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For more information, see Sexual Difficulties Associated with Cancer in Men. The predisposing factors for erectile dysfunction are as follows: Age; Medical conditions such as diabetes mellitus and cardiovascular disease; Neurological conditions including or arising from dementia, multiple sclerosis, stroke, or spinal cord or back injury; Pelvic trauma, prostate surgery, previous priapism, prolonged bike riding (> 4 hours/week, depending on seat and posture); Depression and stress; High blood pressure; Obesity; Increased cholesterol; Smoking; Certain drugs (some antidepressants, particularly SSRIs; diuretics; and others); Alcohol and recreational drugs such as cocaine and heroin may initially stimulate sexual arousal, however long term use has been shown to lead to erectile dysfunction.

If a man has the risk factors for cardiovascular disease during middle age (smoking, obesity, high cholesterol), he is at an increased risk of developing erectile dysfunction.

Exercise has been shown to have a protective effect. Around one third of men who experience erectile dysfunction find that, without treatment, it becomes worse over time.

Around viagra walgreens pharmacy a third of men find that erectile dysfunction improves without treatment. Around half of men with severe erectile dysfunction remain selling viagra online impotent in the long term without treatment.

These figures vary depending on the cause of the erectile dysfunction.

Even if men choose not to pursue treatment for erectile dysfunction, it is important that they be investigated by a doctor, as erectile dysfunction may indicate an increased risk of cardiovascular disease. Temporary failure of erection is very common and is likely to resolve. If ongoing erectile dysfunction develops, the impact on relationships and self-esteem can be devastating.

Men who suffer from erectile dysfunction are known to experience significant psychological distress. It is believed that sexual self-consciousness leads to: Increased appearance related anxieties; Interferes with attention, focus and concentration; Impairs physical performance; and Reduces awareness of our physiological arousals leading to sexual dysfunction.

This improves when erectile dysfunction is successfully treated. While studies are limited, it has been shown that male sexual dysfunction can also negatively impact the sexual function of female partners.

A study comparing the sexual function of women with partners with erectile dysfunction to those without showed that sexual arousal, lubrication, orgasm, satisfaction, pain and total score were significantly lower in those who had partners with erectile dysfunction.

Later in that study, a large proportion of the men with erectile dysfunction underwent treatment. Following treatment, sexual arousal, lubrication, orgasm, satisfaction and pain were all significantly increased. It was concluded generic viagra 150 mg pills that female sexual function is impacted by male erection status, which may improve following treatment of male sexual dysfunction.

It is essential to discuss erectile dysfunction with your doctor, so any serious underlying causes can be excluded and treatment options can be discussed.

Many men are embarrassed discussing this issue with their doctor, or even their partner.

Open communication with your doctor, and in your relationship, is important for effectively managing this common problem. Effective treatment for erectile dysfunction is available, and for most men will allow the return to a fulfilling sex life. The side effects of the treatment for erectile dysfunction vary depending on the treatment that is used. Some may interrupt the spontaneity of sexual activity. For example, PDE-5 inhibitors typically need to be taken one hour before sex.

Side effects may include headaches, indigestion, vasodilation, diarrhoea and blue tinge to vision. Other treatments such as penile injections may cause pain at the injection site, or an erection that will not go down. Treatment options need to be carefully discussed with your doctor to determine which one is best suited to you. Following a detailed discussion about the history of erectile dysfunction and its risk factors, your doctor will examine the testicles and penis to help determine the cause of erectile dysfunction. Your doctor will check reflexes and pulses in the area to see if problems with blood vessels or nerves are contributing to the erectile dysfunction. If necessary, your doctor will order tests to help diagnose erectile dysfunction.

Diagnosis is based on information provided to the doctor regarding the history of erectile dysfunction (how quickly it came on, how often viagra walgreens pharmacy it occurs, etc), the assessment of risk factors, and whether erections still occur overnight while a man is asleep. It is normal for a man to have 3-5 full erections overnight during REM sleep.

In order to establish whether normal erections are occurring overnight (nocturnal order real viagra erections), the doctor may organise nocturnal penile tumescence (NPT) testing. This involves wearing a monitor overnight in your own home. The data from this monitor is then assessed to analyse how often erections occurred, how long they lasted, and how rigid and large the penis was during the erections.

If NPT testing is normal, the cause of erectile dysfunction is usually psychological. If not, further testing of the blood flow in the genital area may be required to see if there is blockage or leakage. The doctor may also organise a blood test of levels of hormones such as testosterone, prolactin and thyroid stimulating hormone to see if these are contributing to the erectile dysfunction. For the great majority of men, erectile dysfunction can be effectively treated.

It is essential that if you experience erectile dysfunction, you discuss it with your doctor. Many treatment options are available, and your doctor can help you decide which one is most appropriate for you.

Some causes of erectile dysfunction such as hormonal problems or anxiety may be cured completely with treatment and/or therapy. Even if the underlying cause cannot be cured, medication may still allow a satisfactory erection.

Ignoring the problem tends not to make it better, and can have a significant impact on relationships and self-esteem.

Treating Erectile Dysfunction — Without the Little Blue Pill.

Non-pharmaceutical alternatives may be more effective.

En espanol | If you watch TV or read magazines, you could easily conclude that men seeking treatment for erectile dysfunction (ED) have but one option: pills.

The three dominant brands — Cialis, Levitra and Viagra — are locked in an expensive battle for men’s allegiances, and have, through their suggestive advertising, triggered both satire and controversy in the 14 years since the Food and Drug Administration approved Viagra. Think about improving your heart health first before pursuing ED treatments. But steamy commercials aside, what if the pills don’t work for you, as is the case in 25 to 30 percent of men with ED, or they stop working after a few years — a common problem for men whose ED is caused by an underlying cardiovascular condition? “A lot of patients think that pills will give them complete restoration,” says Ajay Nehra, M.D., a urology professor at the Mayo Clinic College of Medicine in Rochester, Minn. But many patients instead find that even if they take the pills, they are “not the same” sexually as they were before the onset of their ED, he says.

If you are among the men who want — or need — to try other therapies for ED, here are the three main options, some of which are cheaper and more effective than the pills.

All costs stated below will vary, depending on your insurance plan.

Join AARP today — Receive access to exclusive information, benefits and discounts. Before pursuing ED treatments, though, bear in mind that improving heart health by losing weight, eating a healthier diet, exercising more and quitting smoking typically enhances erectile performance as well as one’s overall health.

In addition, sex therapy counseling sessions can often ease or eradicate ED symptoms, if the underlying cause is psychological in nature, says Drogo Montague, M.D., director of the Center for Genitourinary Reconstruction at the Cleveland Clinic.

Vacuum erection device (penis pump) Penis pumps produce erections by drawing blood, via air suction, into the penis.

The devices consist of a cylindrical tube, 12 to 18 inches long, connected by a small air hose to a hand pump (on many models this resembles the squeeze mechanism on a blood pressure monitor).

Users place the tube over the penis then pump to produce an erection.

They must then place an elastic band around the base of the penis to keep the blood there and maintain the erection.

“Obviously this isn’t the most spontaneous thing,” says Tobias Kohler, M.D., assistant professor of urology at Southern Illinois University School of Medicine. “You can imagine someone having sex with a partner for the first time and pulling out this lunch box.” While the pumps produce erections for 90 percent of users, most abandon it for other treatments, says Trinity J.

Bivalacqua, M.D., assistant professor of urology and oncology at the Johns Hopkins Medical Institution.

The pumps are “very cumbersome and clumsy,” Bivalacqua says.

Despite reliably producing erections, pumps have the lowest satisfaction rate of any erectile dysfunction treatments.

“In my practice, most men who try it will say, ‘Not for me,’ ” he adds. Insurers typically cover 80 percent of the roughly $500 cost for a prescription pump, leaving consumers with around $100 in out-of-pocket expenses.

If you opt for a pump, experts say it’s important to get one through a doctor’s prescription. The pumps sold in sex shops tend to be novelty items that don’t work and may even cause injuries.

These produce erections by injecting or inserting into the penis a drug that increases blood flow. Urethral suppositories, the size of a grain of rice, are inserted via the head of the penis; injections are self-administered near the base of the penis.

The actual insertion of the suppository into the penis isn’t painful, say experts. Nor is the injection itself — done with a very small, thin needle. “Both [methods] are around a 1.5 to 2 on a zero-to-10 pain scale,” Kohler says, “where zero is no pain and 10 is getting run over by a truck.” The biggest complaint about these treatments is a burning sensation in the penis as the drug takes effect.

The frequency, intensity and duration of that side effect vary by method and user but can, in some cases, be bad enough, Montague says, that “a man will get an erection but be too uncomfortable to use it.” Suppositories “were developed so men wouldn’t have to use needles,” Bivalacqua says. They contain the drug alprostadil (also known as prostaglandin E1) and are sold under the brand name Muse. If they are

going

However, Muse produces erections in only 30 to 40 percent of patients, usually those with mild ED, because some of the drug is absorbed systemically and diverted from its function of opening penile arteries to allow more blood to flow in. The out-of-pocket cost is around $20 to $30 per suppository.

For men who don’t mind needles, injections come in various formulations: alprostadil alone; a two-drug combo called bi-mix, which can either be alprostadil mixed with phentolamine or phentolamine mixed with papaverine; and tri-mix, a three-drug mixture of phentolamine, papaverine and a low dose of alprostadil. Of these formulations, alprostadil alone carries the highest reported rate (50 percent of users) of burning and pain; in bi-mix users the rate of burning is around 10 percent, and in tri-mix users it drops to less than 3 percent of users, says Nehra.

“And that improves dramatically over time as men get used to the injection,” he adds .

Because the burning side effect is triggered by alprostadil, the formulations with the least alprostadil — tri-mix and certain versions of bi-mix — could work for men who experience burning with the single-drug formula.

But some men might choose alprostadil

alone

Some injectable formulations need to be refrigerated — yet another reason many men steer away from the needle option. Among ED treatments, injections are also the most common cause of extended erections — rigidity lasting more than four hours, also called priapism — which afflict about 3 to 7 percent of users, Kohler says. That condition, while easily treated with an adrenaline shot, requires urgent attention at a clinic or hospital.

The cost of this ED treatment is $2 to $5 per injection.

Join AARP today — Receive access to exclusive information, benefits and discounts.

A surgically implanted prosthesis can virtually guarantee erections on demand.

“Overall, these have the highest satisfaction for both the patient and his partner,” Nehra says. Ninety-five percent of prostheses implanted in men in the United States are pump-and-chamber devices in which the man activates a pump — via a discrete subdermal push button in the scrotum — that fills his penis with sterile saline from a reservoir implanted along with the pump. The other 5 percent of prostheses are either pump devices in which the saline is permanently in the prosthesis, not in a separate reservoir (urologists may recommend this for men who have had multiple surgeries); or a pair of semi-rigid, malleable rods implanted in the penis, which render it hard at all times.

The patient manually shifts the penis into an erect position for viagra walgreens pharmacy sex.

With the pumps, erections last until the user hits the deflate button, which Kohler says “doesn’t happen” accidentally . He adds that pump prostheses “are locker-room proof: Nobody can see that you have one.” (Obviously, this is not the case with the always-on malleable rod option.) Implanted pumps are reliable, experts say, with more than 90 percent of the devices working for 12 to 15 years. The downside to these prostheses includes the standard risks of surgery, the very low risk of infection — less than 2 percent in most patients, slightly higher in diabetics — and a slight drop in penis length versus a natural erection or other ED treatments. Also, unlike with other methods, any hope for a natural erection is abolished once a pump is implanted. The cost for surgical options varies, and insurance coverage is typically good.