Can being sick cause erectile dysfunction: 8 Sicknesses That Can Wreck a Man’s Sex Life
Erectile dysfunction – Illnesses & conditions
If you have erectile dysfunction (ED), treatment will depend on what’s causing it. The various treatments for erectile dysfunction are outlined below.
Treating underlying conditions
If your erectile dysfunction is caused by an underlying health condition, such as heart disease or diabetes, that condition may need to be treated first. In some cases, treating the underlying cause may also resolve the problem.
If you are taking medication that can cause erectile dysfunction, there may be an alternative. It is important never to stop taking a prescribed medication unless you are advised to do so by your GP or another qualified healthcare professional responsible for your care.
Erectile dysfunction can often be improved by making changes to your lifestyle, such as:
As well as helping to improve your erectile dysfunction, these changes can also improve your general health and may help to reduce your risk of cardiovascular disease (conditions that affect your heart and blood vessels).
Read more about preventing cardiovascular disease
Phosphodiesterase-5 (PDE-5) inhibitors
Phosphodiesterase-5 (PDE-5) inhibitors are one of the most widely used and effective types of medication for treating erectile dysfunction. They work by temporarily increasing the blood flow to your penis.
In England, four PDE-5 inhibitors are available for treating erectile dysfunction. They are:
- sildenafil – sold under the brand name Viagra
- tadalafil – sold under the brand name Cialis
- vardenafil – sold under the brand name Levitra
- avanafil – sold under the brand name Spedra
Sildenafil, vardenafil and avanafil work for about eight hours and they are designed to work ‘on demand’. Tadalafil lasts for up to 36 hours and is more suitable if you require treatment for a longer period of time, for example, over a weekend.
Depending on the type of PDE-5 inhibitor you are taking and the dose, it should take about 30-60 minutes before it starts to work. With sildenafil, vardenafil and avanafil, you should be able to have sex from one to 10 hours after taking the medicine. After taking tadalafil, the effects will last for up to 36 hours.
It may take longer to notice the effects if the tablet is taken with food, so it’s best to take it on an empty stomach. You can then eat after an hour without affecting the medicine.
Only take one tablet within a 24-hour period.
Your GP should explain the benefits of each medication and how it works. The choice may depend on:
- how often you are sexually active
- whether you have tried any of the medications before
There have been many studies to test the effectiveness of these medications. In general, at least two-thirds of men report having improved erections after taking one of these medicines.
If you do not find that PDE-5 inhibitors are effective it may be because:
- you have not waited long enough after taking the dose
- you have waited too long after taking the dose
- the dose is not high enough
- you have not had enough sexual stimulation
These medications are triggered by sexual stimulation, so you also need to be aroused for it to work.
PDE-5 inhibitors should be used with caution in men who have cardiovascular disease, such as coronary heart disease. However, sexual activity is also likely to be beneficial for your cardiovascular health. You should discuss the risks and benefits with your GP.
PDE-5 inhibitors should also be used with caution in men who have anatomical problems with their penis, such as Peyronie’s disease (a condition that affects the tissue of the penis).
PDE-5 inhibitors should also be used with caution in men who:
- are at risk of priapism – a painful erection that lasts for several hours
- are also taking long lasting alpha-blockers – a medication used to treat a number of conditions, such as high blood pressure (hypertension)
Do not take PDE-5 inhibitors if you are also taking medicines or recreational drugs that contain nitrates. The combination of the two substances can have a dangerous effect on your heart.
Organic nitrates are often used to treat angina, and butyl nitrate is a recreational drug that is more commonly known as ‘poppers’.
You are also warned not to take PDE-5 inhibitors if you:
- have been advised not to take part in sexual activity or in activities that widen your blood vessels
- have low blood pressure (hypotension)
- have recently had a stroke – a medical emergency that occurs when the blood supply to the brain is interrupted
- have unstable angina – an underlying heart condition that causes symptoms such as chest pain
- have had a heart attack – a medical emergency where the blood supply to the heart is suddenly blocked
- have a history of non-arteritic anterior ischaemic optic neuropathy – an eye condition that causes a sudden loss of vision
PDE-5 inhibitors can cause some side effects, including:
- headaches and migraines
- flushing (redness)
- nausea (feeling sick)
- vomiting (being sick)
- a blocked or runny nose
- back pain
- vision disturbances
- muscle pain
A vacuum pump consists of a clear plastic tube that is connected to a pump, which is either hand or battery operated.
You place your penis in the tube and pump out all of the air. This creates a vacuum that causes the blood to fill your penis, making it erect. You then place a rubber ring around the base of your penis to keep the blood in place, allowing you to maintain an erection for around 30 minutes.
It may take several attempts to learn how to use the pump correctly, but they are usually effective. After using a vacuum pump, nine out of 10 men are able to have sex, regardless of the cause of their ED.
You should not use a vacuum pump if you have a bleeding disorder or if you are taking anticoagulant medicines, which reduce the ability of your blood to clot.
Side effects of vacuum pumps include pain or bruising, although these occur in less than a third of men.
Men who qualify for NHS prescriptions for erectile dysfunction treatments may be able to get a vacuum pump on the NHS (see above for more details). However, some men will need to buy one.
The Sexual Advice Association produces a number of factsheets, including one on vacuum pumps that provides details of companies that supply them.
If your erectile dysfunction doesn’t respond to treatment, or you are unable or unwilling to use PDE-5 inhibitors or a vacuum pump, you may be given a medicine called alprostadil. This is a synthetic (man-made) hormone that helps to stimulate blood flow to the penis.
Alprostadil is available as:
- an injection directly into your penis – this is called an intracavernosal injection
- a small pellet placed inside your urethra (the tube that carries urine from your bladder to the tip of your penis) – this is called urethral application
You may be trained to correctly inject or insert alprostadil. If your partner is pregnant, use a condom during sex if you are inserting alprostadil into your urethra.
Alprostadil will usually produce an erection after five to 15 minutes. How long the erection lasts will depend on the dose.
In men who did not respond to PDE-5 inhibitors, alprostadil injections were successful in 85 out of 100 men. Alprostadil inserted into the urethra is successful for up to two-thirds of men.
Alprostadil should not be used:
- in men at risk of priapism (a painful erection that lasts for several hours) – for example, those with sickle cell anaemia
- alongside other erectile dysfunction medications
- if you have a penile implant or if you have been advised to avoid sexual activity
Urethral application may also not be used in:
- some men who have anatomical problems with their penis (conditions that affect the physical structure of the penis)
- men who have infections of their penis, such as balantis (inflammation of the head of the penis)
Alprostadil can cause some side effects including:
- changes in your blood pressure
- pain in your penis
- urethral burning or bleeding
- reactions at the site of the injection, such as swelling
As with PDE-5 inhibitors, NHS prescriptions for alprostadil may only be available for men with particular health conditions or those receiving some types of medical treatments. If you need to pay the full prescription cost, a single injection of alprostadil costs around £8 to £22, depending on the dose. A single dose of alprostadil for urethral application is around £10.
If a hormonal condition is causing erectile dysfunction, you may be referred to an endocrinologist (who specialises in the treatment of hormonal conditions).
Hormones are chemicals produced by the body. Many hormonal conditions can be treated using injections of synthetic (man-made) hormones to restore normal hormone levels.
Surgery for erectile dysfunction is usually only recommended if all other treatment methods have failed. It may also be considered in:
- younger men who have experienced serious injury to their pelvic area – for example, in a car accident
- men with a significant anatomical problem with their penis
In the past, surgery was used if there was clear evidence of a blockage to the blood supply of the penis. The surgeon could unblock the blood vessels to restore a normal supply of blood. However, research now suggests that the long-term results of this type of surgery are poor, so it’s unlikely to be used.
Penile implants are a type of surgery that may be considered. These can be:
- semi-rigid implants – which may be suitable for older men who do not have sex regularly
- inflatable implants – which consist of two or three parts that can be inflated to give a more natural erection
Penile implants are not usually available on the NHS and inflatable implants may be very expensive. However, around three-quarters of men report being satisfied with the results of this type of surgery.
As with all types of surgery, having penile implants inserted carries a risk of infection. If you take preventative antibiotics, the rate of infection is around two or three in 100. Mechanical problems with the implants may occur within five years in five per cent of cases.
If your erectile dysfunction has an underlying psychological cause then you may benefit from a type of treatment called sensate focus.
If conditions such as anxiety or depression are causing your erectile dysfunction, you may benefit from counselling (a talking therapy).
Sensate focus is a type of sex therapy that you and your partner complete together. It starts with you both agreeing not to have sex for a number of weeks or months. During this time, you can still touch each other, but not in the genital area (or a woman’s breasts). The idea is to explore your bodies knowing that you will not have sex.
After the agreed period of time has passed, you can gradually begin touching each other’s genital areas. You can also begin to use your mouth to touch your partner, for example, licking or kissing, them. This can build up to include penetrative sex.
You can find out more about sensate focus from the College of Sexual and Relationship Therapists (COSRT).
Psychosexual counselling is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues that may be contributing to your erectile dysfunction. By talking about the issues, you may be able to reduce any anxiety that you have and overcome your erectile dysfunction.
The counsellor can also provide you with some practical advice about sex, such as how to make effective use of other treatments for erectile dysfunction to improve your sex life.
Psychosexual counselling may take time to work and the results achieved have been mixed.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is another form of counselling that may be useful if you have erectile dysfunction. CBT is based on the principle that the way you feel is partly dependent on the way you think about things. CBT helps you realise that your problems are often created by your mindset. It is not the situation itself that is making you unhappy, but how you think about it and react to it.
Your CBT therapist can help you to identify any unhelpful or unrealistic thoughts that may be contributing to your erectile dysfunction – for example, to do with:
- your self-esteem (the way you feel about yourself)
- your sexuality
- your personal relationships
Your CBT therapist will be able to help you to adopt more realistic and helpful thoughts about these issues.
Pelvic floor muscle exercises
Some studies have suggested that, in a few cases, it may be beneficial to exercise your pelvic floor muscles. These are a group of muscles around the underside of the bladder and rectum, as well as at the base of the penis.
Pelvic floor muscle exercise involves strengthening and training the muscles used to control the anus (back passage) and urinate. If your GP feels this type of exercise could be beneficial, then you may want to discuss it with a physiotherapist to learn it correctly.
By strengthening and training these muscles, you may be able to reduce the symptoms of erectile dysfunction.
Some complementary therapies, such as acupuncture, have claimed to treat erectile dysfunction. However, there is little evidence they are useful.
In some cases, they may even include ingredients that could interact with other medications and cause side effects.
Always speak to your GP before using any complementary therapies.
Impotence (Erectile Dysfunction) – Harvard Health
What Is It?
Impotence means that a man’s penis doesn’t get hard enough to have sexual intercourse. The man cannot get or maintain an erection. The medical term is erectile dysfunction (ED).
ED is not the same as premature ejaculation.
The major causes of ED include:
- Vascular (blood vessel) disease — Erections happen when blood collects in the shaft of the penis. Vascular disease can limit the amount of blood flowing to or staying in the penis. Both can result in problems with erections.
- Vascular disease is the most common medical cause of impotence.
- Nerve damage — Nerves must be working normally for a man to get and keep an erection. Nerves can be damaged by diabetes, multiple sclerosis, prostate surgery or damage to the spinal cord.
- Psychological factors — Psychological issues such as depression, anxiety, guilt or fear can sometimes cause sexual problems. At one time, these factors were thought to be the major cause of impotence. Doctors now know that physical factors cause impotence in most men with the problem. However, embarrassment or “performance anxiety” can make a physical problem worse.
- Medications — Many medications cause problems with sexual function. These include drugs for high blood pressure, depression, heart disease and prostate cancer.
- Hormonal problems — Abnormal levels of certain hormones can interfere with erections and sex drive. Hormonal problems, such as a low testosterone level, are an uncommon cause of impotence.
A man with impotence has either a problem getting an erection or difficulty maintaining one. This usually interferes with sexual activity.
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Sex and the Prostate: Overcoming erectile dysfunction when you have prostate disease – Harvard Health Blog
If you are concerned about erectile function, it’s important to understand what erectile dysfunction really is. Failing to have an erection one night after you’ve had several drinks — or even for a week or more during a time of intense emotional stress — is not erectile dysfunction. Nor is the inability to have another erection soon after an orgasm. Nearly every man occasionally has trouble getting an erection, and most partners understand that.
Erectile dysfunction is the inability to attain and maintain an erection sufficient for sexual intercourse at least 25% of the time. The penis doesn’t get hard enough, or it gets hard but softens too soon. The problem often develops gradually. One night it may take longer or require more stimulation to get an erection. On another occasion, the erection may not be as firm as usual, or it may end before orgasm. When such difficulties occur regularly, it’s time to talk to your doctor.
Erectile dysfunction can have many causes, including some forms of prostate disease and medications and surgery for prostate cancer. Fortunately, in many cases, this problem can often be effectively addressed. Some men find relief by taking medications to treat erectile dysfunction. If these aren’t effective for you, a number of other options, including injections and vacuum devices, are available. The possibility of finding the right solution is now greater than ever.
This article explores why men may develop erectile dysfunction as a consequence of some prostate diseases, and details the current treatment options to restore sexual functioning.
The basics: How an erection occurs
At its most basic level, an erection is a matter of hydraulics. Blood fills the penis, causing it to swell and become firm. But getting to that stage requires extraordinary orchestration of body mechanisms. Blood vessels, nerves, hormones, and, of course, the psyche must work together. Problems with any one of these elements can diminish the quality of an erection or prevent it from happening altogether.
Nerves talk to each other by releasing nitric oxide and other chemical messengers. These messengers boost the production of other important chemicals, including cyclic guanosine monophosphate, prostaglandins, and vasoactive intestinal polypeptide. These chemicals initiate the erection by relaxing the smooth muscle cells lining the tiny arteries that lead to the corpora cavernosa, a pair of flexible cylinders that run the length of the penis (see Figure 1).
Figure 1: Anatomy of the penis
The penis is made up of three cylindrical bodies, the corpus spongiosum (spongy body)—which contains the urethra and includes the glans (head) of the penis—and two corpora cavernosa (erectile bodies), that extend from within the body out to the end of the penis to support erection. Blood enters the corpora cavernosa through the central arteries.
As the arteries relax, the thousands of tiny caverns, or spaces, inside these cylinders fill with blood. Blood floods the penis through two central arteries, which run through the corpora cavernosa and branch off into smaller arteries. The amount of blood in the penis increases sixfold during an erection. The blood filling the corpora cavernosa compresses and then closes off the openings to the veins that normally drain blood away from the penis. In essence, the blood becomes trapped, maintaining the erection.
As most people know, testosterone is important to the erection process. Certainly, a man needs a normal level of this hormone to start and maintain an erection. But for all the talk about hormones and virility, doctors don’t know exactly what role sex hormones play in normal libido or the ability to have erections.
Obviously, an erection isn’t permanent. Some signal — usually an orgasm, but possibly a distraction, interruption, or even cold temperature — brings an erection to an end. This process, called detumescence, or deflation, occurs when the chemical messengers that started and maintained the erection stop being produced, and other chemicals, such as the enzyme phosphodiesterase 5 (PDE5), destroy the remaining messengers. Blood seeps out of the passages in the corpora cavernosa. Once this happens, the veins in the penis begin to open up again and the blood drains out. The trickle becomes a gush, and the penis returns to its limp, or flaccid, state.
It’s usually difficult for a man to get another erection right away. The length of the interval between erections varies, depending on a man’s age, his health, and whether he is sexually active on a regular basis. A young, sexually active man in good health may be able to get an erection after just a few minutes, whereas a man in his 50s or older may have to wait 24 hours. One reason may be that nerve function slows with age.
Indeed, erections may work on a use-it-or-lose-it principle. Some research suggests that when the penis is flaccid for long periods of time — and therefore deprived of a lot of oxygen-rich blood — the low oxygen level causes some muscle cells to lose their flexibility and gradually change into something akin to scar tissue. This scar tissue seems to interfere with the penis’ ability to expand when it’s filled with blood.
Why erectile dysfunction may result from prostate disease
In the past, it was thought that most cases of erectile dysfunction were psychological in origin, the result of such demons as performance anxiety or more generalized stress. While these factors can cause erectile dysfunction, doctors now think that 70% of the time the problem can be traced to a physical condition that restricts blood flow, hampers nerve functioning, or both. Such conditions include diabetes, kidney disease, multiple sclerosis, atherosclerosis, vascular disease, and alcoholism.
However, some types of prostate disease and treatments (particularly for prostate cancer) may also be responsible.
A sudden onset of erectile dysfunction may be a sign that a man has prostate cancer, so your doctor will likely order a prostate-specific antigen (PSA) test and do a digital rectal exam during the diagnostic workup to assess this possibility.
Surgery for prostate cancer can sever some of the nerves or arteries that are needed for an erection. For men who undergo a radical prostatectomy (removal of the prostate gland), the estimates of how many men will regain their ability to have erections vary widely, from 25% to 80%. Even so-called nerve-sparing surgical techniques lead to erectile dysfunction in up to half or more of all cases. The results depend on such variables as a patient’s age, the surgeon’s skill, and the tumor locations (if a tumor is too close to the nerve bundle, the nerves can’t be spared). Even when the nerves are not permanently impaired, it can still take six to 18 months for the tiny nerve fibers to recover from the trauma of surgery and restore sexual function.
Radiation treatment for prostate cancer can also harm erectile tissues. Both external beam radiation and radiation-emitting seeds implanted in the prostate (brachytherapy) lead to erectile dysfunction in about half of men who receive these therapies. However, these changes may not occur for up to two years after treatment.
Erectile dysfunction is sometimes a side effect of some hormone therapy medications prescribed for men with prostate cancer that has spread beyond the prostate. Among such hormone-based medications are leuprolide (Lupron), and goserelin (Zoladex). Others, such as flutamide (Eulexin) and bicalutamide (Casodex) may cause erectile dysfunction to a lesser degree. Even prostate cancer itself, in its advanced stages, can spread to the nerves and arteries that are necessary for an erection.
Benign prostatic hyperplasia
Many men who have benign prostatic hyperplasia (BPH), a noncancerous enlargement of the prostate, also experience erectile dysfunction and ejaculatory problems. Although BPH does not itself cause this condition, some of the treatments used for BPH can do so. For example, finasteride (Proscar), an antitestosterone drug prescribed for BPH, has been linked to erectile dysfunction in 3. 7% of men who use it and to diminished libido in 3.3%. But alpha blockers such as terazosin (Hytrin), tamsulosin (Flomax), and doxazosin (Cardura) can improve the symptoms of BPH with a lower risk of sexual side effects. Transurethral resection of the prostate, a surgical technique often used when medication fails, also causes erectile dysfunction in a small percentage of men.
Because testosterone helps spark sexual interest, one might assume that low levels of the hormone are to blame for erectile dysfunction. It’s true that when hormone deficiency is a factor in erectile dysfunction, sexual desire also suffers. And according to some estimates, 10%–20% of men with erectile dysfunction have hormonal abnormalities. The most common hormonal cause of erectile dysfunction is hypogonadism, or testicles that don’t produce enough testosterone.
This inflammation of the prostate gland can be either acute (usually caused by a bacterial infection) or chronic (usually not caused by an infectious agent). Symptoms include pain during urination, more frequent urination, and — possibly — a discharge from the penis or fever. Severe prostatitis can cause erectile dysfunction directly. In milder forms, the condition can produce painful ejaculation, which can certainly interfere with sexual pleasure and may lead to erectile dysfunction. Your doctor may prescribe antibiotics to treat the problem, but it can take several weeks for the infection to clear and for normal erections to return.
Diagnosing erectile dysfunction
If you’ve been having difficulty getting or sustaining erections, talk about it with your doctor. Such a conversation is never easy, but thanks in part to greater publicity about this problem and its treatment, many obstacles have been toppled.
You may recall the TV commercials that showed self-assured men going to the doctor’s office to discuss the problem and emerging relieved after having taken this important step. What’s misleading is that such commercials leave the impression that there’s not much to discuss — all you need is a prescription and your erections will come back. In reality, your doctor must diagnose the cause of your erectile dysfunction in order to recommend an effective treatment.
While therapy usually does involve medication, erectile dysfunction is sometimes a symptom of an underlying condition that requires its own treatment. Also, medication is more effective for some causes of erectile dysfunction than for others. For instance, if you’ve had prostate surgery, pills probably won’t work as well as other treatments. And if a psychological condition is significantly involved, you may benefit from counseling with a mental health professional trained in sex therapy.
Providing your medical history
At first, the doctor will probably ask you about your medical history. Do you have any chronic illnesses? What illnesses and operations have you had in the past? What medications are you taking, if any? Your doctor is also likely to ask about your psychological well-being and lifestyle: Do you suffer (or have you ever suffered) from depression? Are you under a lot of stress? Do you drink alcohol? Smoke? Use illegal drugs? Have you felt a loss of affection for your partner? Have you recently grown interested in a new partner?
As part of this health history, be prepared to tell your doctor specific details about the symptoms that brought you to the office and when they began. Your doctor might want to know how often you had sex before the problem started and if there have been weeks or months in the past when you’ve had erectile dysfunction. Your doctor may conduct a written or verbal screening test.
If the cause is clear — a recent operation for prostate cancer, for example — the conversation may move directly to your treatment options. Otherwise, you may need to answer more questions to help the doctor narrow down the possible causes and avoid unnecessary testing.
A key issue is whether the symptoms came on gradually or suddenly. Erectile dysfunction that comes on gradually often points to causes that involve blood flow or nerves. On the other hand, a sudden loss of sexual desire or the ability to have erections usually suggests that a medication or psychological difficulty, such as depression or stress, may be to blame. Don’t be embarrassed if the doctor asks you about early morning erections or whether you can achieve an erection if you masturbate. The ability to do so is an important clue in determining whether the problem is psychologically or physically based (see Table 1).
Table 1: Diagnosing the problem
|Possible cause of erectile dysfunction||What the doctor does|
|Vascular (circulatory system)||Takes your blood pressure and listens to your heart. Checks pulse in groin and feet. Checks your abdomen for aortic aneurysm.|
|Neurological (nervous system)||Tests reflexes of your knees and ankles, as well as anus. Checks for sensation in your legs and feet.|
|Hormonal (endocrine system)||Assesses testicular size and breast development. Checks your thyroid gland.|
|Local (reproductive system)||Examines your penis for Peyronie’s disease. Checks your prostate.|
|Psychological (stress, anxiety, emotional)||Assesses the history of the problem, especially whether it started suddenly and if nocturnal erections are affected.|
The physical exam
The physical exam for diagnosing the cause of erectile dysfunction usually takes about 10–15 minutes. The doctor will listen to your heart for signs of a murmur and other abnormalities that can affect blood flow. He or she will also take your blood pressure; both high and low blood pressure can impair blood flow. The doctor will check your pulse in several places — at the wrist, ankle, and groin. Slow or low pulse in any of these areas can mean that not enough blood is reaching tissues in the extremities, including the penis.
In addition, the doctor will examine your testicles, penis, and chest. Abnormally small testicles and enlarged breasts are sometimes signs of inadequate testosterone. Patches of scar tissue felt in the penis suggest Peyronie’s disease. Your doctor may check the prostate gland for signs of infection or cancer, by doing a digital rectal exam. Your doctor may also test for neurological problems by checking the reflexes in your legs, groin, and anus.
Your checkup will probably include tests for cholesterol (to assess your risk of cardiovascular disease) and triglyceride and blood sugar levels (to check for diabetes). The doctor might also ask for a urine specimen because the presence of blood could be a sign of a urologic disease, such as bladder cancer.
Now that medication can successfully treat most men with erectile dysfunction, many once routine diagnostic tests are used only when the doctor suspects the patient has an underlying problem requiring additional treatment.
Hormone tests. Checking testosterone levels used to be one of the first tests ordered for men with erectile difficulty, but that was before doctors realized that testosterone deficiency was rarely the source of the problem. Now, hormone testing is done for men whose medical exams suggest an endocrine problem and for those who have experienced a loss of sexual desire.
Your doctor also may want to check your blood levels of prolactin (a pituitary hormone that can block the action of testosterone) or thyroid–stimulating hormone (a good indicator of an under-active or overactive thyroid gland). These tests also used to be commonplace, but are now done only if your doctor thinks you might have a hormonal deficiency or imbalance.
Blood flow tests. A color duplex Doppler ultrasound, an imaging technique, can reveal problems with blood flow through the arteries or veins of the penis, such as venous leakage. A newer version, called penile Doppler, can be done in a physician’s office. If you’ve tried pills for erectile dysfunction but haven’t found them helpful, your doctor may inject prostaglandin, a fatty acid that widens blood vessels, into your penis to see if this causes an erection. If so, there’s a good chance that you will respond to one or more of the injectable drugs used to treat erectile dysfunction.
Nocturnal tumescence tests. If it’s unclear whether your erectile difficulties have a psychological or a physical cause, your doctor may suggest a nocturnal penile tumescence test. Psychological factors come into play when you’re trying to achieve or maintain an erection. But the psyche doesn’t affect nocturnal erections, which occur involuntarily during sleep. Physical causes affect both kinds of erections.
There are several ways to test for nocturnal erections. Medical devices may be attached to the penis to monitor its circumference or its rigidity throughout the night. A low-tech alternative is the postage stamp test. Simply paste a strip of postage stamps around your penis before going to bed. If the strip breaks by the morning, you’ve had at least one nocturnal erection. This confirms that erection is physically possible and indicates that the difficulty you’ve been having is probably due to psychological issues.
Table 2: Comparing the temporary treatments
|Therapy||Onset of action||Duration of effectiveness||Advantages||Disadvantages|
|sildenafil (Viagra)||30–60 minutes||4–5 hours||Oral medication, very effective (about 70%), few side effects||Cannot be used by men taking nitrates or those with unstable cardiovascular disease|
|vardenafil (Levitra)||15–30 minutes||4–5 hours|
|tadalafil (Cialis)||30–45 minutes||24–36 hours|
|alprostadil injections (Caverject, Edex)||5–20 minutes||30–60 minutes||Highly effective (about 80%), few side effects||Requires training; injections unpleasant for many men; may cause penile pain or painful sustained erections (priapism)|
|alprostadil pellets (MUSE)||5–15 minutes||30–60 minutes||Moderately effective (about 30%)||Requires training; may cause penile pain, usually mild; may cause dizziness|
|vacuum pump||Immediate||While in use||Highly effective (about 80%), no serious side effects||Requires training; cumbersome and awkward; may cause penile numbness or bruising|
|penile band (Actis, Erecxel)||Immediate||While in use||Effective when used properly, helpful for men with venous leakage who cannot sustain an erection||May be awkward to use|
Treating erectile dysfunction
If you are diagnosed with erectile dysfunction, you have a number of treatment options.
PDE5 inhibitors: Viagra, Levitra, and Cialis
Approved by the FDA in 1998, sildenafil (Viagra) revolutionized the way we think about — and treat — erectile dysfunction, largely because it is so easy to use and effective. In 2003, the FDA approved two closely related drugs, vardenafil (Levitra) and tadalafil (Cialis), but Viagra remains the best-known and most frequently prescribed oral medication for erectile dysfunction.
All three drugs work in a similar fashion, by affecting the normal physiology of the penis. In particular, they block PDE5, an enzyme that breaks down the erection-producing chemical cyclic guanosine monophosphate. This enables the penis to fill with blood and to stay erect long enough for intercourse. Of course, it’s important to realize that none of these drugs is an aphrodisiac. You’ve got to feel sexually stimulated in order for them to work.
The main differences between the three drugs have to do with timing: how quickly they begin to work, and how long their effects last (see Table 2). Levitra may start working slightly faster than Viagra (within a half-hour instead of an hour) although the FDA says that like Viagra, it should be taken about an hour before sexual activity. Some studies suggest that Levitra may help some men who don’t respond to Viagra. And while some doctors are skeptical about this claim, there’s no harm in trying Levitra or Cialis if Viagra doesn’t work for you.
Cialis stays active in the body much longer than the other drugs. Viagra and Levitra last about 4 to 5 hours (and sometimes up to 12 hours). But with Cialis, the window of opportunity ranges from 24 to 36 hours, which is why it’s sometimes called “the weekend drug.” Another minor difference is that while Viagra’s action may be delayed or impaired when taken with food (especially high-fat foods), that’s not the case with Levitra or Cialis.
Success rates. Because Viagra has been available the longest, there’s more research available on this drug. Pooled data involving studies of 6,659 men have shown that Viagra helped 83% of men have intercourse at least once. On the other hand, Viagra is not a panacea. A 2001 study of its long-term effectiveness, in the Journal of Urology, reported a somewhat lower overall success rate (69%). The success rates for Cialis and Levitra (59% and 69%, respectively) are similar to those for Viagra.
Viagra has proved beneficial for most men with erectile dysfunction resulting from spinal cord injuries. In one study, 83% of such men who took Viagra had improved erections. But for men with diabetes or advanced heart disease, the drug helps only about half of the time. The response is even lower — about 30% — for men who’ve had radical prostatectomy.
Side effects. So far, the risks and side effects of these three drugs seem to be roughly the same. They all work by relaxing smooth muscle cells, which widens blood vessels — primarily in the penis, but also in other parts of the body. The most common side effect is a headache, which occurs in about 16% of users (see Figure 2). Other reactions include flushing, upset stomach, nasal congestion, and urinary tract infections. But when the drugs are used properly, these side effects are relatively mild, and most disappear after a few hours. In rare cases, some men experience temporary, mild visual problems, mainly seeing a blue tinge, but also increased sensitivity to light and blurred vision. However, men with retinitis pigmentosa, a rare eye disease, should be very cautious about using these medications.
Figure 2: Side effects of Viagra
In 2005, reports linked Viagra use to another rare eye disease, nonarteric anterior ischemic optic neuropathy, which can lead to blindness. However, fewer than 50 possible cases were reported as of 2006, compared with the millions of men who have used erectile drugs without problems. Still, these reports serve as a reminder to men over 50 to get regular eye check-ups and to alert a physician to any unusual vision problems after taking a PDE5 inhibitor drug.
Drug interactions. Within several hours of taking PDE5 inhibitor drugs, blood pressure tends to drop slightly: The top (systolic) number dips 8–10 mm Hg, while the bottom (diastolic) number goes down by 5–6 mm Hg. So it’s very important to avoid taking these drugs with medications that contain nitrates, which also lower blood pressure. Interactions between these two types of drugs can cause life-threatening drops in blood pressure. (The nitrates and nitrites found in food don’t pose a problem.) Men who take long-acting nitrates, including isosorbide dinitrate (Isordil, Sorbitrate, and others) and isosorbide mononitrate (Imdur, Ismo, and others), or who use nitroglycerine patches or paste should not take PDE5 inhibitor drugs. And they should not use short-acting, under-the-tongue tablets or a spray form of nitroglycerine within 24 hours of taking either Viagra or Levitra. For Cialis, the ban extends to 48 hours.
Men who take medications known as alpha blockers should be cautious about taking PDE5 inhibitors. These drugs, which include doxazosin (Cardura), terazosin (Hytrin), and tamsulosin (Flomax), are used to treat BPH and high blood pressure. If you take an alpha blocker, ask your doctor before taking any PDE5 inhibitor. For example, Viagra shouldn’t be taken within four hours of taking an alpha blocker.
Other considerations. Although the PDE5 inhibitors are expensive, many health insurance plans (including Medicare) cover them, although most have a limit of four pills per month. Perhaps even more important considerations are the sometimes complicated and unexpected challenges that these medications may present to your sexual relationship. Some partners who’ve grown comfortable in a relationship without intercourse may need time to shift gears, so to speak, if the drug is successful. Use of these drugs may raise other issues for couples. Should you tell your partner before or after you’ve started taking it? Will this put pressure on your partner to have sex? Should you take the medication and just hope your partner will be in the mood? The best way to address these questions is to talk about them with your partner. Particularly if you’re in an established relationship, your partner should know that you have a prescription for one of the drugs, and the two of you can decide together how and when to use it.
What if PDE5 inhibitors don’t work for you? Many men who can’t use these drugs or find them ineffective are able to get erections by injecting one or more prescription drugs into the side of the penis. The very idea may make you squeamish, and it’s certainly not as easy as taking a pill. But the needle isn’t very big (about half an inch long, the same size as those used to inject insulin), and drug injections can produce results.
Indeed, for men whose erectile dysfunction is caused by diabetes, injection therapy is more effective than Viagra. And it’s the single most effective treatment available for men who experience the problem as a result of prostate surgery. Many men learn the technique quickly after a demonstration by a doctor or nurse in the doctor’s office (see Figure 3).
Figure 3: Injection therapy
This simple and highly effective method produces an erection within five to 20 minutes after a man injects medication into the base of the penis, causing the smooth muscle tissue of the penis to relax and allowing blood to flow into the corpora cavernosa.
There are several injectable drugs, all of which work by relaxing the smooth muscle tissue of the penis and allowing blood to flow into the corpora cavernosa. The only one specifically approved for erectile dysfunction is alprostadil (Caverject, Edex). However, a number of older drugs that were approved for other uses are also effective for erectile dysfunction. They are papaverine (Pavabid, Genabid, Pavatine, and others), phenoxybenzamine (Dibenzyline), and phentolamine methylate (Regitine).
An erection usually occurs within five to 20 minutes of an injection and lasts for 30–60 minutes. The effectiveness varies according to the drug used. For example, studies show that the response rate to papaverine is 65%, but for alprostadil, it’s more than 80%. Doctors typically prescribe these drugs in some combination rather than singly; many men who don’t respond to any of these drugs alone can get erections when they combine two or more. A preparation called Trimix contains a mixture of papaverine, phentolamine methylate, and prostaglandin. One study found Trimix aided 62% of men who did not otherwise respond to injection treatments.
The main side effects of the injections are mild to moderate pain, bruising, or scarring. Like Viagra, injectable drugs can also cause low blood pressure. Although rare, this side effect is most likely to occur if a man takes too large a dose or if he injects himself more than once in 24 hours.
Another rare complication is priapism, an erection that lasts too long. Any man who has an erection that lasts for more than three hours after an injection should go to an emergency room. An erection that lasts longer than six hours can cause scarring and complete loss of erectile function. Because of these potential side effects, doctors prescribe the lowest effective dose. A doctor or nurse usually gives a patient an injection in the office to establish what that dose is before writing a prescription.
If you’re using injectable drugs, there are some things you can do to help the therapy feel more natural for you and your partner. One is to take a low dose and ask your partner for manual or oral stimulation to help achieve a full erection. That way, your partner will feel more involved. You might also suggest that your partner watch you inject yourself once or twice to help overcome any initial discomfort with the process. But if you’re more comfortable doing this privately, that’s fine, too. What’s most important for the treatment’s success — and for your emotional well-being — is that you and your partner feel at ease with it.
In addition to being available as an injectable drug, alprostadil comes in the form of tiny pellets designed to be inserted into the penis shortly before intercourse. The pellet form is an alternative to injections. These pellets are part of a therapy called “medicated urethral system for erection,” but your doctor will probably just use the acronym MUSE. This method of treatment uses a disposable plastic applicator to insert a pellet about an inch into the urethra (see Figure 4). From there, the drug is quickly absorbed by the surrounding tissue and reaches the corpora cavernosa, where it dilates the arteries.
Figure 4: MUSE
Using a slim applicator, a man inserts a tiny pellet containing one of the medications used for injection therapy about an inch inside the tip of his penis to attain an erection.
Though an early study reported that MUSE enabled 65% of men to have intercourse successfully at least once, clinical experience has shown that it is effective in only about 30% of men. Although some men consider MUSE easier to use than injections, about 10% of those who try it find the application process mildly painful, and about 3% become dizzy and develop low blood pressure. Because of the risk of low blood pressure, you should not use MUSE more than twice in 24 hours. Like injectable drugs, MUSE is available only by prescription and must first be used in the doctor’s office to determine the lowest effective dose.
Devices to help achieve or maintain an erection
If none of the medications are helpful or appropriate for you, or if you just don’t want to use them, there are other options. In particular, you can turn to a number of different devices to produce or maintain an erection.
Penile band. A penile band may help men who can get an erection but can’t sustain it because of venous leakage. These ringlike devices, which don’t require a prescription (Actis, Erecxel), fasten around the base of the erect penis to keep blood from escaping. Penile bands are completely effective when used properly.
Vacuum erection devices. Until prescription medications came along, the only proven at-home therapy for erectile dysfunction involved using a vacuum pump. With this therapy, you lubricate your penis and put it into an airtight plastic cylinder that’s attached to a handheld pump (see Figure 5). Some pumps are manual, while others operate on a battery. In either case, air is pumped out of the cylinder to create a vacuum, which increases blood flow to the penis. Once an erection occurs, which usually takes about five minutes, you remove your penis from the cylinder and fit a rubber ring around the base of the penis to prevent blood from draining away. The erection lasts until the ring is removed.
Figure 5: Vacuum device
This technique creates an erection by way of a vacuum pump. A man lubricates his penis and puts it into an airtight plastic cylinder attached to a handheld pump. Air is pumped out of the cylinder to create a vacuum, which increases blood flow to the penis and causes an erection.
Vacuum pumps are noninvasive and highly effective, working for about 80% of men. Their advantage over medication is that they can be used as often as a man wants. But there are several disadvantages. Having to fuss with the pump can interrupt lovemaking. And some men find the pumps difficult to use.
In addition, the erection doesn’t feel as natural as one produced by a drug. Although firm, the erection can be somewhat floppy because it starts above the base of the penis. About 10% of men have side effects, such as pain, bruising, or difficulty ejaculating, any of which can cause discomfort during sexual activity. Also, these pumps are not an option for men with blood disorders, such as blood-clotting irregularities or leukemia.
Surgical implants should be considered only after you’ve tried other, less invasive options. Penile implants date back to the 1930s, when a piece of human rib was surgically placed inside a man’s penis. Since then, the process has been refined, and now there are two kinds of implants.
Silicone rods. One type of implant consists of two pencil-thin silicone rods that are placed in the penis above the urethra. The operation is done on an outpatient basis and takes about an hour. The penis remains permanently erect, although it can be pointed down along the thigh to conceal it under clothing.
Inflatable cylinders. Another kind of penile implant consists of two inflatable cylinders positioned in the corpora cavernosa, which produce an erection when filled with saline fluid (see Figure 6). The fluid is pumped from a reservoir implanted in the abdomen or the scrotum. Although an inflatable implant produces a more natural erection than a silicone rod, it’s more prone to complications, like infections and malfunction. About 5% of men need a second operation to replace the implant.
Figure 6: Surgical implant
This implant consists of two inflatable cylinders surgically placed in the corpora cavernosa to produce an erection when filled with saline fluid. The man pumps the fluid by hand from an abdominal reservoir by using a pump located in his scrotum. A different form of implant (not shown) includes two surgically inserted flexible rods that create a permanent erection. The penis can be pointed downward when not in use.
Vascular surgery is used only for men whose erectile dysfunction results from specific blood vessel problems. There are two types of such operations, but neither has a high rate of success. The first — for men whose problem involves the leakage of blood from certain vessels during an erection — ties off those vessels so they retain blood.
The second type of vascular surgery is used when the problem is the blockage of isolated blood vessels. In such cases, the surgery entails bypassing the blocked vessels to allow more blood into the penis. Bypass operations are reserved mainly for patients whose blood flow problems result from injuries such as pelvic fractures. For each of these operations, the success rate in restoring normal erectile function is less than 30%.
Testosterone supplements are appropriate only if you have abnormally low levels of this hormone. The supplements can help boost your libido and improve your ability to have erections. These supplements are now nearly always given in gel form, which you apply daily to your shoulders. Other forms are less convenient (doctor-administered injections) or cause skin irritation (skin patches). The exact role that low testosterone plays in erectile dysfunction remains unclear. However, at least one study suggests that combination treatment with testosterone gel and Viagra may improve response for men with low to low-normal testosterone levels who did not respond to Viagra alone.
Originally published Jan. 1, 2007; last reviewed April 22, 2011.
Frequently Asked Questions About Erectile Dysfunction
Here are the answers to some frequently asked questions our customers have about erectile dysfunction (ED, or ‘impotence’).
How do you prevent erectile dysfunction?
It’s important to maintain a healthy lifestyle to prevent erectile dysfunction. ED occurs mainly in older males, but young men can also suffer from ‘performance anxiety’.
Top tips to achieve better health and avoid ED include:
- Physical activity
- Stress-free life
- Sufficient sleep
- Balanced diet
- No smoking
- Reduction in alcohol consumption
How does erectile dysfunction occur?
Blood vessel deterioration is a primary cause of erectile dysfunction. This means that there’s a narrowing of blood vessels going to the penis. Other causes include hypertension, high cholesterol or diabetes. There are also psychological causes – for example, depression and relationship problems can affect a man’s ability to perform.
What is the best food for erectile dysfunction?
There’s no miracle food to prevent erectile dysfunction. However, erectile problems are usually due to having a bad blood supply to the penis, so foods that are good for your vascular system may help to prevent ED. Such foods include:
- Leafy green vegetables (nitrates)
- Dark chocolate (flavonoids increase circulation)
- Sea food (zinc)
- Watermelon (antioxidants)
- Tomatoes (lycopene boosts circulation)
What can cause erectile dysfunction at 30?
Erectile dysfunction is more common among younger men than previously believed. It can be triggered by health conditions, such as obesity. Hormonal disorders, such as low testosterone could also contribute to ED. An abnormally high or low thyroid hormone level can also result in ED, and young men who use steroids to build muscle mass are also at risk. Anxiety and depression are other common triggers.
Is erectile dysfunction common?
Erectile dysfunction is a very common condition – especially in older men. It’s estimated that 50 percent of men between the ages of 40 and 70 will suffer from ED to some degree.
What causes impotence in middle aged males?
Causes of erectile dysfunction for middle aged men include depression, anxiety or having sex with someone new after being in a long-term relationship. As men age, they can become more sedentary and suffer from health conditions such as diabetes and other vascular conditions.
Can erectile dysfunction be reversed?
Erectile dysfunction can potentially be reversed without medication by focusing on lifestyle factors. These include following a healthy diet, not smoking, exercising and avoiding alcohol.
Can high blood pressure affect erectile dysfunction?
High blood pressure is a common problem associated with erectile dysfunction. This is because high blood pressure stops the arteries that carry blood into the penis from dilating the way they should. As a result, not enough blood flows into the penis to make it erect.
Can erectile dysfunction be caused by stress?
The causes of ED can be both physical and psychological. Studies show that psychological factors are the most common cause. These include stress and anxiety. Increased stress and anxiety can also increase the risk of other conditions that could cause ED, such as heart disease and high blood pressure.
What is the average age for erectile dysfunction?
It’s estimated that half of all men between the ages of 40 and 70 will suffer from erectile dysfunction to some degree. However, it’s treatable and isn’t as inevitable as you may think – and there’s a sliding scale. A study showed that only four percent of men in their fifties and 17 percent in their sixties experience a total inability to have an erection.
What foods are bad for erectile dysfunction?
The best way to improve your sexual health is to clean up your diet. It’s best to avoid foods that can potentially contribute to erectile dysfunction. These include meat, fried foods, foods packed in cans or plastic, and soy (this can affect your hormones).
How do you diagnose erectile dysfunction?
Erectile dysfunction means the repeated inability to achieve or sustain an erection sufficient for sexual intercourse. ED doesn’t mean an occasional failure to achieve an erection, diminished interest in sex or problems with ejaculation. There are a variety of different tests that can be used to identify the cause of ED. These include: physical examinations, psychological testing (for stress, anxiety and depression), blood and urine tests and ultrasound.
What is the best medicine for erectile dysfunction?
The best medicine for erectile dysfunction includes Cialis, Viagra and Levitra.
Is erectile dysfunction curable?
ED can be successfully treated. Along with medication, it’s important to maintain a balanced diet and be physically active.
What is the cause of erectile dysfunction in older men?
Vascular diseases are more common in older men. This is why erectile dysfunction can be a problem among men between the ages of 40 and 60. As well as this, psychological problems can increase with age, such as stress and anxiety.
Which erectile dysfunction drug is best?
Viagra is the most popular drug for erectile dysfunction. However, Cialis and Levitra are also effective.
Can having the flu cause erectile dysfunction
The flu could affect your mood, and therefore your performance. As well as this, flu medication can have side effects that can lead to erectile dysfunction.
Can diabetes cause erectile dysfunction?
ED is a common problem among men who have diabetes. This is because diabetes can damage the blood vessels men need to maintain an erection. Without blood vessels and nerves that control erections, ED can occur even if a man has a healthy sex drive.
For more information about erectile dysfunction, take a look at our treatments page.
Erectile Dysfunction (ED): Causes, Diagnosis & Treatment
Dr. Drogo Montague discusses treatment options for erectile dysfunction.
What is erectile dysfunction (ED)?
Erectile dysfunction (ED) is the inability to get and keep an erection firm enough for sexual intercourse. Estimates suggest that one of every 10 men will suffer from ED at some point during his lifetime. It is important to understand that in most cases, ED is a symptom of another, underlying problem. ED is not considered normal at any age, and may be associated with other problems that interfere with sexual intercourse, such as lack of desire and problems with orgasm and ejaculation.
How common is erectile dysfunction?
Approximately one in 10 adult males will suffer from ED on a long-term basis.
Many men do experience occasional failure to achieve erection, which can occur for a variety of reasons, such as drinking too much alcohol, stress, relationship problems, or from being extremely tired.
The failure to get an erection less than 20% of the time is not unusual and typically does not require treatment. However, the failure to achieve an erection more than 50% of the time generally means that there is a problem and treatment is needed.
ED does not have to be a part of getting older. While it is true that some older men may need more stimulation, they should still be able to achieve an erection and enjoy intercourse.
Symptoms and Causes
What causes erectile dysfunction (ED)?
ED can be caused by a number of factors, including:
- Vascular disease: Blood supply to the penis can become blocked or narrowed as a result of vascular disease such as atherosclerosis (hardening of the arteries).
- Neurological disorders (such as multiple sclerosis): Nerves that send impulses to the penis can become damaged from stroke, diabetes, or other causes.
- Psychological states: These include stress, depression, lack of stimulus from the brain and performance anxiety.
- Trauma: An injury could contribute to symptoms of ED.
Chronic illness, certain medications, and a condition called Peyronie’s disease can also cause ED. Operations for the prostate, bladder, and colon cancer may also be contributing factors.
What medications could cause erectile dysfunction (ED)?
Erectile dysfunction (ED) is a common side effect of a number of prescription drugs. While these medications may treat a disease or condition, in doing so they can affect a man’s hormones, nerves or blood circulation, resulting in ED or increasing the risk of ED.
If you experience ED and think that it may be a result of the medication you are using, do not stop taking the medication. If the problem persists, contact your doctor and he or she may be able to prescribe a different medication. Common medications that may list ED as a potential side effect include:
- Diuretics (pills that cause increase urine flow).
- Antihypertensives (high blood pressure drugs).
- Parkinson’s disease drugs.
- Antiarrhythmics (drug for irregular heart action).
- Muscle relaxants.
- Nonsteroidal anti-inflammatory drugs.
- Histamine h3-receptor antagonists.
- Chemotherapy medications.
- Prostate cancer drugs.
- Anti-seizure medications.
Other substances or drugs that can cause or lead to ED include these recreational and frequently abused drugs:
These drugs not only affect and often suppress the central nervous system, but can also cause serious damage to the blood vessels, leading to permanent ED.
What prescription drugs may cause erectile dysfunction?
Erectile dysfunction (ED) is a common side effect of a number of prescription drugs. While these medications may treat a disease or condition, in doing so they can affect a man’s hormones, nerves or blood circulation. The result may be ED or an increase in the risk of ED.
If you have ED and think that it may be a result of the medication you are using, do not stop taking the medication. If the problem persists, contact your doctor and he or she may be able to prescribe a different medication. Common medications that may list ED as a potential side effect include:
- Diuretics (pills that cause an increase in urine flow).
- Antihypertensives (medication for high blood pressure).
- Parkinson’s disease drugs.
- Antiarrhythmics (medication for irregular heart action).
- Muscle relaxants.
- Non-steroidal anti-inflammatory drugs.
- Histamine h3-receptor antagonists.
- Chemotherapy medications.
- Prostate cancer drugs.
- Anti-seizure medications.
What other substances or drugs may cause erectile dysfunction?
Other substances or drugs that can cause or lead to ED include these recreational and frequently abused drugs:
Aside from the well-known complications that the use and abuse of these drugs can cause, ED is not often mentioned. However, use of these drugs is a risk factor for ED. These drugs not only affect and often times slow down the central nervous system, but can also cause serious damage to the blood vessels, leading to permanent ED.
How are depression and erectile dysfunction related?
For some men, depression can accompany the condition of erectile dysfunction (ED). It is common for men with ED to feel angry, frustrated, sad, unsure of themselves, or even less “manly. ” Such feelings may lead to a lack of self-esteem and, in severe cases, to depression.
Depression that accompanies ED is treatable. The first step in addressing your concerns about ED-related depression is to be honest with yourself, your partner, and your doctor. After depression has been brought out into the open, coping with it will be easier and less stressful.
Diagnosis and Tests
How is erectile dysfunction (ED) diagnosed?
Because there are a variety of causes for ED, there are several different tests your doctor may use to diagnose the condition and determine its cause. Only after the cause of ED is determined can it be effectively treated.
Before ordering any tests, your doctor will review your medical history and perform a thorough physical examination. The doctor will also “interview” you about your personal and sexual history. Some of these questions will be very personal and may feel intrusive. However, it is important that you answer these questions honestly. The questions asked may include:
- What medications or drugs are you currently using? This includes prescription drugs, over-the-counter drugs, herbals, dietary supplements and illegal drugs.
- Have you had any psychological problems such as stress, anxiety and depression?
- When did you first notice symptoms of ED?
- What are the frequency, quality and duration of any erections you have had?
- What are the specifics of the circumstances under which ED first occurred?
- Do/did you experience erections at night or during the morning?
- What sexual techniques do you use?
- Are there problems in your current relationship?
The doctor may also wish to interview your sexual partner since your partner may be able to offer in sight about the underlying causes.
After your physical examination and discussion, your doctor may then order any one of the following tests to further diagnose your condition:
- Complete blood count (CBC): This is a set of blood tests that, among other things, can detect the presence of anemia. Anemia is caused by a low red blood cell count and can cause fatigue, which in turn can cause ED.
- Liver and kidney function tests: These blood tests may indicate whether ED may be due to your kidneys or liver functioning improperly.
- Lipid profile: This blood test measures the level of lipids (fats), like cholesterol. High levels may indicate atherosclerosis (hardening of the arteries), which can affect blood circulation in the penis.
- Thyroid function test: One of the thyroid hormones’ functions is to regulate the production of sex hormones, and a deficiency in these hormones may contribute to or cause ED.
- Blood hormone studies: Testosterone and/or prolactin levels in the blood may be measured to see if abnormalities in either of these sex hormones are present.
- Urinalysis: Analysis of urine can provide a wealth of information, including information on protein, sugar and testosterone levels. Abnormal measurements of these substances can indicate diabetes, kidney disease or a testosterone deficiency, all which can cause ED.
- Duplex ultrasound: This is perhaps the best test for evaluating ED. An ultrasound uses high-frequency sound waves to take “pictures” of the body’s tissues. For people with ED, an ultrasound may be used to evaluate blood flow and check for signs of a venous leak, atherosclerosis (hardening of arteries) or tissue scarring. This test is performed both while the penis is erect (usually induced by an injection of a drug that stimulates erection) and also while it is soft.
- Bulbocavernosus reflex: This test evaluates nerve sensation in the penis. During the test, your doctor will squeeze the head of your penis, which should immediately cause your anus to contract. If nerve function is abnormal, there will be a delay in response time.
- Nocturnal penile tumescence (NPT): This test measures a man’s erectile function while he is sleeping. Normally, a man will have five or six erections while asleep. A lack of these erections may indicate there is a problem with nerve function or circulation to the penis. The test uses two methods, the snap gauge method and the strain gauge method. The snap gauge method is performed by wrapping three plastic bands of varying strength around the penis. Erectile function is then measured based on which of the three bands breaks. The strain gauge method works by placing elastic bands around the tip and base of the penis. If the penis becomes erect during the night, the bands stretch, measuring the changes in penile circumference.
- Penile biothesiometry: This test involves the use of electromagnetic vibration to determine sensitivity and nerve function. A decreased sensitivity to these vibrations may indicate nerve damage.
- Vasoactive injection: During this test, an erection is produced by injecting special solutions that cause the blood vessels to dilate (enlarge) allowing blood to enter the penis.
- Dynamic infusion cavernosometry: This test is used for men with ED who have a venous leak. During this test, fluid is pumped into the penis at a predetermined rate. By measuring the rate at which fluid must be pumped to attain a rigid erection, doctors can determine the severity of the venous leak.
- Cavernosography: Used in conjunction with the dynamic infusion cavernosometry, this test involves injecting a dye into the penis. The penis is then X-rayed so that the venous leak can be seen.
- Arteriography: This test is given to people who are candidates for vascular reconstructive surgery. A dye is injected into the artery believed to be damaged and X-rays will be taken.
Before you are given any of these tests, your doctor will explain what is involved. If you have any questions, do not hesitate to ask your doctor.
Management and Treatment
What doctors treat erectile dysfunction?
The type of medical specialist who treats ED will depend on the cause of the problem. Based on your family’s medical history, as well as your own medical history and current health, your doctor may treat you with oral medications (Viagra®, Levitra®, Cialis®).
If these options fail, you may be referred to a urologist who can assist with other non-surgical options such as vacuum device or injections or surgical treatment options. If needed, your doctor may also refer you to a psychologist specializing in sexual dysfunction.
How is erectile dysfunction treated?
ED can be treated in many ways, including:
- Oral medications.
- Sex therapy.
- Penile injections.
- Vacuum devices.
- Intraurethral medication.
- Surgery (penile implant).
Each type has its own pros and cons. Discuss your options with your doctor to determine the best treatment for you.
The first step to treating ED is to find the underlying cause. Then the appropriate treatment can begin. There are a number of non-surgical and surgical options that can help a man regain normal sexual function.
What non-surgical treatments are there for erectile dysfunction (ED)?
Education and communication
Education about sex, sexual behaviors, and sexual responses may help a man overcome his anxieties about sexual dysfunction.
Talking honestly with your partner about your needs and concerns may also help to overcome many barriers to a healthy sex life.
Medications such as sildenafil (Viagra®), vardenafil (Levitra®), or tadalafil (Cialis®) may help improve sexual function in men by increasing blood flow to the penis. Men who are on medicines that contain nitrates such as nitroglycerine should not take oral ED medications. The combination of nitrates and these specific medications can cause low blood pressure (hypotension).
The most common side effects of these medications are indigestion, nasal congestion, flushing, headaches and a temporary visual disturbance.
Aids such as vacuum devices and penile constriction rings serve as erectile aids for some men.
A vacuum constriction device (above) is a cylinder that is placed over the penis. The air is pumped out of the cylinder, which draws blood into the penis and causes an erection. The erection is maintained by slipping a band off of the base of the cylinder and onto the base of the penis. The band can stay in place for up to 30 minutes. The vacuum device can be safely used to treat most causes of erectile failure. Lack of spontaneity, discomfort, and cumbersomeness of the device seem to be the biggest concerns of patients.
Penile injection therapy (intracavernosal injection therapy)
Men are taught how to inject medications directly into the erection chambers of the penis to create an erection. Injection therapy is effective in treating a wide variety of erection issues caused by blood vessel, nerve and psychological conditions.
Using a tiny needle and syringe, the man injects a small amount of medicine into the side of his penis. The medicine relaxes the blood vessels, allowing blood to flow into the penis. This treatment has been widely used and accepted since the early 1980s. The three most common medicines are prostaglandin E1 (alprostadil), papaverine (Papacon®), and phentolamine (Regitine®).
The most common side effects are pain and penile scarring (fibrosis). In extremely rare cases, patients with cerebral and vascular disease or severe cardiovascular diseases might not be able to tolerate the dizziness and high blood pressure occasionally caused by injection therapy.
A painful erection that lasts longer than two to three hours is called priapism and may occur with injection therapy. This can be lessened with proper dosing and by following the treatment guidelines.
Psychology and sex therapies
Psychological causes may contribute to erectile failure even when there is a clear organic cause.
Therapy with a trained counselor can help a person address feelings of anxiety, fear or guilt that may have an impact on sexual dysfunction.
Sex therapy can be beneficial to most men when counseling is provided by a skilled sex therapist. Sex therapy also helps a man’s partner accept and cope with the problems.
A patient whose ED has a clear psychological cause should receive sex therapy counseling before any invasive treatments are pursued.
Low hormone levels may play a role in ED. Hormone replacement in the form of topical gels, creams, patches, injections and pellets are only used after physician evaluation.
What are surgical treatment options for erectile dysfunction (ED)?
Penile prosthesis surgery
Inflatable penile prostheses are implanted during outpatient surgery. Once they are part of a man’s body, they enable him to have an erection whenever he desires. The use of a prosthesis preserves penile sensation, orgasm and ejaculation for most men.
The most commonly used penile implant consists of a pair of inflatable cylinders that are surgically implanted in the erection chambers of the penis. The cylinders are connected through tubing to a reservoir of fluid under the lower abdominal muscles, and to a pump inside the scrotal sac.
To inflate the penile prosthesis, the man compresses the pump a number of times to transfer fluid from the reservoir to the cylinders. This causes the penis to become erect. When inflated, the prosthesis makes the penis stiff and thick, which is very similar to a natural erection.
A penile prosthesis does not change the sensation on the skin of the penis or a man’s ability to achieve orgasm or ejaculate. Pressing on a deflation valve attached to the pump returns the fluid to the reservoir, which returns the penis to a flaccid state.
The surgical procedure is performed through one or two small incisions that are generally well hidden. Other people will be unable to tell that a man has an inflatable penile prosthesis. Complications following surgery are not common, but primarily include infection and mechanical device failure.
Approximately 95% of penile implant surgeries are successful in producing erections that enable men to have sexual intercourse. Moreover, patient satisfaction questionnaires show that up to 90% of men who have undergone penile implants say they would choose the surgery again, and overall satisfaction ratings are higher than those reported by men using oral medication or penile injection therapy.
Can erectile dysfunction (ED) be prevented?
For people who are at risk of developing ED due to personal behavior, steps may be taken to try to prevent its occurrence. However, other causes may not be preventable.
A number of studies now suggest a link between ED and obesity, high cholesterol, hypertension, diabetes and heart disease.
The following recommendations may help prevent ED or improve the problem if it is already present:
- Eat a healthy diet. A diet that limits saturated fat intake and includes several portions of fruits, vegetables and whole grains can benefit men with ED.
- Reduce cholesterol. High cholesterol can harden, narrow or block the arteries (atherosclerosis) leading to the penis. Men can lower cholesterol through diet, exercise and medication.
- Maintain a healthy weight.
- Exercise regularly. Regular exercise may reduce the risk of ED. Choose exercises that you enjoy and will make a regular part of your day. In addition to reducing the risk of ED, exercise also can help you manage stress. Check with your doctor before starting any exercise program.
What should I do if I am having problems achieving/keeping an erection?
If you suspect you have erectile dysfunction, please see your primary care physician or a urologist. He or she can perform tests to find out what is causing your problem and refer you to a specialist if needed. Once the cause is identified, there are several treatment options to choose from.
Does insurance cover erectile dysfunction (ED) treatment?
Insurance coverage for ED depends on the type of treatment prescribed and whether your insurance covers sexual dysfunction at all. Speak with your insurance provider to determine if the option you are considering will be covered.
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Can COVID-19 Really Cause Erectile Dysfunction?
Have you lost your mojo recently in the bedroom? There might be one thing—rather virus—to blame for it: COVID-19.
While loss of smell and taste, fatigue and difficulty breathing are some of the hallmark side effects of the respiratory virus COVID-19, erectile dysfunction (ED) is one that’s hitting men below the belt.
Researchers and doctors, such as Rahul Mehan, MD, a urologist at Banner Health in Mesa, AZ, are seeing a connection between the virus and ED. In fact, Dr. Mehan’s practice has seen a significant increase of new patients with ED during the pandemic—particularly, younger men in their 40’s and 50’s with sexual dysfunction.
“The virus causes a very strong inflammatory response throughout our entire bodies, from our hearts to our brains, so it’s not surprising sexual dysfunction could be connected too,” Dr. Mehan said. “We’re still learning more about what the long-term sexual repercussions of COVID-19 are, but as a urologist, I’m definitely concerned about what we’ve learned so far as it pertains to erectile dysfunction.”
The link between COVID-19 and erectile dysfunction
If you’ve recently had COVID-19 and are struggling in the bedroom, Dr. Mehan indicated the ways COVID-19 could have impacted your libido.
1. Damaged blood vessels in penis
Did you know that some of the smallest and most fragile blood vessels are in the penis? In addition to supplying blood to the lower half of your body, they are also crucial in supplying blood flow to your reproductive organs and aiding in erections.
In some men, COVID-19 can trigger hyperinflammation in the body, which can cause small blood clots to form as well as inflammation in the lining of the blood vessels. The blood supply to the penis can become blocked or narrowed, making it more difficult for you to get an erection.
2. Damaged cells in the testicles
Testosterone, which is also crucial for erections, are also not immune to the effects of COVID-19. Recent studies suggests COVID-19 may deplete testosterone levels and fertility in males.
“The COVID-19 virus enters cells with the help of a protein called ACE2, which is prevalent in the testes,” Dr. Mehan said. “The virus uses the ACE2 to infect the testes. Because this is where testosterone and sperm are made in men, it can be suggested that the virus can affect erections and your fertility.”
Specifically, one study out of Italy found lower levels of testosterone in men who had recovered from COVID-19. Dr. Mehan said this is a reminder for men who are experiencing new onset ED to have their hormones checked to ensure their testicles are functioning well.
3. Mental health impact
There is no doubt that most people have experienced some degree of emotional distress following isolation, social distancing, loss of relatives and friends, and economic challenges. These alone could destroy your sex drive. Beyond this, however, the mental toll on those recovering from the virus—especially “long-haulers” who are still experiencing symptoms or side effects—could be particularly at risk for ED.
“Sexual activity is strongly associated with mental health,” Dr. Mehan said. “To have good sexual function you have to have your head in the game.”
4. Burden on overall poor health
ED is typically a symptom of a larger underlying problem. If you’re already in poor health, you may be more likely to experience ED and be at greater risk for severe COVID-19 and additional lingering health problems as a result. COVID-19 can affect the heart and worsen underlying cardiovascular conditions, such as myocarditis, arrythmias and acute cardiovascular events, and a plethora of other complications. In some cases of these, men may be started on new medications that can also negatively impact their sexual function.
Treating erectile dysfunction
With COVID-19 already impacting so much of our daily lives, adding ED as a possible side effect can be a crushing blow for some men. If you’ve recovered from COVID-19 and are experiencing ED, it’s a good idea to chat with your doctor or urologist first before reaching for a blue pill or other aids. Your doctor can help determine the cause of your ED and offer some potential solutions.
“Simply ordering a pill online may not be the right answer and we really need to dig deeper and look at all the variables,” Dr. Mehan said. “Just because you’re experiencing erectile dysfunction, doesn’t mean it’s game over. We can definitely help and have amazing new treatment options to address all men regardless of the severity. If you want to improve your sexual function, we can help!”
Best way to prevent consequences of COVID-19: Get vaccinated and mask up
One way to lower your risk for side effects of COVID-19 is by getting vaccinated against it. There’s no evidence that the COVID-19 vaccine causes ED (or worsens it), so that alone should be enough to get your shot when it becomes available. “Remember the Benjamin Franklin axiom, ‘an ounce of prevention is worth a pound of cure,’” Dr. Mehan said.
In addition to getting your vaccination, continue to follow the Centers for Disease Control and Preventation (CDC) guidelines and do whatever you can to prevent the spread of the virus.
Check out this video to learn more about COVID-19’s association with erectile dysfunction. If you’re on the lookout for an ED specialist, visit bannerhealth.com to find a Banner Health specialist near you.
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Why COVID-19 may cause erectile dysfunction
COVID-19 can lead to a variety of long-term health problems — from shortness of breath and fatigue to muscle pain and memory problems — because of the damage the virus inflicts on the lungs, heart and brain. But the virus may cause another problem, too: erectile dysfunction.
“Even if you have a mild infection, we now know that people can have long-term health effects from this virus, [such as] neurological complications,” infectious disease expert Dena Grayson, MD, told NBC Chicago. “There is some real concern here that men could have long-term issues of erectile dysfunction from this virus because we know that it causes issues in the vasculature.”
Grayson added that “the vast majority of people do seem to recover from this virus, but as time goes on and more and more people are infected, we’re going to unfortunately see more and more of these long-term negative consequences of infection.”
Erectile dysfunction is complex and can be caused by both physical and psychological problems, including heart disease, high blood pressure and diabetes, as well as stress, anxiety and depression, according to the Mayo Clinic.
Doctors say there could be links between between COVID-19 and erectile dysfunction. (Photo: Getty Images)
As far as whether COVID-19 can cause erectile dysfunction, Michael Eisenberg, MD, a male sexual function specialist at Stanford University Medical Center, calls the risk “theoretical,” telling Yahoo Life, “I haven’t seen any direct reports of that. But it certainly doesn’t surprise me.”
Eisenberg explains that “we’re still relatively early in our understanding of COVID-19. Certainly, there’s an association between health and erectile function. Patients who have been hospitalized with different illnesses, they do report erectile function in decline right afterwards.” Eisenberg adds: “If men are really ill, nothing works that well, including erections.”
Dr. Mohit Khera, a professor of urology at Baylor College of Medicine, tells Yahoo Life that there is a “plausible link” between the virus and erectile dysfunction. “COVID can have a direct and even indirect effect on erectile dysfunction,” Khera says.
In addition, a July 2020 study on COVID-19 and erectile dysfunction suggests that the virus “might exacerbate cardiovascular conditions; therefore, further increasing the risk of ED,” noting that “COVID-19 survivors might develop sexual and reproductive health issues. ”
Khera says that patients who are more likely to suffer severe complications “are patients who have comorbid conditions like obesity, diabetes and metabolic syndrome. Those are the same risk factors of erectile dysfunction.”
How COVID might cause erectile dysfunction
COVID-19 triggers an attack on the lining of the blood vessels called the endothelium. “Pro-inflammatory cytokines are released, and they injure the lining of the blood vessels,” Khera says. “It’s the same lining of the blood vessels of the heart, so we’re seeing a lot of heart attacks with COVID.” But the attack “affects all blood vessels,” which can affect blood flow, including to the penile tissues.
In addition, pro-inflammatory cytokines can injure testicular function, according to Khera. “Many men are found to have lower testosterone levels after COVID,” he says. “Testosterone is responsible for sex drive.”
The psychological toll of having COVID-19 can also affect sexual function. COVID-19 patients have a higher risk of developing depression or an anxiety disorder. “Men who are stressed have a much more difficult time” with erectile function, and “depression contributes to erectile dysfunction,” Khera says.
Eisenberg says that erectile dysfunction in general is “very common,” affecting about 30 million American men. Along with following public health recommendations, including physical distancing, wearing masks and washing hands often to help prevent a COVID-19 infection, Eisenberg says that making healthy lifestyle choices and managing any existing health conditions can help prevent erectile dysfunction.
“Everything that’s good for your heart is good for your penis,” Eisenberg says. “So a good diet and exercise,” as well as reducing stress, not smoking, and maintaining a healthy weight, helps.
For the latest coronavirus news and updates, follow along at https://news.yahoo.com/coronavirus. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.
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90,000 symptoms, causes, diagnosis, treatment and prevention
Erectile dysfunction is often a consequence of the presence of other diseases in a person, which provoke sexual impotence. This ailment should not be confused with a man’s lack of sex drive or libido. Indeed, sometimes from a physiological point of view, a person is completely healthy, but he does not have a desire for intimacy. Impotence is a state when a person has a desire to have sex, but for one reason or another, there is no way to realize the attraction.That is, this disease makes it impossible to have sexual intercourse. Untreated infections of the genitourinary tract can cause the onset of erectile dysfunction. Disruptions in the work of the endocrine, nervous or cardiovascular systems can provoke impotence.
Symptoms and signs
Often, health problems begin to make themselves felt long before the onset of erectile dysfunction. Ignoring such alarm calls from the body can then result in a big problem.Consider the symptoms of impotence, what are the manifestations of this insidious ailment.
You should visit a urologist if there is one or more of the following phenomena. Impotence has the following signs:
- ejaculation occurs earlier than usual;
- during intimacy, it is difficult to start or continue sexual intercourse due to insufficient firmness of the penis;
- during intercourse, the erection disappears partially or completely;
- orgasm is dull, not bright enough;
- with ejaculation, the semen is less than it was before;
- during intimacy there is discomfort, discomfort in the genital area, pelvis or perineum;
- despite arousal, an erection occurs with great difficulty, even in comfortable and familiar conditions for a person;
- nocturnal, morning and involuntary erections disappear, or there are very few of them.
The listed signs of impotence in men are the reason for going to the urologist. If two or more symptoms are present, visit the clinic as soon as possible.
Do you have symptoms of impotence?
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Causes and causes of development
Impotence can appear suddenly, or it can make itself felt already at a fairly respectable age.A frequent occurrence when impotence occurs after 50. The comforting fact is that in 90 men out of 100 this ailment can be eliminated. The sooner treatment is started, the sooner sexual impotence will be overcome.
The main and more common causes of impotence in men:
- malfunctions of the central nervous system;
- genetic disorders;
- pathology of veins, blood vessels;
- previous urinary tract infections;
- traumatic situations;
- unhealthy lifestyle and stressful situations;
- neglect of personal hygiene rules;
- disruptions in the hormonal system.
Other causes of impotence: endocrine diseases, diabetes, Down syndrome, inflammation in the prostate, problems with brain activity.
In the high-risk group, people who lead the wrong lifestyle have bad habits: alcoholism, drug addiction, smoking. For example, in those men who often and in large doses drink alcohol, impotence occurs quite often. Nicotine and drug addiction are no less harmful to the sexual health of the stronger sex.
When tobacco is smoked, the oxygen content in the blood decreases. As a result, this negatively affects the state of all body cells, including the brain. Since it is in the brain that impulses are created, which are then transmitted to the cells of the genital organ, smoking is quite capable of being the main cause of impotence. Even in smokers, blood vessels become inelastic, narrowing occurs, and this also provokes problems with erection.
The use of alcoholic beverages provokes disturbances in the functioning of the nervous system, thrombosis is possible and, in general, problems with the cardiovascular system arise. Another aspect of alcohol is to stimulate the production of estrogen. As a result, the hormonal background changes, which leads to problems with potency and reduces libido.
In addition to dependent people, men with obesity, overweight are at risk.
Constant stress, neurotic lifestyle, overstrain at work or work without days off, irregular work schedule, improper alternation of work and rest regimes are no less dangerous than bad habits.
In terms of the threat of impotence onset, age is not a significant factor. Over time, the possibilities of a man in an intimate sense diminish. However, if you lead a healthy rational lifestyle, then the potency can persist well beyond 50-60 years. Therefore, to say that impotence at 40 is normal, as well as at 50 is meaningless. This disorder can occur at any age as a result of certain failures in the body.
If you postpone a visit to a doctor, psychological impotence can turn into organic. Complications of the disease are very unpleasant. Timely treatment of impotence in men will prevent the occurrence of these phenomena:
- Mental and nervous breakdowns, malfunctions of the nervous system;
- family conflicts;
- decreased sex drive up to its complete disappearance;
90,012 attempted suicide due to sexual inferiority as a man.
Now impotence in men is successfully treated with various drugs.It is better not to postpone the visit to the doctor indefinitely. Even if erectile dysfunction does not cause physiological problems, it is very harmful to the psychological state of a person. Violations in the genital area are a fairly strong blow to self-esteem for the stronger sex. A man may experience depression and even suicidal tendencies. Irritability and self-doubt, fears, complexes, feelings of inadequacy, and a decrease in self-esteem appear. This does not in the best way affect social, business relationships and moods in the family. The person becomes withdrawn, aggressive, may start using alcohol or drugs. There is also the uncontrolled use of drugs for impotence, which is often advertised. Since taking any medication is best coordinated with a doctor, uncontrolled medication can only aggravate the situation and cause additional complications.
When to see a doctor
If 25% of all intimate contacts ended unsuccessfully (you were unable to start or complete intercourse), perhaps it is about impotence.Also, if you find one or more of the above symptoms of erectile dysfunction, it makes sense to seek help from a specialist. The optimal treatment regimen will be prescribed, which is the most suitable and comfortable for the patient. At a consultation with a urologist, you will learn about the treatment of impotence in general terms. After making an accurate diagnosis, the doctor will tell you how to treat impotence in more detail.
Preparing to visit a doctor
Before visiting a specialist, you need to make a list of medications that you took (if any). Also, be prepared for the doctor’s need to clarify several important questions, for example:
- hereditary predisposition – did any of your family have problems with childbirth, etc.;
- Have you recently had any illness;
- Do you suffer from chronic ailments;
- how long ago the problems with potency began;
- Do you have any phobias related to sex, etc.?
Before treating impotence, the urologist will need to make a complete picture of the problem.This is necessary so that the treatment is comprehensive and helps to eliminate the root causes of the disease, and not only relieve the symptoms.
Diagnosis of impotence
Diagnosis of the disease is needed in order to find out the root cause of dysfunction. For this purpose, one should initially distinguish between psychogenic and organic pathologies. Usually, a technique for monitoring nocturnal erections is used, and an intracavernous injection test is also used. This will make it possible to establish the true nature of the violations: whether the disease is provoked by psychogenic factors or is it of organic origin.In the latter case, a number of additional studies will be required to identify the root cause of the pathology.
To find out how to cure impotence in the best way, you should consult a urologist. The optimal treatment regimen will be selected for you. Usually, one of the following methods is used to correct such violations:
- psychotherapeutic technique;
- injection therapy;
- pills for impotence are prescribed;
- mechanical stimulation of the penis is prescribed;
- surgical method.
As a traditional therapy, the prescription of drugs for impotence is usually used.
Treatment with folk (non-traditional) impotence remedies can be used as a small addition to the main treatment. Taking such medicines is possible only after agreement with the attending physician. With the independent manufacture and use of drugs for impotence, various complications are possible, which will only aggravate the problem.Self-medication is contraindicated in erectile dysfunction, since it can cause significant damage to health.
Preventive measures are:
- healthy lifestyle, giving up bad habits;
- Correct alternation of work and rest, exclusion of work on irregular schedules or reduction, if necessary, of physical activity;
- moderate sports;
- balanced nutrition, inclusion in the diet of food rich in protein, vitamins and minerals;
- regular sex;
- sleep at least 8 hours a day.
How to make an appointment with a urologist
You can make an appointment with the urologist of JSC “Medicine” (the clinic of Academician Roitberg) using the form on the website, by phone +7 (495) 775-73-60 or at the clinic’s administrators: 2nd Tverskoy-Yamskaya lane, 10 . ..
Erectile dysfunction – modern methods of treatment of impotence, prices for diagnosis and treatment of erectile dysfunction (impotence) in the “CM-Clinic”
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Erectile dysfunction is the inability of a man to maintain a sufficient level of erection for full sexual intercourse. The second name of the pathology is impotence. Erectile ability is the key to male confidence. Deterioration of sexual life leads to psychoneurotic disorders, apathy and even depression. According to statistics, every 10th man faces erectile dysfunction.And now the situation is even more serious – the frequency of early impotence is increasing.
Erectile dysfunction in men is a reason to contact the andrologists “CM-Clinic” in Moscow. The staff of the center includes over 40 specialists from various medical fields. Our doctors specialize in providing modern care for diseases of the genitourinary and reproductive system. Many years of experience of professionals and modern equipment of the clinic will help a man to resume a full sexual life.
Why does erectile dysfunction develop?
A man’s sexual health depends on many conditions:
- the correct functioning of the endocrine system;
- psychological health;
- satisfactory state of micro- and macrocirculation;
- anatomical features of the structure of the genital organs;
- neurological health.
The impact of negative factors inevitably affects the sex life of a man.Erectile dysfunction is provoked by drug addiction, alcohol dependence, psychopathology. Among endocrine factors, such dysfunction accompanies diabetes mellitus and gonadal insufficiency. Anatomical abnormalities are also not uncommon – there are Peyronie’s disease, fibrous deposits and sclerotic changes in the corpora cavernosa of the penis. In some cases, diseases of spinal pathologies, polyneuropathy and cerebrovascular accidents lead to sexual inadequacy.
However, modern medical practice shows that the causes of erectile dysfunction are most often due to the unsatisfactory condition of the vessels supplying the penis.The provocateurs of this process are atherosclerotic lesions, hypertension and diabetic microangiopathy. Therefore, a patient with erectile dysfunction is shown a comprehensive examination to identify the root cause.
Diagnosis of erectile dysfunction: when to visit the clinic?
Erectile disorders are more often the result of other pathologies, i.e. these are the first symptoms of a serious illness that begins, so you should immediately contact the clinic.The doctor will establish the causes of the disorder and tell you which specialist to contact in order to solve the problem once and for all.
Alarming signs indicating the initial stages of sexual dysfunction in adult men are:
- periodic or regular disappearance of an erection in the midst of sexual intercourse;
- premature ejaculation;
- lack of orgasm;
- lack of ejaculation;
- lack of erection, despite obvious arousal;
- a sharp decrease in libido;
- inability to have sexual intercourse with a partner;
- Regular preference for self-gratification over physiological sex.
If you experience these symptoms, we advise you to make an appointment with your doctor. Timely consultation will prevent negative consequences for your health. Phone for appointment +7 (495) 292-39-72
The first doctor to be visited by a man with such complaints is the andrologist. The specialist will conduct an examination, collect anamnesis, and, if necessary, appoint consultations with other doctors (urologist, sexologist, venereologist) and a set of diagnostic tests.To identify the causes of erectile dysfunction, carry out:
The list of studies may differ in different clinical situations. All types of laboratory and instrumental diagnostics of erectile dysfunction can be performed at the “CM-Clinic”. Our center guarantees patients comfort, complete anonymity, professional support until a positive result is achieved.
Treatment options for erectile dysfunction
Diagnostic results are very important for the treatment of erectile dysfunction.The task of the CM-Clinic specialists is to eliminate the causes of the disease, and not to mask unpleasant symptoms. Only in this case can a complete cure be achieved. The therapy is selected by the andrologist, focusing on the provoking factors:
- for psychological disorders, specific medications and psychotherapeutic counseling are indicated;
- for endocrine disruptions – hormone replacement or suppressive therapy;
- for neurological disorders – complex treatment with the involvement of a neurologist in a hospital setting, etc.d.
In the treatment of erectile dysfunction of cardiovascular genesis, an integrated approach of an andrologist and a cardiologist, and, if necessary, a vascular surgeon is important. Medicines are prescribed, spa treatment and physiotherapy procedures are recommended. In severe and advanced cases, surgical treatment can be used (to restore the normal anatomy of the penis).
Surgery or Shock Wave Therapy?
Currently, among all types of impotence, the most numerous is the group of men with vasculogenic erectile dysfunction.Pathology is accompanied by impaired blood supply to the vessels of the penis due to vascular weakness or circulatory pathologies. Previously, such patients were offered only surgical treatment (insertion of a silicone implant into the corpora cavernosa of the penis). Today, there is a worthy alternative to intervention – the use of shock wave technologies.
Center “CM-Clinic” is equipped with special equipment designed for shock wave therapy. With its help, low-frequency waves are applied to the tissue of the penis.This stimulates revascularization and full renewal of blood circulation in the penis during erection.
Wave treatment is applied in a course, during which the patient visits the urologist, andrologist’s office several times in our clinic. An improvement in potency occurs already 2 weeks after the start of therapy. The procedure is absolutely painless, well tolerated, and has no contraindications.
Treatment of erectile dysfunction in the “CM-Clinic” is an individual approach to each patient, the use of innovative methods of diagnosis and elimination of sexual dysfunctions.Prices for services, consultations and procedures can be found out personally from the attending physician or in the “Price” section on the website.
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90,000 Erectile dysfunction in chronic kidney disease: from pathophysiology to management
E. Papadopoulou, A. Varuktsi, A. Lazaridis, K. Butari, M. Dumas, Greece
Erectile dysfunction (ED) is defined as a persistent inability to achieve and / or maintain an erection of the penis sufficient for intercourse.The erection process is a complex neurovascular event. In response to sexual stimulation, nerve endings in the corpora cavernosa and endothelial cells release nitric oxide (NO), the main vasoactive mediator of erection. NO promotes vasodilation of the vessels of the penis and an increase in blood flow in them by activating soluble guanylate cyclase with the production of 3,5-cyclic guanosine monophosphosphate
For an adequate erection, an appropriate hormonal environment is needed, in which testosterone plays the main role. Violations of neurovascular control, abnormal hormone levels and psychological factors are responsible for most cases of ED, which is classified into psychogenic (generalized 90,300, situational), organic (vasogenic, neurogenic, anatomical, endocrinological, 90,300) and mixed.
Psychogenic factors include primary lack of sexual arousal, chronic sexual intimacy disorder, depression and anxiety.A number of neurological disorders have been associated with ED, including Parkinson’s disease, stroke, malignant tumors of the nervous system, multiple sclerosis, and spinal cord injury. Hormonal disorders that cause ED include hypogonadism, hyperprolactinem
In men with chronic kidney disease (CKD), testicular insufficiency and secondary disorders of the pituitary gonad
Histological changes in the testes in CKD include decreased spermatogenic activity, especially in the late stages of spermatogenesis, which are hormone-dependent
In men with CKD, especially during the dialysis stage, hypogonadism is often diagnosed, defined as a decrease in total testosterone levels <300 ng / ml. The consequences of hypogonadism are decreased libido, ED, oligospermia, infertility and anemia. At the same time, total plasma estrogen levels are often elevated. Plasma concentrations of luteinizing hormone (LH) also increase, probably as a result of decreased release of testosterone by Leydig cells with the consequent loss of normal negative feedback.The metabolic clearance rate of LH decreases and is not corrected by dialysis.
Patients with uremia also have impaired LH secretion, which may result from changes in the release of ising hormone (GnRH) gonadotropin-ril
In addition to LH in men with CKD, the secretion of follicle stimulating hormone
In men with CKD, plasma levels of prolactin are significantly increased (hyperprolactin
According to the current hypothesis, atherosclerosis is more likely to develop first in small arteries and then in large ones. Because the arteries in the penis are much smaller in diameter (1–2 mm) compared to the coronary arteries (3–4 mm), the symptoms of ED occur several years before the symptoms of coronary artery disease (CHD). It has been proven that ED is a stronger predictor of coronary artery disease compared to all traditional risk factors, including a burdened family history, hypertension and dyslipidemia, and can be used as a reliable marker of coronary artery disease both in CKD patients and in the general male population.
As already mentioned, the main neurotransmitter of the
An important factor contributing to ED in CKD is uremic polyneuropathy. Signs of autonomic and peripheral neuropathy are especially pronounced in patients on dialysis, and include a pathological response to the Valsalva maneuver, disturbances in nocturnal tumescence, and the bulbocavernous
CKD has been associated with increased levels of distress, anxiety and depression. At the dialysis stage, these problems are aggravated, and there are difficulties with interpersonal communication, employment 90,300, social activity and quality of life decrease. Fistulas and inserted catheters also contribute to a decrease in sexual desire and the development of ED. The presence of depressive symptoms, which are very common in hemodialysis patients, is independently associated with sexual dysfunction.
ED management in CKD
Treatment for ED should begin with an assessment of overall health and lifestyle modifications (quitting smoking, reducing alcohol consumption, getting regular physical activity, etc.)etc.). In patients on dialysis, it is necessary to optimize dialysis and ensure an adequate supply of nutrients. The drug profile is individually assessed for each patient, taking into account the fact that many drugs, in particular diuretics, β-blockers, antidepressants and H2-blockers, are associated with ED. Drugs that cause hyperprolactinem
“Curable” causes of ED
Psychogenic ED. When ED is suspected of being caused by depression or other psychogenic causes, psychotherapy and psychoeducational interventions such as rational therapy, emotional therapy, group sex therapy and sex counseling are recommended.
In men with late hypogonadism, administration of exogenous testosterone has many beneficial effects. However, in men with CKD and ED, the effectiveness of this approach is less straightforward, as libido, mood, and overall energy levels improve more than erectile function. Testosterone replacement therapy can also increase muscle mass and improve erythropoiesis. Testosterone derivatives are available in injectable, oral, buccal, transdermal and subdermal dosage forms.Potential side effects include cardiovascular events, prostate cancer and worsening sleep apnea.
A promising new approach aimed at correcting endocrine disorders is the administration of dopamine agonists such as cabergoline. This drug normalizes prolactin levels, increases plasma testosterone levels, improves libido and potency.
Dietary supplements containing zinc may increase testosterone levels, but their effect on sexual function has not been proven.
Oral vitamin E supplementation may decrease prolactin levels and increase plasma testosterone levels.
First line oral pharmacotherapy
The first-line drugs for ED therapy in patients with CKD, as well as in the general population, are phosphodiesterase-
x controlled trials
sildenafil in patients with CKD and ED was associated with a significant improvement in the overall score of IIEF-5 and its individual domains (frequency and quality of erection, the ability to penetrate and maintain the frequency of penetration, erection confidence) compared with placebo, as well as an increase in overall satisfaction
Other treatment options
In case of insufficient response to oral treatment, intraurethral or intracavernous
The third line of therapy is penile prosthetics, which provides a more lasting result. However, prosthetics are recommended to be postponed until kidney transplantation, as many patients experience spontaneous improvement in sexual function after the transplant.
Erectile dysfunction in transplant patients
Kidney transplantation is considered the most effective therapeutic option in patients with CKD. Most kidney transplants are performed in middle age, when sexual function and fertility are still important.Several studies have demonstrated 90,300 but that the prevalence of 90,300 ED in kidney transplant recipients is about 50%. Postoperative sexual function may be limited by
Sexual dysfunction and chronic renal failure have common pathophysiological mechanisms, and the same comorbid conditions contribute to their development. In patients with CKD, erectile dysfunction is more common than in the general population, and strongly correlates with age and stage of renal failure.The most effective and affordable method of treating ED in CKD remains PDE-5 inhibitors, primarily sildenafil, for which an extensive evidence base has been accumulated when prescribing to men with CKD.
References are being revised.
Papadopoulou E., Varouktsi A., Lazaridis A. et al. Erectile dysfunction in chronic kidney disease: From pathophysiology to management. World J Nephrol. 2015 Jul 6; 4 (3): 379-387.
Authors: E. Papadopoulou, A.Varuktsi, A. Lazaridis, K. Butari, M. Dumas, Greece
90,000 Treatment of impotence and erectile dysfunction – Online appointment in Sochi
Impotence is the inability to maintain an erection at a sufficient level for intercourse. Similar disorders occur in 52% of men. Erectile dysfunction can occur at any age, however, it is more common in mature men. Violation of potency usually occurs in men aged 40 to 70 years.
When this problem arises, men have many questions: how to cope with a disorder of this nature, how to cope with psychological problems, etc., the specialists of the URO-PRO clinic are ready to answer all your questions and provide effective treatment.
Features of early impotence
Many people used to think that only men over 40 years old have difficulties with potency, but now more and more doctors have to look for the causes of erectile problems and ways to restore potency in very young guys.Early impotence requires finding the necessary medications.
Even a completely healthy man may develop certain erectile dysfunctions, but if these problems recur periodically or persist, you should definitely seek the advice of a specialist.
Forms of erection dysfunction
Treatment of impotence is prescribed based on the causes of its occurrence. Impotence can be divided into three types:
The psychogenic form of impotence is characterized by the fact that it suppresses the central nervous system, as well as the mechanism of erection itself. Psychogenic disorders include depression, phobias, etc. Disorders associated with psychological problems are usually caused by complexes that have developed throughout a man’s life. Often, psychogenic erectile dysfunction is cumulative in nature – complexes accumulate and eventually make themselves felt.
Organic impotence is vasculogenic, hormonal and psychogenic.The vasculogenic form of ED occurs due to arterial and veno-occlusive disorders.
Against the background of organic dysfunction, psychogenic pathologies can also occur.
Symptoms of impotence
Experts mainly distinguish three types of erection:
- and masturbatory.
An adequate type of erection is an erection that occurs during intercourse.Spontaneous erection is reflex, it occurs outside of sexual intercourse, mainly in the REM sleep phase and disappears upon awakening.
Psychogenic impotence is characterized by an unexpected weakening of an adequate erection while maintaining spontaneous and masturbatory. The quality of the erectile function can be influenced by the sexual attractiveness of the partner, the form of behavior and the peculiarity of the situation. In some cases, there is a disorder of ejaculation, orgasm and desire.
Erectile disorders of a vasculogenic nature can lead to a gradual weakening of not only an adequate erection, but also spontaneous, and sometimes to absolute impotence, while maintaining sexual desire. With vascular lesions, periods are possible when a man’s erection is completely absent.
Multisystem vascular lesions can cause “steal syndrome”: during active movements, the erection weakens due to the redistribution of blood to the working muscles.An increased erection in the standing position, but weakened in the supine position may indicate vasculogenic impotence.
The onset of impotence for a neurogenic reason depends on the degree of damage to the central nervous system. Neurogenic receptors can suppress both adequate and spontaneous erection.
Erectile dysfunction, which occurs against the background of androgenic deficiency, develops gradually and is characterized by a decrease in desire.
Reasons for ED
Erectile dysfunction can appear for various reasons associated with impaired blood flow to the corpora cavernosa.Arterial changes that cause blood to drain from the penis can negatively affect erectile function.
Often, a decrease in erection occurs against the background of other diseases, for example, atherosclerosis, diabetes mellitus or arterial hypertension. Erectile dysfunction can appear with overexertion, depression and other depressed conditions.
However, not only diseases can cause erectile dysfunction, but also external factors:
- electromagnetic radiation;
- unfavorable ecological situation.
For the treatment of impotence, it is necessary to take into account chronic diseases of various organs, they can negatively affect sexual function, for example, vascular diseases, disorders of the endocrine and nervous systems.
Potency can worsen due to recent injuries, as well as old enough.
One of the main factors affecting potency is age or bad habits.
More than 200 types of pharmaceutical agents are known to those skilled in the art that are capable of causing erectile dysfunction.These drugs include anesthetics, antibacterial agents, etc.
How is ED diagnosed at the Uro-PRO clinic?
In the IMC “URO-PRO” in Sochi, diagnostics is carried out based on sexological testing, with the help of which it is possible to evaluate all aspects of the work of the reproductive system. Diagnosis of the disease begins with the collection of all information about the patient’s condition. During the consultation, the sexologist pays attention to all the details of the patient’s sex life.It is important to take into account the psychological relationship in the couple, as well as the views of the sexual partner on the existing problem, thus the specialist determines the urgency of the problem and motivation.
Information required for detailed diagnostics:
- risk factors;
- information on acquired diseases;
- information on injuries received;
- information on operations on the genitourinary system;
- on the prostate gland;
- on the rectum.
The severity of the disease can already be determined on the basis of these data.
Our specialists use only innovative diagnostic methods:
- Doppler ultrasonography of the vessels of the penis;
- tests using vasoactive agents;
These procedures can be completed already at the first consultation in order to identify the causes of sexual disorders and prescribe personalized treatment.
The restoration of sexual function occurs regardless of the patient’s age. Doctors-sexologists of the IMC “URO-PRO” in Sochi, thanks to proven methods, successfully treat erectile dysfunction and completely restore male potency.
Modern medicine knows a variety of methods for treating impotence, among them five main ones can be distinguished.
- Injection pharmacotherapy method. This method is used to treat all forms of ED. Tablets and injections to improve potency can be used in combination.
- Method of psychotherapy and sex therapy. They are used only for impotence caused by psychological problems, less often as an additional method for somatic or organic forms of impotence.
- Medicines to increase potency. It is used as a first-order choice at all stages of organic ED, regardless of the reasons for its occurrence.
- Vacuum erection therapy method. Used to obtain or maintain an erection with the help of various modifications of vacuum erectors. Today, this type of treatment is used less and less due to the high frequency of patients refusing to use it. This is justified by the fact that an erection caused by this method, usually of low quality, can hold the penis in this state with the help of the squeezing end for no more than 20 minutes. Also, the degree of satisfaction with intercourse among partners is quite low with this technique.
- Operational methods of treatment. Genital surgery and penile prosthetics. The first group of interventions is divided into operations on the veins and arteries of the genital organ. Vein surgery is prescribed for certain types of erectile dysfunction, most often in conjunction with erection pills. Surgery on arteries is ineffective and rarely used. Falloprosthetics is the most effective of all types of therapy. The surgical method of treatment is usually used only in cases where the prescribed therapy did not help.
Detailed diagnostics helps the specialist to determine the most effective method for treating impotence.
The percentage of cases of successful solution of problems in this area is high, and the effectiveness of treatment is noticeable after the first visit. Sexologists at the URO-PRO Medical Center use a systematic approach, choosing the best methods of therapy.
Doctors of the clinic “URO-PRO” will write out recommendations on the general state of health of the patient, prescribe effective treatment of impotence with injectable or tablet preparations, taking into account the characteristics of the state of the body.
A universal and effective technique for restoring potency has not yet been invented, therefore, in each case, doctors personally select methods of treating male impotence. Our doctors will select the course of therapy that is right for you, using the latest developments.
Do not self-medicate, contact highly qualified specialists at the URO-PRO clinic in the city of Sochi.
You have the opportunity to make an appointment right now by filling out the online form on our website.
Treatment of erectile dysfunction with stem cells in Germany
Departure for treatment in Germany is now possible!
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Erectile dysfunction (impotence) is a disease in which it becomes impossible to achieve a sufficient erection for sexual intercourse.This pathology can have many reasons. Depending on the origin, erectile dysfunction requires a different approach to treatment. Cellular regenerative medicine has been developing in recent years. In Germany, stem cells are used to improve male potency.
Types of erectile dysfunction
There are many classifications of erectile dysfunction. The most important is the etiological classification, which divides this disease into groups, depending on the cause of its occurrence.The approach to the treatment of the disease depends on the cause of the deterioration of erection.
Erectile dysfunction can be:
- Psychogenic – associated with psychological factors, occurs mainly in young men
- Organic – often develops in old age, is associated with anatomical and functional disorders in the body
In turn, organic erectile dysfunction can be:
- Vasculogenic or vascular – caused by damage to blood vessels or deterioration of their condition due to age-related changes
- Neurogenic – the result of damage to peripheral nerves, most often found in diabetes mellitus and in men with a removed prostate
- Endocrine – a group of diseases that leads to a decrease in testosterone production
- Penile – associated with diseases of the penis (the most common cause is Peyronie’s disease)
Erectile dysfunction of organic origin is rarely cured Once and for all.More often, permanent symptomatic treatment is used, which is applied on demand and can improve an erection for a short time, sufficient for intercourse. Supportive therapy is used, which slows down the further progression of the pathology. Sometimes it is necessary to resort to surgical methods if conservative methods of treatment do not lead to success.
The disease is extremely common among elderly patients.An epidemiological study in Cologne showed that in the age group of men 30-80 years, the prevalence of pathology is 19.2%. However, the indicators significantly depend on age. In different categories of men, the frequency of erectile dysfunction ranged from 2.3% to 53.4%.
Thus, age is the main risk factor for pathology. Other adverse factors that increase the likelihood of developing pathology:
- Low physical activity
The MMAS study showed that regular exercise reduces the risk of erectile dysfunction by 70% for 8 years.
For the successful treatment of erectile dysfunction, it is important to establish the cause and mechanisms of erectile dysfunction. The main efforts of doctors who are engaged in diagnostics are aimed at this.
The doctor begins by finding out the history and examining the patient’s medical records. He clarifies all the risk factors that lead to one or another type of erectile dysfunction.
Vasculogenic ED . Usually occurs against the background of arterial hypertension, obesity, smoking, diabetes mellitus.It occurs mainly in older men. Often combined with ischemic heart disease, atherosclerotic lesions of the vessels of the legs and brain.
Neurogenic ED . It happens central and peripheral. Central develops against the background of brain tumors, Parkinson’s disease, multiple sclerosis, spinal hernias in the lumbar spine. Peripheral – the result of diabetes mellitus, alcoholism, polyneuropathy, surgery (usually radical prostatectomy).
Anatomical (penile) ED . It develops in patients with Peyronie’s disease, after a fracture of the penis or other injuries. The reasons may be congenital pathologies: curvature of the penis, hypospadias, epispadias, micropenis.
Endocrine ED . Any diseases and conditions that lead to a decrease in testosterone production lead to it. This can be both primary hypogonadism associated with damage to the testicles, and the result of insufficient or excessive production of other hormones that affect the secretion of androgens.Probable endocrine causes: hyperprolactinemia, hypothyroidism, Cushing’s disease.
Psychogenic ED . It can be generalized or situational. With generalized, a person is not capable of sexual arousal. Depression or another mental disorder could be the cause. Situational psychogenic ED can be associated with a specific partner, situation, place or time.
Medicinal erectile dysfunction is distinguished separately. This is an erectile dysfunction by various mechanisms under the influence of drugs.They can affect blood vessels, nerves, hormone production, but usually these are temporary side effects that go away after drug withdrawal. Most often, ED is provoked by narcotic substances, antiandrogens, neuroleptics, antidepressants, antiallergic (antihistamines) drugs and some drugs for the treatment of hypertension (beta-blockers and potassium-sparing diuretics).
Some diseases have already been identified in the patient at the time of treatment and recorded in his medical record.A number of pathologies can be detected by a specialist urologist or andrologist directly at the reception. The doctor sometimes reveals an enlarged prostate, anatomical abnormalities of the penis, small testicles, etc.
Basic laboratory tests aimed at elucidating the cause of erectile dysfunction:
- Determination of total testosterone in the morning portion of blood
- Tests for FSH, LH, prolactin, thyroid hormones – in the case of low testosterone levels
- Fasting glucose level and cholesterol, triglycerides, lipoproteins of different classes)
Nocturnal tumescence and stiffness of the penis .Determines the safety of the erectile mechanism. Held for 2 nights or more. The onset of spontaneous nocturnal erections up to 60% for at least 10 minutes indicates the safety of the erectile mechanism.
Intracavernous injection test. After the introduction of antispasmodics into the penis, no more than 10 minutes later, a hard (inability to bend the penis) erection should occur, lasting from 30 minutes. If violations are identified, duplex scanning (ultrasound) of the vessels of the penis is performed.
Ultrasound of the penile arteries . The norm is considered to be blood pressure in them from 30 mm. rt. Art., and the resistance index should be more than 0.8. If the result is normal, then vasculogenic (vascular) erectile dysfunction is excluded.
Standard treatment for ED
The main directions of treatment for erectile dysfunction:
Elimination of the causes of erectile dysfunction . Perhaps in a limited number of cases, with psychogenic ED, traumatic vascular injury and some endocrine diseases.Most of the cases of the disease cannot be completely cured.
Elimination of risk factors . Under their influence, the disease progresses. Patients are advised to adjust their lifestyle: move more, reduce body weight, keep blood pressure at a normal level with drugs, eat healthy food. All these measures can improve the condition of blood vessels, normalize metabolic processes and hormonal levels.
Symptomatic treatment .Used to achieve an erection just before intercourse. For this, various groups of drugs are used (most often type 5 phosphodiesterase inhibitors) and vacuum devices (negative local pressure therapy).
Usually, the treatment process is divided into three stages. Initially, 1-line therapy is used. At some point, it stops working. Then the doctors resort to 2-line treatment. When these measures also stop working, only the 3-line treatment remains, which is surgical.
Therapy depends on the type of erectile dysfunction. Psychological impotence is most common in young men. It is treated with psychotherapy, antidepressants, anxiolytics (relieve anxiety). If the reason is fatigue, health improvement in general is required, increased ability to work, normalization of weight, etc.
In case of development of endocrine erectile dysfunction, the normalization of hormonal levels is required. The patient is prescribed testosterone preparations if he develops primary hypogonadism, which is caused by damage to the testicles.Sometimes testosterone levels decrease as a result of other endocrine disorders, as many hormones regulate androgen production. In this case, other drugs can be used: thyroxine in case of hypothyroidism, bromocriptine in hyperprolactinemia, or hCG in hypogonadotropic hypogonadism. Whatever the endocrine disorders, taking hormones or their antagonists usually allows you to quickly normalize hormones and testosterone production. After that, the erection improves.But the patient has to receive hormone therapy all the time.
Vascular ED is the most common variant. It is treated with PDE5 inhibitors. These drugs dilate blood vessels and provide blood flow to the penis. Some products last only a few hours, others – up to 2 days. These are the most common drugs for the treatment of impotence, but they only give a symptomatic effect.
In the event of an injury to the penis, the vessels may be damaged. In this case, a traumatic variant of vasculogenic ED develops.It can be treated with surgical revascularization (restoring blood flow). The efficiency of such operations is about 70%. The operation is not performed with veno-occlusive ED due to unsatisfactory efficacy, therefore, it is excluded by ultrasound before treatment.
Other oral medications and topical drug therapy are used. Locally prescribed papaverine, nitroglycerin or minoxidin in the form of a gel. The composition usually includes a vasodilator component to improve the absorption of active substances.The effectiveness of these drugs is low – about 40%.
LOD therapy involves the use of local negative pressure. To do this, the patient needs a vacuum device, which men call a pump in conversation. The vacuum draws blood and allows you to achieve an erection even without sexual arousal. Latex rings are then attached to the base of the penis to prevent it from flowing out.
The effectiveness of the procedure is 90%. However, after 2 years, it gradually decreases to 60%.Most men refuse LOD therapy 3 months after its start due to insufficient satisfaction with intimate life: the mechanisms of erection occurrence are effective, but not physiological. Side effects occur in 30% of patients. The ring cannot be used for more than 30 minutes in a row due to the threat of tissue death, which limits the time of intercourse.
Intracavernous injections – have an efficiency of 85% or more. Until 20 years ago, this was the first line therapy. Alprostadil is used.Although the technique is effective, it has side effects and is therefore not suitable for everyone. 50% of men have pain at the injection site, 5% have an excessively long erection. The risk of cicatricial changes in the penis is 2%, and the likelihood of developing priapism is 1%.
Endourethral administration of alprostadil is sometimes used. The advantage of this procedure is obvious: there is no need to inject into the penis. But there are also disadvantages: the efficiency is only 30-65%. Only high doses of the drug work, but they often cause systemic side effects.Up to 14% of patients complain of dizziness, and 5% of patients have bleeding from the urethra due to improper administration. 30-40% of men complain of pain. In addition, the resulting erection does not last long.
Line 3 treatment is a penile prosthesis. Flexible or inflatable prostheses are used. The most natural erection is achieved with a 3-piece prosthesis.
Risk of complications:
- Within 5 years, about 5% of prostheses break
- The risk of developing infectious complications in the best clinics is 2-3%, and when installing prostheses with antibiotics – 1%
Disadvantages of standard methods
Standard Erectile dysfunction treatment has several disadvantages.It is not always effective and often dangerous. Only a small number of cases of the disease can be cured. For the rest, only symptomatic therapy is carried out, the effectiveness of which is gradually decreasing.
Each method has its own disadvantages. With prolonged use of drugs, side effects are possible. They are also caused by local therapy with a pump or drugs. Some complications are severe enough to require surgery or invasive procedures.
Surgery is the most effective method to obtain long-term results. But this method of treatment is not acceptable for all men. It carries certain risks: the aesthetic result is not always satisfactory, and the achieved erection is not associated with sexual arousal – this violates the physiology of sexual intercourse. Even in the best clinics, 2-3% of patients develop infectious complications, which require a second operation.
Cellular technologies may soon replace standard techniques.They are already in use in developed countries. Stem cells provide good results in different types of erectile dysfunction. They rebuild tissues by improving the innervation, blood circulation of the penis and the production of hormones. These methods are safe and give results that last for a long time.
Intracavernous administration of MSCT
Mesenchymal stem cells (MSCT) can be obtained from adipose tissue. It contains much more of them than in the peripheral blood or bone marrow.MSCT are increasingly used to treat a wide variety of diseases: orthopedic, neurological, gynecological, urological.
MSCT injections into the corpora cavernosa of the penis can improve the blood supply to this organ and its innervation. This approach is effective for penile, vasculogenic, and neurogenic erectile dysfunction. The essence of the method:
- Adipose tissue is taken from the anterior abdominal wall by liposuction. The procedure is performed under general or local anesthesia.The adipose tissue is sucked off with a syringe. The volume of the tissue obtained is about 250 ml.
- Get the stromal-vascular fraction from adipose tissue. It contains a large number of mesenchymal stem cells. A variety of methods can be used to obtain the fraction. In some clinics, they are obtained manually, using enzymatic methods, in several stages. But in Germany, medical centers that deal with cell therapy are equipped with special devices. They receive the stromal-vascular fraction from adipose tissue in an automatic mode.This fraction contains many more stem cells, which allows for better results in the treatment of erectile dysfunction.
- The stromal-vascular fraction is injected into the intracavernous bodies at a dose of 4 ml. This amount contains an average of 50 million mesenchymal stem cells. The dose is evenly distributed – it is usually administered at 6 different points. A tourniquet is used for 15 minutes to restrict the outflow of blood from the penis and reduce the migration of stem cells from the injection site.
Stem cells stimulate the regeneration of tissues of the penis, blood vessels and nerves. They are long-term curative, not palliative or symptomatic. Having undergone a course of therapy in Germany, the patient can expect that an erection will last for a long time. If necessary, the treatment can be repeated after several years. This procedure is an alternative to surgery in situations where erectile dysfunction is not amenable to pharmacological correction or other methods of conservative treatment.
Oleg, 59 years old . After the stem cell injections, I felt a slight burning sensation for several days. Edema persisted, but there was no severe discomfort. But after a few weeks I felt a second youth! If earlier in bed it turned out at best twice a third, but now the wife is completely satisfied. Stem cell therapy made me feel like a man. Previously, I only had Viagra in my arsenal, but recently it has stopped helping.This prompted me to go to Germany for diagnosis and treatment. Thanks to Booking Health – they helped organize everything. I ended up in a good clinic and saved about 30% on the cost of medical procedures.
Stem cells in neurogenic ED
Damage and degeneration of the pelvic and penile nerves is one of the most common problems in older men. Most often, neurogenic erectile dysfunction develops against the background of diabetes mellitus. It also occurs after surgery to remove the prostate gland.
It is neurogenic erectile dysfunction that is the most difficult to treat. In fact, there are no effective drugs for restoring an erection with nerve damage. If Viagra or other PDE-5 inhibitors can be used for vascular erectile dysfunction, testosterone-based drugs are used for endocrine dysfunction, then doctors are powerless if nerves are damaged.
However, encouraging results are shown by stem cell injections. They are injected both directly into the corpora cavernosa and intravenously.In the second case, the effect is comparable, but much more stem cells are required. Therefore, intracavernous administration is more often used.
Clinical studies show excellent treatment results. Under the action of stem cells, a full-fledged regeneration of the cavernous nerves occurs. At the same time, the use of cellular technologies is completely safe. In clinical trials, no complications or clinically significant side effects have been identified. The treatment works well and is well tolerated by patients.
How long to wait for erection recovery:
- Intermediate results can be felt at the end of the first month after stem cell injections
- Significant results are achieved after one and a half months
- The best results in most studies developed 3 months after the procedure
For evaluation erections are used on a variety of scales. After the introduction of stem cells, the average score on the IIEF-5 scale by the end of 3 months increases from 6-8 to 24-25 points.The severity of erection according to the Yunem scale increases from ER3 to ER5. On electromyograms of the corpus cavernosum of the penis, there is a positive trend.
In recent years, more and more research has been carried out aimed at studying the effect of stem cells on a man’s erection. And more and more clinics in developed countries are introducing this technique into practical medicine. Already today, you can take advantage of advances in the field of cell therapy. To do this, it is enough to visit one of the German clinics that practice this technique for treating erectile dysfunction.
Advantages of the method:
- Introduced own, not donor cells, which makes the procedure safe
- The results are long-term, and not symptomatic, as when using drugs
- The method of treatment is minimally invasive and well tolerated by the patient
- High cost in comparison with other methods of conservative treatment
- Delayed effect – the first results need to wait 1-1.5 months, and the maximum – 3 months
The use of stem cells is usually recommended when the possibilities of standard conservative therapy have already been exhausted.At the same time, the patient wants to resume a full-fledged intimate life and at the same time wants to avoid surgery (falloprosthetics).
Valery, 35 years old . Due to diabetes mellitus, complications began to develop. The disease was detected late, so I did not receive treatment for a long time. As a result, the erection completely disappeared. For some time it was possible to maintain it with the help of drugs prescribed by the doctor. But after about 2 years they stopped working. I have no problems with finances, so I went to Germany for treatment.I was offered a falloprosthetics, as tests showed that it would hardly be possible to restore an erection with drugs. I gave up the operation. Then I was offered an alternative option: stem cells. It worked! For the first time, I pleased my wife a month after the procedure. After 3 months, my “device” began to work without “failures”. It’s been 2.5 years now, and so far everything is fine with my erection.
Stem cells in endocrine ED
Endocrine erectile dysfunction is caused by a decrease in testosterone levels.The patient can receive continuous injections of this hormone. But with the help of stem cells, it is possible to achieve an increase in its endogenous formation – this method of treatment is more physiological and does not require constant drug support.
With age, a man’s production of pluripotent stem cells decreases, so tissues are renewed less intensively. Gradually, testicular sclerosis occurs – the number of Leydig cells responsible for the production of testosterone decreases annually by 1%. The production of androgens also decreases by about 1% annually.With a lack of male hormones, libido decreases and erectile dysfunction develops.
Pluripotent stem cells can be obtained from a donor. They are administered intravenously, at intervals of 2-3 months. With the help of this procedure, in 50-60-year-old patients, it is possible to dramatically increase the level of testosterone in the blood. It gradually reaches values typical for young men. The results persist for a long time, since the procedure does not cause temporary hyperproduction of androgens, but an increase in the number of Leydig cells in the testes.
Constantine, 62 years old . Long ago I began to notice that my erection and desire are weakening. I went to the doctor – he gave me testosterone injections. I received this treatment for about 3 years, and it worked. I was recently examined in Germany for another disease. When it came to my problem, the doctor suggested using stem cells for a long-term solution. After several intravenous infusions, I did not feel any effect.However, I did not receive any more testosterone preparations, and the erection remains excellent, despite the fact that I have not given hormone injections for more than 2 years! Recently I was tested: the clinic said that my testosterone level is about the same as that of a 40-year-old man.
The number of people who have received stem cell treatment for erectile dysfunction is in the thousands. Not a single case of severe complications was recorded. This procedure is safe, effective and gives long-lasting results by stimulating tissue regeneration.
How to travel to Germany for medical treatment?
It used to be quite difficult to go to Germany for treatment: you had to look for a clinic yourself, contact its administration, wait for an invitation for treatment, translate documentation, look for an interpreter for oral communication. It takes a person a huge amount of time, effort and money to organize a trip. But today this is no longer required: Booking Health can take over all organizational concerns.
You can use our service to find a clinic.If necessary, our specialists will help you choose the best center that specializes in the treatment of erectile dysfunction with stem cells. There you will undergo diagnostics and therapy that will bring you the best results. In particular, many men are treated at the Clinic for Advanced Biological Medicine Frankfurt am Main. The clinic’s specialists establish the cause of erectile dysfunction and carry out all stages of stem cell therapy – stimulation to increase the number of multipotent stem cells in the body, their collection and cultivation, replantation of stem cells into the body and supportive infusion therapy.In most cases, one visit to the clinic is enough to achieve the desired result.
Benefits of booking treatment through the Booking Health service:
- We will help you choose a clinic based on statistics, equipment, specialization, experience and results of stem cell treatment.
- The cost of medical services for you will be much lower due to the absence of allowances and coefficients for foreign patients.
- We will reduce the waiting time for the start of treatment and will book you on a convenient date.
- We will provide communication with the attending physician.
- We will prepare and control the program.
- We will control the accounts, the volume of services provided, and return all unspent funds after the end of the program.
- Insurance against increased cost of treatment in case of complications (coverage 200,000 euros, validity period – 4 years)
- We will buy in Germany and send drugs prescribed by a doctor.
- If necessary, we will organize additional examination, treatment, rehabilitation in clinics in Germany.
- We will provide communication with the medical center after the completion of the program.
We will solve all your travel arrangements, book tickets and a hotel for you, meet you at a German airport and take you to a clinic or hotel, and after the end of the course of treatment we will take you back to the airport.
Choose treatment abroad and you will undoubtedly get an excellent result!
Authors: Dr. Valeria Kruzhilina, Dr. Nadezhda Ivanisova
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Diagnosis: erectile dysfunction | Expert advice | Thematic pages
Diagnosis: erectile dysfunction
Modern urology defines erectile dysfunction as a prolonged (at least six months) inability of a man to achieve and maintain an erection sufficient for satisfactory sexual activity.Manifestations of erectile dysfunction:
- sluggish, insufficient erection for intercourse;
- sudden disappearance of an erection directly during intercourse;
- complete lack of erection.
In a man’s body, there is a constant interaction and rivalry between erectogenic and inhibitory stimuli. The first includes visual, tactile and olfactory erotic representations. To inhibiting – anxiety, fear, apprehension, expectation of failure, depression, overwork, chronic stress – everything that is so much in the life of modern men.
The easiest and most convenient way to explain stable failures in bed is stress and hassle at work. But to blame everything on psycho-emotional and physical overloads is wrong both from a scientific and from a purely everyday point of view. Only in 10 – 15% of cases, erectile dysfunction is of a psychogenic nature; in most men, the cause of the disease lies not in the head, but in the state of the blood vessels.
AL. Kamalov, Research Institute of Urology, Rosmedtechnology:
Vascular pathology is the main cause of erectile dysfunction, and ED itself can be a symptom of cardiovascular disease, and is often one of the early symptoms.Coronary artery disease occurs in 40% of patients with ED within 4 years of follow-up. It is male sexual dysfunctions that often allow doctors to identify serious problems with the heart and large vessels in time, for which we should be grateful to erectile dysfunction.
Unfortunately, today in Russia only 7-10% of men receive real ED treatment. Moreover, treatment is not always effective. Very often, urologists prescribe drugs for ED for the treatment of prostatitis and benign prostatic hyperplasia.But the most frequently prescribed means of treating sexual dysfunctions in the largest cities of our country are still herbal preparations and dietary supplements, whose effectiveness in relation to ED is comparable to placebo. As a result, a patient with erectile dysfunction spends 2 to 5 years looking for adequate treatment. And the longer he does not receive effective therapy, the more severe the group of patients gets.
Therefore, loved ones, and first of all the beloved woman, should do everything so that a man with ED see a doctor as soon as possible.After all, a man who decided to undergo treatment is already half cured.
Advice from a nurse psychologist to patients’ wives
Of course, most women know that men have problems with erection, but when this happens to her partner, the woman simply does not know how to behave. Most often, the thought rushes through my head: It’s all my fault! – and further detailed reflections follow: Has become old and in general I have long suspected that he has a mistress.This reaction is one of the most common mistakes. Having worked herself up to the full, a woman will want to receive explanations, will interrogate and, as a result, will not receive any intelligible answer. Moreover, in response to reproaches and an offensive tone, a man may seriously withdraw, withdraw, and then a protracted conflict will begin in the couple, which excludes not only sexual relations, but everyone else.
Another variant of ineffective behavior is when a woman decides that now she will immediately fix everything, improve, and rushes with excessive activity to achieve an erection, to try new ways of arousal.Unfortunately, this tactic is exhausting for both: an erection will not come, but a feeling of dissatisfaction will be provided.
And the third thing that you really don’t need to do is act as if nothing happened or you didn’t notice anything. You also don’t need to say: Darling, this is not at all important to me, I love you like that, especially if in your soul you are experiencing a whole storm of negative emotions.
Hushing up the problem can lead to the fact that partners switch to work, hobbies, parenting and intimate relationships come to naught, turn into friendships.It will be extremely difficult to restore the original partnership from the state of friendship.
Here are the steps to help you get back to normal:
- Be sure to figure out exactly what feelings impotence caused you: annoyance, disappointment, irritation, panic or something else. If you feel rejected and unwanted, don’t build up resentment. Share your concerns with your partner. In such situations, it is very important to pull out your feelings, to speak sincerely and in detail.It is important that some time elapses between the failure in bed and the conversation; the event must be digested, and not discussed hot on the trail:
- Try not to put pressure on the feeling of guilt, the man reproaches himself without that. Try to understand: yes, he had a failure, but he had no intention of ruining the intercourse;
- Men who are thin, vulnerable, delicate, strongly oriented towards the opinions of others are more likely to suffer from psychological impotence. In a way, this is the reverse side of soulfulness and intelligence;
- Don’t underestimate the importance of impotence.If it is important for you to have a sexual relationship, discard excessive shyness and tell him about it in your own words, directly, without hints;
- If you have already sought help from a doctor or psychologist, then while the treatment lasts, strengthen emotional closeness. Touch your partner, hug, show other signs of attention. Men, as well as women, need tactile closeness in order not to feel lonely;
- If you are used to the fact that a man was the initiator of touching all the time, then you may have to get used to the role of a leader and take the first steps yourself;
- If your couple had to see a doctor, it means that there really is a close relationship between you – love, friendship, trust.Remember that sexual problems are a kind of indicator that shows the quality of human relationships. When a man and a woman love and appreciate each other, treatment is always successful.
Be careful with medicines!
Erectile dysfunction and medications are a separate topic. Unfortunately, there are many more pills that cause ED than those that actually help from it. Diuretics and many other drugs for lowering blood pressure, antidepressants and tranquilizers, drugs for the treatment of stomach ulcers, hormonal drugs (corticosteroids) and many other drugs have a bad effect on male strength.
Effective drugs for impotence are generally available today. Healthy men also buy them to improve the quality of sex. And patients with erectile dysfunction often independently increase the dose to enhance the effect. In this case, caution is needed, since each of them can cause one or another unwanted side effect. Most of these effects are due to the main mechanism of action of the drugs – vasodilation. This is a headache, flushing of the face, dizziness, nasal congestion, nausea.In general, undesirable effects are mild, with prolonged treatment they disappear on their own. Drugs in this group are contraindicated in patients with coronary artery disease taking nitrates and molsidomine-containing drugs.
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Erectile Dysfunction | University Hospital Freiburg
Erectile dysfunction (also impotence or ED for short) is a violation of male sexual functions. The risk of ED increases with age, with organic causes playing a major role.In some cases, the development of symptoms can also cause psychological problems, such as depression, a state of fear – especially for young men. Often, erectile dysfunction is a consequence of arteriosclerosis and thus indicates a risk of stroke or myocardial infarction in men over 50. After establishing the diagnosis of ED, the patient is advised to immediately consult a therapist and cardiologist.
From a medical point of view, erectile dysfunction can be called a condition when a man for more than 6 months with multiple attempts was unable to
- to achieve the erection required for coitus
- or maintain it until ejaculation.
In other words: when the male penis does not achieve the required state of erection, or quickly loses it.
Temporary, sudden, or sporadic cases of sexual inadequacy should not be considered a disorder requiring therapy.
Causes and risks
Most of the erectile dysfunction is caused by age-related organic changes in the body of a man. So, along with diabetes mellitus ( Diabetes mellitus ), multiple sclerosis, Parkinson’s disease, this includes
- high blood pressure (hypertension),
- damage to the cavernous / cavernous bodies,
- coronary calcinosis,
- sedentary lifestyle
- and poor nutrition can lead to problems with erection.
A man’s potency is negatively affected by
- disorders of the musculoskeletal system (for example, prolapse of intervertebral discs, spinal cord injury, blockages in the lumbar region),
- as well as the action of medications (psychotropic drugs, beta-blockers, antiandrogenic drugs ).
- The male sex hormone testosterone primarily plays a role in the generation of sexual desire (libido). Lack of this hormone in a man’s body (hypogonadism) for a long time can also lead to problems with erection.
Examination and diagnostics
To find out the causes of sexual dysfunction, initially
- anamnesis is collected by a urologist, which must include a history of all side diseases related to risk factors and a list of medications taken by the patient.
- After a physical examination of the patient by means of ultrasound, it is possible to establish possible mechanical damage.
- A blood test indicates existing hormonal disorders (for example, a lack of testosterone) and metabolic problems (for example, diabetes mellitus).
- In special cases, a cavernous / cavernous body injection test (SKIT) is performed using pharmaco-duplex sonography of the penis. At the same time, a vasodilating medication is injected into the cavernous / cavernous bodies of the penis with a thin needle, then in color ultrasound, the blood supply to the arteries of the penis is measured.
- Only rarely is there an indication for selective angiography of the penile arteries or for x-ray imaging of the corpora cavernosa / corpora cavernosa (cavernosonography).
- In the absence of contraindications, medications are most often used in the treatment of ED. The most important substance is a group 5 phosphodiesterase inhibitor (PDE-5 inhibitor such as sildenafil, tadalafil, vardenafil or avanafil). These drugs differ in their duration of action and the timing of the onset of their effect after administration.The drugs inhibit their own enzyme PDE-5, which is responsible for reducing the neurotransmitter that the body produces intensively during sexual arousal and which causes increased blood circulation in the penis.
- Another method of treatment is the so-called. SKAT-therapy (autoinjection therapy of the cavernous / cavernous bodies). In this method, a medication is injected into the base of the penis through a very thin needle, which enhances the erection and the blood supply to the cavernous / cavernous bodies. With the MUSE method (medicated urethral system for restoring erection / transurethral application), prostaglandin-E, which increases blood flow, is injected into the urethra.
- During vacuum therapy, a plastic cylinder equipped with a pump is put on the penis. As a result of a decrease in pressure below atmospheric, blood, under the action of a vacuum, enters the penis, due to which an erection occurs. A rubber ring on the root of the penis prevents back blood flow. However, the ring should be removed after 30 minutes to avoid circulatory problems.
- All forms of severe erectile dysfunction (for example, after radical surgery to remove prostate cancer or after injuries) have been successfully treated for over 40 years.At the same time, a hydraulic implant is inserted into the penis through a small incision as part of the operation. It consists of two cylinders along the corpus cavernosum / corpus cavernosum. A pump is placed in the scrotum to activate and deactivate the process. A thin hose connects the reservoir in the hypogastric region. By pressing on the pump under the skin of the scrotum, the patient pumps the sterile solution from the reservoir into the cylinders. In this case, the member becomes hardened. Outwardly, this is in no way different from a natural erection.In this case, the sensitivity in the penis is not disturbed and the patient, as before, is able to experience orgasm and ejaculation.