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What is erectile dysfunction (ED)?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. For 2025, the prevalence of ED is predicted to be approximately 322 million worldwide. 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. What are the risk factors for 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:
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. What are the different types (and causes) of ED?The following are some of the different types and possible causes of erectile dysfunction: Organic Erectile DysfunctionOrganic 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. 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. 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.
Premature Ejaculation (PE)Premature ejaculation is a male sexual dysfunction characterized by:
Premature ejaculation is divided into lifelong and acquired categories:
How is ED diagnosed?Diagnostic procedures for ED may include the following:
What is the treatment for ED?Specific treatment for erectile dysfunction will be determined by your doctor based on:
Some of the treatments available for ED include: Medical treatments:
The FDA recommends that men follow general precautions before taking a medication for ED. Men who are taking medications that contain nitrates, such as nitroglycerin, should NOT use these medications. Taking nitrates with one of these medications can lower blood pressure too much. In addition, men who take tadalafil or vardenfil should use alpha blockers with care and only as instructed by their physician, as they could result in hypotension (abnormally low blood pressure). Experts recommend that men have a complete medical history and physical examination to determine the cause of ED. Men should tell their doctor about all the medications they are taking, including over-the-counter medications. Men with medical conditions that may cause a sustained erection, such as sickle cell anemia, leukemia, or multiple myeloma, or a man who has an abnormally-shaped penis, may not benefit from these medications. Also, men with liver diseases or a disease of the retina, such as macular degeneration or retinitis pigmentosa, may not be able to take these medications, or may need to take the lowest dosage. These medical treatments should NOT be used by women or children. Elderly men are especially sensitive to the effects of these medical treatments, which may increase their chance of having side effects. Hormone replacement therapyTestosterone replacement therapy may improve energy, mood, and bone density, increase muscle mass and weight, and heighten sexual interest in older men who may have deficient levels of testosterone. Testosterone supplementation is not recommended for men who have normal testosterone levels for their age group due to the risk of prostate enlargement and other side effects. Testosterone replacement therapy is available as a cream or gel, topical solution, skin patch, injectable form and pellet form placed under the skin. Penile implantsTwo types of implants are used to treat ED, including:
Infection is the most common cause of penile implant failure and occurs less that 2 percent of the time. Implants are usually not considered until other methods of treatment have been tried but they have a very high patient satisfaction rate and are an excellent treatment choice in the appropriate patient. How do couples cope with ED?Erectile dysfunction can cause strain on a couple. Many times, men will avoid sexual situations due to the emotional pain associated with ED, causing their partner to feel rejected or inadequate. It is important to communicate openly with your partner. Some couples consider seeking treatment for ED together, while other men prefer to seek treatment without their partner's knowledge. A lack of communication is the primary barrier for seeking treatment and can prolong the suffering. The loss of erectile capacity can have a profound effect on a man. The good news is that ED can usually be treated safely and effectively. Feeling embarrassed about sexual health problems may prevent many men from seeking the medical attention they need, which can delay diagnosis and treatment of more serious underlying conditions. Erectile Dysfunction itself is often related to an underlying problem, such as heart disease, diabetes, liver disease, or other medical conditions. Since ED can be a forewarning symptom of progressive coronary disease, doctors should be more direct when questioning patients about their health. By asking patients more directly about their sexual function through conversation or a questionnaire during a checkup, doctors may be able to detect more serious health conditions sooner. #TomorrowsDiscoveries: Testosterone Therapy –Adrian Dobs, M.D., M.P.H.
Dr. Adrian Dobs and her team are interested in finding out whether men could benefit from testosterone replacement therapy as they age. What is the fastest way to cure premature ejaculation?masturbating 1 to 2 hours before having sex. using a thick condom to help decrease sensation. taking a deep breath to briefly shut down the ejaculatory reflex (an automatic reflex of the body, during which you ejaculate) having sex with your partner on top (to allow them to pull away when you're close to ejaculating)
Is premature ejaculation a form of erectile dysfunction?What's the difference between erectile dysfunction and premature ejaculation? If you have erectile dysfunction, you can't attain or maintain your erection. If you have premature ejaculation, you have an erection but you reach orgasm and ejaculate earlier than you or your partner would have liked.
How can I regain erectile strength?Recent studies have found that exercise, especially moderate to vigorous aerobic activity, can improve erectile dysfunction. Even less strenuous, regular exercise might reduce the risk of erectile dysfunction. Increasing your level of activity might also further reduce your risk.
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