Sexual dysfunction and ED become more common as men age. The percentage of complete ED increases from 5% to 15% as age increases from 40 to 70 years. But this does not mean growing older is the end of your sex life. ED can be treated at any age. Also, ED may be more common in Hispanic men and in those with a history of diabetes, obesity, smoking, and hypertension. Research shows that African-American men sought medical care for ED twice the rate of other racial groups.
Malleable implants usually consist of paired rods, inserted surgically into each of the corpora cavernosa. The rods are stiff, and to have an erection, one bends them up and then when finished with intercourse one bends them down. They do not change in length or width. The malleable implants are the least mechanical and thus have the lowest risk of malfunction. However, also have the least "normal appearance."

Dr. Matthew Walvick, D.O. is a board certified Internal Medicine physician. He completed his undergraduate education at UCLA. He received his medical degree from Touro University College of Osteopathic Medicine in Vallejo, California. He completed his Internal Medicine residency at UCSF's Fresno Medical Education Program. Prior to joining Lemonaid Health, Dr. Walvick was a practicing primary care physician at John Muir Health and then doing house calls with the start-up Heal. Dr. Walvick is excited to be a part of the Lemonaid Health team making healthcare refreshingly simple.

Lindsay Mitchell, ARNP is a Board Certified Family Nurse Practitioner and graduated with high honors from South University in Savannah, GA. She has a background in primary care, women’s health and focusing on evidence based practices. She has a strong passion for providing efficient and accessible patient care, along with caring for underserved patient populations. Prior to becoming an ARNP, she worked as a registered nurse in the emergency department in Jacksonville, Fl.

In one study, 9.6% reported ‘occasional’ erectile dysfunction, 8.9% reported erectile dysfunction occurring ‘often’, and 18.6% reported erectile dysfunction occurring ‘all the time’. Of these, only 11.6% had received treatment.In another study, only 14.1% of men reported that they had received treatment, despite experiencing erectile dysfunction for longer than 12 months.

I know it’s awkward to talk about money like you’re business partners but partners is just what you are: You’re fiancés who share finances. So you need to be very clear about what this merger means. Right now, it doesn’t sound like you’re being very transparent with each other. Why were you surprised to find he was making more and contributing less than you feel he should? Do you not know how much he makes? Does he not know how much you expect him to pay back?
Your erection problems may be putting a strain on your relationship. You may have stopped touching and cuddling your partner, scared that it could lead to sex - and then to disappointment because you cannot get hard. You may have found it has led to regular arguments. At its worst, erection problems can lead to the breakdown of relationships. So it is vitally important to talk things over with your partner.
So here’s something that’s really fascinating. Healthy eating is a way to reduce anxiety and stress. Now how, you may be asking, right? Well, think about it. We live in a world where there are so many variables and where we don’t have control over our lives. But now, with healthy eating, we have control over what goes into our body. And now having that control empowers us to be even healthier, to be more directive in what we do. And certainly, that begins then to reduce the anxiety and the stress. So all in one, you have a healthier body, but certainly a healthier mind.
Stress is your body responding to your environment. And it’s a good thing—in limited doses. When you get stressed out your body makes chemicals like adrenaline that make you stronger, faster, fitter, and even able to think more clearly. Most people call this reaction the “fight-or-flight” response, and it’s a life-saver in dangerous situations. In a very real sense, adrenaline makes you a part-time superhero. The problems happen when your body deals with constant stress.

Don’t give up or blame yourself - you shouldn’t assume that your situation is impossible to improve or that your partner is disappointed in you. Studies show as long as you don’t stop trying to engage your partner sexually, they will still respond positively. If you communicate and stay positive you can work with your partner to get the result you’re looking for.
Smoking damages blood vessels, inhibiting blood flow throughout the body ... and I mean throughout the body. While studies have found that men with erectile problems only make up 20 percent of the general population, 40 percent of men with erectile problems are smokers. And a 2011 study of a group of male smokers with erectile problems found that 75 percent of them saw those erectile problems disappear after they quit.
This penile tumescence monitor is placed at the base and near the corona of the penis. It is connected to a monitor that records a continuous graph depicting the force and duration of erections that occur during sleep. The monitor is strapped to the leg. The nocturnal penile tumescence test is conducted on several nights to obtain an accurate indication of erections that normally occur during the alpha phase of sleep.

Stop trying to force the erection - it’s not possible to give yourself an erection just by trying hard enough, if it were then you wouldn’t be reading this. An erection is known as an ‘unconscious response’, meaning you can’t control it by thinking about it. In fact focusing on your erection too much is more likely to block it, so try instead to focus something else, such as:
In most healthy men, some of the drug will remain in the body for more than two days after a single dose of tadalafil. Metabolism (clearing of the drug from the body) of tadalafil can be slowed by liver disease, kidney disease, and concurrent use of certain medications (such as erythromycin, ketoconazole, and protease inhibitors). Slowed breakdown allows tadalafil to stay in the body longer and potentially increase the risk for side effects. Therefore, doctors have to lower the dose and frequency of tadalafil in the following examples:
Everyone knows that regular exercise is good for the body and the mind, and in many cases, exercise can be good for relieving stress and helping men’s bodies produce more testosterone. In some cases, however, exercise can be detrimental. This is the case in cycling as long and regular rides can cause the nerves in the perineum to be compacted, leading to a loss of feeling in the penis and/or testicles. Over time, this nerve compaction and damage may lead to either erectile dysfunction or ejaculatory dysfunction.

Since endothelial dysfunction, CVD and ED are closely associated in epidemiological studies, the question for clinicians is whether to recommend the man presenting with ED undergo a cardiovascular (CV) evaluation. Clearly, based on numerous studies, ED can be considered at least a ‘marker’ for possible further vascular disease or CVD.15 In their report, Vlachopoulos and coworkers make the point that the man presenting with ED, the clinician, is offered an opportunity to attempt to improve the health of the man by addressing lifestyle modification, and consider further vascular evaluation owing to the clear relationship between endothelial dysfunction, ED and CVD.19


Men are very susceptible to visual stimulation, particularly as children and teenagers. Seeing anything appealing (say, a person or image) activates pathways in the brain that tell nerves in your lower spinal cord to trigger a release of nitric oxide, which relaxes blood vessel walls and floods your penis with blood, making it hard. Nitric oxide is the key chemical here, as you need a mix released from your nerves AND from your blood vessels to get an erection. If the blood vessels, nerves, or both are damaged, it's difficult to get a hard erection. That's why your doctor may well be interested if you're struggling with erections, as it could be a sign of early heart disease or diabetes.

Vascular: Anything that affects the flow of blood to the penis can result in erectile dysfunction. The main culprit tends to be atherosclerosis, the condition that narrows arteries and which can result in poor blood circulation, high blood pressure, heart disease and stroke. Atherosclerosis causes about half the cases of erectile dysfunction in men over 50. Also, the veins through which the blood leaves the penis may not be working properly, allowing the blood to leave too soon.
It is estimated that up to 20 million American men frequently suffer from impotence and that it strikes up to half of all men between the ages of 40 and 70. Doctors used to think that most cases of impotence were psychological in origin, but they now recognize that, at least in older men, physical causes may play a primary role in 60% or more of all cases. In men over the age of 60, the leading cause is atherosclerosis, or narrowing of the arteries, which can restrict the flow of blood to the penis. Injury or disease of the connective tissue, such as Peyronie's disease, may prevent the corpora cavernosa from completely expanding. Damage to the nerves of the penis, from certain types of surgery or neurological conditions, such as Parkinson's disease or multiple sclerosis, may also cause impotence. Men with diabetes are especially at risk for impotence because of their high risk of both atherosclerosis and a nerve disease called diabetic neuropathy.
ED is often the result of atherosclerosis, and as a result, men with ED frequently have cardiovascular disease. Sexual activity is associated with increased physical exertion, which in some men may increase the risk of having a heart attack (myocardial infarction or MI). The major risk factors associated with cardiovascular disease are age, hypertension, diabetes mellitus, obesity, smoking, abnormal lipid/cholesterol levels in the blood, and lack of exercise. Individuals with three or more of these risk factors are at increased risk for a heart attack during sexual activity. The Princeton Consensus Panel developed guidelines for treating ED in men with cardiovascular disease. Thus, if you have ED and cardiovascular disease (for example, angina or prior heart attack), you should discuss whether or not treatment of ED and sexual activity are appropriate for you.
Picture the scene. You get home from the bar with your date. You both decided to leave a little early, after only two drinks, because the chemistry was really there and both of you wanted to cut to the chase and get intimate. To discover each other's bodies. To eat of the fruits of passion. In short, to have sex. You stick the key in the lock, swing the door open, and invite her into your beautiful place. OK, well it might not be exactly beautiful. It might be a bit of a mess, frankly. But you don't let that ruin the moment. You turn around and passionately kiss her. How the two of you make it to your bedroom with some clothing still on is anybody's guess. You jump on the bed and hurriedly strip. God — can't this go any faster, you wonder? 

All NOS subtypes produce NO, but each may play a different biologic role in various tissues. nNOS and eNOS are considered constitutive forms because they share biochemical features: They are calcium-dependent, they require calmodulin and reduced nicotinamide adenine dinucleotide phosphate for catalytic activity, and they are competitively inhibited by arginine derivatives. nNOS is involved in the regulation of neurotransmission, and eNOS is involved in the regulation of blood flow.
A system for inserting a pellet of alprostadil into the urethra is marketed as MUSE. The system uses a pre-filled applicator to deliver the pellet about an inch deep into the urethra at the tip of the penis. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects of the preparation are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness of the penis due to increased blood flow; and minor urethral bleeding or spotting.
The inflatable type of device consists of cylinders that are implanted in the corpora cavernosa, a fluid reservoir implanted in the abdomen, and a pump placed in the scrotum. The man squeezes the pump to move fluid into the cylinders and cause them to become rigid. (He reverses the process by squeezing the pump again.) While these devices allow for intermittent erections, they have a slightly higher malfunction rate than the silicon rods.
Injection of vasodilator substances into the corpora of the penis has provided a new therapeutic technique for a variety of causes of erectile dysfunction. The most effective and well-studied agents are papaverine, phentolamine, and prostaglandin E[sub 1]. These have been used either singly or in combination. Use of these agents occasionally causes priapism (inappropriately persistent erections). This appears to have been seen most commonly with papaverine. Priapism is treated with adrenergic agents, which can cause life-threatening hypertension in patients receiving monoamine oxidase inhibitors. Use of the penile vasodilators also can be problematic in patients who cannot tolerate transient hypotension, those with severe psychiatric disease, those with poor manual dexterity, those with poor vision, and those receiving anticoagulant therapy. Liver function tests should be obtained in those being treated with papaverine alone. Prostaglandin E[sub 1] can be used together with papaverine and phentolamine to decrease the incidence of side effects such as pain, penile corporal fibrosis, fibrotic nodules, hypotension, and priapism. Further study of the efficacy of multitherapy versus monotherapy and of the relative complications and safety of each approach is indicated. Although these agents have not received FDA approval for this indication, they are in widespread clinical use. Patients treated with these agents should give full informed consent. There is a high rate of patient dropout, often early in the treatment. Whether this is related to side effects, lack of spontaneity in sexual relations, or general loss of interest is unclear. Patient education and followup support might improve compliance and lessen the dropout rate. However, the reasons for the high dropout rate need to be determined and quantified.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
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