The Department of Urology brings together the best of patient care, education and research. Urology Research
Hormone imbalance, particularly low testosterone, can also play a role in ED. Men can naturally increase testosterone levels by routinely engaging in weight training exercises. For aging men whose testosterone levels have dipped, hormone therapy is a safe and effective treatment option.
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VEDs are noninvasive devices that are available OTC or by prescription. They are used to generate negative pressure, drawing arterial blood into the corpora cavernosa, thereby promoting erection.5,7 Despite being less discreet than other treatment options, they are effective, low-cost, and associated with high rates of satisfaction.6 Use of VEDs can cause transient penile petechiae or bruising, discomfort or pain, and difficulty with ejaculation.6,7 Men receiving anticoagulants are at increased risk of bruising, and therefore, caution should be observed when considering a VED.7
Smoking, drinking alcohol and the use of recreational drugs such as narcotics, stimulants and hallucinogens can all affect sexual function. Chemicals from smoking can interfere with blood flow to your penis and damage the lining of the blood vessels or lead to atherosclerosis (hardening of the arteries). It can also affect the smooth muscle tissue that needs to relax to allow blood to flow in. Short-term use of alcohol affects sexual desire, reduces performance and delays orgasm and ejaculation.
Stendra (avanafil)Viagra (sildenafil)Cialis (tadalafil)Levitra or Staxyn (vardenafil)
Treatment depends on what is causing it. If it is caused by uncontrolled blood sugar and high blood pressure, take your medicine and follow your doctor’s instructions.
Coronary Artery DiseaseCoronary artery disease (CAD) and ED frequently occur concomitantly due to mutual risk factors such as diabetes, hypertension, and hyperlipidemia. In men with CAD, the incidence of ED is estimated to be 42% to 57%. Because the primary cause of ED is vasculogenic, ED can precede CAD, stroke, and peripheral artery disease by an average of 3 years.27,28 The package insert for PDE5Is cautions providers about using these agents in patients with uncontrolled hypertension (>170/100 mmHg), CAD with unstable angina, or a history of myocardial infarction (MI), stroke, or life-threatening arrhythmia within the past 6 months.8-11 The primary concern with using PDE5Is in these patients is that the physical demands of intercourse could provoke a CV event.
Shockwave therapy for ED is still considered an experimental treatment option. There is some data to support its efficacy, but research is ongoing to determine how well it works long-term and whether it can replace or be offered along with other proven ED treatments. What Is Shockwave Therapy?
Injections do require training and it may be tricky to get the right dose initially. We always do the first injection in the office to show you how to do it and to give us a good idea about the proper dose. Our patients are usually anxious about injecting their penis but are almost always surprised by how painless the process is. Pros Cons Very effective (85%) Mimics normal erection Discreet Risk of prolonged erection (priapism) Risk of penile scarring Pain with injection (usually mild) Bruising or bleeding Hard to use if have tremor or poor vision or severe obesity Poor long-term satisfaction (less than 40%)
All of this is why they require a prescription. Your consulting physician will determine what will be safe and effective for you based on your medical history and any current medications that you use. Thankfully, PDE-5 medications for ED are prescribed very widely, and the healthcare community considers them safe for most men, with rare and mostly mild side effects reported.
Pharmalogic TreatmentPharmacologic options for treatment of ED include oral phosphodiesterase type 5 inhibitors (PDE5Is) or intraurethral or intracavernosal injection alprostadil.6 Intracavernosal nonprostaglandin agents such as papaverine, phentolamine, and atropine have also been used to successfully manage ED, but none are FDA-approved for this indication. Testosterone replacement may also be considered for men with hypogonadism.6
Erectile dysfunction is a potential complication following prostate cancer treatments. The nerves that control an erection lie very close to the prostate and may be injured during treatment. However, some men may regain their previous level of erectile function with nerve-sparing procedures. But it may take up to a year while some men may never recover their ability to have a natural erection.
In general, more than 6 in 10 men say they have harder erections after taking it.
In our opinion, tadalafil beats sildenafil and vardenafil, which makes it the best choice for most men. But most importantly, scientific research leads to the same conclusion. In a meta-analysis of numerous studies, couples preferred tadalafil to sildenafil — and it wasn’t very close. In one study, nearly 80% of women preferred their sexual partners to use tadalafil, compared to sildenafil (15% preference). Therefore, the chances are pretty good that tadalafil will be best for you, too.
8. When choosing an injection site, avoid any area where a vein is clearly visible. We recommend changing injection sites from left to right as well as up and down the shaft and back again to ensure that you do not develop scar tissue at one specific site.
ED is linked to a number of physical and psychological problems. These include physical conditions such as heart disease, high blood pressure, high cholesterol, diabetes, multiple sclerosis and Parkinson's disease Psychological and emotional problems such as stress, anxiety and tiredness.
chest pains – if this happens during or after sex, get into a semi-sitting position and try to relax (remember do not use nitrates for chest pain while taking tadalafil)prolonged and sometimes painful erections – if you have an erection that lasts for more than 4 hours, contact a doctor immediatelya sudden problem with your eyesight or hearinga serious skin reaction – symptoms may include red raised patches on your skin or red spots (hives), a swollen face and swelling around the eyesseizures or fitsSerious allergic reaction Immediate action required: Call 999 or go to A&E now if: you get a skin rash that may include itchy, red, swollen, blistered or peeling skinyou're wheezingyou get tightness in the chest or throatyou have trouble breathing or talkingyour mouth, face, lips, tongue or throat start swelling