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Erectile Dysfunction: Lifestyle Changes to Improve ED
"The findings presented by these authors are interesting and certainly have potential clinical implications for the various forms of dystrophinopathy [heart damage]," she said, adding that heart failure is a major cause of illness and death in late-stage Duchenne muscular dystrophy.
Article and Author Information
A test that was frequently performed in the past was nocturnal penile tumescence testing. This was thought to be useful in distinguishing psychogenic from organic impotence. This test involves placing a band around the penis and instructing the patient to wear it for 2-3 successive nights. If an erection occurs, which is expected during rapid eye movement sleep, the force and duration are measured on a graph. Inadequate or absent nocturnal erections suggest an organic dysfunction, while a normal result indicates a high likelihood of a psychogenic etiology. Other devices are available to provide similar information. Some are also able to measure rigidity (resistance to mild compression) and tumescence (size). This test is rarely used in current practice, but it can be helpful in situations in which the diagnosis is in doubt.
Alprostadil (Alprox TD)
"Most of us think that one of the measurements one must do when you have a patient with newly diagnosed [erectile dysfunction] is look at testosterone levels," says Glenn Cunningham, MD, spokesman for the Endocrine Society and a professor at Baylor College of Medicine in Houston.
In fact, the most favorable risk/ benefit ratio is seen with a dose optimization regimen of 3mg, with the 3mg dose providing efficacy comparable to that of 4mg, but with fewer side effects. (15)
"If you suddenly start trotting out all your old Victoria's Secret underwear -- or buy some sexy new clothes -- well, that's only going to put more pressure on him, and it's not going to help the ED one bit," says Foley.
One drawback to the use of these external vacuum devices is the need to assemble the equipment and the difficulty in transporting it. Many patients lose interest in using the device because of the preparations that are necessary, the lack of easy transportability, the inability to hide the tension ring, and the relative lack of spontaneity. Approximately half the men who use a vacuum device obtain very good erections, but only half of these men consistently use the device for a prolonged period.
The safety and efficacy of tadalafil in the treatment of erectile dysfunction was evaluated in 22 clinical trials involving more than 4,000 men. Seven of these trials were randomized, prospective, placebo-controlled studies of 12 weeks' duration. Two of these studies (involving 402 men) were conducted in the Untied States, and the other five studies (involving 1112 men) were conducted outside the Untied states. Two of these trials were conducted in special erectile dysfunction populations; one in men with diabetes mellitus, another in men who developed erectile dysfunction after nerve-sparing prostate cancer surgery.
Watchful waiting means a "wait-and-see" approach. A single episode of an erection problem is often a temporary and easily reversible problem. Do not assume it will happen again. If possible, forget about it and expect a more successful experience the next time. If you or your partner is concerned about it, talk about the problem and openly discuss your fears and anxieties.
Lifetime Piling Up
One simple device now making a comeback is the penile pump. It's a vacuum pump that lets a man draw blood into the penis. A constriction ring placed at the base of the penis keeps the penis erect during intercourse.
Some evidence suggests that smaller penis size is associated with erectile dysfunction.
"There is an association, but we don't know which one comes first," said study author Dr. Xiang Gao, an instructor in medicine at Harvard University School of Public Health. If researchers do discover how they're connected, it could lead to more effective treatments, he said.
The most important concern is the labeled contraindication for patients taking nitrates of any kind because of the potential for sudden severe hypotension. Patients taking nitrates have high levels of nitric oxide in the bloodstream. Sildenafil potentiates the effect of the nitrates by inhibiting the breakdown of cGMP, causing hypotension due to severe vasodilation.
Reviewed by the doctors at the Glickman Urological Institute at The Cleveland Clinic.
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