rushed into the chambers of the penis. Once the desired rigidity is achieved, a constricting ring is applied to the base of the penis to prevent the blood from rushing out of the penis and the vacuum pump is then removed. The vacuum pump can be a viable solution for patients who do not respond or are not suitable for oral and injectable medications and are not keen on penile prosthesis implantation. We advise you to book a consultation with Mr Garaffa, one of the world leading experts in the diagnosis and management of erectile dysfunction and one of the largest penile prosthesis implanters in the world. Your condition will be treated discretely and you will be offered the treatment that best suits you and that will allow you to regain sexual activity with confidence. Erectile dysfunction, or male impotence, is the inability to get or keep an erection to have successful intercourse. Approximately 94 million men worldwide suffer from erectile dysfunction and, most importantly, nearly every man who has the condition can be helped. Talking with your doctor is the first step in getting the proper treatment for erectile dysfunction. Treatment process begins with a physical exam that can include an examination of your vascular system, nervous system, thyroid, prostate, and genitals. If your physician suspects a psychological cause for erectile dysfunction, he or she may suggest treatment from a psychiatrist, psychologist, sex therapist or marriage counselor. It is important to understand that counseling can many times identify and solve many underlying psychological issues causing erectile dysfunction. Such counseling may also be a part of a recommended regimen to treat the problem. When considering lifestyle changes as an approach to correct erectile dysfunction, consideration of habits that may be contributing to the condition need to be addressed. These include: Decreasing or limiting the consumption of alcohol Dietary changes to reduce the intake of fat and cholesterol Eliminating the use of tobacco and substance abuse Losing weight Exercising regularly. A physician’s review of the medications you are presently taking may result in changes to them especially if they are known to cause erectile dysfunction. Non-invasive treatments that include the use of oral medications such as Viagra, Cialis and Levitra are all proven to improve blood flow to the penis by working directly on the blood vessels. They allow the arteries to expand to produce an erection. Note that while widely available today, they do not work for 20 to 30 percent of men. Vacuum pump therapy may be prescribed as a non-invasive alternative. The pump device is placed over the penis and a vacuum is created mechanically enhancing the flow of blood into the penis. A rubber ring placed at the base of the penis helps to maintain the blood maintaining the erection. These cannot be prescribed for patients with bleeding disorders, are on anticoagulants or those with sickle cell anemia. The patient inserts a small dose of medication directly into the urethral opening at the end of the penis where the medication becomes absorbed into the erectile tissue. This causes the blood vessels to relax so that the penis fills with blood and becomes erect. For this treatment, the patient or his partner inject medication directly into the base of the penis. It relaxes muscle tissue and allows blood to flow into the penis creating an erection. Surgery (Penile Implants) If the above treatments are unsuccessful in managing erectile dysfunction and psychological causes are ruled out, your physician may recommend penile implant surgery. The implant, called a penile prosthesis, is contained within the body. Considerations for choosing the appropriate implant include medical condition, lifestyle, personal preference and cost. As with all surgeries, there are associated risks that include pain, infection and other complications. Learn more about Erectile Dysfunction/Impotence in our Health Library. Organic Causes of Erectile Dysfunction in Men Under 40. Washington, DC 20037 (USA) Related Articles for " " Abstract FullText PDF References Extras : 2. There are a significant number of men under 40 who experience erectile dysfunction (ED). In the past, the vast majority of cases were thought to be psychogenic in nature. Studies have identified organic etiologies in 15-72% of men with ED under 40. Organic etiologies include vascular, neurogenic, Peyronie's disease (PD), medication side effects and endocrinologic sources. Vascular causes are commonly due to focal arterial occlusive disease. Young men with multiple sclerosis, epilepsy and trauma in close proximity to the spinal cord are at increased risk of ED. It is estimated that 8% of men with PD are under 40, with 21% of these individuals experiencing ED. Medications causing ED include antidepressants, NSAIDs and finasteride (Propecia), antiepileptics and neuroleptics. Hormonal sources are uncommon in the young population, however possible etiologies include Klinefelter's syndrome, congenital hypogonadotropic hypogonadism, and acquired hypogonadotropic hypogonadism. The workup of young men with ED should include a thorough history and physical examination. The significant prevalence of vascular etiologies of ED in young men should prompt consideration of nocturnal penile tumescence testing and penile Doppler ultrasound. Treatment options that may improve ED include exercise and oral PDE-5 inhibitors. Our understanding of erectile dysfunction (ED), defined as the inability to achieve or maintain an erection sufficient for sexual performance, has changed drastically over the last 50 years [1]. Once assumed to be a problem primarily rooted in the psyche, ED is now understood to frequently have a physiological basis [2]. Organic sources including vascular, neurologic and hormonal abnormalities, with occasional psychogenic overlay, are often the causes attributed to ED in older men, while men under the age of 40 are often thought to have only psychogenic factors contributing to their ED. However, a review of the literature reveals that many cases of ED are organic in origin, including vascular, neurogenic, hormonal or due to medication side effects. Assuming that ED is psychogenic may miss significant underlying disease, a correction of which could lead to considerable improvement in many men's lives. 52% of men aged 40-70 have some degree of ED and moderate to severe cases increase sharply with age [2]. The percentage of men under 40 with ED varies greatly according to the study and methods used to determine the cause of ED, as shown in table viagra no prescription cheap 1. Erectile dysfunction (impotence) is the inability to get and keep an erection. Occasional erection trouble isn't necessarily a cause for concern. However, if erectile dysfunction is an ongoing issue, it can cause stress, affect your self-confidence, and cause relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment, and it is a risk factor for heart disease. If you're concerned about erectile dysfunction, talk to your doctor. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed. See your doctor if: You have concerns about your erections or you're experiencing other sexual problems such as premature or delayed ejaculation You have diabetes, heart disease or another known health condition that might be linked to erectile dysfunction You have other symptoms along with erectile dysfunction. Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction, and sometimes a combination of physical and psychological issues causes erectile dysfunction. In many cases, erectile dysfunction is caused by a physical issue. Common causes include: Heart disease Clogged blood vessels (atherosclerosis) High cholesterol High blood pressure Diabetes Obesity Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol Parkinson's disease Multiple sclerosis Certain prescription medications Tobacco use Peyronie's disease — development of scar tissue inside the penis Alcoholism and other forms of substance abuse Sleep disorders Treatments for prostate cancer or enlarged prostate Surgeries or injuries that affect the pelvic area or spinal cord. The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include: Depression, anxiety or other mental health conditions Stress Relationship problems due to stress, poor communication or other concerns. Various risk factors can contribute to erectile dysfunction, including: Medical conditions, particularly diabetes or heart conditions Tobacco use, which restricts blood flow to veins and arteries, can — over time — cause chronic health conditions that lead to sildenafil citrate tablets 200mg price erectile dysfunction Being overweight, especially if you're obese Certain medical treatments, such as prostate surgery or radiation treatment for cancer Injuries, particularly if they damage the nerves or arteries that control erections Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions Psychological conditions, such as stress, anxiety or depression Drug and alcohol use, especially if you're a long-term drug user or heavy drinker. Complications resulting from erectile dysfunction can include: An unsatisfactory sex life Stress or anxiety Embarrassment or low self-esteem Relationship problems The inability to get your partner pregnant. Erectile Dysfunction (ED) is another name for impotence and refers to the inability to maintain an erection that is firm enough or lasts long enough to engage in sexual intercourse. ED is common in men, with over 100 million living with the difficulty. ED is easily treatable and there are several options to choose from. ED is typically caused by a physical problem: Diabetes – this disease can damage the nerves or blood vessels that control the blood flow to the penis Cardiovascular Problems – these issues can decrease the blood flow to the penis through blocked arteries or leaking veins Trauma or Surgery – if you’ve had trauma or surgery in the prostate, bladder, colon, or rectal area, these nerves can be damaged and lead to ED Spinal Cord Injury – this injury can stop nerve impulses from reaching the penis Medications – some medications, including those for high blood pressure, can restrict blood flow to the penis Hormone Problems – any issues caused by kidney or liver failure can result in ED Alcoholism – large intakes of alcohol over an extended period of time can lead to permanent nerve damage. There are several treatment options for Erectile Dysfunction, including medications, devices, therapy, surgery, and implants. Oral Medications – Viagra, Levitra, Cialis, and Stendra all help improve blood flow to the penis and help produce an erection Vacuum Erection Devices – help draw blood to the penis via a vacuum chamber Intraurethral Suppositories – inserted into the urethra and is absorbed in the penis resulting in an erection Injection Therapy – requires the injection of medicine directly into the penis prior to intercourse Penile Implants – an effective surgical option for men who have unsuccessfully tried other treatment options. To receive a consultation with a physician and learn which option is best for you and your spouse, schedule an appointment at either our Macon or Warner Robins locations. You can also learn more about Erectile Dysfunction here. Common drug treatments for erectile dysfunction are effective, but also have side effects. A new ‘trade-off’ study can help men – and their doctors and partners – choose the drug that best meets their needs Losing weight, improving your diet, and getting regular exercise ( such as walking) may also boost sexual function, and avoid the side effects associated with drug treatment.
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