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 It is important as you talk with your doctor that you be candid in terms of when your troubles started, how bothersome your erectile dysfunction is, how severe it is, and discuss all your medical conditions along with all prescribed and nonprescribed medications that you are taking. Your doctor will ask several questions to determine if your symptoms are suggestive of erectile dysfunction and to assess its severity and possible causes. Your doctor will try to get information to answer the following questions: Is the patient suffering from erectile dysfunction or from some other form of sexual dysfunction such as loss of libido or a disorder of ejaculation (for example, premature ejaculation) or orgasm, or problems with penile curvature/pain (Peyronie's disease)? Is your erectile dysfunction due to psychological (stress, relationship problems, etc.) or physical factors? Your doctor may ask if you note erections at night or in the early morning. Men have involuntary erections in the early morning and during REM sleep (a stage in the sleep cycle with rapid eye movements). Men with psychogenic erectile dysfunction (erectile dysfunction due to psychological factors such as stress and anxiety rather than physical factors) usually maintain these involuntary erections. Men with physical causes of erectile dysfunction (for example, atherosclerosis, smoking, and diabetes) usually do not have these involuntary erections. Men with psychogenic erectile dysfunction may relate the onset of problems to a "stressor," such as failed relationship. Your doctor may suggest a test to determine if you have erections during sleep, which may suggest that there may be a psychological cause of ...
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 And in the placebo group, this increase repeated itself after the second injection. However, in the group treated with sildenafil, the increased heartbeat was slowed by 50 percent, resulting in a smaller increase in blood flow and blood pressure generated by the heart in response to chemical stimulation. Between injections, heart function was not altered in the sildenafil group, demonstrating the absence of adverse side effects on the resting human heart. “Knowing more about the effects of sildenafil on heart function will allow for safer evaluation of its use buy original viagra as a treatment for heart problems,” says Kass. “Until now, it was widely thought that drugs like sildenafil had no effects on the human heart and that its only purpose was vasodilation in the penis and the lungs. “Our results set the stage for further studies of sildenafil’s immediate and long-term effects on the heart and its ability to modify other neurohormonal and stress stimuli, including adrenaline and hypertension,” he adds. While the precise biological actions of sildenafil in the heart are not fully understood, the drug is known to work by stopping the action of an enzyme, called phosphodiesterase 5 (PDE5A), the researcher says. This enzyme is involved in the breakdown of a key molecule, cyclic GMP, which helps control stresses and limit overgrowth in the heart. PDE5A is also the biological pathway blocked in the penis by sildenafil to promote the relaxation of blood vessels and maintain erections. Funding for this study was provided by the National Institutes of Health (NIH), the Peter Belfer Laboratory Foundation and the Bernard Family Foundation. The makers of the drug had no ...
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 This effect results from the peripheral arterial and venous vasodilating action of sildenafil, and it is not dose- (25 to 100 mg) or age-dependent, and seldom causes orthostatic hypotension; 3) sildenafil does not have a significant effect on heart rate 11, 12. Effect on platelets ? Bleeding episodes and increase in the bleeding and prothrombin times have not been observed, even in patients using acetylsalicylic acid or warfarin. However, assessment with the simultaneous use of other platelet antiaggregating agents (ticlopidine, clopidogrel, and dipyridamole) does not exist, nor assessment in patients with blood disorders; therefore, caution is advisable in such situations 11, 12. Effect on vision - Increase in light sensitivity and a blue-greenish or blurred vision due to the inhibiting action of sildenafil on 6 phosphodiesterase present in the retinal photoreceptors may occur. Patients, in whom these visual disorders may impair their activities, such as operators of automotive vehicles and airplanes, should be informed. Sildenafil should be carefully used in the presence of retinitis pigmentosa 11, 12 . Adverse effects ? 1) Vasodilating effects: headache (16%), flushing (10%), and rhinitis (4%). Dizziness (2%), hypotension and postural hypotension (2% each) occurred with equal frequency in the sildenafil and placebo groups; 2) Gastrointestinal effects: dyspepsia due to reflux (7%); 3) Visual effects: increase in light sensitivity or blue-greenish or blurred vision (3%), mainly with doses of 100mg; 4) Musculoskeletal effects: muscle pains, especially with multiple doses, without alterations in the concentration of creatinine phosphokinase and in the electromyogram; 5) ...
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 Viagra: Potential for cardiac risk with sexual activity in patients with preexisting cardiovascular disease; therefore, treatment for erectile dysfunction generally should not be instituted in men for whom sexual activity is inadvisable because of their underlying cardiovascular status. May cause dose-related impairment of color discrimination; use caution in patients with retinitis pigmentosa. Evaluate underlying causes of erectile dysfunction or BPH before initiating therapy. Revatio: In small, prematurely terminated study of patients with PAH secondary to sickle-cell disease, vaso-occlusive crises requiring hospitalization were more commonly reported by patients who received sildenafil than by those randomized to placebo; effectiveness of sildenafil in PAH secondary to sickle-cell anemia has not been established; the clinical relevance to men treated for erectile dysfunction with sildenafil is not known. Revatio: Not for use in children with PAH; increased mortality with increasing doses (hazard ratio 3.5) was observed in randomized, double-blind, placebo-controlled clinical trial of 234 children (1-17 years) with PAH who had mild-to-moderate symptoms at baseline. Revatio: Epistaxis occurred in 13% of patients with PAH secondary to connective tissue disease (eg, scleroderma); this effect was not seen in idiopathic PAH; incidence was also higher in those receiving concomitant PO vitamin K antagonist therapy (9%) than in those not receiving such therapy (2%) Pregnancy & Lactation. Limited published data from randomized controlled trials, case-controlled trials, and case series do not report a clear association with sildenafil and major birth defects, miscarriage, or ...
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 Vardenafil belongs to a class of drugs called phosphodiesterase type-5 (PDE5) inhibitors. A PDE5 inhibitor stops PDE5 from constricting the arteries. By relaxing the arteries, vardenafil enhances blood flow when a man is sexually aroused. The active ingredient works on the chain of reactions within the penis during arousal. When a male is sexually aroused, nitric oxide is released into his penis, and this buy cialis online visa triggers a chain of reactions. This causes an enzyme, guanylate cyclase, to produce cyclic guanosine monophosphate (cGMP). cGMP regulates the contraction and dilation, or expansion, of blood vessels that carry blood to and from the penis. The chemical reaction causes the vessels that supply the penis to dilate, while those removing blood from the penis contract. Phosphodiesterase-5 (PDE5), another enzyme breaks down or destroys cGMP. When cGMP is destroyed, the blood vessels return to their normal size, effectively ending the erection. Viagra, Cialis, Levitra, and Stendra: Which is best? Viagra, Cialis, Levitra, and Stendra are popular drugs for treating the symptoms of erectile dysfunction. They all have approval from the United States Food and Drug Administration (FDA), and they have the same function, but there are some differences between them. It is important to understand these differences in order to make the best choice about which to choose. Share on Pinterest Cialis and Viagra are PDE5 inhibitors that help to relax the muscles and increase blood flow. Viagra is the brand name for the drug sildenafil, Cialis is the brand name for tadalafil, Levitra is the brand name for vardenafil, and Stendra is the brand name for avanafil. This means ...
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 Axol Therapy is a modern approach to healing the body by using four types of energy: Heat, Electrohydraulic, Acoustic, and Light (HEAL). Unfocused acoustic waves are delivered to the shaft of the penis using a treatment wand that features a patented unfocused electrohydraulic acoustic wave. The pulsed acoustic waves are delivered through the skin into the tissue to open and repair aging blood vessels, stimulate new blood vessel growth, restore blood flow, and improve erectile quality. Axol Therapy typically takes only 20 minutes, once a week, for a total of six sessions in the physician’s office. For men who are the right candidates, Axol Therapy is a safe and effective option without the side effects often experienced with oral medications. Most patients can get the quality, rigid erections they once had with Axol Therapy’s gentle acoustic pulse treatment within just six office visits. Incremental improvement in erectile function may be seen after just a few sessions. There are a number of significant benefits to Axol Therapy. For men who are candidates for this treatment option, a future without erectile dysfunction is perhaps the biggest one. The restoration of a man’s vitality and spontaneous active sex life are also major benefits of this exciting new treatment. Erectile dysfunction (ED) is defined as difficulty in getting and maintaining an erection that is firm enough for sex. This condition is very common, and is actually the most frequent sexual health complaint from men of all ages. At Las Vegas Urology, our team of urologists is able to offer the complete spectrum of treatment for ED that you wont find anywhere else. Generally all symptoms of erectile ...
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 2, 3 In the Massachusetts Male Aging Study, a random sample survey of 1290 men aged 40 to 70 years, the age-adjusted prevalence of complete ED (no erections) was 15% in those with treated hypertension and 14% in those taking antihypertensive agents compared with a prevalence of 9.6% in the entire sample. Sildenafil, an orally active and selective inhibitor of cGMP-specific phosphodiesterase type 5, is an effective and well-tolerated treatment for ED of various causes. 4 By inhibiting the degradation of cGMP in the corpus cavernosum of the penis, sildenafil enables smooth muscle relaxation and penile erection in patients with ED. The most common adverse events associated with sildenafil treatment are headache and flushing, 5 which reflect its modest vasodilating properties. 6 Oral sildenafil (100 mg) produces transient decreases in systolic (8 to 10 mm Hg) and diastolic (3 to 6 mm Hg) blood pressure in healthy male volunteers. 5 Peak decreases are observed 1 h after dosing and coincide with peak plasma concentrations of drug. These changes in blood pressure generally return to pretreatment values by 4 to 8 h after dosing in healthy men. 6 This post hoc analysis assessed the efficacy and safety of sildenafil in men with ED who were receiving concomitant treatment with antihypertensive agents. Efficacy data were analyzed post hoc for groups of patients enrolled in 10 of 18 randomized, double-blind, placebo-controlled studies of sildenafil in the treatment of ED of various causes. In these 10 studies that assessed efficacy with the same outcome measure, a total of 3414 patients, 1218 (36%) of whom were taking concomitant antihypertensive medication, were randomized to ...
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 At single oral doses of 100 mg and 200 mg, transient dose-related impairment of color discrimination (blue/green) was detected using the Farnsworth-Munsell 100-hue test, with peak effects near the time of peak plasma levels. This finding is consistent with the inhibition of PDE6, which is involved in phototransduction in the retina. An evaluation of visual function at doses up to 200 mg revealed no effects of sildenafil citrate on visual acuity, intraocular pressure, or pupillometry. Sildenafil citrate is rapidly absorbed after oral administration, with a mean absolute bioavailability of 41% (25% to 63%). Maximum observed plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state. When sildenafil citrate is taken with a high-fat meal, the rate of absorption is reduced, with a mean delay in Tmax of 60 minutes and a mean reduction in Cmax of 29%. The mean steady-state volume of distribution (Vss) for sildenafil is 105 L, indicating distribution into the tissues. Sildenafil and its major circulating N-desmethyl metabolite are both approximately 96% bound to plasma proteins. Protein binding is independent of total drug concentrations. Bioequivalence was established between the 20 mg tablet and the 10 mg/mL oral suspension when administered as a 20 mg single oral dose of sildenafil (as citrate). Sildenafil is cleared predominantly by the CYP3A (major route) and cytochrome P450 2C9 (CYP2C9, minor route) hepatic microsomal isoenzymes. The major circulating metabolite results from N-desmethylation of sildenafil, and is, itself, further metabolized. This metabolite has a phosphodiesterase selectivity profile similar to ...
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 Erectile dysfunction (ED) can have many causes, such as certain medical conditions, medications and stress. It's important to identify the cause of erectile dysfunction and treat any underlying conditions. When a man becomes sexually excited (aroused), his brain sends signals to the nerves in his penis. The nerves increase the blood flow to the penis, causing the tissue to expand and harden. Anything that interferes with the nervous system or the blood circulation could lead to erectile dysfunction. Anything that affects the level of sexual desire (libido) can also cause erectile dysfunction because a reduced libido makes it more difficult for the brain to trigger an erection. Psychological conditions, such as depression, can reduce libido, as can changes in hormone levels (chemicals produced by the body). There are four main types of health conditions that can cause physical problems resulting in erectile dysfunction. These are: conditions affecting the flow of blood to your penis – vasculogenic conditions affecting your nervous system, which is made up of your brain, nerves and spinal cord – neurogenic conditions affecting your hormone levels – hormonal conditions affecting the physical structure of your penis – anatomical. Penis injuries or surgical treatment of the penis, pelvis or surrounding areas can sometimes lead to erectile dysfunction. Erectile dysfunction is also thought to occur in up to 15-25% of people who experience a severe head injury. Examples of vasculogenic conditions that cause erectile dysfunction include: cardiovascular disease – a disease of the heart or blood vessels, such as atherosclerosis (hardening of the arteries) high blood pressure ...
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 Our expert team has helped develop new minimally invasive and robotic surgical procedures to treat cancers, incontinence, and more. We give you access to leading-edge treatments and clinical trials that aren’t widely available. In addition, we have established the eighth fellowship program in the nation dedicated solely to teaching physicians how to care for men’s health. We have some of the world’s most experienced robotic surgeons for urologic procedures. In fact, doctors come from all over the world to learn at our Urology Robotic Program — the #1 ranked program in South Florida. The University of Miami Health System was the first academic medical center in the world to get the da Vinci Xi robotic surgery system and has completed more than 5,000 robotic surgeries — procedures that offer less pain and scarring and a faster recovery. Treatment for an erection problem depends on the cause of the problem. Many doctors take a step-by-step approach to treating erection problems. Treatment can include: Avoiding tobacco and drugs and limiting alcohol. Talking about the issue with your partner, doing sensual exercises, and getting counseling. Looking for and then stopping medicines that may be causing your condition. Taking testosterone or another treatment to fix a hormone problem, such as low testosterone, if tests show that you have one. They include sildenafil (such as Viagra), tadalafil (such as Cialis), and vardenafil (such as Levitra). Check with your doctor to see if it is safe for you to take one of these medicines with your other medicines. These pills can be dangerous if you have heart disease that requires you to take nitroglycerin or other medicines that contain ...
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 When the pump is activated, fluid flows from the reservoir into the tubes, which harden and become erect. Pressing a valve on the pump mechanism deactivates it, and the fluid returns to the reservoir, resulting in a flaccid penis. Complications can include infection, bleeding, pain and discomfort, mechanical failure, or extrusion of part of the prosthesis through a weakened wall of the erectile chambers. Penile implant surgery is a major surgery that is usually invasive and expensive. Nonetheless, it can benefit men who do not respond to any other form of treatment. These surgical procedures are not performed by Boston Medical Group physicians. A VSD is a battery or manually-operated cylindrical pump which fully encloses the penis. When activated, it creates a vacuum by sucking air out of the sealed chamber, which draws blood to the penis. A firm rubber ring is placed around the base of the penis to trap the blood in the erectile chamber, which keeps the penis firm. Disadvantages can include incomplete erections, discomfort, and the time required for operation, but VSDs are often valuable when used along with other treatments, like ICP. Approximately 2% to 5% of patients are candidates for vascular reconstructive surgery, which includes arterial bypass and venous ligation. Risks include those related to other major surgical procedures. Boston Medical Group physicians do not perform these surgeries. Some men experience a condition called andropause, similar to menopause in women, which can be caused by low testosterone. Symptoms can include, but are not limited to, feelings of sluggishness, fatigue, poor sleeping habits, weight gain, low sex drive, or erectile ...
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