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27.04.2016
Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Erectile dysfunction is the inability to achieve and maintain an erection sufficient for satisfactory sexual intercourse. It may result from any one of the following factors: psychological, neurologic, hormonal, arterial, and venous.
Penile erection is an event that has physiological, psychological and hormonal aspects to it. Hormonally, a low testosterone state results in a decrease in nighttime erections and decreases sex drive.
The penis is essentially a complex blood vessel that fills and empties in response to nerve and hormonal signals. Erectile dysfunction can be the presenting symptom for a variety of diseases such as diabetes mellitus, heart disease, hyperlipidemia, high blood pressure, spinal-cord compression, and pituitary tumor. It is important to understand the goals and preferences of the patient when treating erectile dysfunction, as this issue largely drives therapy. Until other treatments became more popular in the 1980s and 1990s, psychotherapy was the mainstay of ED treatment.
Drugs for treating ED can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis.
Testosterone pills can reduce ED in some men with low natural testosterone levels, but it is often ineffective and may cause liver damage. Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood.
Mechanical vacuum devices induce erections by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. Surgical procedures to improve erections are performed for 3 reasons: to implant a device that can cause the penis to become erect, to reconstruct arteries and increase penile blood flow, and to occlude veins that allow blood to leak out of the penis and cause ED.
Surgical treatment is typically a last resort for erectile dysfunction a€“ and often involves an inflatable device. Recognizing that the balls are the source of sperm led many doctors to attempt to cure erectile dysfunction with transplants.
I want to get a vending machine, with fun sized candy bars, and the glass in front is a magnifying glass. Yes, I would like to receive occasional email offers from our affiliated websites, partners and sponsors. Recently it has become quite clear that, in many cases, erection dysfunction can be a “silent marker” for the later development of cardiovascular disease. Upon sexual stimulation, nerve impulses from the cavernous nerves in the penis stimulate relaxing factors from cells inside the penis, resulting in relaxation of smooth muscle in the arteries of the penis with a 20 fold increase in blood flow into the penis. Within the muscle lining the cells inside the penis, nitric oxide causes higher levels of cyclic guanosine monophosphate (GMP).
It is made up of the same cells that make up other blood vessels and is subject to the same changes with age and disease as are other blood vessels. As men age, the latency period between erections after ejaculation increases, erections are less firm, ejaculation is less forceful, and the semen volume decreases. Therefore, a thorough patient history, physical examination and appropriate lab tests aimed at detecting these diseases are undertaken. Healthy lifestyle changes like quitting smoking, losing excess weight, gaining better control of diabetes and increasing physical activity may improve overall health and also help some men regain sexual function. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use these drugs because the combination can cause a sudden drop in blood pressure.


Other forms of testosterone may be safer than oral testosterone; however, only a small proportion of ED (estimated at 6%) is due to low testosterone. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (prostaglandin E2) dilate blood vessels by a mechanism slightly different than the phosphodiesterase inhibitors and can help induce and maintain erections. The system uses a prefilled applicator to deliver the pellet about an inch deep into the urethra. The best candidates for such surgery are young men with a well-defined blockage of an artery because of pelvis injury or fracture. What follows is relaxation of the smooth muscle lined spaces within the penis and rapid filling and expansion of these spaces causing penile enlargement. Cyclic GMP results in a block in calcium influx, smooth muscle relaxation, and an erection.
Organic causes include medication-related ED, or that due to medical, vascular or neurological disease.
High prolactin levels are a medically important cause of both decreased sex drive and poor erections in young men and is medically treatable. It is now clear that the same risk factors that occur for heart attacks and strokes, termed cardiovascular risks factors, are also important in the development of erectile dysfunction.
A recent study in the Journal of the American Medical Association followed men age 55 and older for over 7 years and assessed them for both erectile dysfunction and cardiovascular disease, including heart attacks and strokes. There is also a decrease in serum testosterone concentration in men with age but it is not felt to be the major contributor to the changes in erections as men age. Standardized, validated survey instruments such as the SHIM-5 are now available to assess erectile dysfunction (Figure 1).
Since that time, vardenafil (Levitra), tadalafil (Cialis), and avanafil (Stendra) have also been approved. One of these medications may cause a sudden drop in blood pressure when taken with an alpha-blocker.
Other drugs (including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone) may be effective for ED, but studies to substantiate these claims are inconsistent. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring.
Implants are devices, however and have complications that include mechanical breakdown, erosion and infection.
The procedure is almost never successful in older men with diffuse vascular disease due to atherogenesis. The pump sits under the loose skin of the scrotal sac.Pressing on the pump pushes the fluid into the balloons and the penis should become erect within 30 seconds. Due to this, the small veins that normally drain the penis become compressed thus stopping outflow of blood from the penis.
Sildenafil, vardenafil tadalafil, and avanafil are drugs currently FDA approved to treat erection dysfunction and they work by blocking the breakdown of the energy molecule cyclic GMP. These risk factors include: high blood pressure, elevated cholesterol and lipid levels, obesity, cigarette smoking and diabetes mellitus. In patients with new erectile dysfunction there was a 25% increased risk for heart attacks, strokes, chest pain, or mini-strokes, compared to men with no erectile dysfunction. Often, the characteristics of the erection problem can help with the diagnosis: with arterial problems, more stimulation may be needed to achieve an erection, whereas with venous leak, an erection is easily achieved but lost very quickly.
If an isolated low testosterone level is found, then testosterone replacement may be the treatment of choice. Surgery to tie off veins permitting blood to leak from the penis has the opposite goal: to reduce leakage of blood out of the penis that causes ED.


The first drug lord to fly cocaine into the United States, Carrillo supposedly died on the operating table whilst undergoing plastic surgery to alter his appearance.
Frank Lydston implanted the testicle of a suicide victim into his own scrotum, kicking off a wave of experiments that saw doctors doing all kinds of shenanigans down there. These events effectively trap the blood within the penis and raise the penis from flaccid to erect position. They are related to stress (emotional or physical), performance anxiety, strained relationship, lack of sexual arousability, and to depression and schizophrenia.
Many of these symptoms have now been termed the “metabolic syndrome.” For this reason, men with otherwise unexplained erectile dysfunction and who harbor such risk factors should also be evaluated for cardiovascular risk.
In fact, ED is as important a cardiovascular disease risk factor as is smoking or a family history of heart disease.
Recommended lab tests include urinalysis, complete blood count, and measurement of fasting blood glucose, cholesterol and triglycerides, and testosterone. Taken an hour before sexual activity, they work by enhancing the effects of nitric oxide, which relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.
Given the complexity of the venous drainage patterns from the penis, this type or penile surgery is rarely done in men with mild to moderate ED. There are some risks attached to the operation, though, including infection and damage to the penis,' he said. One California doctor implanted testicles from death row convicts as well as injecting men with solutions made from boar, ram and goat testes.
Before ejaculation, a reflex is triggered (bulbocavernosus) which causes the muscles that surround the penis to forcefully compress the penis, such that the blood pressure within the penis reaches levels that exceed that found elsewhere in the body. Essentially these drugs work by giving the same stimulatory effect that coffee has on the body, but to the penis instead.
Indeed, it is also true that among patients who seek medical care for ED, nearly 20% have undiagnosed high blood pressure, 15% have diabetes, and 5% may have significant heart disease. If cardiovascular risk factors exist, then patients should be recommended to undergo cardiac evaluation before treatment is considered.
While these drugs improve the response to sexual stimulation, they do not trigger an automatic erection. Needless to say, none of this stuff had any positive effect, despite their claims to the contrary.
The penis falls when there are no more energy molecules available, or due to nervous system discharge during ejaculation. The majority of men with ED will respond to these drugs and for this reason, they are considered first line therapy for ED. Inflatable implants consist of paired cylinders that are surgically inserted inside the penis and then expanded using pressurized fluid from a co-implanted fluid reservoir and a pump. This discharge results in a latency period or “down time” during which it is difficult to achieve another erection. The cylinders are inflated by pressing on the scrotal pump and reproduce a more natural erection with expansion of both the width and length of the penis.



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Category: Duration Of Ed Treatment



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