Vascular risk factors and erectile dysfunction,natural cures for ed and premature ejaculation zinc,can high blood pressure pills cause erectile dysfunction video - You Shoud Know

Difficulty in maintaining an erection sufficient for sex can be an early warning sign of heart problems. Atherosclerosis is the usual cause of heart attacks, strokes, and peripheral vascular diseases.
Besides sharing a common disease process, erectile dysfunction and heart disease also share many risk factors.
This doesn’t necessarily mean that erectile dysfunction causes heart problems, but, more likely, that both share a common pathology of the blood vessels known as endothelial dysfunction. Healthcare Professionals would include: Physicians (MD,OD), Physician assistants, Nurses, Pharmacists,Allied Health Workers (PT, OT, SLP, etc), Chiropractors, Paramedics, Optometrists, Dentists, Podiatrists etc, and students within these disciplines.
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Besides the above pharmaceutical agents, there are also numerous herbal products and nutritional supplements that are advertised in the market for helping erection. So far in Greece, four different oral drugs have been available for ED treatment: Avanafil, (Spedra ??),  vardenafil (Levitra??), sildenafil (Viagra??, and recently its generics Sildenafil Actavis??, Sildenafil Pfizer??, Sildenafil Sandoz??) and tadalafil (Cialis??).
All above preparation forms are indicated to be taken by the patient ‘on demand’, that is about one hour before sexual intercourse, whereas  Avanafil is recommended to be taken about 15-30 minutes before the sexual act. Their efficacy rate amounts to 70%, while this drops to 50% in patients who have severe concomitant diseases, such as diabetes mellitus, neurological diseases or after radical prostatectomy for prostate cancer. These drugs are absolutely contra-indicated in patients who receive nitrates (drugs for coronary disease), since drug interaction may significantly reduce blood pressure. The injection is done with a special syringe and fine insulin needle directly into the two ‘cylinders’ (corpora cavernosa) along the penis. Extracorporeal Shock Wave Therapy (ESWT) is a painless and effective therapeutic method to treat erectile dysfunction of exclusively vascular etiology.
As for efficacy, studies have shown that 60-70% of patients who respond to oral ED drugs will not need ED drugs any more after the application of sound waves and will have satisfactory sexual intercourse. Penile prosthesis is a device placed inside the penis to help the male achieve erection for a successful sexual intercourse. A spontaneous and simple-appearing sexual act, in fact, is a series of meticulously synchronized processes.
The preceding activities of the nerve endings cause dilatation of arterioles by relaxing their smooth muscle coat, which in turn causes filling of the spaces of corpora cavernosa resulting in its expansion.
After the penis is inserted in the vagina, an act of sexual intercourse or copulation takes place, and continues until the time of orgasm and subsequent ejaculation.
Friction between the glans penis and vaginal mucosa, reinforced by several other afferent stimuli and psychogenic factors, causes a reflex discharge along the sympathetic to the seminal pathway, the muscle coats of the epididymis, ductus deferens, the seminal vesicles, and the prostate gland.
After ejaculation and cessation of exotic stimuli, sympathetic tonic discharge resumes; this results in the contraction of smooth muscles around sinusoidal spaces and arterioles.
Aging has the strongest association with erectile dysfunction, and may be a common denominator in many patients. Psychogenic causes include, among others, states of anxiety, depression, a troubled relationship, and fear of performance. Diabetes[16,17] and alcoholic neuropathy,[20,21] spinal cord injury, nerve damage, multiple sclerosis, and cerebrovascular accidents are significant contributory factors for organic impotence. Erectile dysfunction has also been reported in patients on psychotherapeutic drugs, which produce central nervous system depression.
Sleep laboratories monitor patients for rapid eye movement (REM) sleep, when an erection is seen. Some physicians advocate intracavernosal injection of a small amount (10 mg of prostaglandin E1) of alprostadil. A test of questionable value, duplex Doppler ultrasonography, has been used to evaluate arterial and venous blood flow of the penis. Vacuum constriction devices, were once a popular noninvasive method of treating impotence.[5,11] The vacuum, created in the cylinder of the vacuum constriction device, causes the flow of blood in the corpora cavernosa of the penis.
Whether it is the latest research on how to reduce heart disease, slow the aging process, or prevent brain aging, Life Extension® reports it first. Abstract: Organic conditions are the most common cause of erectile dysfunction (ED), particularly in men older than 50 years. Nearly all primary care providers have men in their practice who suffer from erectile dysfunction (ED). The disorder is highly age-dependent; the combined prevalence of moderate to complete ED rises from approximately 22% at age 40 years to 49% by age 70 years. Psychological factors play a role in a small percentage of long-term cases (those that persist for more than one year)1. Peyronie disease causes fibrosis of the corporal bodies of the penis and restricts the blood supply, which results in angulation of the penis and decreased rigidity beyond the fibrotic plaque.
Damage to the cavernous nerves that originate in the pelvis can inhibit the initiation of sufficient stimuli to achieve an erection. Low testosterone levels -- which are usually responsible for a decrease in libido -- are frequently associated with aging and can cause ED. Several classes of drugs have been linked to ED; medication may be the cause of the disorder in as many as 25% of patients2. Monitoring erections that occur during sleep (nocturnal penile tumescence or NPT) can help rule out certain psychological causes of impotence.
In some cases, a psychosocial examination, using an interview and questionnaire, reveals psychological factors. Perform a focused neruovascular examination; assess the cremasteric reflex and pinprick and light-touch responses. Evaluate the bulbocavernosus reflex and sphincter tone during the rectal examination to assess S2 through S4 nerve function. If the testosterone level is at or below the lower limit of normal, measure serum prolactin and luteinizing hormone levels.
Assess glucose level and renal and liver function if these studies have not been done within the past year. The absence of nocturnal erections or the lack of erections with masturbation strongly suggests a physical cause of the patient's ED.
Palpate the shaft of the penis to determine whether hard, plaque-like structures are lodged within that may prevent a normal erection (Peyronie disease).
Perform a focused neurovascular examination; assess the cremasteric reflex and pinprick and light-touch responses. If the patient has not been tested for diabetes within the past year, assess the glycohemoglobin level. Perhaps the most significant advance in the oral treatment of ED was the release of sildenafil in 19988. Sildenafil inhibits phosphodiesterase, the enzyme that breaks down cyclic guanosine monophosphate (cGMP) to guanosine monophosphate (GMP). The potential side effects of sildenafil, including headache, visual disturbances, and indigestion, are generally mild. Because sildenafil is often used by men who have cardiovascular risk factors, such as hypertension, hyperlipidemia, and diabetes, the effect of the drug on cardiovascular events is an important concern. Prescribe a starting dose of 25 mg for patients who have significant liver or renal impairment and for those who use drugs that are metabolized by the cytochrome P450 eA4 enzyme -- such as cimetidine, erythromycin, and fluconazole. At the biochemical level, smooth muscle relaxation is mediated through the release of nitric oxide from the nerves that supply the penis.
Low levels of testosterone, or hypogonadism, may result from primary failure of the testis to produce the hormone or from secondary failure caused by pituitary factors (for example, decreased LH production associated with a tumor of the anterior pituitary gland).
Supplemental testosterone is available in injectable, tablet, patch, and topical gel forms.
Oral testosterone appears to be less effective than the injectable form; it is rapidly absorbed and does not remain in circulation long enough to produce an adequate result. Transdermal patches, such as Androderm (testosterone, 2.5 or 5 mg) and Testoderm TTS (testosterone, 5 mg) can be applied to the arms, back, abdomen, or thighs. Although testosterone gels are simpler to apply, more research is needed to evaluate possible side effects experienced by the partner from the transfer of the medication during intercourse8.



Negative pressure created by these devices allows blood to be drawn into the corporal bodies of the penis.
This vasodiolator can be administered into the urethra via suppository or more frequently, directly into the corporal bodies of the penis by self-injection with a 25-gauge needle.
The absence of nocturnal erections or the lack of erections with masturbation or self-stimulation strongly suggest a physical cause of the patient's erectile dysfunction (ED). The usual starting dose of sildenafil is 50 mg, which is taken 45 to 60 minutes before engaging in sexual intimacy. Reserve hormone supplementation for the small percentage of patients whose ED is caused directly by testosterone deficiency. Understanding the connections between the two may help you get treatment before heart problems become serious. Erectile dysfunction is an alert to look for atherosclerosis in larger arteries supplying your heart and other organs, and to take steps to treat it. Erectile dysfunction, therefore, is a biomarker for heart disease, which means if you have it, you need to get your heart health checked out right away. To this end eDucate uses a wide array of learning tools, including Webinars, Quick Review Charts, Graphs, Brochures, Videos and Slide Presentations.
Virag announced that the papaverine intracavernous injection can cause penile erection by immediately increasing penile blood flow.
However, there is no scientific evidence that these preparations are more effective than placebo. In case of psychogenic erectile dysfunction, drug therapy can help only if combined with therapy by the Sexologist. Tadalafil has an action of 36 hours, while the other three drugs have a duration of 6-12 hours. This form is indicated for patients who have frequent sexual activity or suffer from benign prostate hyperplasia (BPH). Most common side effects are headache, indigestion, muscle pain; more rare side effects are nasal congestion and eye disorders. It is an injection of various vasodilating agents that improve penile blood perfusion (papaverine, phentolamine and alprostadil).
With regard to patients who do not respond to ED drugs, 70% of them will respond to the drugs after the application of sound waves.
It is a therapeutic option for patients who have tried all other therapies (drugs, penile injections) without any success.
Unfortunately, this harmony may be jeopardized by the occurrence of erectile disorders, and often lead to separation. Its precise erudition may add to the comprehension of the physiological phenomenon, comprising libido, erection, copulation, orgasm, and the ejaculation. Libido is the conscious feeling of the sexual urge, which originates in the brain center through the impulses received by various sense organs. Accordingly, strong pressure is exerted on the veins that normally drain blood from the penis. The sperm, along with the secretion of the accessory glands, are discharged into the posterior urethra, between the internal and external sphincter of the bladder. Arterial flow is diminished to flaccid levels, much of the blood from sinusoidal spaces is expelled, and the venous channels are restored (Figure 2).
They are abridged by mixed erectile dysfunction, which is composed of a variable mixture of psychogenic and organic factors (Figure 1). This is usually due to physical causes such as endocrinopathies, nervous system disorders, or maldevelopment of the penis and its incompetent veins. With aging, there may occur atheroma of internal iliac arteries and their pudendal branches.
Psychogenic erectile dysfunction usually has an acute onset, often related to specific events. The former include atherosclerosis due to smoking, diabetes, low levels of high-density lipoprotein cholesterol, high levels of low-density lipoprotein, and total cholesterol, as well as hypertension.
Damage or degeneration of peripheral nerves supplying the corpora may also cause impotence; cauda equina, and the lesions due to prolapsed intervertebral disc and iatrogenic neural injury during abdominoperineal resection of the rectum[20,21,24,28] are some examples. Further, testosterone secreted from Leydig's cell of the testes under the influence of luteinizing hormone affects men's sexuality.[16,17] Thus, the medications such as luteinizing hormone, releasing hormone agonist or stilbestrol, which lower circulating testosterone also cause erectile dysfunction.
It is variously considered to be due to an elevation of serum prolactin concentration, sedative effect, anticholinergic effect, decreased dopamine activity, or central effects on the limbic system.[4,7,10] More and more drugs are being added to the list of those which induce erectile dysfunction (Table II). Hypogonadism due to dysfunction of Leydig's cells, hyperprolactinemia, hyperparathyroidism, anemia, protein malnutrition, zinc deficiency, hypertension, and use of antihypertensive drugs[33] are a few implicated propositions.
In order to achieve success in the aforementioned objectives, the patient and his partner need to provide a detailed confidential history.
The latest breakthrough (sildenafil) seems to occupy a place of pride among the current drugs for the purpose.
Yohimbine hydrochloride is an a-adrenoceptor antagonist, which acts both peripherally and centrally; however, it is not highly effective in established organic impotence. They have also been used in erectile dysfunction, as the presence of dopaminergic pathways in the paraventricular nucleus is important in engendering erectile response. A central dopamine stimulant has been given with success in patients with functional erectile dysfunction; however, many patients observe nausea and vomiting after its use. This relatively acceptable, noninvasive route of drug delivery has proved to induce similar hemodynamic changes in the corpora cavernosa as have been achieved by intracavernosal injections. Phentolamine (a-adrenoceptor blocker) and papaverine (non-specific phosphodiesterase inhibitor) have been used in the form of intracorporeal injections. They can be simple rods, malleable rods, self-contained hydraulic, multicomponent hydraulic, or articulated prostheses.
ED may signal an underlying, treatable disorder such as hypertension, diabetes mellitus, hypercholesterolemia, heart disease, or peripheral vascular disease. The man's sexual partner may also be interviewed to determine expectations and perceptions encountered during sexual intercourse. Baum gratefully acknowledges the assistance of Lindsay Leuthen, BS, in the preparation of this article. Likewise, if you have heart disease, getting the right treatment may help with erectile dysfunction. The endothelium keeps the inside of arteries toned and smooth to ensure smooth flowing of blood. Atherosclerosis also increases your risk of other problems, including aneurysm, stroke and peripheral artery disease. In men older than 70, erectile dysfunction is much less likely to be a sign of heart disease. Needless to say that many of these products sold online (on the Internet) are particularly dangerous!
This does not mean that this is how long the erection will last, since these agents do not induce erection by themselves but only after sexual stimulation. Prostate hyperplasia is the most common disease causing urinary difficulty in men above 50 years old.
Even if occurring, these side effects are mild and subside immediately after the regimen is discontinued.
The injection is done by the patient himself, after he has been trained by the Urologist and after having together decided on the proper individualized dosage. The application of soundwave technology on the penile cavernous bodies promotes the formation of new penile vessels (neoangiogenesis), increases blood flow, improves penile blood perfusion and ultimately results in achieving better quality erections. It is imperative to comprehend the intricate mechanism of erection in order to individualize the approach to management. The proper functioning of the sexual apparatus is dependent not only on its nervous and muscular integrity, but also on the endocrinal and psychic factors. In the event of aroused libido, the brain center sends impulses to the spinal center, which in turn passes them expeditiously to the peripheral nerves of the penis. After orgasm is reached, the rhythmic contractions of the bulbocavernous and ischiocavernous muscles ejaculate the semen through the penis into the vagina.


With advanced techniques of diagnosis of the erectile functions it has been found that more than 75% of patients have organic causes.
Further, there is degeneration of the extra-corporeal smooth muscles resulting in venous leakage in the penis. Adrenal androgens, metabolite dehydroepiandrosterone sulfate, show a strong correlation with impotence.
To restore confidence, the patient is taught all the consecutive intricacies of the disorder until full rectification of the erectile dysfunction is achieved. The previously used phentolamine, which is an a1-adrenoceptor antagonist, is another safe and effective treatment. Nonorganic impotence responds positively with transbuccal apomorphine, but its use is limited by side effects such as orthostatic hypertension, nausea, vomiting, and persistent yawning. Sildenafil is a selective inhibitor of phosphodiesterase type 5, which results in the increased duration of action of intracorporeal cyclic guanosine monophosphate, that in turn results in the enhancement of normal erectile response (Figure 2).
Topical nitroglycerin paste, prostaglandin-E1,[48] and papavarine[49] have been used with variable success (Table III). MUSE (medicated urethral system for erection), a popularly known procedure, consists of insertion of a prostaglandin E1 pellet in the urethra through an applicator.[49] Urethral pain, bleeding, and priapism may be unwanted side effects. A simple recounting of sexual activity might distinguish among problems with erection, ejaculation, orgasm, or sexual desire. If nocturnal erections do not occur, then the cause of impotence is likely to be physical rather than psychological.
When plague builds up in the arteries because of damage to the endothelium caused by high blood pressure, smoking or high cholesterol, it leads to hardening of the arteries. The blood vessels that supply the penis (penile artery) are only 1-2 millimeters in diameter and the blood vessels that supply the heart (coronary artery) are 3-5 millimeters in diameter. It is estimated that by 2020 cardiovascular disease will be the cause of over 40% deaths in India as compared to 24% in 1990, with India set to be ‘heart disease capital of world’.
The first drug in the market was the injectable prostagladine E1, but the real breakthrough took place in 1998 with sildenafil for oral administration. They are all vasodilating agents; by improving penile blood perfusion, they achieve better penile rigidity and longer erectile duration.
So, what these agents actually achieve is allowing every patient to get involved in sexual activity whenever they wish to within the hours of their action. Tadalafil has been proven to help not only erection but also urination in BPH men, when there are symptoms such as urinary frequency, urgency or dysuria (painful urination). The drug acts topically, and erection is achieved 10-15 minutes following the injection, irrespective whether there is sexual desire. Malleable, or semi-rigid, prostheses are composed of two cylinders that are inserted within the two cavernous bodies, in order to achieve satisfactory penile erections. Other systems of the body are complementary and their disorders may ultimately affect this phenomenon, causing erectile dysfunctions. Sympathetic nerves, which act as a motor to the seminal tract, simultaneously close the internal vesicle sphincter, and thus prevent a reflex of semen into the bladder. Priapism or risk of ischemic injury to the intracavernous smooth muscles[5,7,11] are unwarranted side effects. This condition is called Atherosclerosis and it happens when bad cholesterol or LDL crosses the damaged endothelium and enters the wall of the artery. The smaller arteries in the body, such as in the penis, are the first to narrow down due to plaque deposition. A few years later, in 2003, two more pharmaceutical agents came out with the same indication: tadalafil and vardenafil.
It should be pointed out that food intake affects negatively the action of Sildenafil and Vardenafil (in the form to be swallowed, but not in the oral disintegrating form), whereas Tadalafil is not at all affected by food intake. After an experience of 18 years, ED drugs have proven to be safe as long as they are used according to the therapist physician’s instructions. In patients with severe erectile dysfunction, the success rate of the method drops to 50% and therapeutic efficacy reduces over time.
Thus, erection is a complex, involuntary, neuropsychological, hormone mediated vascular event that happens when blood flows rapidly into the penis and becomes trapped in its spongy chamber. An erector muscle of the penis (ischiocavernosus) draws the penis forward and makes it well adapted for penetration of the vagina.
Further, the contraction of detrusor vesicae and the associated inhibition of constrictor vesicae prevent a simultaneous discharge of urine. The psychogenic stimuli to the sacral cord may inhibit reflexogenic erection and subsequently activation of the parasympathetic dilator nerves to the penis. These drugs have been proven to significantly help erectile dysfunction (ED), and are administered ONLY WITH MEDICAL PRESCRIPTION. Avanafil is not affected by food intake either; however, its absorption is delayed when a high-fat meal  has preceded. Besides, two of them (sildenafil and tadalafil) are already used on a chronic daily basis for the treatment of another severe disease, pulmonary hypertension. Whenever the patient wants to achieve an erection, he presses the pump and the normal saline inside the reservoir ‘inflates’ the cylinders located inside the cavernous bodies. An increasing use of drugs, a legacy of civilization, has considerably compounded the problem.
Later, the cavernous smooth muscles become less sensitive to the neurotransmitters because of the excessive sympathetic outflow and elevated catecholamine levels. Over years, the accumulating mess of cholesterol, cells, and other debris becomes a plaque in the wall of the artery. When intercourse is completed, the man presses again the pump and the fluid flows back to the reservoir and erection subsides.
Therapy for erectile dysfunction, apart from psychosexual counseling, includes medical treatment by alpha adrenoceptor antagonists, dopamine agonists, phosphodiesterase type 5 inhibitors, sublingual apomorphine hydrochloride, or hormone therapy.
It should be pointed out that what we want to achieve with the injection is erection of 30 minutes to 1 hour at the most. The advantage of penile prostheses is that they have an excellent aesthetic result; however, they have a much higher cost compared to non-inflatable prostheses. Transdermal or transurethral corporeal drug delivery are other possible treatment modalities. Therefore, the patient should be well informed so that, in case priapism occurs, he immediately informs his physician to be treated as an emergency case. It should be known that erection prolongation of more than 6-8 hours may cause penile impairment and permanent severe erectile dysfunction (fibrosis within the corpora cavernosa). The patient can resume to his daily activities a few days after surgery and can start sexual activity after one month. It has been found that 30-50% of patients who select this form of therapy will continue using it after the first 3 months. When being well-informed, both patients and their partners present a satisfaction rate over 90%.
Complications are rare, with most severe complication the infection or mechanical failure of the prosthesis; in such a case, the prosthesis has to be immediately removed.
Although used worldwide as the most effective ED treatment, “tri-mix” is not available in the market. Out of its 3 ingredient drugs, only alprostadil is available in pharmacies, as it is the only agent prescribed and officially sold  (commercial brand: Caverject??) ONLY WITH MEDICAL PRESCRIPTION.
The dose is individualized for each patient, with a normal dose of 5-20?g and the maximum daily dose amounting to 40?g.



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