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Give guidance, not just Viagra, to men with diabetes and related impotence.

Diabetic men with erectile dysfunction might consider a prescription for a drug like Viagra to be a permanent cure for a temporary issue: Take a pill, problem solved.

But the truth, a leading urologist says, is entirely different.

“If a diabetic patient has erectile dysfunction, it’s not enough to provide Viagra [sildenafil] or Cialis [tadalafil] and then send him on his merry way,” J.

Francois Eid, MD, a New York City urologist, said at the annual meeting of the American Association of Diabetes Educators. “It’s important to let individuals know the drug has not cured the erectile dysfunction.

If patients don’t take care of the diabetes, the erectile dysfunction progresses.” In an interview, Dr.

Eid shared several messages for medical professionals who treat men with diabetes and related erectile dysfunction: • Diabetes has “devastating” effects on the penis, and may even cause it to shrink. • Long-term uncontrolled diabetes can make ED permanent. • generic viagra with dapoxetine While ED drugs often fail in men with diabetes, several other options exist; and penis implants may provide significant relief. An estimated 50%-75% of men with diabetes experience from some degree of ED, which is thought to be three times more common in diabetic men than other men, according to Dr.

“Diabetes has a devastating effect on the muscle tissue inside the penis,” he said. “All the tiny little arteries that feed blood to the muscle get occluded.

Little by little, the muscle inside the penis shrinks.” Indeed, some diabetics with ED complain that their penises have shrunk, he said. Diabetic damage doesn’t stop with these small vessels, he said.

“You really have two parallel situations: You need blood flow that feeds the muscle of the penis, and you need an artery dedicated to bringing blood rapidly when a generic viagra with dapoxetine man becomes aroused and wants to be sexually active,” he said.

They’ll say ‘I can get a partial erection, but I can’t maintain it.’ ” What comes after an ED diagnosis in diabetic patients? Eid will instantly refer these men to a cardiologist. “If a patient has diabetes and is newly diagnosed, a significant portion of these men are going to develop coronary artery disease in the next 2-3 years,” he said. “One of the things we do is recommend is that they see a cardiologist and perhaps have a stress test or some sort of evaluation.” Dr. Eid also urges these patients to treat their diabetes in order to avoid developing ED for life. “They need to manage their diabetes and make sure they control it so the ED will not progress and will stabilize, as a result,” he said. “If the diabetes is controlled after the

patient

Other options include penile self-injections, vacuum

devices

And he said men rarely have success using vacuum devices, which are available over the counter.

By contrast, penis implants can successfully treat erectile dysfunction in many cases, Dr.

Men

Fluid then flows from an implanted reservoir into a cylinder implanted in the penis. Men are often pleased by penis implants because they can have sex spontaneously without having to plan for it ahead of time, as required by medications.

Eid receives or has received research support/grants from American Medical Systems,

Coloplast

He is or was a consultant and on the speakers bureau for Coloplast, American Medical Systems, Lilly ICOS, Bayer and Pfizer.

Erectile Dysfunction Drug Also Helps Men Ejaculate and Orgasm. New Study Shows Cialis Assists Men with Problems Ejaculating and Achieving an Orgasm, Despite the Severity of Their ED. NEW YORK (January 30, 2013) — New data suggests the erectile dysfunction (ED) drug Cialis may also be beneficial in helping men who have problems with ejaculation and orgasm, report researchers from NewYork-Presbyterian Hospital/Weill Cornell Medical Center in the February issue of the British Journal of Urology International. Cialis is currently approved for the treatment of ED, benign prostate hypertrophy (BPH) and for treatment of men with both conditions. Their study, a meta-analysis of 17 double-blind, placebo-controlled clinical trials of men with ED, is the first to analyze the benefit an agent like Cialis offers for common issues of sexual dysfunction that may have little to do with ED. Their study concluded that approximately 70 percent of men who used Cialis during sexual activity for 12 weeks were able to ejaculate most of the time and to reach orgasm, compared to 30 percent in the placebo group. Also, these benefits from the drug were seen despite the level of a man's ED severity. "There are many men who

have

"Our study shows Cialis works very well for these men with problems ejaculating." Dr. Paduch says up to 18 percent of men have a normal erection but don't ejaculate, or take a long time to do so.

He adds that while the issue may be more prevalent in the elderly, it affects men of all ages.

"Many of my patients are young men who want to have children and so they want to solve their issues with ejaculation," says Dr.

Paduch, who is also an associate professor of urology and reproductive medicine at Weill Cornell.

Every

internist

The largest analysis to date of orgasmic and ejaculatory dysfunction, also published in the British Journal of Urology International, followed nearly 12,130 men with mild to severe ED and found that 65 percent of the participants were unable to have an orgasm and 58 percent had problems with ejaculation. Even men with no or very minimal ED reported poor ejaculatory function (17 percent) and poor ability to have an orgasm (22 percent).

Paduch pointed out that approximately 30 million American men — half of generic viagra with dapoxetine all men aged 40 to 70 — have trouble achieving or sustaining an erection. "While medications like Viagra and Cialis have been successful in helping many of these men, our research suggests there are other common sexual issues that remain largely unaddressed," he said in 2011.

Non-erectile sexual dysfunction is underreported and undertreated due to social stigma and, in particular, misunderstandings about the physiology of male sexual response and orgasmic dysfunction, Dr.

"For decades it was believed that only women had problems with orgasm, but our research shows that orgasmic dysfunction could be as prevalent among men as it is among women." In this new study, Dr. Paduch and his colleagues examined data from 17 placebo-controlled 12-week trials of Cialis, given at different doses.

These studies included 3,581 participants with a mean age of 54.9, including 1,512 men with severe ejaculatory dysfunction (EJD) and 1,812 with severe orgasmic dysfunction (OD).

In some cases, patients with one or both of these conditions reported only mild or moderate ED. The researchers examined the study participants' responses on questionnaires about the effect Cialis had on ED, EJD, and OD, among other measures of sexual satisfaction.

The original questionnaire was primarily focused on the effects of Cialis on ED, but provided valuable additional information.

They found that treatment with Cialis (10 or 20 milligrams taken as needed) was associated with significant increase in

ejaculatory

Also, patients with moderate dysfunction also experienced significant improvements with Cialis, Dr. "More study is needed, but we are hopeful our findings may lead to a treatment for many men who cannot now achieve sexual satisfaction," Dr. Other study co-authors include Alexander Bolyakov, a research associate in the Department of Urology at Weill Cornell, and Paula K. Polzer and Steven Watts, the study's senior investigator, both of Lilly Research Laboratories of Eli Lilly.

This research study was funded by Eli Lilly and Company, the manufacturer of Cialis.

Paduch and Bolyakov are funded study investigators and consultants for Eli Lilly. In addition, Polzer and Watts are employees of, and minor shareholders in, Eli Lilly.

This study was selected by BJUI's Editor-in-Chief as the "Article of the Week" with Dr.

Paduch also featured in an online video discussing his research. We’ve all heard those warnings at the end of Viagra, Cialis or Levitra commercials about contacting your doctor if you have an erection that lasts longer than four hours (prompting many a joker to declare, “the hell with the doctor, I’m calling my friends!”). But priapism, a prolonged erection unaccompanied by sexual desire and unaffected by orgasm, is actually no laughing matter.

“A prolonged erection is usually painful,” says Dr. Ira Sharlip, clinical professor of urology at the University of California at San Francisco and spokesperson for the American Urological Association.

“Men usually know something’s wrong even if they’ve never heard of this condition, and almost always come in for care because of the pain. There are some men who don’t want to go to the doctor or an emergency room, but addyi without prescription they should know that it’s a potentially serious condition which can result in permanent erectile dysfunction if it’s not taken care of.” Named for Priapus, the Greek god of fertility who sported an oversized, eternally-erect penis (so large, in fact, he used it to frighten away anyone who tried to plunder his gardens), priapism brought on by erectile dysfunction drugs is extremely rare. “The [Food and Drug Administration] requires a warning in the package insert because of the potential complication, but I’ve been prescribing Viagra for 10 years to many thousands of men and have never seen a case,” says Sharlip, who maintains a private urology practice in San Francisco.

“It does happen even in men who aren’t taking erection drugs – I’ve taken care of the problem at the emergency room at the medical center where I work — but it’s really rare.

So rare, that I don’t discuss this as a potential complication with my patients.” This site is protected by recaptcha Privacy Policy | Terms of Service. Rough statistics from the FDA’s adverse event reporting system (AERS) regarding the erectile dysfunction (ED) drugs Viagra, Cialis and Levitra show a total of just 93 cases of prolonged erection greater than four hours or painful erection greater than six hours (priapism) in all of 2007 — 74 for Viagra, three for Levitra and 16 for Cialis.

According to the FDA, physicians are encouraged to report suspected adverse events, although the event may be related to an underlying disease, another drug or simple chance. Priapism is much more commonly seen in conjunction with penile injection therapy (an alternate treatment for ED), blood diseases such as leukemia or sickle-cell anemia, injury or trauma to the penis, spinal cord injuries, or as a side effect to certain drugs such as the antidepressant trazadone. The condition is found in all age groups, including children (usually in association with leukemia). There are also extremely rare cases of priapism in females (known as clitorism).

A recent msnbc.com column dealth with a 70-year-old man who thought he had a form of priapism. To understand priapism, it’s

important

Once the stage is set (via a little blue pill and a few soft lights, a hint of lingerie, and the musical stylings of Barry White), the spongy tissues along the length of the penis fill with blood and harden and the veins leaving the penis constrict.

Unfortunately, in the small percentage of men suffering from priapism, the system goes haywire and they’re unable to get rid of their erection once it shows up. In a nutshell, blood can get in but it can’t get out, a condition that sounds a bit like one of those old Roach Motel commercials, but is actually quite serious.

“If an erection is left in place for more than 12 hours, damage to the tissue in the erection chambers can occur,” says Sharlip. “It can be a cause of serious erectile dysfunction. They may be able to get a partial erection in the future, but not a full erection.” Worse yet, there have been reported cases of permanent penile injury thanks to untreated priapism.

Christopher Steidle, author of “The Impotence Sourcebook,” details the case of “H.A.,” a medical professional who, after reading about the treatment of erectile dysfunction with penile injections, injected himself with an excessive dose.

Unfortunately, he then developed priapism, but was so embarrassed he went for seven days before seeking medical help. According to Steidle, “the resulting erection was unsalvageable, and the

patient

As for those who would make light of what doctors consider a serious medical emergency? “I suppose it’s funny to talk about,” says Sharlip. “But it’s not funny when it happens to you.” Emerging treatment options for ED: Hope or hype? Novel therapies are promising but face questions about patient selection and efficacy.

Erectile dysfunction is a common concern among aging males. Not only does ED affect quality of life, but it is also linked to cardiovascular disease, hypertension, diabetes, and overall health.

Currently, there are three categories of ED treatments. Oral medications such as phosphodiesterase type-5 (PDE-5) inhibitors (sildenafil, vardenafil, tadalafil, and avanafil) have comparable efficacy.

Intracavernosal injections (alprostadil, phentolamine, papaverine, and/or atropine) or intraurethral suppositories (alprostadil) are alternatives in patients who are non-responders to oral medications or have side effects.

Penile implants are the most invasive treatment but provide durable results and the highest satisfaction rates of all of treatments.

Given the prevalence of ED, there is significant incentive to find more effective and less invasive treatment options.

Here we review new and emerging treatment options for this common condition.

We also review the use of nutraceuticals, which are not new but have seen explosive growth in recent years (see, “Nutraceuticals for ED at a glance.") New oral agents and pathways. PDE-5 inhibitors remain the cornerstone of oral therapies. Researchers have explored alternative pathways for novel therapeutics (table), although success has been limited. Currently, no novel oral medications are in clinical development.

Prior targets have focused on central pathways (dopaminergic and melanocortin) and peripheral pathways (guanylyl cyclase and Rho-A/Rho kinase), but novel oral therapies directed at these pathways have shown limited efficacy and tolerability. An overview of the cellular pathways is shown in the figure.

Initially, the use of dopamine agonists for Parkinson’s disease was associated with increased libido. Apomorphine is a dopamine D1 and D2 receptor agonist that was approved for ED in Europe in 2001.

In a phase III double-blind, parallel-arm, crossover study of nearly 900 men with ED, more than 50% of those using apomorphine were able to obtain an erection sufficient for intercourse compared to 33% of men using placebo (BJU Int 2002; 89:409-15).

However, the FDA did not approve the drug in the United States because of concerns about hypotension.