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Second line therapies for ED include the use of intraurethral prostaglandin E1 (Muse), the vacuum device, and intracavernous injection therapies.

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If you are suffering from any sexual problems, then try to look for some basic symptoms of Erectile dysfunction.
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This section offers general information about treatment options and situations can vary in different countries.
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Injection therapy: The modern age of such drug therapies began in 1993 when the injection of papaverine (Pavabid), an alpha-blocker that produces vasodilatation (widening of the blood vessels), was shown to produce erections when injected directly into the penis. Soon afterward, other vasodilators, such as prostaglandin E1 (PGE 1) monotherapy (Caverject, Edex), PGE1 and phentolamine (Regitine), and Trimix (papaverine, phentolamine and prostaglandin E1), were demonstrated to be effective. The benefit of combination therapy is the decreased dosing of each with less side effects. Most important is the reduction of the prostaglandin PGE1 dosing, which is associated to the localized pain.

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Patients with organic erectile dysfunction should be examined with color Doppler flow analysis using direct pharmacological stimulation with an intracavernosal injection of 10–20 μg prostaglandin E1. Diagnostic criteria for veno-occlusive dysfunction are a high systolic flow rate >25 cm/s (peak systolic velocity) and a persistent end-diastolic velocity of >5 cm/s 15 min post-injection (rigid phase) with a resistive index <0.75 (7).

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Extra weight can make a man more likely to develop diabetes or cardiovascular disease, which are both associated with erectile dysfunction. Also, carrying fat around the middle can affect a man’s hormones, which can contribute to penile dysfunction.

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However, Pedersen and Kristensen are doubtful that such a precise conclusion can be drawn without further research. The study indicates that intense exercise has an effect on erectile dysfunction, but whether that means 30, 40, or 50 minutes of training three or four times a week is something that should be studied further, they say.
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1. Overview2. Symptoms3. Causes4. Diagnosis5. Prevention6. Treatment7. Everyday Life8. Questions9. Resources

With so many possible causes, your doctor has a number of tests they can use to figure out the best treatment for you.
Response is dose related and usually occurs within 10–15 min, and does not require stimulation. The intraurethral preparation, medicated urethral suppository for erection (MUSE), consists of a tiny pellet of drug inserted into the urethral meatus. Response is also dose related, and onset similar to the cavernosal preparations.
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If regular exercise doesn’t resolve the issue, consult with your doctor. There are other options available to treat erectile dysfunction. Your doctor may suggest any of the following:

In men, Kegel exercises can help with erectile dysfunction (ED) and enhance sexual performance. One study of men with ED found that after 6 months of performing Kegel exercises, 40% of men regained normal erectile function. Helping prevent incontinence (which can be important after prostate surgery) Longer time between bathroom visits Fewer “accidents” and leaking Drier underwear Preventing accidental passage of gas or stool Bulbocavernosus (BC) muscle Squeezes semen or urine out of the urethra Squeezes more blood into the end of the penis This is the main muscle used when performing Kegels Pubococcygeus (PC) muscle Plays a role in urination and bowel movements Forms a large part of the pelvic floor, supporting lower organs Contracts during orgasm Iliococcygeus (IC) muscle Forms part of the strength of the pelvic floor Pulls the anus back up after a bowel movement
Mechanical vacuum devices cause an erection by creating a vacuum around the penis that draws blood into the penis, engorging it, and expanding it. The devices have three components:
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Erectile dysfunction, also known as impotence, is when a man is unable to get or maintain an erection.

Aerobic exercises, such as walking or running, improve cardiovascular health, help men maintain a healthy weight, and decrease the risk of high blood pressure. In a review of studies on exercise and E.D., researchers discovered that 160 minutes of moderate to vigorous aerobic activity per week divided over four days decreased E.D. (Gerbild et al., 2018).
Adopt a regular exercise program, and your general health will improve. Working out may even help you stave off serious conditions such as high blood pressure and diabetes, which sometimes require medications that inhibit arousal. These two medical conditions also can damage the tiny arteries in the penis, resulting in erectile dysfunction. In fact, erectile dysfunction is often one of the first noticeable side effects of high blood pressure and diabetes.
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You can help yourself by cutting down on alcohol, stopping smoking and reducing the stress in your life. References Sexual dysfunction in men – when Viagra doesn't work Goodfellow Unit, NZ, 2019 Erectile dysfunction BPAC, NZ, 2008 Erectile problems Best Health, UK, 2014 Dietary supplements for erectile dysfunction – a natural treatment for ED? Mayo Clinic, US, 2017 Reviewed by Jeremy Steinberg is a GP with special interests in musculoskeletal medicine, evidence-based medicine and use of ultrasound. He's been reviewing topics for Health Navigator since 2017 and in his spare time loves programming. You can see some of the tools he's developed on his website. A compact guide to sexual health Lifelong sexuality Related topics Anxiety | Mate māharahara Sex & cancer Sexual health overview Men's health Sildenafil Tadalafil Vardenafil Credits: Health Navigator Editorial Team. Reviewed By: Dr Jeremy Steinberg, FRNZCGP Last reviewed: 13 May 2020 Page last updated: 09 Dec 2021

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National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology: Survivorship [Version 2.2019]. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf on January 31, 2020.

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In men, Kegel exercises can help with erectile dysfunction (ED) and enhance sexual performance. One study of men with ED found that after 6 months of performing Kegel exercises, 40% of men regained normal erectile function. Helping prevent incontinence (which can be important after prostate surgery) Longer time between bathroom visits Fewer “accidents” and leaking Drier underwear Preventing accidental passage of gas or stool Bulbocavernosus (BC) muscle Squeezes semen or urine out of the urethra Squeezes more blood into the end of the penis This is the main muscle used when performing Kegels Pubococcygeus (PC) muscle Plays a role in urination and bowel movements Forms a large part of the pelvic floor, supporting lower organs Contracts during orgasm Iliococcygeus (IC) muscle Forms part of the strength of the pelvic floor Pulls the anus back up after a bowel movement

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The lab testing obtained for the evaluation of erectile dysfunction may vary with the information obtained on the health history, physical examination, and recent lab testing. A testosterone level is not necessary in all men; however, a physician will order labs to determine a patient's testosterone level if other signs and symptoms of hypogonadism (low testosterone) such as decreased libido, loss of body hair, muscle loss, breast enlargement, osteoporosis, infertility, and decreased penile/testicular size are present.

Erectile dysfunction occurs when a man is not able to maintain or get an erection. It’s common in men of all ages. Facing erectile dysfunction once in 2-3 months is fine. But if it becomes an ongoing problem, it needs medical intervention in time.
Surgery, including treatments for prostate cancer, bladder cancer, or BPH, can sometimes damage nerves and blood vessels near your penis. If the nerve damage is permanent, you’ll need treatment to get an erection. But sometimes surgery causes temporary ED that gets better on its own after 6 to 18 months.
In their extensive review, Bassil and coworkers summarise the benefits and risks, with benefits such as improvement of sexual function, bone density, muscle strength, cognition and overall improvement in quality of life. Among the risks that have been suggested include erythrocytosis, liver toxicity, worsening of sleep apnoea and cardiac function, possibly increasing symptoms of benign prostatic hyperplasia (BPH). They also note that although a possibility of stimulation of prostate cancer has been hypothesised, no scientific or clinical evidence exists to this possible risk.38
“Erectile Dysfunction (ED).” UW Health. Retrieved from: http://www.uwhealth.org/urology/erectile-dysfunction-ed/20537
Some men are hesitant to tell their doctors about their symptoms of ED because they’re embarrassed or afraid. You should know that your doctor is there to help you through this process and provide any support that you might need. !

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Evaluation should include a breast examination, rectal examination of the prostate, and a PSA level (prostate specific antigen) blood test. Patients who have breast and prostate cancers should not use testosterone. how-to-stay-erect-for-hours-pills-information

Erectile dysfunction is a defined as recurring inability to achieve and maintain satisfactory erection for sexual intercourse associated with relevant life impairment. The underlying etiologies may be manifold and complex. Currently, vascular etiologies are highly prevalent especially amongst elderly men. Of special interest, especially venogenic causes are of increasing relevance. Therapeutic options comprise risk factor modification, pharmacotherapy, surgical treatment, and endovascular treatment. Especially endovascular treatment options have recently increased in popularity including transcatheter embolization procedures for veno-occlusive dysfunction.
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Blood test A blood sample may help your doctor look for signs of diabetes, heart disease, low testosterone, or other issues such as liver or kidney disease.Urine test A urine test can look for markers of diabetes.Ultrasound/Doppler exam This test can let your doctor see if you have problems with penile blood flow.Psychological exam Your doctor might screen you for depression or another mental health disorder that could be linked to ED symptoms.What Should You Tell Your Doctor About Symptoms?
Your blood test results will be displayed in an easy to read format and any readings that aren’t optimal will be highlighted clearly. Your results will also be reviewed by a clinician who can offer advice based on the outcome of your test.
Of course, the test cannot and will not replace a medical examination and diagnosis. For each form of erectile dysfunction a medical examination is advisable. This is all the more true as even mild erectile dysfunctions can be an early warning sign for circulatory disorders such as coronary heart disease or peripheral arterial occlusive disease. Please answer the following 15 questions completely, otherwise an appraisal is not possible. You receive the test result at the end. It is only visible to you. 1. How often have you managed to get an erection during sexual activity in the last month? no sexual activity almost always or always most times (much more than half the time) sometimes (about half the time) a few times (much less than half the time) almost never or never 2. When you had erections with sexual stimulation in the last month, how often were your erections hard enough for penetration? no sexual activity almost always or always most times (much more than half the time) sometimes (about half the time) a few times (much less than half the time) almost never or never 3. When you attempted sexual intercourse in the last month, how often were you able to penetrate your partner? no attempt almost always or always most times (much more than half the time) sometimes (about half the time) a few times (much less than half the time) almost never or never 4. During sexual intercourse in the last month, how often were you able to maintain your erection after you had penetrated your partner? no attempt almost always or always most times (much more than half the time) sometimes (about half the time) a few times (much less than half the time) almost never or never 5. During sexual intercourse in the last month, how difficult was it to maintain your erection to completion of intercourse? no attempt extremely difficult very difficult difficult slightly difficult not difficult 6. How often have you attempted sexual intercourse in the last month? no attempts 1-2 attempts 2-3 attempts 5-6 attempts 7-10 attempts 11-20 attempts 7. When you attempted sexual intercourse, how often was it satisfactory for you? no attempt almost always or always most times (much more than half the time) sometimes (about half the time) a few times (much less than half the time) almost never or never 8. How much did you like your sexual intercourse in the last month? no sexual intercourse very well liked well liked it was all right. not much liked not liked 9. When you have had sexual stimulation or intercourse during the last month, how often have you ejaculated? no sexual stimulation or intercourse almost always or always most times (much more than half the time) sometimes (about half the time) a few times (much less than half the time) almost never or never 10. When you have had sexual stimulation or intercourse during the last month, how often have you had the feeling of orgasm (with or without ejaculation)? 11. How often did you feel sexual desire during the last month? almost always or always most times (much more than half the time) sometimes (about half the time) a few times (much less than half the time) almost never or never 12. How high would you rate your sexual desire during the last month? very high high moderate low very low to no desire 13. How satisfied have you been with your overall sex life during the last month? very satisfied quite satisfied about equally satisfied quite unsatisfied very unsatisfied 14. How satisfied have you been with your sexual relationship with your partner during the last month? very satisfied quite satisfied about equally satisfied quite unsatisfied very unsatisfied 15. How do you rate your confidence with regard to the last month that you could get and keep an erection? very high high moderate low very low

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Pills are an easy way to treat ED, but you might get a stronger erection from injecting medication directly into your penis. That’s because these drugs widen your blood vessels so your penis fills with blood. Another option: A medicated pellet you put into the opening at the end of your penis. The pellet can trigger an erection within 10 minutes.

Commercials for drugs to improve “low T,” or testosterone, the male hormone, are now vying for airtime, but they address desire, not performance. "Male hormone is not an approved treatment for erectile dysfunction," notes Bennett. "It may be used to increase desire in men who have low testosterone, but it doesn’t improve blood flow to an erection." A doctor can do a blood test to check you for low testosterone, but it is a rare cause of ED. Hormone therapy with injections, patches, or gels applied to the skin may improve mood and sex drive, but it likely won’t fix any mechanical issues. Also, testosterone drugs should not be used by men with prostate cancer. Side effects include acne, breast enlargement, prostate enlargement, and fluid retention.
Erectile dysfunction may have a significant impact on both patients and their relationships. It therefore is important to seek appropriate help and support, both from GPs and from other organisations, such as Relate.
Low testosterone levels. This can make it difficult to get an erection. It can also reduce a man's sex drive.Nerve damage from prostate surgery.Nicotine, alcohol, or cocaine use.Spinal cord injury.
Urinalysis (urine test, drug test) is a test performed on a patient's urine sample to diagnose conditions and diseases such as urinary tract infection, kidney infection, kidney stones, and inflammation of the kidneys, or screen for progression of conditions such as diabetes and high blood pressure.
Injections work quite well for most men, but not everyone is willing to stick a needle into one's penis. Most of my patients actually do quite well after a teaching session that we do in the office. It also helps that the needle is tiny and the part of the penis where you have to inject does not generally hurt.

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Second line therapies for ED include the use of intraurethral prostaglandin E1 (Muse), the vacuum device, and intracavernous injection therapies.

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Extra weight can make a man more likely to develop diabetes or cardiovascular disease, which are both associated with erectile dysfunction. Also, carrying fat around the middle can affect a man’s hormones, which can contribute to penile dysfunction.

erectile-dysfunction-exercises-pdf-information

1. Overview2. Symptoms3. Causes4. Diagnosis5. Prevention6. Treatment7. Everyday Life8. Questions9. Resources

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If regular exercise doesn’t resolve the issue, consult with your doctor. There are other options available to treat erectile dysfunction. Your doctor may suggest any of the following:

new-erectile-dysfunction-medicine

Erectile dysfunction, also known as impotence, is when a man is unable to get or maintain an erection.

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The same concerns regarding the use of sildenafil with nitrates and alpha-blockers apply to vardenafil.

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Second line therapies for ED include the use of intraurethral prostaglandin E1 (Muse), the vacuum device, and intracavernous injection therapies.

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Extra weight can make a man more likely to develop diabetes or cardiovascular disease, which are both associated with erectile dysfunction. Also, carrying fat around the middle can affect a man’s hormones, which can contribute to penile dysfunction.

erectile-dysfunction-exercises-pdf-information

1. Overview2. Symptoms3. Causes4. Diagnosis5. Prevention6. Treatment7. Everyday Life8. Questions9. Resources

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If regular exercise doesn’t resolve the issue, consult with your doctor. There are other options available to treat erectile dysfunction. Your doctor may suggest any of the following:

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Erectile dysfunction, also known as impotence, is when a man is unable to get or maintain an erection.

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The same concerns regarding the use of sildenafil with nitrates and alpha-blockers apply to vardenafil.

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