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The most important component of diagnosing erectile dysfunction is obtaining a complete medical and sexual history. It is important to distinguish the condition from other sexual dysfunctions, such as premature ejaculation and loss of libido. Several formalized sexual questionnaires, such as the IIEF (Internation Index of Erectile Function) and EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction), allow one to detect the presence and grade the severity of erectile dysfunction. The complete IIEF is composed of 15 questions; an abridged 5-item version, called the sexual health inventory for men (SHIM), has been developed and validated.29 Allowing a patient to complete such a questionnaire before his first clinical encounter may produce a more comfortable clinical environment.30 The duration of the problem, time of onset and degree of patient and partner concern should also be elucidated. The circumstances surrounding erectile dysfunction may be helpful in determining whether a situational or nonorganic factor is involved. Sudden onset, maintenance of nocturnal erections, presence of psychological problems and concurrent major life events or relationship issues may be associated with nonorganic erectile dysfunction.31 Concurrent medical illnesses and any medications the patient may be taking should be reviewed. Erectile dysfunction is often a component of generalized medical illness and may represent the initial presentation of cardiovascular disease or diabetes. The history may also reveal certain reversible or modifiable risk factors, such as tobacco use or inadequate diabetes control.
Advances in suppositories, injectable medications, implants, and vacuum devices have expanded the options for men seeking treatment for ED. These advances have also helped increase the number of men seeking treatment. Gene therapy for ED is now being tested in several centers and may offer a long-lasting therapeutic approach for ED.
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MONDAY, May 12 (HealthDay News) -- Patients with Duchenne muscular dystrophy often suffer from heart failure, but Viagra might prevent or delay the onset of this condition, a new Canadian study finds.
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Viagra, Levitra, and Cialis all belong to a class of drugs called phosphodiesterase (PDE) inhibitors. Taken an hour before sexual activity, these drugs work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.
There have been rare reports of priapism (prolonged and painful erections lasting more than 6 hours) with the use of oral PDE5 inhibitors such as vardenafil, sildenafil and tadalafil. Patients with blood cell diseases such as sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks of developing priapism. Priapism untreated can cause injury to the penis tissue and lead to permanent loss of potency. If there is prolonged erection (longer than 4 hours), immediate medical assistance should be sought.
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Quitting smoking, exercising regularly, losing excess weight, curtailing excessive alcohol consumption, controlling hypertension, and optimizing blood glucose levels in patients with diabetes are not only important for maintaining good health but also may improve erectile function. Some studies suggest that men who have made lifestyle improvements experience increased rates of success with oral medications.
ANTHONY J. VIERA, LT, MC, USNR,
In addition to using a behavioral method, you may want to try thought distractions. For example, while you’re being sexually stimulated, think about the names of players on your favorite sports team.
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Conclusion Dramatic advances in the management of erectile dysfunction have occurred over the past decade. Most patients with the condition are now managed by primary care physicians and specialists other than urologists. A thorough clinical examination can help to differentiate from the numerous causes of erectile dysfunction. Oral therapy with a PDE-5 inhibitor (sildenafil, vardenafil or tadalafil) should be considered for first-line treatment of erectile dysfunction. Although PDE-5 inhibitors should not be given to patients taking nitrates, because of the risk of hypotension, in general they are well tolerated by the majority of patients. Those who do not respond to this first-line therapy should be referred to a urologist for further evaluation and consideration of alternative treatments.
To bypass roadblocks along the brain-to-penis highway, drugs can be injected or inserted directly into the penis. While some men find this painful to think about, many others find that it can restore a satisfying sex life and is highly effective.
Sildenafil is available as oral tablets at doses of 25, 50, and 100 mg. It should be taken approximately one hour before sexual activity. In some men, the onset of action of the drug may be as early as 11-20 minutes. Sildenafil should be taken on an empty stomach for best results since absorption and effectiveness of sildenafil can be diminished if it is taken shortly after a meal, particularly a meal that is high in fat.
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In a multi-center, double blind study (18), 520 patients (average age of 54) took either 2mg, 4mg, 5mg, 6mg of apomorphine or a placebo. The number of attempts resulting in an erection firm enough for intercourse was recorded, along with the actual attempts resulting in intercourse.
The problem does not go away with self-care measures -- effective treatments are available
Because of its unique locally acting mechanism of potentiating the physiologic response to sexual arousal, sildenafil is effective in men with erectile dysfunction of organic, psychogenic or combined causes. The use of sildenafil in women is under study but has not yet been approved.
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These drugs work by preventing the breakdown of PDE5, which is an enzyme in penile smooth muscle which leads to better function of penile erectile tissue. The PDE5 inhibitors, although not initiating an erection, enhance erections to any given sexual stimulus.
THURSDAY, Feb. 1 (HealthDay News) -- More than 18 million men in the United States are affected by erectile dysfunction, a new study finds.
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