The partner notification service is part of a public health initiative to help protect the public and limit the spread of STIs.
For an algorithm to facilitate evaluation and treatment of patients with ED, see figure 2. .
Chris Myers, study co-author, explained weak pelvic floor muscles 'may directly impact erectile strength and the ejaculatory process'.
Erectile dysfunction can be caused by any number of medical and psychological conditions. In general, ED is divided into organic (having to do with a bodily organ or organ system) and psychogenic (mental) impotence. Interestingly, and not surprisingly, most men with organic causes have a mental or psychological component, as well.
Failure to stay erect is usually due to tiredness, stress, anxiety or alcohol, and is not a cause for concern.
Lycopene can be found in a variety of bright red fruits and vegetables. It is a carotenoid that acts as an antioxidant and helps the body scavenge free radicals that can damage DNA. Lycopene may also reduce LDL (bad) cholesterol, a risk factor for high blood pressure and reduced blood flow (Arab & Steck, 2000).
Aetna considers Xiaflex (collagenase clostridium histolyticum) for the treatment of Peyronie’s disease medically necessary when the following criteria are met: The member has stable Peyronie’s disease without clinical changes (e.g., worsening curvature) for at least three months; and The member has a palpable plaque and curvature deformity of at least 30 degrees and less than 90 degrees prior to initiating Xiaflex therapy; and The member has intact erectile function (with or without medication); and The member is 18 years of age or older; and The member will receive a maximum of one treatment course with a maximum of 8 injections total, including any injections the member has received for any previous treatment.
There are also injectable drugs for erectile dysfunction. Some men sustain stronger erections by injecting these medications directly into the penis. These drugs work by widening the blood vessels, causing the penis to become engorged with blood. Another option is a medicated pellet that is inserted into the urethra and can trigger an erection within 10 minutes. Patients should discuss the use of these injections in detail with their doctor before use. Erectile Dysfunction Treatment: Vacuum Devices (Pumps)
A man’s psychological state is clearly an essential consideration when addressing issues of sexual function. While ED that is purely psychological is not common, many men who experience difficulty with erections may develop anxiety or fear about being able to get an erection the next time they try. This anxiety may lead to a stress response involving activation of the sympathetic nervous system and release of adrenaline, which will tend to make it even more difficult to get an erection. Conflict with a partner (or the absence of a partner) will also tend to increase stress and potentially interfere with erectile function.
When psychological factors are believed to be the principle cause of ED– particularly in men who are experiencing anxiety or depression – psychological counseling is mandatory. Consultation with a mental health professional with expertise in sexuality should be considered in all cases as this consultation is seldom harmful and the majority of patients will have some psychogenic or relational component to their sexual symptoms.
The role of the endothelium in erectile function became clearer with the observation that the phosphodiesterase type 5 (PDE5) inhibitor, sildenafil, enhanced erectile function. Erection occurs with the release of nitric oxide (NO) from the vascular endothelial cells.17 The reduction in endothelial cell production of NO results in the negative impact on the smooth muscles in the corporal bodies and results in less relaxation of the smooth muscle cells with decrease in blood supply and resulting ED. A similar phenomenon is well known to impact the coronary arterial system resulting in CVD.
According to the American Urological Association, ED affects as many as 30 million men in the United States.
Improvements in your lifestyle, such as a eating healthy diet, reducing alcohol intake, losing weight and increasing your exercise can dramatically improve erectile dysfunction. More specific treatment usually involves: weight loss and increased exercise (this may reduced the risk of erectile dysfunction by up to 70%) treatment of any hormone abnormality (testosterone treatment is only indicated if your testosterone levels are low and may be harmful if your the levels are normal); lifestyle modification (e.g. reduce stress, stop smoking, reduce alcohol consumption & stop illicit drugs); treatment of any anatomical abnormality if present (e.g. circumcision, frenuloplasty, penile straightening); psychological support if necessary.
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Aetna considers Xiaflex as experimental and investigational for all other indications except for Dupuytren's contracture, see CPB 0800 - Dupuytren's Contracture Treatments.
The recommended starting dose is 100 mg taken as early as 15 minutes prior to sexual activity, no more than once a day. The maximum dose is 200 mg. Avanafil may be taken with or without food. As with the other PDE5 inhibitors, sexual stimulation is necessary for avanafil to work.
Some types of cancer surgery can affect erections. (See Managing Male Sexual Problems Related to Cancer to learn more.) If any of these surgeries are part of your treatment plan, talk to your doctor before the procedure. Ask doctor about how your erections might be affected by surgery and what may be the best way to manage the problem.