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Blood Pressure Effects In Patients On Stable Alpha-Blocker Treatment. Three clinical pharmacology studies were conducted in patients with benign prostatic hyperplasia (BPH) on stable-dose alpha-blocker treatment, consisting of alfuzosin, tamsulosin or terazosin. This study was designed to evaluate the effect of 5 mg vardenafil compared to placebo when administered to BPH patients on chronic alpha-blocker therapy in two separate cohorts: tamsulosin 0.4 mg daily (cohort 1, n=21) and terazosin 5 or 10 mg daily (cohort 2, n=21). The design was a randomized, double blind, cross-over study with four treatments: vardenafil 5 mg or placebo administered simultaneously with the alpha-blocker and vardenafil 5 mg or placebo administered 6 hours after the alpha-blocker. Blood pressure and pulse were evaluated over the 6-hour interval after vardenafil dosing. One patient after simultaneous treatment with 5 mg vardenafil and 10 mg terazosin exhibited symptomatic hypotension with standing blood pressure of 80/60 mmHg occurring one hour after administration and subsequent mild dizziness and moderate lightheadedness lasting for 6 hours. For vardenafil and placebo, five and two patients, respectively, experienced a decrease in standing systolic blood pressure (SBP) of >30 mmHg following simultaneous administration of terazosin. Hypotension was not observed when vardenafil 5 mg and terazosin were administered 6 hours apart. Following simultaneous administration of vardenafil 5 mg and tamsulosin, two patients had a standing SBP of 30 mmHg was observed in two patients on tamsulosin receiving simultaneous vardenafil and in one patient receiving simultaneous placebo treatment. When tamsulosin ... More

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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 diseases can lead to erectile dysfunction by interfering with blood flow or nerve impulses throughout the body. Cardiovascular disease Atherosclerosis (hardening of the arteries) Kidney disease Multiple sclerosis. Lifestyle choices, such as smoking, alcohol abuse, and obesity can impair blood circulation and lead to erectile dysfunction. Smoking, excessive drinking, and drug abuse may damage the blood vessels and reduce blood flow to the penis. 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 ... More

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The perceived prevalence of ED needed to be expanded. The impression had to be created that ED was of significant concern to many, perhaps even most, men or at least those over 40 years of age. The criterion of success for treating ED had to be redefined. And finally, Viagra had to be seen as an important treatment option for men with any degree of ED, including rare or transitory failures to achieve or maintain erections. Redefining the Prevalence of ED and Its Psychological Effects. On its Web site, Pfizer states that “in fact, more than half of all men over 40 have difficulties getting or maintaining an erection” ( http://www.viagra.com/ed/index.asp). The Web site does not give a reference to support this statement. One possible source of support for this statement is the Massachusetts Male Aging Study (MMAS), a community-based, random sample observational survey of men aged 40 to 70 years old conducted from 1987 to 1989 in cities and towns near Boston, Massachusetts [ 2]. The authors of the study extrapolated the results to argue that 52% of the entire male population in the United States between the ages of 40 and 70 suffer from ED. The authors stated: “In the MMAS sample the prevalence of impotence of all degrees was estimated at 52%. Projection of these results to 1990 population data would suggest that impotence affects 18 million American men 40 to 70 years old” [ 2]. However, the MMAS figures viagra online no prior prescription must be viewed with a number of caveats. First, there were actually two different groups of men in this study. The first, and larger, group answered a series of nine questions about sexual activity. The second, and much smaller, group ... More

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Visit Back2BU for the latest updates and information on BU's response to COVID-19. Students can find additional information in the Undergraduate Student Guide and Graduate & Professional Student Guide. Goals Center for Sexual Medicine Faculty and Staff Make an Appointment For Health Care Professionals Training Opportunities. The most common sexual dysfunctions in men include lack of interest, premature ejaculation and erectile dysfunction. The latter affects 52% of men between the ages of 40 and 70, including mild, moderate and complete forms of ED. Organic or physical causes for sexual dysfunction in men include vascular, hormonal and neurologic factors. Concerning vascular causes, the risk factors for atherosclerosis (including smoking, high blood pressure, diabetes (diabetics do not respond well to pills like sildenafil (Viagra)) and high cholesterol are ALSO risk factors for erectile dysfunction. Since a straddle injury or use of a narrow saddle can obstruct and impair arteries to the penis, bicycle riding is also considered a risk factor for erectile dysfunction. Little attention has been paid to endocrine factors. Testosterone modulates desire, arousal and orgasmic function. Concerning the orgasmic response, testosterone modulates the integrity of genital sensory receptors. Concerning the arousal response, decreased testosterone blood levels can influence the efficacy of sildenafil (Viagra). If the sildenafil response is not reliably improving erection, the physician should first check if the patient is taking the pill correctly. The physician should also check the patient’s testosterone level. One investigator in Italy gave testosterone to patients with low ... More

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Neurophysiologic testing (vibrometry; bulbocavernosus reflex latency; cavernosal electromyography; somatosensory evoked potential test; pudendal and sphincter electromyography) Nocturnal penile tumescence and rigidity assessment. Specialized endocrinologic testing (hypothalamic-pituitary-gonadal function studies; magnetic resonance imaging of the sella turcica) Vascular diagnostics (duplex ultrasonography; penile pharmacocavernosometry and pharmacocavernosography; penile arteriography; computed tomography or magnetic resonance imaging; nuclear imaging) Adapted with permission from Jardin A, Wagner G, Khoury S, et al. Recommendations of the 1st International Consultation on Erectile Dysfunction. Plymouth, U.K.: Health Publication Ltd, 2000:718–719 . Abstract Prevalence Pathophysiology Diagnosis and Evaluation Treatment Link to Cardiovascular Disease References. First-line therapy for ED is aimed at lifestyle changes and modifying pharmacotherapy that may contribute to ED8 ( Table 2 6). Sedentary lifestyle, a significant risk factor for cardiovascular disease, may also be a modifiable risk factor for ED.15 Obesity nearly doubles the risk of ED3; one study determined that one third of men who were obese improved their ED with moderate weight loss and an increase in the amount and duration of regular exercise.14 The risk of moderate or total ED is almost double in men who smoke compared with nonsmokers.16 Patient education should be aimed at increasing exercise, losing weight to achieve a body mass index (BMI) less than 30 kg per m 2 , and stopping smoking. Psychological causes (e.g., anxiety, depression, guilt, history of sexual abuse, marital or relationship problems, ... More

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Calabro et al 7 reported that treatment with OXC at 1800 mg/d caused retrograde ejaculation in a 35?year?old man with traumatic epilepsy, and the retrograde ejaculation disappeared after switching to other AEDs. However, Calabro et al 30 also reported that 2 young men with epilepsy had loss of libido and a lack of sex appeal after taking LEV, and recovered sexual function after switching to other AEDs. In case studies or sample studies, LTG has not been found to have any adverse effects on sexual function, and it has been shown to have a positive effect on sexual function. 18, 31 A clinical study by Gil?Nagel et al 18 followed 141 patients with epilepsy treated with LTG as initial or replacement therapy for 4?8 months; male patients with epilepsy showed significant improvement in their sexual function compared with function before treatment. The authors thought that this was probably a multivariate result of an improvement in seizures, the elimination of adverse effects of other AEDs, and the stabilizing effect of LTG. In this study, the patients with epilepsy had a lower erectile function score than the healthy control group. In patients with epilepsy, premature ejaculation levels have a lower trend, but it was not statistically significant. These results, to some extent, suggest that epilepsy itself can adversely affect the erectile function score. The scores of erectile function and premature ejaculation were increased in the OXC, LEV, and LTG groups when compared between before and after treatment, but no statistical significance was found. This may be related to the small case number in this study. We also presume that these 3 AEDs may have effects on improvement ... More

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That improves your blood flow and helps you get an erection. For the drugs to work, you need to be sexually aroused. The International Society for Sexual Medicine defines erectile dysfunction as a man’s inability to achieve or maintain an erection suitable for satisfactory sex. In order to understand erectile dysfunction, it is important to understand how erections occur. When a man is sexually aroused, nerves and camber pharmaceuticals sildenafil chemicals work together to relax smooth muscle tissue and widen arteries so that the penis can fill with blood. Veins constrict to keep the blood inside the penis, forming the erection. Once the man ejaculates, the blood is released back into the body. Erectile dysfunction becomes more common as men get older. It is also associated with some medical conditions, like heart disease and diabetes. In fact, an estimated 50% of diabetic men have some degree of erectile dysfunction. Smoking: It increases your risk of hardening of the arteries. It’s that blood flow that helps you get an erection; Being overweight: Carrying extra pounds increases your risk of blood vessel disease, a cause of erectile dysfunction; Inactive lifestyle: If you want to reduce your chance of getting erectile dysfunction, get off the couch. Regular exercise can camber pharmaceuticals sildenafil help to make sure that when the time comes, you’re ready; Poorly managed diabetes: Diabetes can affect blood flow to your penis. Maintain a healthy diet, get regular exercise, and take your medicine as prescribed; High cholesterol: It can damage the linings of blood vessels, including those in the penis. It can also affect the arteries leading to your genitals. Eat ... More

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Other medical conditions, such as heart disease, diabetes, high blood pressure or kidney problems. Worries, anxiety or stress about other aspects of your life. Side effects of medication, such as from some anti-depressants or anti-spasticity drugs. Ageing - difficulties with erections are more frequent in older men. Venous leak - a physical condition in which the extra blood in the penis is not retained during an erection. The cause of your symptom may involve several factors, some related to MS and others not. Effective management requires a thorough assessment of all the possible contributing issues. It is estimated that nearly one in five men in the general population has a problem with achieving an erection at some point, either every now and again or more consistently over a prolonged period of time. Erectile dysfunction is thought to be more common amongst men with MS and research suggests anything from one quarter to two thirds of men with MS may be affected at some point. The most important and most powerful starting point for managing sexual issues is a willingness to talk about them. Although there are treatments available that can restore the ability to achieve an erection, the effective management of the symptom requires an assessment of the whole person. For example, if fatigue is affecting your sexual performance, a pill that makes it easier to achieve an erection is not going to resolve the problem of physical stamina. Similarly, medication alone won't resolve feelings of being unattractive or sexually less desirable that can come from living with a long-term condition. As well as considering medication, treatment may involve counselling and finding new ... More

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Treatment for young men affected by ED caused by psychological factors may involve taking medications such as PDE-5 inhibitors. However, any course of medication prescribed will usually be combined with psychotherapeutic interventions designed to identify and address the problems which are causing ED, [21] for example by improving a person’s self-esteem or mediating their response to stress. Q: Is there a permanent cure for erectile dysfunction? A: Although there is no guaranteed cure for erectile dysfunction, there are a number of treatment options that can provide long-term relief. Treatment options affect everybody differently, meaning what proves effective for one person may not be the best option for another. Doctors can help advise on the best treatment methods. Q: Are there any home remedies or natural products that can be used to prevent or treat erectile dysfunction? A: Seeking medical advice before using any home remedy is advised. Many people report the use of home remedies to treat ED. However, natural products, including those listed below, are not recommended treatments for ED, because they are insufficiently scientifically researched for their effectiveness to be proven, and furthermore may be harmful in some cases. Some natural remedies for ED include: [17] L-arginine. A natural supplement that may help to widen the blood vessels in the penis, but should not be viagra online no prior prescription taken alongside Viagra. A natural supplement that is anecdotally reported, but not scientifically proven, to help improve blood flow to the penis. However, a doctor should always be consulted before using natural products, particularly in conjunction with ... More

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Dosages ranged from 600 to 1,000 milligrams (mg) three times daily. They concluded there was “suggestive evidence for the effectiveness of red ginseng in the treatment of erectile dysfunction.” More current research is examining how red ginseng influences ED. Ginsenosides are one element present in Panax ginseng extract that have action at the cellular level to improve erection. The action of Panax ginseng appears to be most effective for those with high lipids in their blood and metabolic syndrome. This herb is known to have anti-inflammatory action, improve lung function, and improve blood flow in other diseases — all characteristics that may reduce ED. One small study indicated that Rhodiola rosea may be helpful. Twenty-six out of 35 men were given 150 to 200 mg a day for three months. They experienced substantially improved sexual function. This herb has been shown to improve energy and reduce fatigue. More studies are needed to understand action and ensure safety. Dehydroepiandrosterone (DHEA) is a natural hormone produced by your adrenal glands. It can be converted to both estrogen and testosterone in the body. Scientists make the dietary supplement from wild yam and soy. The influential Massachusetts male aging study showed that men with ED were more likely to have low levels of DHEA. In 2009, 40 men with ED participated in another study in which half receiving 50 mg DHEA and half receiving a placebo once a day for six months. Those receiving the DHEA were more likely to achieve and maintain an erection. More recently, DHEA has been identified as an option for treatment of ED for men with concurrent diabetes. ED commonly affects these men because of hormonal ... More

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