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admin | Category: Ed 1000 Treatment In Australia | 19.06.2016
The prevalence of erectile dysfunction is higher in treated compared with untreated hypertensive patients, suggesting a detrimental effect of antihypertensive therapy on erectile function. JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser.
Erectile dysfunction is a microvascular-endothelial disease that affects the quality of life. The goals of patient evaluation, are to assess the likely cause of the erectile dysfunction and identify medical or psychologic conditions that may be contributing to the dysfunction or that may influence treatment options. Often one can get an excellent clue to the etiology by the history and physical examination which can then be tested by precise laboratory tests. History and Clinical ExaminationAnatomic, psychogenic, endocrinologic, neurologic, and vascular abnormalities may all contribute to impotence.
A thorough history is the most important factor in the evaluation of the patient with erectile dysfunction. Psychogenic disorders may occasionally be primary factors contributing to erectile dysfunction. Once a concern with the patient's sexual function is identified, the next step is to differentiate erectile dysfunction from other sexual problems, such as loss of libido or ejaculatory problems. The full 15 question IIEF which helps in distinguishing what type of sexual dysfunction is present can be accessed here. The shortened 5 question IIEF which helps in judging the severity of true erectile dysfunction can be accessed here. Early recognition of psychogenic disturbances allows the physician to avoid costly and confusing evaluation for other etiologies of impotence.
Because impotence is known to be associated with many common medical conditions and medications, a careful medical history may yield insights into the etiology of impotence. Careful physical examination with particular attention to sexual and genital development may occasionally reveal an obvious cause of impotence.
The cardiovascular examination should include assessment of vital signs (especially blood pressure and pulse) and signs of hypertensive or ischemic heart disease. In many cases, a careful history and physical exam will direct the physician to the most expedient cost-effective evaluation and eliminate the need for unnecessary diagnostic tests. This chapter aims to summarize the effects of the various antihypertensive drug categories on erectile function, highlight the differences between drug categories, and discuss the effects of switching antihypertensive drug class on erectile function.

Hypertension is a major cardiovascular risk factor, while antihypertensive therapy is associated with dramatic reduction in cardiovascular events. At the same time, some have multiple causes, such as a person with diabetes who is also on certain antihypertensive medications. Therefore, the evaluation of impotence begins with a comprehensive history and physical examination. Recognition of these patient characteristics should lead the clinician to entertain the possibility of a primary psychogenic etiology of impotence.
The physician should use appropriate vocabulary, avoiding slang or excessively technical terminology. Moreover, many patients complain of erectile dysfunction when they mean something lese such as premature ejaculation etc., and again this needs to be recognized before embarking on the detailed evaluation. Particular attention should be given to the cardiovascular, neurologic and genitourinary systems, as these systems are directly involved with erectile function. Careful examination of the penis may reveal an anatomic abnormality such as a micropenis, the presence of chordee, or a Peyronie's plaque. Abdominal or femoral artery bruits and asymmetric or absent lower extremity pulses are indicative of vascular disease. Patients with diabetes or neurodegenerative disorders may show evidence of peripheral neuropathy. Experimental data suggests that significant between-class and in-class differences exist regarding the effects of antihypertensive agents on erectile function. Large community-based studies indicate that hypertension increases substantially the risk for erectile dysfunction.
A careful sexual history and knowledge of concurrent illnesses and medications are essential. Having the patient define the terms in his own words will help the physician and patient communicate more effectively. Many common medications such as psychotropic drugs and antihypertensives have been associated with impotence.
Observational and small randomized studies, large clinical trials, and meta-analyses point towards the same direction.
Erectile dysfunction is approximately twice as prevalent in hypertensive patients compared to normotensive individuals.

The sexual history should include the duration of impotence, level of libido, and a complete inventory of sexual partners. The International Index of Erectile Function (IIEF) is a valuable tool for defining the area of sexual dysfunction. Similarly, a patient's surgical history may also provide clues to the possible causes of impotence. Certain genetic syndromes such as Kallmann's or Klinefelter's syndrome may present with obvious physical signs of hypogonadism or distinctive body habitus. The superficial anal reflex, indicative of normal somatic function of sacral cord levels S24, is assessed by touching the perianal skin and noting contraction of the external anal sphincter muscles. Diuretics and beta-blockers seem to exert detrimental effects on erectile dysfunction, ACE inhibitors and calcium antagonists seem to exert neutral effects, while ARBs and nebivolol seem to be associated with beneficial effects on erectile function. Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias.
Of major clinical importance, erectile dysfunction is usually more severe in hypertensive compared to normotensive subjects and tends to be more prevalent in treated than in untreated hypertensive patients, suggesting that antihypertensive therapy may, at least in part, contribute to erectile dysfunction. The IIEF is designed to be a self-administered measure of erectile dysfunction, but it also assesses a patient's function in other phases of sexual function. Prior radical pelvic surgery (eg, prostatectomy, abdominoperineal resection), radiation, and pelvic trauma are known to be associated with impotence. Age, duration, and severity of hypertension, comorbidities, and the type of antihypertensive therapy are the major determinants of erectile dysfunction in hypertensive patients. The IIEF also establishes a reliable baseline that can be used to monitor changes related to treatment. It is performed by placing a finger in the rectum and noting contraction of the anal sphincter and bulbocavernosus muscle when the glans penis is squeezed. This review aims to summarize epidemiological data regarding the prevalence of erectile dysfunction in hypertensive patients compared to normotensive individuals, the determinants of erectile dysfunction in hypertensive patients, and critically evaluate available data.
Adverse reactions to bendrofluazide and propranolol for the treatment of mild hypertension.

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