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Patches now available Intracavernosal administration of alprostadil (Caverject) has reported success rates of 67 to 85 percent and has been used in the treatment of erectile dysfunction for several years.11 When injected directly into the corpus cavernosum, alprostadil (prostaglandin E1) acts on the arteriolar smooth muscle cells, causing them to relax and produce an erection, usually within several minutes. Its mechanism of action is to stimulate an increase in the levels of intracellular cyclic nucleotides that cause relaxation. The usual dose is between 5 and 40 g per injection. The current average wholesale price ranges from about $86 for six of the 5-mg doses to approximately $163 for six of the 40-g doses.12 Patients usually start at 2.5 g and titrate up in 5-g increments for effect, with a maximum dose of 60 g. No more than three injections per week are recommended, with a minimum period of 24 hours between injections.13 Initial dosing and required adjustments should be carried out in the physician's office. Several medications are being studied for treating erectile dysfunction; they include IC351 (another PDE5 inhibitor), sublingual apomorphine, and the combination of yohimbine and L-arginine. Scientists also are studying gene therapy to treat erectile dysfunction. Herbal and other alternative treatments The study, "Lack of Central Nitric Oxide Triggers Erectile Dysfunction in Diabetes," was conducted by Hong Zheng, William G. Mayhan, and Kaushik P. Patel, Departments of Cellular and Integrative Physiology; and Keshore R. Bidasee, Department of Pharmacology, University of Nebraska Medical Center, Omaha, NE. The results appear in the March 2007 edition of the American Journal of Physiology Regulatory, Integrative and Comparative Physiology, one of 11 peer-reviewed scientific publications issued monthly by The American Physiological Society (APS) (www.The-APS.org). What Doctors Treat ED? ERECTILE DYSFUNCTION cialis Memory loss Compulsive behaviors There have been rare reports of priapism (prolonged and painful erections lasting more than 6 hours) with the use of oral PDE5 inhibitors such as vardenafil, sildenafil and tadalafil. Patients with blood cell diseases such as sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks of developing priapism. Priapism untreated can cause injury to the penile tissue and lead to permanent loss of potency. If there is prolonged erection (longer than 4 hours), immediate medical assistance should be sought. Be assertive instead of aggressive. "Assert" your feelings, opinions or beliefs instead of becoming angry, combative or passive. Some insurance plans cover sex therapy. Once you select a therapist, call her/him to ask about whether or not his or her services are covered by your insurance provider. If payment cannot be worked out through insurance, many therapists can adjust their fees. Sex therapy clinics tend to be less expensive than private therapists. The cost of sex therapy programs varies, but generally range between $600 and $2,300 dollars, depending on the nature of the problem and the response to treatment. Return to top Is premature ejaculation a sign of a serious health problem? Lifestyle: alcohol and drugs, obesity, cigarette smoking (Incidence of impotence is approximately 85 percent higher in male smokers compared to non-smokers[9]., Smoking is a key cause of erectile dysfunction.[10][11] Smoking causes impotence because it promotes arterial narrowing.[12] See also Tobacco and health. ) Physical examination Have you noticed changes in sensations in your penis?

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