The prostaglandin E1 is contained in a small suppository located at the tip of an applicator. You should urinate first as this lubricates the urethra and makes it easier to insert the applicator into the tip of the urethra (urethral meatus, the opening at the tip of the penis that urine passes through). A patient can release the suppository into urethra by gently wiggling the applicator and pressing the button at the end. Rubbing the penis allows the suppository to dissolve, and the prostaglandin is absorbed through the tissue of the urethra into the penis. It takes 15 to 30 minutes for this occur. Once into the penis, the prostaglandin causes increased blood flow into the penis. The prostaglandin can be present in the ejaculate, and thus doctors recommend that men use a condom when having intercourse with a pregnant partner. Men may need to use a condom if vaginal irritation occurs in female partner.
Remember those cultural messages we discussed earlier, about how men are wild sex aliens from the planet Weenus? Well, men are raised hearing those messages, too, and they can end up screwing with their sexual self-image —for instance, they can lead men to obsess over their own virility, and panic about impressing a new partner, until they've thought their boner into a corner and can't get an erection. Performance anxiety is one of the most common culprits behind lost erections, especially among younger, less experienced men.
Studies to further define vasculogenic disorders include pharmacologic duplex grey scale/color ultrasonography, pharmacologic dynamic infusion cavernosometry/ cavernosography, and pharmacologic pelvic/penile angiography. Cavernosometry, duplex ultrasonography, and angiography performed either alone or in conjunction with intracavernous pharmacologic injection of vasodilator agents rely on complete arterial and cavernosal smooth muscle relaxation to evaluate arterial and veno-occlusive function. The clinical effectiveness of these invasive studies is severely limited by several factors, including the lack of normative data, operator dependence, variable interpretation of results, and poor predictability of therapeutic outcomes of arterial and venous surgery. At the present time these studies might best be done in referral centers with specific expertise and interest in investigation of the vascular aspects of erectile dysfunction. Further clinical research is necessary to standardize methodology and interpretation, to obtain control data on normals (as stratified according to age), and to define what constitutes normality in order to assess the value of these tests in their diagnostic accuracy and in their ability to predict treatment outcome in men with erectile dysfunction.
Psychological processes such as depression, anxiety, and relationship problems can impair erectile functioning by reducing erotic focus or otherwise reducing awareness of sensory experience. This may lead to inability to initiate or maintain an erection. Etiologic factors for erectile disorders may be categorized as neurogenic, vasculogenic, or psychogenic, but they most commonly appear to derive from problems in all three areas acting in concert.
Psychosocial factors are important in all forms of erectile dysfunction. Careful attention to these issues and attempts to relieve sexual anxieties should be a part of the therapeutic intervention for all patients with erectile dysfunction. Psychotherapy and/or behavioral therapy alone may be helpful for some patients in whom no organic cause of erectile dysfunction is detected. Patients who refuse medical and surgical interventions also may be helped by such counseling. After appropriate evaluation to detect and treat coexistent problems such as issues related to the loss of a partner, dysfunctional relationships, psychotic disorders, or alcohol and drug abuse, psychological treatment focuses on decreasing performance anxiety and distractions and on increasing a couple's intimacy and ability to communicate about sex. Education concerning the factors that create normal sexual response and erectile dysfunction can help a couple cope with sexual difficulties. Working with the sexual partner is useful in improving the outcome of therapy. Psychotherapy and behavioral therapy have been reported to relieve depression and anxiety as well as to improve sexual function. However, outcome data of psychological and behavioral therapy have not been quantified, and evaluation of the success of specific techniques used in these treatments is poorly documented. Studies to validate their efficacy are therefore strongly indicated.
The general medical history is important in identifying specific risk factors that may account for or contribute to the patient's erectile dysfunction. These include vascular risk factors such as hypertension, diabetes, smoking, coronary artery disease, peripheral vascular disorders, pelvic trauma or surgery, and blood lipid abnormalities. Decreased sexual desire or history suggesting a hypogonadal state could indicate a primary endocrine disorder. Neurologic causes may include a history of diabetes mellitus or alcoholism with associated peripheral neuropathy. Neurologic disorders such as multiple sclerosis, spinal injury, or cerebrovascular accidents are often obvious or well defined prior to presentation. It is essential to obtain a detailed medication and illicit drug history since an estimated 25 percent of cases of erectile dysfunction may be attributable to medications for other conditions. Past medical history can reveal important causes of erectile dysfunction, including radical pelvic surgery, radiation therapy, Peyronie's disease, penile or pelvic trauma, prostatitis, priapism, or voiding dysfunction. Information regarding prior evaluation or treatment for "impotence" should be obtained. A detailed sexual history, including current sexual techniques, is important in the general history obtained. It is also important to determine if there have been previous psychiatric illnesses such as depression or neuroses.
The recommended starting dose of tadalafil for use as needed for most patients is 10 mg taken orally approximately one hour before sexual activity. A doctor may adjust the dose higher to 20 mg or lower to 5 mg depending on efficacy and side effects. Doctors recommended that patients take tadalafil no more frequently than once per day. Some patients can take tadalafil less frequently since the improvement in erectile function may last 36 hours. Patients may take tadalafil with or without food. Tadalafil is currently the only PDE5 inhibitor that is FDA-approved for daily use for erectile dysfunction and is available in 2.5 mg or 5 mg dosages for daily use.
Since no two men are alike, the best ED treatment plan will depend on what’s causing your problem. That’s why you need to put aside your embarrassment and make an appointment to visit with see a qualified doctor who specializes in helping guys get back to enjoying their time with their spouses or partners to the fullest. You’ll be relieved to talk to someone who understands and has solutions.
Jenna finds working with and helping people on a daily basis combines her two greatest passions - health care and helping others to make a difference in their lives. Prior to Lemonaid, she was a Certified Nursing Assistant caring for senior citizens, had advocated and provided resources for the mentally ill, and also had customer service experience in the field of behavioral health. Jenna graduated from the University of Arizona with a degree in Psychology.
Name of DrugWhen to TakeDoseDietary RestrictionsViagraTake between 30 and 60 minutes (and up to 4 hours) before sex; works for about 4 hoursRecommended dose for most men is 50mgs; after that, dosage may go to as high as 100mg, or as low as 25mg, which may be prescribed for men over 65.Quickly absorbed by the body, less effective after a high-fat meal, and best taken on an empty stomach.Name of DrugWhen to TakeDoseDietary RestrictionsLevitraTake 1 hour before sex; works for 4 to 5 hours, and may be slightly more effective than ViagraStarting dose for most men is 10mgs a day, but men over 65 often start on the 5mg pill.Can be taken with or without food, although slightly less effective after a high-fat meal. Avoid anything containing grapefruit juice; it may make side effects worse.Name of DrugWhen to TakeDoseDietary RestrictionsCialisComes in two forms. The daily pill stays effective in between doses, but may take 4 to 5 days before it begins working. The “weekender” version of Cialis can start working in as little as 30 minutes for men who take the highest dose of the drug (20mgs); it stays effective in the body for up for 36 hours.Daily pill comes in both a 2.5mg and 5mg tablet; most men start with the lower dose. The use-as-needed, “weekender” pill comes in 5, 10 and 20mg strengths; recommended starting dose is 10mg,Can be taken with or without food. Avoid heavy drinking (5 glasses of wine or 5 shots of whiskey); when combined with Cialis, it can lead to headaches, dizziness, an increase in heart rate, and a drop in blood pressure.Name of DrugWhen to TakeDoseDietary RestrictionsStaxyn Take 1 hour before sex, although many men report erections in 20 to 30 minutes. Because Staxyn comes in a sleek black package and is taken as a rapidly dissolving tablet (without water), some men think of it as a more discrete way to treat ED.Comes in 10mg tablets; do not take more than 1 a day.Avoid taking it with any kind of liquid. Should be placed directly on the tongue and allowed to dissolve without chewing.Name of DrugWhen to TakeDoseDietary RestrictionsStendraPrescribing information now recommends taking it 30 minutes before sex. Some men, however, report results in as little as 10 to 12 minutes, depending on the dose. Because of these findings, Auxilium Pharmaceuticals, the Chesterbrook, Pa., company that has U.S. marketing rights to the drug, has asked the FDA to revise the prescribing information.Starting dose is 100mgs for most men, but the 50mg tablet is recommended for men taking alpha-blocker drugs, like those used for high blood pressure and prostate problems.May be taken with or without food, and with a moderate amount of alcohol (3 drinks). Drinking more than that can increase the chances of side effects like rapid heart rate, low blood pressure, dizziness and headaches.Name of DrugWhen to TakeDoseDietary RestrictionsPenile injections & the MUSE suppositoryTake 5 to 10 minutes before planning to have sex; erections last for 30 to 60 minutes.MUSE comes in 4 dosage strengths; most men start at 125mgs. Avoid taking more than twice within a 24-hour period.N/A
Erectile dysfunction (ED) affects 50% of men older than 40 years,  exerting substantial effects on quality of life.  This common problem is complex and involves multiple pathways. Penile erections are produced by an integration of physiologic processes involving the central nervous, peripheral nervous, hormonal, and vascular systems. Any abnormality in these systems, whether from medication or disease, has a significant impact on the ability to develop and sustain an erection, ejaculate, and experience orgasm.
It can also help to tell your partner (either before you start or when it happens) that hey, sometimes it takes your penis a while to warm up or sometimes it comes and goes as it pleases — and that they shouldn't take it personally and you won't let it ruin the moment. When it happens, take a few deep breaths, focus on your partner, and go back to doing whatever was feeling good before. "If they approach that with authentic confidence, the partner is usually like 'OK, cool,'" says Skyler. "Remember, you're more than just your penis."
Psychological factors — Psychological issues such as depression, anxiety, guilt or fear can sometimes cause sexual problems. At one time, these factors were thought to be the major cause of impotence. Doctors now know that physical factors cause impotence in most men with the problem. However, embarrassment or "performance anxiety" can make a physical problem worse.
Only a small proportion of cases of erectile dysfunction are caused by hormone abnormalities. The most frequent hormone abnormality is a reduced level of the male sex hormone testosterone required to get an erection which can be restored by appropriate hormone replacement. It's unwise to take testosterone preparations unless you've had tests that confirm a deficiency.
If you just got off solo, you might have to wait before you can hop into bed with your partner, says Dr. Brahmbhatt. It might have something to do with a spike in the hormone prolactin after you orgasm, according to a study published in the International Journal of Impotence Research. This hormone has been linked to difficulties maintaining an erection or even ejaculating.
Your boyfriend is having a pretty normal problem but because guys are so insecure, they almost never talk about it. That silence often makes guys, especially young guys, panicky — like they’re the only ones in the world dealing with this problem. That freaks them out even more, and that anxiety feeds on itself in a fairly classic and unfortunately common pattern: When a guy has trouble getting it up, he gets so down that the impotence gets worse before it gets better. Anxiety-driven impotence can be a vicious cycle: Quite unlike his dick, the problem just grows and grows.
In the meantime, make sure he gets some rest and takes it easy. The more you two stress about it — and the more pressure he feels you are putting on him — the harder it will get for him to get hard, in all likelihood. So take a few days off. Relax, be patient, and help him find him some help if he needs it. In the meantime, here's a Cosmopolitan.com guide about exactly this topic from sex therapist Dr. Jane Greer.
Ultrasound with Doppler imaging (ultrasound plus evaluation of blood flow in the arteries and veins) can provide additional information about blood flow of the penis and may help in the evaluation of patients prior to surgical intervention. This study is typically performed after the injection of a chemical that causes the arteries to open up, a vasodilator (prostaglandin E1), into the corpora cavernosa in order to cause dilation of blood vessels and promote blood flow into the penis. The rate of blood flow into the penis can be measured along with an evaluation of problems with compression of the veins.
Some may use alcohol as a way to get into the mood and overcome some of the nerves associated with having sex, but too much of a good thing can actually backfire. In fact, having a long history of alcohol abuse may lead to long-term erectile dysfunction. As many as 70 percent of men with chronic erectile dysfunction also have a history of alcohol abuse.
The circulatory system plays a central role in obtaining and sustaining erections. Augmentation of blood flow to the corporal bodies depends on the intravascular pressure in the penile artery. Vascular lesions—typically atherosclerotic, but occasionally fibrotic—and systemic hypotension will limit flow to the corpora. In certain patients, blood flow at rest may be sufficient to obtain an erection but not sufficient to maintain it during intercourse, when the pelvic musculature places greater demands on a compromised blood supply.
The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) study, designed to determine whether an individual man’s sexual outcomes after most common treatments for early-stage prostate cancer could be accurately predicted on the basis of baseline characteristics and treatment plans, found that 2 years after treatment, 177 (35%) of 511 men who underwent prostatectomy reported the ability to attain functional erections suitable for intercourse. 
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Can apple cider vinegar treat erectile dysfunction? Apple cider vinegar is thought to have many health benefits, but can it help treat erectile dysfunction (ED)? ED can result from cardiovascular problems, diabetes, and other factors. Apple cider vinegar may help improve symptoms of conditions related to ED. Find out how it may help, and how to use it safely. A Home-Based Walking Program Improves Erectile Dysfunction in Men With an Acute Myocardial Infarction. The American Journal of Cardiology, 115(5), 5741-575. Retrieved from http://www.ajconline.org/article/S0002-9149(14)02270-X/abstract