Combination therapy has proven effective for some men who don’t respond adequately to oral medicines. The idea is to use two drugs with different mechanisms of action for better results. Commonly, sildenafil is used in combination with pellets of alprostadil (synthetic prostaglandin E1) that are inserted into the urethra (the tube in the penis that carries urine from the bladder to the outside of the body). Alprostadil also increases the blood supply to the penis, but by different means.
This form of therapy has a response rate of well over 70%. The sympathetic nervous system normally maintains the penis in a flaccid or non-erect state. All of the vasoactive drugs, when injected into the corpora cavernosae, inhibit or override sympathetic inhibition to encourage relaxation of the smooth muscle trabeculae. The rush of blood engorges the penile corpora cavernosae sinusoidal spaces and creates an erection.
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.
Sexual dysfunction was rated for the last one year and temporary or situational complaints were ignored. Data regarding the quantity of alcohol usually consumed per day [in standard drinks; where 1 drink = 30 ml. Spirits = 330 ml. Beer = 1/3 sachet of arrack] and duration of dependence, was extracted from the items corresponding to the section on Mental and Behavioural disorders due to use of alcohol [F10.0] in the SCAN and used in the analyses. However, only the presence or absence of tobacco consumption and not a measure of severity was used for analyses. The ratings were sought after two weeks of inpatient stay after the period of detoxification with benzodiazepines.
Poor sleep patterns can be a contributing factor for erectile dysfunction, Mucher says. One review published in the journal Brain Research emphasized the intricate relationship between the level of sex hormones like testosterone, sexual function, and sleep, noting that testosterone levels increase with improved sleep, and lower levels are associated with sexual dysfunction. Hormone secretion is controlled by the body’s internal clock, and sleep patterns likely help the body determine when to release certain hormones.
The truth is medication or psychosexual counselling are the first treatments a doctor will suggest because they’ve been proven to work. If a doctor has approved a medication for you then it’s safe. If you would still like to see if herbal supplements work for you, then there is a list below of supplements thought to work for erectile dysfunction. Just before you invest your money in them, remember they aren’t proven to work:
The initial step in evaluating ED is a thorough sexual history and physical exam. The history can help in distinguishing between the primary and psychogenic causes. It is important to explore the onset, progression, and duration of the problem. If a man gives a history of “no sexual problems until one night,” the problem is most likely related to performance anxiety, disaffection, or an emotional problem. Aside from these causes, only radical prostatectomy or other overt genital tract trauma causes a sudden loss of male sexual function.
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.
Medications used in the treatment of other medical disorders may cause erectile dysfunction. If you think erectile dysfunction is caused by a medication, talk with your doctor about drugs that might not cause this side effect. Do not just stop taking a prescribed medication before talking with your health care provider. Common medications associated with erectile dysfunction are:
Problems with the veins that drain the penis can also contribute to erectile dysfunction. If the veins are not adequately compressed, blood can drain out of the penis while blood is coming into the penis and this prevents a fully rigid erection and maintaining an erection. Venous problems can occur as a result of conditions that affect the tissue that the veins are compressed against, the tunica albuginea. Such conditions include Peyronie's disease (a condition of the penis associated with scarring [plaques] in the tunica albuginea that may be associated with penile curvature, pain with erections, and ED), older age, diabetes mellitus, and penile trauma (penile fracture).
Currently, placement of a penile prosthesis is the most common surgical procedure performed for erectile dysfunction. Penile prosthesis placement is typically reserved for men who have tried and failed (either from efficacy or tolerability) or have contraindications to other forms of therapy including PDE5 inhibitors, intraurethral alprostadil, and injection therapy.
ED is common and has a significant impact on men and their partners. The first step is acknowledging that ED is affecting you and that it bothers you. If so, then it is time to get help. Often your primary care health provider can start the evaluation of your ED to determine if there are any potential reversible causes. It is important to be evaluated if you have ED as ED is often caused by medical conditions, which if not recognized and treated, could cause you harm. Did you know that the ED is a strong predictor of underlying cardiovascular disease? If you have underlying cardiovascular disease, your primary health care provider or a specialist (if needed) needs to make sure it is safe for you to participate in sexual activity.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.
The bad news: Men with diabetes are three times more likely to report having problems with sex than non-diabetic men. The most common sexual problem is Erectile Dysfunction, or ED, sometimes called impotence. Even worse, because ED is such a private issue, many men feel embarrassed to discuss the problem with their doctor, or even their partner, so the problem is never addressed.