Managing Expectations: Onset of Action and Sexual Planning

Erectile dysfunction is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance. The Massachusetts Male Aging Study surveyed 1,709 men aged 40–70 years between 1987 and 1989 and found there was a total prevalence of erectile dysfunction of 52 percent. It was estimated that, in 1995, over 152 million men worldwide experienced ED.

OTHER THERAPEUTIC OPTIONS

A tension ring can then be placed around the base of the penis to maintain an erection. Penile implants – Surgical implants can be an option for some people if medicines aren’t effective. These implants are rod-shaped devices that are placed on either side of the penis. They can either be inflatable, or firm but flexible. Erectile dysfunction has a lot of possible causes and is frequently the result of a combination of factors.

Be physically active

But the right combination of lifestyle changes, medicine and other treatments can help you regain control over your sexual health and reduce the stress that often comes with ED. If you feel like you might be experiencing erectile dysfunction, talk to your primary care doctor. They can give you an initial assessment and refer you to a sexual health expert or urologist if necessary. Erectile dysfunction is when a man cannot achieve or maintain an erection that is firm enough for sexual intercourse. Having ED once in a while is normal, but if you experience ED for more than three months, talk to your doctor. For 2025, the prevalence of ED is predicted to be approximately 322 million worldwide.

• Medications for ED should be used strictly as prescribed.
• Overuse or misuse of drugs can lead to complications.
• Not all men will respond to the same medication.
• Combining treatments might provide better results.
• Keep medication away from children and pets.
• Always inform your doctor about other health conditions.

In the past, erectile dysfunction was commonly believed to be caused by psychological problems.

It is now known that, for most men, erectile dysfunction is caused by physical problems, usually related to the blood supply of the penis. Many advances have occurred in both diagnosis and treatment of erectile dysfunction. According to the NIH, erectile dysfunction is also a symptom that accompanies many disorders and diseases. Direct risk factors for erectile dysfunction may include the following: Hypogonadism in association with a number of endocrinologic conditions Hypogonadism in association with a number of endocrinologic conditions Low levels of HDL (high-density lipoprotein) Low levels of HDL (high-density lipoprotein) Chronic sleep disorders (obstructive sleep apnea, insomnia) Chronic sleep disorders (obstructive sleep apnea, insomnia) Peyronie's disease (distortion or curvature of the penis) Peyronie's disease (distortion or curvature of the penis) Many chronic diseases, especially renal failure and dialysis Many chronic diseases, especially renal failure and dialysis Smoking, which exacerbates the effects of other risk factors, such as vascular disease or hypertension Smoking, which exacerbates the effects of other risk factors, such as vascular disease or hypertension Age appears to be a strong indirect risk factor in that it is associated with increased likelihood of direct risk factors, some of which are listed above. Accurate risk factor identification and characterization are essential for prevention or treatment of erectile dysfunction.

• Lifestyle changes can improve ED symptoms significantly.
• Regular exercise boosts blood flow and sexual health.
• Quitting smoking enhances erectile function.
• Limiting alcohol intake can prevent worsening ED.
• Maintaining a healthy weight reduces risk factors.
• Managing stress improves overall sexual performance.

The following are some of the different types and possible causes of erectile dysfunction: Organic ED involves abnormalities the penile arteries, veins, or both and is the most common cause of ED, especially in older men.

When the problem is arterial, it is usually caused by arteriosclerosis, or hardening of the arteries, although trauma to the arteries may be the cause. The controllable risk factors for arteriosclerosis--being overweight, lack of exercise, high cholesterol, high blood pressure, and cigarette smoking--can cause erectile failure often before progressing to affect the heart.

Choosing your ED drug

The most common cause of erectile dysfunction is a cardiovascular problem. The blood vessels in the penis are among the smallest in the body and are often the first to exhibit symptoms of high blood pressure (hypertension) or arthersclerosis (hardening of the arteries), or diabetes. Other causes of erectile dysfunction include surgery, such as prostate cancer surgery, that affects the nerves or blood vessels that play a role in getting erections. Side effects from medications such as antidepressants or antihistamines, emotional or mental stress, and lifestyle choices including smoking and alcohol and drug abuse can also cause ED. Although common among older men, ED isn’t part of normal aging.

For You

Aging increases the chance of developing the above causes of erectile dysfunction, but age in itself should not be considered a cause of ED. Moreover, there is no reason that getting older should prohibit an active sex life. The symptoms of an enlarged prostate may be mild or come and go, and as a result, most men wait several months, even years, before seeing a doctor. In general, waiting to see a physician does not pose a problem. Diagnosing erectile dysfunction involves a discussion of your medical history and symptoms; a physical examination to look for signs of problems with your circulatory, nervous, and endocrine system; and routine lab tests to check for underlying conditions such as heart disease, diabetes, and low testosterone. Many experts believe that atrophy, a partial or complete wasting away of tissue, and fibrosis, the growth of excess tissue, of the smooth muscle tissue in the body of the penis (cavernous smooth muscle) triggers problems with being able to maintain a firm erection.

• Sildenafil (Viagra): A popular PDE5 inhibitor to treat erectile dysfunction.
• Tadalafil (Cialis): Offers longer-lasting effects for up to 36 hours.
• Vardenafil (Levitra): Acts quickly and lasts several hours.
• Stendra (Avanafil): Provides rapid onset of action within 15 minutes.
• Alprostadil (injection): Penetrates directly into the penis to induce an erection.
• Erectile dysfunction patches: Topical patches delivering medication for quicker absorption.

Poor ability to maintain an erection is often an early symptom of erectile dysfunction. Although the condition is called venous leak, the real problem is not with the veins but malfunction of the smooth muscle that surrounds the veins. The end result is difficulty with maintain a firm erection (losing an erection too quickly) that is now believe to be an early manifestation of atherosclerosis and vascular disease.

Intra-cavernosal Injection

The ideal patient to receive this type of therapy has mild to moderate erectile dysfunction; however, it has also been shown to be effective in patients with severe ED who respond poorly to traditional medication. ShockWave therapy requires six treatments in the clinic. While the therapy is not currently FDA-approved, ShockWave technology has been peer-reviewed and shows encouraging results. Some men may experience Erectile Dysfunction following a prostatectomy to treat prostate cancer. Read more about Erectile Dysfunction Rehabilitation after a Radical Prostatectomy.

Can ED medications cause permanent damage or long-term side effects?

Metabolic Syndrome has also been linked to Erectile Dysfunction. Over-the-counter pills sold on late night TV and in men’s magazines are herbal supplements that are not regulated by sex medicine the FDA and have not been shown to be effective for erectile dysfunction or penile enlargement. Start the conversation by acknowledging that this is a hard subject for you to talk about. You might also mention that you’re concerned about erectile dysfunction being an early indicator of a more severe problem like cardiovascular disease or diabetes. Your urologist will discuss your concerns with the professionalism you’d expect when discussing any other medical condition and will help put you at ease. Erectile Dysfunction is common in people with diabetes. An estimated 10.9 million adult men in the U.S.

General Considerations

Erectile dysfunction treatment options in San Antonio are available with our experienced urologists. Medication Adjustments: Adjusting a medicine that is triggering ED may be all you need to do Behavioral Changes: The first step in treating ED is to eliminate possible reversible causes. These changes include controlling hypertension and diabetes. Quitting smoking, exercising, or losing weight can improve ED. Counseling: This can help if your ED is affected by stress, depression or anxiety Medications: Sildenafil (Viagra®) is an oral medication that revolutionized the treatment of erectile dysfunction.

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It and newer medications of the same class work by preventing the breakdown of cyclic GMP, a molecule in the penile blood vessels involved in normal erections. It augments and prolongs the normal penile mechanism and is generally very safe. It does, however, interfere with nitrate metabolism; therefore, if a patient takes any form of nitroglycerin, he cannot take Viagra. It requires intact penile and pelvic blue tablets nerves to work. Vacuum Erection Device: Also called a penis pump, this device draws blood into your penis using a plastic tube and pump. have diabetes, and 35 to 50 percent of these men are impotent.

The process involves premature and unusually severe hardening of the arteries. Peripheral neuropathy, with involvement of the nerves controlling erections, is commonly seen in people with diabetes.

Counseling for Erectile Dysfunction

A constriction ring/band at the base of your penis helps you keep the erection. The band can be left in place for half an hour. These devices require practice but are safe and reliable. Penile Injections and Suppositories: Various medicines can be injected into the penis to cause an erection. These medications act as direct penile vascular tissue relaxants, bypassing the need for nerves and relaxing penile blood vessels allowing inflow of blood.

The Connection Between Erectile Dysfunction and Heart Disease

The needle used is small and is inserted with minimal discomfort. An erection occurs in 5-15 minutes and may last for an hour.In pellet therapy, rice-sized pellets are inserted into the urethra relax the muscles and blood vessels in your penis to allow blood to flow in to create an erection. Surgery/Penile Implant: When other treatments have not worked, the surgical placement of a penile implant or penile prosthesis can allow men to be sexually intimate. Sensation and orgasm do not change with the placement of a penile implant. ShockWave Therapy: We are pleased to introduce Low-intensity extracorporeal ShockWave therapy for the treatment of erectile dysfunction. Depression is another cause of ED and is closely related to erectile dysfunction. Because there is a triad relationship between depression, ED and cardiovascular disease, men with depression should be fully evaluated for medical illness as well as psychological factors.

• Natural supplements like ginseng are claimed to help ED.
• Evidence supporting supplements is limited and inconsistent.
• Some herbal remedies may interact with medications.
• Always consult a doctor before using supplements.
• Lifestyle changes are often more effective than herbal supplements.
• Beware of unregulated supplements and false claims.