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Nearly every man can experience brief problems with erectile function. In almost all cases it is related to certain and specific life circumstances, problems, or stressful situations. Usually, these erectile problems disappear once the situation is resolved or changed. You generally don’t need to go to the doctor. .
A lot of women may be familiar with Kegels, as these are often recommended after childbirth, and are named after Dr. Kegel (yep, he was a real person!) who studied and practised sexual medicine in the 1940s.
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Any exercise which increases your heart and breathing rate is known as aerobic exercise - so that includes many different types of exercise, from football, running and badminton to spinning, dancing and swimming.
Medication can be a big help if the extent of the ED is not that considerable and a couple faces it occasionally.
The authors thanks Dr. Heinz Schönhofen from Center of Radiology Baden in Switzerland for excellent implementation of CT cavernosography and high quality CT images. 1. NIH Consensus Conference. Impotence. NIH consensus development panel on impotence. Jama. (1993) 270:83–90. doi: 10.1001/jama.270.1.83 2. Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile dysfunction in young men-a review of the prevalence and risk factors. Sex Med Rev. (2017) 5:508–20. doi: 10.1016/j.sxmr.2017.05.004 3. Rogers JH, Goldstein I, Kandzari DE, Köhler TS, Stinis CT, Wagner PJ, et al. Zotarolimus-eluting peripheral stents for the treatment of erectile dysfunction in subjects with suboptimal response to phosphodiesterase-5 inhibitors. J Am Coll Cardiol. (2012) 60:2618–27. doi: 10.1016/j.jacc.2012.08.1016 4. Dicks B, Bastuba M, Goldstein I. Penile revascularization–contemporary update. Asian J Androl. (2013) 15:5–9. doi: 10.1038/aja.2012.146 5. Rogers JH, Karimi H, Kao J, Link D, Javidan J, Yamasaki DS, et al. Internal pudendal artery stenoses and erectile dysfunction: correlation with angiographic coronary artery disease. Catheter Cardiovasc Interv. (2010) 76:882–7. doi: 10.1002/ccd.22646 6. Lue TF. Erectile dysfunction. N Engl J Med. (2000) 342:1802–13. doi: 10.1056/NEJM200006153422407 7. Rebonato A, Auci A, Sanguinetti F, Maiettini D, Rossi M, Brunese L, et al. Embolization of the periprostatic venous plexus for erectile dysfunction resulting from venous leakage. J Vasc Interv Radiol. (2014) 25:866–72. doi: 10.1016/j.jvir.2014.01.015 8. Shafik A, Shafik I, El Sibai O, Shafik AA. On the pathogenesis of penile venous leakage: role of the tunica albuginea. BMC Urol. (2007) 7:14. doi: 10.1186/1471-2490-7-14 9. Doppalapudi SK, Wajswol E, Shukla PA, Kolber MK, Singh MK, Kumar A, et al. Endovascular therapy for vasculogenic erectile dysfunction: a systematic review and meta-analysis of arterial and venous therapies. J Vasc Interv Radiol. (2019) 30:1251–8. doi: 10.1016/j.jvir.2019.01.024 10. Diehm N, Marggi S, Ueki Y, Schumacher D, Keo HH, Regli C, et al. Endovascular therapy for erectile dysfunction-who benefits most? insights from a single-center experience. J Endovasc Ther. (2019) 26:181–90. doi: 10.1177/1526602819829903 11. Wespes E. Erectile dysfunction in the ageing man. Curr Opin Urol. (2000) 10:625–8. doi: 10.1097/00042307-200011000-00016 12. Rhoden EL, Teloken C, Sogari PR, Vargas Souto CA. The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction. Int J Impot Res. (2002) 14:245–50. doi: 10.1038/sj.ijir.3900859 13. Kaufman JM, Borges FD, Fitch WP III, Geller RA, Gruber MB, Hubbard JG, et al. Evaluation of erectile dysfunction by dynamic infusion cavernosometry and cavernosography (DICC). Multi-institutional study. Urology. (1993) 41:445–51. doi: 10.1016/0090-4295(93)90505-5 14. Gratzke C, Angulo J, Chitaley K, Dai YT, Kim NN, Paick JS, et al. Anatomy, physiology, and pathophysiology of erectile dysfunction. J Sex Med. (2010) 7:445–75. doi: 10.1111/j.1743-6109.2009.01624.x 15. Ye T, Li J, Li L, Yang L. Computed tomography cavernosography combined with volume rendering to observe venous leakage in young patients with erectile dysfunction. Br J Radiol. (2018) 91:20180118. doi: 10.1259/bjr.20180118 16. Katzenwadel A, Popken G, Wetterauer U. Penile venous surgery for cavernosal venous leakage: long-term results and retrospective studies. Urol Int. (1993) 50:71–6. doi: 10.1159/000282455 17. Lewis RW. Venous surgery for impotence. Urol Clin North Am. (1988) 15:115–21. 18. Aschenbach R, Steiner T, Kerl MJ, Zangos S, Basche S, Vogl TJ. Endovascular embolisation therapy in men with erectile impotence due to veno-occlusive dysfunction. Eur J Radiol. (2013) 82:504–7. doi: 10.1016/j.ejrad.2012.10.030 19. Fernandez Arjona M, Oteros R, Zarca M, Diaz Fernandez J, Cortes I. 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Sildenafil (Viagra) was the first oral phosphodiesterase type 5 (PDE5) inhibitor approved by the FDA in the United States for the treatment of erectile dysfunction (it is not approved for women). Sildenafil inhibits PDE5, which is an enzyme that destroys cGMP. By inhibiting the destruction of cGMP by PDE5, sildenafil allows cGMP to accumulate. The cGMP in turn prolongs relaxation of the smooth muscle of the corpora cavernosa. Relaxation of the corpora cavernosa smooth muscle allows blood to flow into the penis resulting in increased engorgement of the penis. In short, sildenafil increases blood flow into the penis and decreases blood flow out of the penis.
When you have heart disease, or coronary artery disease (blocked blood vessels), it will affect the tiny arteries in your penis sooner. Many times, we will refer you to a cardiologist to determine if you have cardiovascular disease that is causing your ED. increasing physical activity, quitting tobacco products, losing weight, and consuming a healthy, well-balanced diet.
Risk exposure is important to consider in the PDE5 inhibitors. Cardiovascular diseases may be a contraindication to treatment, as severely impaired patients may run the risk of a cardiac complication related to vigorous sexual activity. Likewise, patients actively taking nitrates, including nitroglycerine and other agents, are contraindicated from receiving prescriptions for PDE5 inhibitor. Relative contraindications to the use of PDE5 inhibitor include alpha-adrenergic antagonists. Visual disturbances can be seen with sildenafil (blue haze to the visual field) as a result of inhibition of the PDE6 enzyme.
A vacuum constriction device (VCD) is an external pump with a band on it that a man with erectile dysfunction can use to get and maintain an erection.
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You may see many herbs and supplements that claim to help sexual performance or desire. However, none have been proven to successfully treat ED. Plus, they may not always be safe. DO NOT take anything without talking with your provider first.
“Quite often, oral medications may be the only treatment required and men can resume normal sexual life. If a patient does not respond to oral medications, penile prosthesis (implants) is a viable and long-term option especially in severe cases. While least-chosen, it is important to know penile implants are easy to use and men report a high satisfaction rate. Speaking to an andrologist or urologist is the best option, as they can explain the risks and benefits of each treatment.”
Discussing ED with your family doctor or urologist may be uncomfortable, but it is important to do so. Together you can discuss which treatment is right for you.
Certain feelings can interfere with normal sexual function, including feeling nervous about or self-conscious about sex, feeling stressed either at home or at work, or feeling troubled in your current sexual relationship. In these cases, treatment incorporating psychological counseling with you and your sexual partner may be successful. One episode of failure, regardless of cause, may propagate further psychological distress, leading to further erectile failure. Individuals suffering from psychogenic ED may benefit from psychotherapy, treatment of the ED, or a combination of the two. Also, medications used to treat psychologic troubles may cause ED; however, it is best to consult with your physician prior to stopping any medications that you are taking. Althof, S.E., E.W. Corty, S.B. Levine, et al. "EDITS: development of questionnaires for evaluating satisfaction with treatments for erectile dysfunction." Urology 53.4 April 1999: 793-799. American Foundation for Urologic Disease. American Foundation for Urologic Disease. American Urological Association. "Erectile Dysfunction." 2011.