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External Mechanical Devices: This category of treatments includes external vacuum therapies: devices that go around the penis and produce erections by increasing the flow of blood in, while constricting the flow out. Such devices imitate a natural erection, and do not interfere with orgasm. External vacuum therapy mechanisms are approximately 95 percent successful in causing and sustaining an erection.

All are portable, and

costs

The vacuum constriction device consists of a vacuum cylinder, various sizes of tension rings, and a vacuum pump, either hand-operated or electric. The penis is placed in a cylinder to which a tension ring is attached. Air is evacuated from the cylinder by means of the pump, creating a vacuum, which produces the erection. The cylinder is removed, leaving the tension ring at the base of the penis to maintain the erection.

You must use the correct-size tension ring and remove it, to prevent penile bruising, after sustaining the erection for 30 minutes.

Such devices may be unsuitable for men with certain bleeding disorders.

In general, vacuum constriction devices are successful in management of long-term ED.

“Rejoyn” is an inexpensive, nonprescription alternative to the vacuum-actuated devices. Described by its manufacturer as a “support sleeve,” it does not “cause” an erection, but rather supports the flaccid penis as if it were erect (one wears it under a condom).

Counseling: The great majority of ED cases in diabetic men have a physical cause, such as neuropathy or circulatory problems.

In some cases, however, the cause of ED is psychological, including depression, guilt, or anxiety. With a thorough exam, the doctor should be able to determine whether the ED is psychological or physical in nature. If the cause is psychological, your doctor may refer you to a psychiatrist, psychologist, sex therapist, or marital counselor. Most psychologically-based ED is easily and successfully treated. Surgery: There are two kinds of surgery for ED: one involves implantation of a penile prosthesis; the other attempts vascular reconstruction.

Expert opinion about surgical implants has changed during recent years; today, surgery is no longer so widely recommended. There are many less-invasive and less-expensive options, and surgery should be considered only as a last resort.

The obvious risks are the same that accompany any surgery: infection, pain, bleeding, and scarring. If for some reason the prosthesis or parts become damaged or dislocated, surgical removal may be necessary. With a general success rate of about 90 percent, any of the devices will restore erections, but they will not affect sexual desire, ejaculation, or orgasm.

Prostheses: Many different types of penile prostheses are available, in three categories: rods, inflatable prostheses, and self-contained prostheses. Semi-rigid or malleable rods are the simplest and least expensive of all.

Their main disadvantage is that the penis remains constantly erect, which may cause problems with concealment. Inflatable prostheses are complex mechanical devices that imitate the natural process of erection. Parts are inserted surgically into the penis and scrotum, and activated by squeezing. When erection is no longer desired, a valve on the pump is pressed, and the penis becomes flaccid.

Self-contained single-unit prostheses are similar to the inflatable types, but more compact. When erection is desired, the unit is activated by either squeezing or bending, depending on which of the two types of self-contained prostheses is used.

Vascular Reconstructive Surgery corrects defects in penile blood vessels. The surgeon may reconstruct the arterial blood supply, or remove veins when the cause is due to leakage.

Less than five percent of men with ED may benefit from vascular surgery.

Preventing ED Like all sildenafil tablet buy online diabetic complications, ED can occur even when you have followed your doctor’s advice and carefully managed your diabetes.

Also like all diabetes complications, ED is less likely to occur with good blood sugar control. Poorly controlled diabetes and high cholesterol increase the chances of vascular complications, which may lead to ED or other circulatory problems. In addition, regular smoking and alcohol use can contribute to ED. You are not alone; others have faced these difficulties. Is Viagra the World's Most Popular Male Sexual Performance Drug?

by Michael Castleman, December 11, 2013 | Comments: 0. In four studies where couples used Viagra, then Cialis (or vice versa), the women strongly preferred the latter. En espanol | In the pantheon of globally recognized brand names, Viagra is right up there with Coca-Cola

and

I found 12 studies — none of them funded by the drug companies themselves — in which men from various countries tried both drugs and then reported which one they chose to continue. And the 8,300 participants favored Cialis by a wide margin — 3 to 1, on average.

In studies that also included the third major erection drug, Levitra (vardenafil), Cialis was still substantially more popular than either competitor. In four studies where couples used Viagra, then Cialis (or vice versa), the women strongly preferred the latter. Blindfolds: A classic sex accessory A better sex life?

Take the slow route Date night ideas for couples in a rut. Join AARP Today — Receive access to exclusive information, benefits and discounts.

Viagra and Levitra are effective for approximately four hours, Cialis for 36.

If a man takes Cialis on Friday evening, he can count on erection assistance through part of Sunday.

Both men and women say they like the fact that Cialis allows them to take their eyes off that ticking clock and make love whenever they wish. So for dating couples or new lovers who prize sexual spontaneity, Cialis has a clear advantage.

Oddly, Cialis is favored by a less sexually impulsive group as well: long-term spouses, who are likelier to schedule sex dates.

The drug's more wide-open window of opportunity apparently makes for friendlier spousal negotiations over time and place.

Except for their duration of action, all erection medications function in similar fashion.

They work equally well if taken on an empty stomach or after a meal. None produce spontaneous erections, so no mortifying bulges in the produce aisle; they enhance firmness only in the context of erotic stimulation.

Their side effects are quite similar, too: headache (16 percent of users), upset stomach (7 percent) and nasal congestion (4 percent). (Important note: Never use erection medications if you're taking nitroglycerin for angina; the combination

can

Remember how close we came to losing Jack Nicholson in Something's Gotta Give? ) And you might be surprised to learn how few older men use any erection drug at all: Sales of "vitamin V" have never reached more than about half of what experts predicted when such medications were first approved in 1998. When Cornell researchers surveyed 6,291 older men on the subject, 48 percent reported some degree of erectile dysfunction, but only 7 percent had ever tried an erection drug. One reason is that, compared with women, men are less willing to take medication.

But the main reason is that the drugs enhance intercourse, whereas older couples generally evolve away from the old in-out toward hand massage, oral sex and vibrator play. A "fact of life" for many older lovers is that intercourse is a hassle. Even with drugs, erections may be iffy; even with lubrication aplenty, vaginal dryness or atrophy may cause pain during intercourse.

That's why many older lovers move on from intercourse to other pleasures. And if you're no longer having intercourse, erections aren't necessary, so why take a drug? In addition, men don't need erections to have orgasms. You read that right: Given sufficient fondling, a man can have a marvelous orgasm with a semifirm or even flaccid penis.

Among men who try erection medications, only half refill their prescriptions.

The manufacturers claim the drugs are 70 to 85 percent effective, but research shows their effectiveness to be more in the 50 to 60 percent range; for men with diabetes, heart disease, or high cholesterol or blood pressure, it online sildenafil citrate can be even lower. And wait until you hear how the

studies

That means even drug-fueled erections can be on the soft side, leaving many men feeling disappointed.

Bottom line: If you've never tried an erection medication, you're in the majority.

But if you use one, you — and your partner — will likely be happiest with one that lasts the longest.

For now, according to the latest surveys, that's Cialis.

Michael Castleman, publisher of the website GreatSexAfter40.com, writes about sex for AARP. Why long-married couples are splitting up One job where it pays to be in your 60s Affordable Care Act questions?

See the AARP home page for deals, savings tips, trivia and more.

Most men with ED start with pills, such as Viagra™, Levitra™, Cialis™ and Stendra™. These may improve blood flow to the penis, and with sexual stimulation, can help you achieve an erection.

17-19 40 If men don’t respond to oral medications, they may try other options. PROS: Pills can help online sildenafil citrate you achieve an erection quickly and may have an effect on sexual intimacy.

CONS: Some men cannot achieve a satisfactory erection with pills and other men will switch the type of pills to achieve a satisfactory outcome.

70% of cases but less effective in patients with diabetes or damage to the nerves or endothelium. 27 40 About 50% of men with ED stop oral medications due to side effects, cost and because the medications stop working.

These medications (alprostadil, papaverine, etc.) may be combined and injected directly into the base or side of the penis. The recommended frequency of injection is no more than three times weekly, and should produce an erection in 5-20 minutes.

PROS: An option for physical or psychological causes of erectile dysfunction using a fine gauge needle that may feel sildenafil citrate 100mg tab price like pinprick.

CONS: Beyond a possible fear of needles, men may experience pain, fibrosis, and risk of a persistent erection.

PATIENT SATISFACTION AND OUTCOMES: Approximately 60% of patients were satisfied and continued use. 68 Satisfaction for men and partners at 4 years was 91.4% and clinical studies report.

These medications (alprostadil, etc.) are inserted into the urethra at the end of the penis using an applicator (also called MUSE™).

To relax the muscle, encourage blood flow, and cause an erection, apply medications that dissolve inside the penis 16 minutes before intimacy. PROS: For use multiple times a week, it may also be an option for physical or psychological causes of ED.

CONS: In addition to general discomfort, common side effects include penile pain and urethral pain or burning.

PATIENT SATISFACTION AND OUTCOMES: Clinical study satisfaction rates are limited, but one study found 64 of 192 men (33%) were satisfied.

69 In clinical literature, success rates are reported at 40-66%. MAKE SURE YOU UNDERSTAND THE OPTIONS AVAILABLE TO YOU AND BE OPEN AND UPFRONT ABOUT HOW THE OPTIONS FIT YOUR LIFESTYLE. Men with diabetes are more likely to move to advanced treatments than those without diabetes. 9 A healthy lifestyle can help you control your diabetes and improve ED symptoms. Treatment options are available; however, men with diabetes are less responsive to oral ED medications.

What’s good for the heart is good for your ED symptoms. If ED occurs, most treatment options are available.

However, oral ED medication and heart medications don’t mix well and the medication in some injections should not be used if you have blood clotting problems.

While ED may be a side effect of prostate cancer treatment, erectile function

does

Despite wide usage, 30-50% of patients who turn to sexual aids after surgery discontinue use within a year. Fast-acting erectile dysfunction drug Stendra approved by FDA.

(CBS News) A new erectile dysfunction drug that reportedly works in less than 15 minutes has just received approval from the U.S.

On Friday the FDA approved Vivus Inc.'s Stendra to take as an "as-needed" pill for men before sexual activity.

Current ED drugs on the market include Pfizer Inc.'s Viagra, Eli Lilly's Cialis and GlaxoSmithKline and Bayer's drug Levitra.

The new drug Stendra, the brand name for avanafil, is the first new erectile dysfunction drug in a decade for this class of drugs known as phosphodiesterase type 5 (PDE5) inhibitors. "This approval expands the available treatment options to men experiencing erectile dysfunction, and enables patients, in consultation with their doctor, to choose the most appropriate treatment for their needs," Dr. Victoria Kusiak, deputy director of the Office of Drug Evaluation III in the FDA's Center for Drug Evaluation and Research, said in an FDA statement.

Similar to its counterparts, the drug works by helping increase blood flow to the penis.

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"This is potentially the fastest acting of the four," Dr.

Wayne Hellstrom, professor of urology at Tulane University School of Medicine in New Orleans, told Reuters.

Patients taking Stendra are recommended to take the drug 30 minutes before sexual activity but clinical trials have shown the drug works as fast as 15 minutes.

Viagra may take an hour to start working, Reuters reported. In clinical trials, 77 percent of men with general ED were able to get erections after taking Stendra, compared with 54 percent of men taking a placebo pill, WebMD reported.

Stendra resulted in successful intercourse for 57 percent of men with general ED, compared with 27 percent of men on placebo.

According to the FDA, the most common side effects for men taking Stendra were headache, face redness, nasal congestion, cold-like symptoms, and back pain. In rare cases men may get online sildenafil citrate an erection that does not go away after four hours - a condition known as priapism. If that happens, patients should seek immediate medical care, the FDA said. As with other PDE5 inhibitors, Stendra should not be used by men who also take nitrates commonly used to treat chest pain, because the combination can cause a sudden drop in blood pressure.

Erectile dysfunction: giving patients more choice and better treatments. Erectile dysfunction affects around 50% of men between 40 and 70 years old.

Futura Medical is currently developing a topical gel product, named MED2005, as a new therapeutic approach for the condition.

Can MED2005 add to the treatment choices in the erectile dysfunction space? Many studies have found that sales of Viagra (sildenafil), a tablet used to treat erectile dysfunction in men, surge around Valentine’s Day.

This has contributed to 14 February also being designated as UK National Impotence Day in previous years, and this year as Thinking about Sex Day, by the Sexual Advice Association (SAA). Erectile dysfunction is very common; it affects around half of men aged between 40 and 70 years old, according to online sildenafil citrate the SAA.

It is now known to be caused by both

psychological

conditions

Although these therapies have an approximately 70% success rate, PDE5 inhibitors have to be taken between 30 minutes and two hours before sexual activity leading a lack of spontaneity in the sex lives of those

taking

These issues were noted by Professor David Ralph, consultant urologist at University College London and trustee of the SAA, during an R&D discussion event organised by Futura Medical earlier this month.

Second line therapies for erectile dysfunction include alprostadil injections; two branded examples are Caverject and Viridal.

For these therapies, aprostadil, which is the same chemical produced by an erect penis, is injected into the shaft of the penis to help blood flow. Ralph noted this treatment can cause scarring to patient’s penises; the SAA also states it can be very painful. There are other therapies where alprostadil in pellet form is administered into the urethra, however, Ralph comments that efficacy is not as good as the injectable form. A third line of therapy for severe cases are penile prosthesis and surgical removal of the prostates. Moving towards the ideal treatment for erectile dysfunction. Since oral agents introduced in the 1990s are the most recent major innovation in the erectile dysfunction field, there is a lot of patient expectation for more high-quality treatment options. In his presentation, Ralph described the ideal treatment for erectile dysfunction as having good evidence of efficacy, having rapid onset, being safe, cheap and discrete, being a localised therapy, not affected by food and drink and acceptable to the patient’s sexual partner.

Using its expertise in transdermal delivery, Futura Medical has developed a topical gel product, called MED2005, using its DermaSys technology to treat mild and moderate erectile dysfunction, which it believes ticks most of these boxes. MED2005 builds upon recent developments in creating creams for erectile dysfunction. An example is Takeda’s Vitaros, a topical cream formulation of alprostadil, which incorporates a skin-permeation enhancer that aids absorption after application to the meatus of the penis.

Futura Medical’s topical gel enables the targeted and rapid delivery of glyceryl trinitrate (GTN), a drug originally developed to treat angina, into the glans penis. Phase I and II trials showed that MED2005 was efficacious compared to placebo becoming effective within ten minutes, was not impacted by alcohol or food and caused few adverse events for either the male participants or their partners.

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The company also noted that in the pharmacodynamics Phase II trial in one third of cases the female partner applied the gel; it is common with existing therapies for partners to be largely excluded from treatment.