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Stem cells were delivered via intracorporal penile injections to replenish the depleted endothelial cells and/or caveronous smooth muscle

cells

A different theoretical understanding is that stem cell therapy results in the host's regeneration, as opposed to simply replenishment, of endothelial and cavernous smooth muscle cells and is able to restore the interactions between these structures ( 8 ).

The vast majority of published studies focus on animal models with only one study in humans

and

Lin reports that intracavernous injected stem cells can escape the penis and hone into the bone marrow possibly accounting for systemic antidiabetic effects and prolonged restoration of erectile function ( 8 ).

New and promising therapies for ED continue to evolve. The PDE5i's significantly advanced our understanding and ability to treat men suffering from ED.

However, stem cell therapy may become the next generation of ED treatment offering the field of sexual medicine and our patients new possibilities.

While it will take time to conduct the necessary human trials and obtain regulatory and ethical approvals, stem cell therapy may move us into the next wave of treatment options for ED. Psychotherapy for erectile dysfunction: now more relevant than ever. Dean JD, McMahon CG, Guay AT, Morgentaler A, Althof SE, Becher ER et al. The International Society for Sexual Medicine's Process of Care for the Assessment and Management of Testosterone Deficiency in Adult Men.

Male sexual function: A guide to clinical management. Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA. Oral sildenafil in the treatment of erectile dysfunction. Padma-Nathan H, Hellstrom WJ, Kaiser FE, Labasky RR Lue TR Nolten WE, et al. Treatment of men with erectile dysfunction with transurethral alprostadil. Medicated Urethral System for Erection (MUSE) Study Group. Shabsigh R, Padma-Nathan H, Gittleman M, McMurray J, Kaufman J, Goldstein I.

Intracavernous alprostadil alfadex (EDEX/VIRIDAL) is effective and safe in patients with erectile dysfunction after failing sildenafil (Viagra).

Penile prostheses for the treatment for erectile dysfunction. Lin CS, Xin ZC, Wang Z, Deng C, Huang YC, Un G, et al.

Stem cell therapy for erectile dysfunction: a critical review.

Althof , Executive Director, Center for Marital and Sexual Health of South Florida, Professor Emeritus, Case Western Reserve University School of Medicine, 1515 North Flagler Drive, Suite 540, West Palm Beach, Florida 33401, Fax: + 1 561 822-5458, E-mail: sxa6@case.edu. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Rua Bambina, 153 22251-050 Rio de Janeiro RJ Brazil Tel. Erectile Dysfunction (ED) The UW Health Men’s Health program

offers

urological

It is a very common condition, but is also a very emotional and sensitive topic to discuss.

Erectile dysfunction is defined as the inability to maintain an erection sufficient for sexual intercourse.

Achieving an erection is a complex process involving the brain, hormones, nerves, muscles and blood circulation.

If something interferes with this process, the result may be erectile dysfunction. In some cases, erectile dysfunction is the first sign of other serious underlying health conditions, such as cardiovascular problems, that need treatment because erectile dysfunction can share the same risk factors for heart attacks and strokes.

About 5 percent of men that are 40 years old have complete erectile dysfunction, and that number increases to about 15 percent of men at age 70. Mild and moderate erectile dysfunction affects approximately 10 percent of men per decade of life (i.e., 50 percent of men in their 50s, 60 percent of men in their 60s).

Erectile dysfunction can occur at any age, but it is more common in men that are older. Older men are more likely to have health conditions that require medication, which can interfere with erectile function.

Additionally, as men age, they may need more stimulation to get an erection and more time between erections. There are three essential components of male sexual function: Interest and desire for sexual activity (libido) The ability to obtain and maintain an erection Ejaculation and climax (orgasm) During an initial visit, the urologist will help to differentiate which components of the male sexual function are affected. This is an important step because treatment options for differ depending on the affected components.

There are many possible causes of erectile dysfunction, both physical and psychological, including: Psychological/Environmental. There are several steps men can take to reduce their risk for erectile dysfunction, including: Quit smoking Exercise regularly Maintain a healthy weight and healthy diet Limit or avoid the use of alcohol Reduce stress Get help for anxiety or depression Discontinue drugs with harmful side effects Have regular check-ups with a primary care physician to monitor blood pressure, blood sugar and cholesterol levels.

UW Health urologists with advanced training offer medical and surgical treatment options for men and their partners affected by erectile dysfunction. There are several different ways that erectile dysfunction can be treated.

For some men, making a few healthy lifestyle changes may solve the problem. Your urologist will help determine the most effective course of treatment for your condition. Erectile dysfunction (ED) is when a man has persistent problems achieving and/or sustaining an erection. Erectile dysfunction can make sexual intercourse impossible without treatment.

Erectile dysfunction can first emerge in a man as early as 40 according to the Massachusetts Male Aging Study on sexual dysfunction.

They also found that an estimated 18 to 30 million men are affected by erectile dysfunction. Erectile dysfunction refers specifically to problems achieving or maintaining an erection. Other forms of male sexual dysfunction include poor libido and problems with ejaculation.

Men with erectile dysfunction often have a healthy libido, but their bodies fail to respond in the sexual encounter by producing an erection. Can Low Testosterone (Low T) Cause Erectile Dysfunction? While low T isn't the only cause of erectile dysfunction, the two do seem to be connected.

However, the connection between low testosterone and erectile dysfunction is complicated.

Researchers believe two are connected because they both seem to coincide as a man ages.

However, some men with low testosterone continue to produce healthy erections. Symptoms of

erectile

Men who cannot have or maintain an erection at least 75% of the time that they attempt sex are considered to have erectile dysfunction.

According to the Massachusetts Male Aging Study, about 40% of men experience some degree of inability to have or maintain an erection at age 40 compared with 70% of men at age 70.

And the percentage of men with erectile dysfunction increases from 5% to 15% as age increases from 40 to 70 years.

When blood fills two chambers in the penis (known as the corpora cavernosa) an erection occurs.

This causes the penis to expand and stiffen, much like a balloon as it is filled with water.

The process is triggered by nerve impulses from the brain and genital area. Anything that interferes with these impulses or restricts blood flow to the penis can result in erectile dysfunction. The link between underlying chronic disease and erectile dysfunction is most striking with diabetes. Approximately half of the men with diabetes experience erectile dysfunction.

Nevertheless, good blood sugar control can minimize this risk. In addition, the following

four

Smoking makes men with atherosclerosis even more vulnerable to erectile dysfunction. Smokers have almost twice the risk of erectile dysfunction compared with nonsmokers.

Being overweight and getting too little exercise also contribute to erectile dysfunction. Men who exercise regularly have a lower risk of erectile dysfunction. Surgical or radiation treatments for prostate cancer, bladder cancer, or prostate enlargement (BPH) can sometimes damage nerves and blood vessels near the penis.

Occasionally, the nerve damage is permanent and the patient requires treatment to achieve an erection. Sometimes, surgery causes temporary erectile dysfunction that improves on its own after 6 to 18 months.

Many medications can cause or contribute to erectile dysfunction, including certain blood pressure drugs, antidepressants, and tranquilizers.

Men with erectile dysfunction should talk with their doctor if they suspect a prescription or over-the-counter drug may be causing erectile problems. It is common for men with erectile dysfunction to have an underlying physical basis for it, particularly in older men. However, psychological factors may be present in 10% to 20% of men with erectile dysfunction.

Experts say stress, depression, poor self-esteem, and performance anxiety can impair the ability to have an erection. These factors can also make erectile dysfunction worse in men whose sexual dysfunction stems from something physical. Avid cyclists suffer more erectile dysfunction than other athletes because the shape of some bicycle seats causes pressure on the nerves that are vital to sexual arousal.

Cyclists who ride for many hours each week may benefit from seats designed to protect the perineum.

To diagnose erectile dysfunction, the doctor will ask questions about the symptoms and medical history. A complete physical exam is done to detect poor circulation or nerve trouble.

The physician will look for abnormalities of the genital area that could cause problems with erections.

Many lab tests can be helpful in diagnosing male sexual problems. Measuring testosterone levels can determine whether there is a hormonal imbalance, which is often linked to decreased desire. These tests may reveal underlying medical causes of ED: Blood cell counts Cholesterol levels Blood sugar levels Liver function tests.

Erectile dysfunction can be a warning sign of serious underlying disease.

Research has found that erectile dysfunction is a strong predictor of heart attack, stroke, and even death from cardiovascular disease.

All men with erectile dysfunction should be evaluated for cardiovascular disease.

Notably, this does not mean every man with erectile dysfunction will develop heart disease, or that every man with heart disease has erectile dysfunction; however, erectile dysfunction patients should be aware of the link.

Often men with erectile dysfunction are able to improve sexual function by making a few lifestyle changes.

Stopping smoking, losing weight, and exercising regularly can help by improving blood flow. If you suspect a medication could be contributing to erectile dysfunction, talk to your doctor about it. While popularized in the media, Viagra is not the only erectile dysfunction drug.

Other erectile dysfunction drugs include: Cialis Levitra Staxyn Stendra. These drugs work by improving blood flow to the penis during arousal and are taken 30 to 60 minutes before sexual activity. Cialis can be taken up to 36 hours before sexual activity and also comes in a lower, daily dose. 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) Vacuum devices for erectile dysfunction, also called pumps, offer an alternative to medication. To use a pump, the penis is placed inside a cylinder.

Then the pump free viagra without prescription draws air out of the cylinder to create a partial vacuum around the penis causing it to fill with blood, leading to an erection. An elastic band worn around the base of the penis is used to maintain the erection during intercourse. Individuals should discuss the use of this device, and especially the elastic band use to avoid potential penile damage.

If erectile dysfunction is caused by a blockage in an artery leading to the penis, surgery can be used to restore blood flow.

Optimal candidates are typically younger men whose blockage stems from an injury to the crotch or pelvis. The surgery is not recommended for older men with widespread narrowing of the arteries throughout their bodies.

For those men with persistent erectile dysfunction, a penile implant can restore sexual function. An inflatable implant uses two cylinders that are surgically placed inside the penis.

When an erection is desired, the man uses a pump to fill the cylinders with pressurized fluid.

Alternatively, a malleable implant with surgically implanted rods can be used to bolster erections.

Psychotherapy can be beneficial for men with erectile dysfunction even when erectile dysfunction has a known physical cause.

The therapist can instruct the man and his partner in techniques to reduce performance anxiety and improve intimacy. Therapy can also help couples adjust to the use of vacuum devices and implants. Erectile Dysfunction Treatment: Alternative Therapies. Men with erectile dysfunction should talk with their doctors before trying supplements for erectile dysfunction.

They can contain 10 or more ingredients and may complicate other health conditions.

Asian ginseng and ginkgo biloba (seen here) are popular, but there isn't a lot of good research on their effectiveness.

Some men find that taking a DHEA supplement improves their ability to have an erection. Unfortunately, the long-term safety of DHEA supplements is unknown.

There are dozens of "dietary supplements" that claim to treat erectile dysfunction, but the FDA warns that many of these are not what they seem. One investigation discovered that supplements for erectile dysfunction can often contain prescription drugs not listed on the label, including the active ingredient in Viagra. These can put the man at risk for dangerous drug interactions.

To reduce your risk of erectile dysfunction, exercise and maintain a healthy weight, stop smoking, avoid alcohol and substance abuse, and keep your diabetes under control, if you have it. It's natural to feel angry or embarrassed when confronted with erectile dysfunction.

Talking openly about erectile dysfunction with your partner will help them understand the diagnosis and treatment options (and will reassure your partner that you haven't lost interest).

IMAGES PROVIDED BY: Zoran Milich/Allsport Concepts Fancy Plush Studios/Digital Vision Thomas Hoeffgen/Stone Brian Evans/Photo Researchers Inc Cristina Prdrazzini/Photo Researchers Inc Altrendo Images Robert Llewllyn/Workbook Stock Jeffrey Hamilton/Photodisc Dream Pictures/The Image Bank Glow Images Jose Luis Pelaez/Blend Images Lew Robertson/Brand X Thierry Dosogne/The Image Bank Corbis Photo Inc/ Age Fotostock Neville Sukhia Photography/Flickr Superstock Inc BSIP/Photo Researchers Inc Nucleus Medical Art, Inc.

David Bluffington/Age Fotostock Smneedham/FoodPix DiMaggio, Kalish/Flirt Moodboard Marcus Lund/Cultura. Reviews in Urology Journal: "Relationship Between Testosterone and Erectile Dysfunction" 3 ways to treat erectile dysfunction without Viagra.

Erectile dysfunction occurs when you can't get an erection or can't keep a firm enough erection to have sex. Having mild or moderate erectile dysfunction is common — it affects

about

Though there are drugs like Viagra on the market, some people would prefer a more natural approach. Here are a few methods you can try at home to help treat erectile dysfunction.

"Kegel exercises help strengthen the muscles that keep the erection full and hard," says William Brant, MD, a urologist at Granger Medical Clinic in Utah. These muscles, called your pelvic floor muscles, sit beneath your prostate and rectum and their strength can affect your ability to keep an erection. This is because when you flex your pelvic floor muscles, they put pressure on the veins in your penis., This makes it harder for blood to flow out of your penis and keep your erection intact. You can find your pelvic floor muscles by acting as if you are trying to stop peeing mid-flow or keep yourself from passing gas.

The muscles that you feel moving are the ones you will use in kegel exercises. Here is how to do a kegel workout: Tighten your pelvic floor muscles – sitting or lying down may make this easier. To get positive results, you should aim to do 3 sets of 10 repetitions per day.

Though more research is needed, there is some evidence that Korean red ginseng can help treat erectile dysfunction.

Ginseng works by helping the muscles in the penis relax, Brant says, "it is this relaxation that allows blood to fill the penis and create an erection." A 2008 review of several studies found that taking 600 milligrams of red ginseng helped men get and keep erections.

However, many of these studies were on small groups and larger studies are still needed to see if these results apply to a general population.

You can find red ginseng sold as capsules or as a tea, but Brant cautions that these supplements are not always reliable. Because supplements are not regulated by the FDA, the dosages on the labels may not be accurate or they may contain other unlisted ingredients.

It is important to talk to your doctor before trying over-the-counter remedies for erectile dysfunction to make sure that you are not putting your health at risk. Getting an erection involves many of the systems in your body including your nerves, your blood circulation, and your muscles.

For this reason, conditions linked to an unhealthy lifestyle, like heart disease and obesity, can put you at greater risk for erectile dysfunction. "Don't think of the penis in isolation," Brant says, "penis issues may represent general health issues." To improve erectile functioning, it's important to make lifestyle changes that will improve the health of your blood vessels, the channels that carry blood to all parts of your body, including your penis.

Brant recommends three lifestyle shifts that can help treat erectile dysfunction: Exercise more.

When you exercise, your body produces more nitric oxide, a compound that causes the muscles in your blood vessels to relax, allowing blood to flow more freely. This allows your penis to more easily become erect and stay erect.

A 2018 review found that physical activity can significantly improve erectile dysfunction, and experts recommend doing 40 minutes of exercise four times per week for best results.

If you smoke cigarettes, you are almost twice as likely as nonsmokers to experience erectile dysfunction. This is because the chemicals in cigarettes damage the lining of your blood vessels, known as the endothelium. The endothelium is what produces nitric oxide and without enough of it, it is much more difficult for blood to flow into your penis.

Drinking a low to moderate amount – fewer than 14 drinks per week for men – is not likely to increase your risk for erectile dysfunction.

However, if you drink more than this, especially over a long period free viagra without prescription of time, you may have a harder time keeping an erection. This is because alcohol dilates your blood vessels, allowing blood to flow into your penis, but also allowing it to flow out, leaving your penis flaccid. Erectile free viagra without prescription dysfunction is a common issue for men, particularly as you grow older, but there are several ways to treat it at home. If none of these methods work for you, reach out to your doctor to discuss other options like prescription medication. When your erec­tion falls flat, you need real and hon­est infor­ma­tion on what to do.

Ignore those mir­a­cle cures and ran­dom Google search­es; get seri­ous about fix­ing your prob­lem and talk to a doctor. Erec­tile dys­func­tion ( ED ), or male impo­tence, is the per­sis­tent inabil­i­ty to achieve or main­tain an erec­tion firm enough to have sex­u­al inter­course and occurs for more than a few weeks or months.

The Nation­al Insti­tutes of Health esti­mates that erec­tile dys­func­tion strikes rough­ly 30 mil­lion men in the Unit­ed States, so you are not alone. Erec­tile dys­func­tion pri­mar­i­ly affects men over the age of 20 , but preva­lence does increase with age. The Jour­nal of Sex­u­al Med­i­cine reports that one of out every four new ED patients is less than 40 years old. There are many dif­fer­ent rea­sons you expe­ri­ence impo­tence rang­ing from health prob­lems like high blood pres­sure to psy­cho­log­i­cal and emo­tion­al issues, or even side effects from a med­ica­tion. It is impor­tant to talk to your doc­tor about

this

Every per­son is dif­fer­ent, so your physi­cian will focus on the spe­cif­ic con­di­tion that could be caus­ing your erec­tile dys­func­tion.

Read more about five treat­ment options for erec­tile dysfunction. Oral Med­ica­tions There are a num­ber of pre­scrip­tion med­ica­tions avail­able (Via­gra, Lev­i­t­ra, Cialis) that may improve blood flow to the penis. Com­bined with sex­u­al stim­u­la­tion, this can pro­duce an erec­tion. These med­ica­tions all work sim­i­lar­ly to each oth­er; how­ev­er, there are some dif­fer­ences in effec­tive­ness and how quick­ly they begin to work.

Com­mon side effects may include headache, facial flush­ing, stuffy nose and an upset stomach. These med­ica­tions can NOT be tak­en if you use Nitrates for chest pain or oth­er med­ical prob­lems. This com­bi­na­tion can cause dan­ger­ous­ly low blood pressure. Vac­u­um Erec­tile Device (Penile Pump) A vac­u­um erec­tile device ( VED ) is a device that con­sists of a hol­low plas­tic tube, a hand or bat­tery-pow­ered vac­u­um pump and a ten­sion ring.

The tube, placed over the penis, cre­ates a vac­u­um that pulls blood into the penis. Once an erec­tion is achieved, an elas­tic ten­sion ring is placed at the base of the penis to help main­tain the erec­tion.

Since effec­tive oral med­ica­tion came onto the mar­ket, VEDs are used less to achieve erec­tion since they can be cum­ber­some and less effective.

Intrau­rethral Suppository/?Medicated Ure­thral Sys­tem for Erec­tion ( MUSE ) Med­icat­ed Ure­thral Sys­tem for Erec­tion ( MUSE ) uses an appli­ca­tor con­tain­ing a small pel­let with a med­ica­tion that is insert­ed into the ure­thra.

Once the pel­let is released, the med­ica­tion dis­solves inside the ure­thra and helps to increase blood flow to the penis to achieve an erec­tion.