How is Erectile Dysfunction (ED) Diagnosed?

Because there are a variety of causes for Erectile Dysfunction ( ED ), there are several different tests your doctor may use to diagnose the condition and determine its cause. Only after the cause of ED is determined can it be effectively treated.

ED Diagnosis

Your doctor will ask you about your medical history. He or she will want to learn if any medical conditions might be causing the impotence. These may include vascular, neurological and hormonal disorders.

Vascular disorders affect the entire body. Many men who have impotence because of vascular disease also have a history of heart disease, stroke or poor circulation in their legs.

Neurological problems can contribute to impotence in men with a history of diabetes and spinal cord injury. They also can cause symptoms in other parts of the body.

In men with abnormal hormone levels, a reduced sex drive often accompanies impotence.

Your doctor will review the medications you take. These include over-the-counter products and herbal remedies.

Your doctor will ask about your sex life. He or she will ask about the quality of your sexual relationships.

Your doctor will examine you to look for evidence of medical problems. This will include an examination of your penis and testes. Your blood may be tested for blood sugar, cholesterol and levels of certain hormones.

Occasionally, a doctor may order additional tests. One such test is a nocturnal penile tumescence study. This is a way to determine how often you get erections while you sleep.

Another test that may be done is a Doppler ultrasound of the blood vessels in the penis. This test measures how well the blood is flowing in your penis.

Your doctor may not be able to give you a specific reason why you have impotence. But many of the treatments work well no matter what caused the problem. So extensive testing may not be necessary.

Before ordering any tests, your doctor will review your medical history and perform a thorough physical examination. The doctor will also “interview” you about your personal and sexual history. Some of these questions will be very personal and may feel intrusive. However, it is important that you answer these questions honestly. The questions asked may include:

What medications or drugs are you currently using? This includes prescription drugs, over-the-counter drugs, herbals, dietary supplements and illegal drugs.
Have you had any psychological problems such as stress, anxiety and depression?
When did you first notice symptoms of ED?
What are the frequency, quality and duration of any erections you have had?
What are the specifics of the circumstances under which ED first occurred?
Do/did you experience erections at night or during the morning?
What sexual techniques do you use?
Are there problems in your current relationship?

The doctor may also wish to interview your sexual partner since your partner may be able to offer in sight about the underlying causes.

After your physical examination and discussion, your doctor may then order any one of the following tests to further diagnose your condition:

Complete blood count (CBC): This is a set of blood tests that, among other things, can detect the presence of anemia. Anemia is caused by a low red blood cell count and can cause fatigue, which in turn can cause ED.
Liver and kidney function tests: These blood tests may indicate whether ED may be due to your kidneys or liver functioning improperly.
Lipid profile: This blood test measures the level of lipids (fats), like cholesterol. High levels may indicate atherosclerosis (hardening of the arteries), which can affect blood circulation in the penis.
Thyroid function test: One of the thyroid hormones’ functions is to regulate the production of sex hormones, and a deficiency in these hormones may contribute to or cause ED.
Blood hormone studies: Testosterone and/or prolactin levels in the blood may be measured to see if abnormalities in either of these sex hormones are present.
Urinalysis: Analysis of urine can provide a wealth of information, including information on protein, sugar and testosterone levels. Abnormal measurements of these substances can indicate diabetes, kidney disease or a testosterone deficiency, all which can cause ED.
Duplex ultrasound: This is perhaps the best test for evaluating ED. An ultrasound uses high-frequency sound waves to take “pictures” of the body’s tissues. For people with ED, an ultrasound may be used to evaluate blood flow and check for signs of a venous leak, atherosclerosis (hardening of arteries) or tissue scarring. This test is performed both while the penis is erect (usually induced by an injection of a drug that stimulates erection) and also while it is soft.
Bulbocavernosus reflex: This test evaluates nerve sensation in the penis. During the test, your doctor will squeeze the head of your penis, which should immediately cause your anus to contract. If nerve function is abnormal, there will be a delay in response time.
Nocturnal penile tumescence (NPT): This test measures a man’s erectile function while he is sleeping. Normally, a man will have five or six erections while asleep. A lack of these erections may indicate there is a problem with nerve function or circulation to the penis. The test uses two methods, the snap gauge method and the strain gauge method. The snap gauge method is performed by wrapping three plastic bands of varying strength around the penis. Erectile function is then measured based on which of the three bands breaks. The strain gauge method works by placing elastic bands around the tip and base of the penis. If the penis becomes erect during the night, the bands stretch, measuring the changes in penile circumference.
Penile biothesiometry: This test involves the use of electromagnetic vibration to determine sensitivity and nerve function. A decreased sensitivity to these vibrations may indicate nerve damage.
Vasoactive injection: During this test, an erection is produced by injecting special solutions that cause the blood vessels to dilate (enlarge) allowing blood to enter the penis.
Dynamic infusion cavernosometry: This test is used for men with ED who have a venous leak. During this test, fluid is pumped into the penis at a predetermined rate. By measuring the rate at which fluid must be pumped to attain a rigid erection, doctors can determine the severity of the venous leak.
Cavernosography: Used in conjunction with the dynamic infusion cavernosometry, this test involves injecting a dye into the penis. The penis is then X-rayed so that the venous leak can be seen.
Arteriography: This test is given to people who are candidates for vascular reconstructive surgery. A dye is injected into the artery believed to be damaged and X-rays will be taken.

Before you are given any of these tests, your doctor will explain what is involved. If you have any questions, do not hesitate to ask your doctor.

How Are Depression and Erectile Dysfunction related?

For some men, depression can accompany the condition of erectile dysfunction (ED). It is common for men with ED to feel angry, frustrated, sad, unsure of themselves, or even less “manly.” Such feelings may lead to a lack of self-esteem and, in severe cases, to depression.

Depression that accompanies ED is treatable. The first step in addressing your concerns about ED-related depression is to be honest with yourself, your partner, and your doctor. After depression has been brought out into the open, coping with it will be easier and less stressful.

Antidepressants and other psychiatric medicines may cause Erectile Dysfunction

- - Amitriptyline (Elavil)
  - Amoxapine (Asendin)
  - Buspirone (Buspar)
  - Chlordiazepoxide (Librium)
  - Chlorpromazine (Thorazine)
  - Clomipramine (Anafranil)
  - Clorazepate (Tranxene)
  - Desipramine (Norpramin)
  - Diazepam (Valium)
  - Doxepin (Sinequan)
  - Fluoxetine (Prozac)
  - Fluphenazine (Prolixin)
  - Imipramine (Tofranil)
  - Isocarboxazid (Marplan)
  - Lorazepam (Ativan)
  - Meprobamate (Equanil)
  - Mesoridazine (Serentil)
  - Nortriptyline (Pamelor)
  - Oxazepam (Serax)
  - Phenelzine (Nardil)
  - Phenytoin (Dilantin)
  - Sertraline (Zoloft)
  - Thioridazine (Mellaril)
  - Thiothixene (Navane)
  - Tranylcypromine (Parnate)
  - Trifluoperazine (Stelazine)

Recommend Surgery Treatment for Erectile Dysfunction

For most men, surgery should be a last resort.

Penile implants are devices placed inside the penis to allow men with erectile dysfunction (ED) to get an erection. Penile implants are typically recommended after other treatments for ED fail.

There are two main types of penile implants, semirigid and inflatable. Each type of penile implant works differently and has various pros and cons.

The placement of penile implants requires surgery. Before choosing penile implants, make sure you understand what surgery involves, including possible risks, complications and follow-up care.

Talk with your doctor about whether surgery is right for you. A urologist performs surgery at a surgical center or hospital to

implant a device to make the penis erect
rebuild arteries to increase blood flow to the penis

Implanted devices. Implanted devices, known as prostheses, can help many men with ED have an erection. Implants are typically placed by a urologist. The two types of devices are

inflatable implants, which make your penis longer and wider using a pump in the scrotum
malleable implants, which are rods that allow you to manually adjust the position of your penis

You usually can leave the hospital the day of or day after the surgery. You should be able to use the implant 4 to 6 weeks after the surgery.

Once you have either implant, you must use the device to get an erection. Possible problems with implants include breaking and infection.

Why penile implants is done ?

For most men, erectile dysfunction can be successfully treated with medications or use of a penis pump (vacuum constriction device). You might consider penile implants if you aren’t a candidate for other treatments or you can’t get an erection sufficient for sexual activity by using other methods.

Penile implants can also be used to treat severe cases of a condition that causes scarring inside the penis, leading to curved, painful erections (Peyronie’s disease).

Penile implants aren’t for everyone. Your doctor might caution against penile implants if you have:

ED that’s situational, the result of a relationship conflict or potentially reversible
An infection, such as a pulmonary infection or urinary tract infection
Diabetes that isn’t well-controlled

Keep in mind that while penile implants allow men to get an erection, they don’t increase sexual desire or sensation. Most penile implants also won’t make your penis any larger than it naturally is at the time of surgery. In fact, your erect penis might be slightly shorter than it used to be.

Types of penile implants

There are two main types of penile implants:

Inflatable implants. Inflatable devices, the most common type of penile implant used, can be inflated to create an erection and deflated at other times. Three-piece inflatable implants use a fluid-filled reservoir implanted under the abdominal wall, a pump and a release valve placed inside the scrotum, and two inflatable cylinders inside the penis.To achieve an erection, you pump the fluid from the reservoir into the cylinders. Afterward, you release the valve inside the scrotum to drain the fluid back into the reservoir. The two-piece model works in a similar way, but the fluid reservoir is part of the pump implanted in the scrotum.
Semirigid rods. Semirigid devices are always firm. The penis can be bent away from the body for sexual activity and toward the body for concealment.A positionable penile implant is a semirigid device with a central series of segments held together with a spring on each end. It can maintain upward and downward positions better than other semirigid rods can.

Other special designs can fit a shortened penis, or one that’s larger than average. Some inflatable penile implants are also available with antibiotic coatings, which might help reduce the risk of infection.

Comparing implant types

When choosing which type of penile implant is right for you, consider your personal preference and your medical history. Your doctor might suggest one type of design over another based on your age, risk of infection, and health conditions, injuries or medical treatments you’ve had in the past.

Type of penile implant	Pros	Cons

Three-piece inflatable	Creates the most natural, rigid erection Provides flaccidity when deflated	Has more parts that could malfunction than does any other implant Requires a reservoir inside the abdomen
Two-piece inflatable	Provides flaccidity when deflated	Is mechanically more complicated than is a semirigid implant Provides less firm erections than does a three-piece implant
Semirigid rod	Has a low chance of malfunction due to the small number of parts Is easy to use for those with limited mental or manual dexterity	Results in a penis that is always slightly rigid Puts constant pressure on the inside of the penis, which can cause injury Can be difficult to conceal under clothing

Before penile implant surgery you might also need to:

Avoid certain medications. Your doctor might recommend that you temporarily stop taking aspirin and anti-inflammatory drugs, which can increase your risk of bleeding.
Arrange for a ride home. Ask your doctor when you’ll be able to go home after surgery. Penile implant surgery typically involves an overnight stay.
Limit food and liquids. Don’t eat or drink anything after midnight before your surgery, or follow specific instructions from your doctor.

What you can expect

Before the procedure

Penile implant surgery is usually done at a surgery center or hospital. Your doctor might give you medication to make you unconscious during the surgery (general anesthesia) or medication that blocks pain in the lower part of your body (spinal anesthesia).

Your doctor will give you IV antibiotics to help prevent infection. The surgery site will also be shaved immediately before surgery to reduce the risk of infection.

During surgery

A tube (catheter) might be inserted into your bladder via your penis to collect urine at some point during surgery. Your surgeon will make an incision below the head of the penis, at the base of the penis or in the lower abdomen.

Next, your surgeon will stretch the spongy tissue in the penis that would normally fill with blood during an erection. This tissue is inside each of the two hollow chambers called the corpora cavernosa.

Your surgeon will choose the correct size implant and place the implant cylinders inside your penis. All sizes are customized to your exact body measurements.

If your doctor is implanting a two-piece inflatable device, a pump and valve are placed inside the scrotum. For a three-piece device, your doctor will also implant a fluid reservoir under the abdominal wall through an internal incision.

Once the device is in place, your surgeon will sew the incisions closed. Penile implant surgery usually takes 45 minutes to an hour.

After surgery

After penile implant surgery, you’ll likely need to take medications to ease pain. Mild pain might persist for several weeks. You might also need to take antibiotics for one week to prevent infection.

Your doctor might recommend keeping your penis up on your lower abdomen and pointing toward your bellybutton during the healing process to prevent downward curvature.

Your doctor will provide specific instructions about when you can resume normal activities. Most men can resume strenuous physical activity and sexual activity about four to six weeks after surgery. You’ll likely need to return to your doctor to have your stitches removed in about two weeks.

At this point, your doctor might recommend fully inflating and deflating inflatable penile implants twice a day to give you practice using them and stretch the area surrounding the cylinders.

Risks of penile implants

Risks of penile implant surgery include:

Infection. As with any surgery, infection is possible. You might be at an increased risk of infection if you have a spinal cord injury or diabetes.
Implant problems. New penile implant designs are reliable, but in rare cases the implants might malfunction. Surgery is necessary to remove, repair or replace a broken implant.
Internal erosion or adhesion. In some cases, an implant might stick to the skin inside the penis or wear away the skin from inside the penis. Rarely, an implant breaks through the skin. These problems are sometimes linked to an infection.

Treating an infection

Infections after penile implant surgery typically occur in the first few weeks or possibly years later. Early infections can cause swelling of the scrotum, pus buildup and fever. Later infections might involve persistent or recurrent long-term pain.

Surgery to remove the implant is likely necessary to treat an infection. Replacing a penile implant can be complicated and can lead to a buildup of scar tissue and a decrease in penis length.

How you prepare for penile implants

Initially, you’ll talk to your doctor or a urologist about penile implants. During your visit, your doctor will likely:

Review your medical history. Be prepared to answer questions about current and past medical conditions, especially your experience with ED. Talk about any medications you’re taking or have taken recently, as well as any surgeries you’ve had.
Do a physical exam. To make sure penile implants are the best options for you, your doctor will do a physical exam, including a complete urologic exam. Your doctor will confirm the presence and nature of ED, and make sure that your ED can’t be treated in another way.He or she will also try to determine whether there’s any reason that penile implant surgery is likely to cause complications. Your doctor will also examine your ability to use your hands, since some penile implants require greater manual dexterity than others.
Discuss your expectations. Make sure you understand what the procedure involves and the type of penile implant that suits you best. It’s also important to know that the procedure is considered permanent and irreversible.Your doctor will also explain the benefits and risks, including potential complications. Ideally, you’ll include your partner in the discussion with your doctor.

Results

Although penile implants are the most invasive and least often chosen treatment for erectile dysfunction, most men and their partners report satisfaction with the devices. The 10-year device survival is between 60 and 80 percent.

Controlled Substance May Causes Erectile Dysfunction

Impotence means that a man’s penis doesn’t get hard enough to have sexual intercourse. The man cannot get or maintain an erection. The medical term is erectile dysfunction (ED).

ED is not the same as premature ejaculation.

The major causes of ED include:

Vascular (blood vessel) disease — Erections happen when blood collects in the shaft of the penis. Vascular disease can limit the amount of blood flowing to or staying in the penis. Both can result in problems with erections.
Vascular disease is the most common medical cause of impotence.
Nerve damage — Nerves must be working normally for a man to get and keep an erection. Nerves can be damaged by diabetes, multiple sclerosis, prostate surgery or damage to the spinal cord.
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.
Medications — Many medications cause problems with sexual function. These include drugs for high blood pressure, depression, heart disease and prostate cancer.
Hormonal problems — Abnormal levels of certain hormones can interfere with erections and sex drive. Hormonal problems, such as a low testosterone level, are an uncommon cause of impotence.

Controlled Substance or drugs that can cause or lead to ED include these recreational and frequently abused drugs:

Alcohol.
Amphetamines.
Barbiturates.
Cocaine.
Marijuana.
Methadone.
Nicotine.
Opiates.

Aside from the well-known complications that the use and abuse of these drugs can cause, ED is not often mentioned. However, use of these drugs is a risk factor for ED. These drugs not only affect and often times slow down the central nervous system, but can also cause serious damage to the blood vessels, leading to permanent ED.

The List of Prescription Drugs That May Cause Erectile Dysfunction

Erectile dysfunction (ED) is a common side effect of a number of prescription drugs.

While these medications may treat a disease or condition, in doing so they can affect a man’s hormones, nerves or blood circulation. The result may be ED or an increase in the risk of ED.

If you have ED and think that it may be a result of the medication you are using, do not stop taking the medication. If the problem persists, contact your doctor and he or she may be able to prescribe a different medication. Common medications that may list ED as a potential side effect include:

- - Diuretics (pills that cause an increase in urine flow).
  - Antihypertensives (medication for high blood pressure).
  - Antihistamines.
  - Antidepressants.
  - Parkinson’s disease drugs.
  - Antiarrhythmics (medication for irregular heart action).
  - Tranquilizers.
  - Muscle relaxants.
  - Non-steroidal anti-inflammatory drugs.
  - Histamine H2-receptor antagonists.
  - Hormones.
  - Chemotherapy medications.
  - Prostate cancer drugs.
  - Anti-seizure medications.

Drugs that may cause erection problems

Many medicines and recreational drugs can affect a man’s sexual arousal and sexual performance. What causes erection problems in one man may not affect another man.

Talk to your health care provider if you think that a drug is having a negative effect on your sexual performance. Never stop taking any medicine without first talking to your provider. Some medicines may lead to life-threatening reactions if you do not take care when stopping or changing them.

The following is a list of some medicines and drugs that may cause erectile dysfunction (ED) in men. There may be additional drugs other than those on this list that can cause erection difficulties.

Antidepressants and other psychiatric medicines:

- - Amitriptyline (Elavil)
  - Amoxapine (Asendin)
  - Buspirone (Buspar)
  - Chlordiazepoxide (Librium)
  - Chlorpromazine (Thorazine)
  - Clomipramine (Anafranil)
  - Clorazepate (Tranxene)
  - Desipramine (Norpramin)
  - Diazepam (Valium)
  - Doxepin (Sinequan)
  - Fluoxetine (Prozac)
  - Fluphenazine (Prolixin)
  - Imipramine (Tofranil)
  - Isocarboxazid (Marplan)
  - Lorazepam (Ativan)
  - Meprobamate (Equanil)
  - Mesoridazine (Serentil)
  - Nortriptyline (Pamelor)
  - Oxazepam (Serax)
  - Phenelzine (Nardil)
  - Phenytoin (Dilantin)
  - Sertraline (Zoloft)
  - Thioridazine (Mellaril)
  - Thiothixene (Navane)
  - Tranylcypromine (Parnate)
  - Trifluoperazine (Stelazine)

Antihistamine medicines (certain classes of antihistamines are also used to treat heartburn):

- - Cimetidine (Tagamet)
  - Dimenhydrinate (Dramamine)
  - Diphenhydramine (Benadryl)
  - Hydroxyzine (Vistaril)
  - Meclizine (Antivert)
  - Nizatidine (Axid)
  - Promethazine (Phenergan)
  - Ranitidine (Zantac)

High blood pressure medicines and diuretics (water pills):

- - Atenolol (Tenormin)
  - Bethanidine
  - Bumetanide (Bumex)
  - Captopril (Capoten)
  - Chlorothiazide (Diuril)
  - Chlorthalidone (Hygroton)
  - Clonidine (Catapres)
  - Enalapril (Vasotec)
  - Furosemide (Lasix)
  - Guanabenz (Wytensin)
  - Guanethidine (Ismelin)
  - Guanfacine (Tenex)
  - Haloperidol (Haldol)
  - Hydralazine (Apresoline)
  - Hydrochlorothiazide (Esidrix)
  - Labetalol (Normodyne)
  - Methyldopa (Aldomet)
  - Metoprolol (Lopressor)
  - Nifedipine (Adalat, Procardia)
  - Phenoxybenzamine (Dibenzyline)
  - Phentolamine (Regitine)
  - Prazosin (Minipress)
  - Propranolol (Inderal)
  - Reserpine (Serpasil)
  - Spironolactone (Aldactone)
  - Triamterene (Maxzide)
  - Verapamil (Calan)

Thiazides are the most common cause of erectile dysfunction among the high blood pressure medicines. The next most common cause is beta blockers. Alpha blockers tend to be less likely to cause this problem.

Parkinson disease medicines:

- - Benztropine (Cogentin)
  - Biperiden (Akineton)
  - Bromocriptine (Parlodel)
  - Levodopa (Sinemet)
  - Procyclidine (Kemadrin)
  - Trihexyphenidyl (Artane)

Chemotherapy and hormonal medicines:

- - Antiandrogens (Casodex, Flutamide, Nilutamide)
  - Busulfan (Myleran)
  - Cyclophosphamide (Cytoxan)
  - Ketoconazole
  - LHRH agonists (Lupron, Zoladex)
  - LHRH agonists (Firmagon)

Other medicines:

- - Aminocaproic acid (Amicar)
  - Atropine
  - Clofibrate (Atromid-S)
  - Cyclobenzaprine (Flexeril)
  - Cyproterone
  - Digoxin (Lanoxin)
  - Disopyramide (Norpace)
  - Dutasteride (Avodart)
  - Estrogen
  - Finasteride (Propecia, Proscar)
  - Furazolidone (Furoxone)
  - H2 blockers (Tagamet, Zantac, Pepcid)
  - Indomethacin (Indocin)
  - Lipid-lowering agents
  - Licorice
  - Metoclopramide (Reglan)
  - NSAIDs (ibuprofen, etc.)
  - Orphenadrine (Norflex)
  - Prochlorperazine (Compazine)
  - Pseudoephedrine (Sudafed)
  - Sumatriptan (Imitrex)

Opiate analgesics (painkillers):

- - Codeine
  - Fentanyl (Innovar)
  - Hydromorphone (Dilaudid)
  - Meperidine (Demerol)
  - Methadone
  - Morphine
  - Oxycodone (Oxycontin, Percodan)

Recreational drugs:

- - Alcohol
  - Amphetamines
  - Barbiturates
  - Cocaine
  - Marijuana
  - Heroin
  - Nicotine

Alternative Names

Impotence caused by medications; Drug-induced erectile dysfunction; Prescription medicines and impotence

Is Viagra Bad for Your Heart ?

Taken alone, Viagra won’t hurt your heart. But don’t take it if you’re already taking nitrates for heart health, Dr. Montague says.

Viagra was originally intended to treat angina (chest pain), which it does well — just no better than other medications. Stiffer erections were a side effect.

“Here’s a drug that not only treats angina and is good for the heart, but it works on the penis when other medications don’t,” he says.

Like nitrates, it helps dilate blood vessels constricted by coronary artery disease.

But it also similarly lowers blood pressure.

If you take the two medications together, your blood pressure could drop too low, putting you at risk for a heart attack.

Is it safe to take Viagra with my heart medications?

Sexual activity plays a crucial role in the psychological health and quality of life scores in patients with cardiovascular disease. Unfortunately, intimacy is frequently an issue in patient with cardiovascular disease.

The causes of sexual dysfunction following myocardial infarction are multiple and include anxiety, depression, medication effect and vascular insufficiency.

Regardless of the cause, the results can be devastating to relationships and the psyche.

There are three phosphodiesterase-5 inhibitors currently available in the United States: sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). For simplicity and because of its name recognition, I will use the trade name Viagra to represent all phosphodiesterase-5 (PDE5) inhibitors even if the studies were completed using one of the other drugs. I do not endorse Viagra above any of the others. Viagra has been shown to be effective in the treatment of erectile dysfunction. Viagra works by increasing the amount of nitric oxide available which enhances erectile function.

So can I take Viagra with my heart medications?

Viagra has been shown to be safe in stable cardiovascular diseases including heart failure, hypertension, and coronary artery disease. Although many have looked, there has been no clear evidence that Viagra is associated with increased rate of heart attacks or cardiovascular events. When Viagra is combined with most blood pressure medicines, there is a small but real additive effect but no change in cardiovascular events.

However, when Viagra is combined with doxazosin and tamsulosin, two alpha-blocking medications often used to treat BPH (benign prostate hypertrophy) some patients develop low blood pressures. It is recommended that if these prostate medications are required, the smallest doses of each respective medication should be used. Patients already receiving Viagra and other PDE5 inhibitors for pulmonary hypertension should not receive a second PDE5 for the treatment of erectile dysfunction.

On the whole, Viagra can be considered safe with almost all of your cardiac medications. Unfortunately, the combination of Viagra with nitrates should never be considered safe. Together they can cause life threatening hypotension, also known as low blood pressure. Nitrates should not be taken within 24 hours of sildenafil or vardenafil and within 48 hours of tadalafil.

I have included a short list of commonly prescribed nitrates to help you avoid them.

Nitroglycerin
1. Sublingual nitroglycerin tablets (Nitrostat)
2. Sublingual nitroglycerin spray
3. Nitro patch
4. Nitro paste
5. Isosorbide mononitrate (Imdur, ISMO)
6. Isosorbide dinitrate (Isordil)

How Clogged Arteries Cause Erectile Dysfunction ?

Are Clogged Arteries To Blame For Erectile Dysfunction?

A growing body of scientific evidence supports the fact that erectile dysfunction can be caused by a clog or multiple clogs in the penile arteries. As most men know, an erection is produced when arousal causes blood flow to enter the penis through the penile arteries as they widen and allow blood to flow into the network of vessels that travel through the stomach and lead into the penis. The result is swelling which is commonly known as an erection.

But in a man with a blockage in the penile arteries, blood cannot move into the penis the way it would for an otherwise healthy man. The result would be either a partial erection or no erection at all.

The Chicken or the Egg: Clogged Arteries Cause ED

It is true that clogged arteries can cause ED but it is also equally true that clogged arteries in the penis can be a symptom of heart disease which means clogged arteries in the rest of the body. According to Harvard Health they are a warning signal of heart disease.

The path to erectile dysfunction often starts at the heart, which pumps blood through arteries to all areas of the body. Erectile dysfunction often occurs when these pathways are blocked by plaque, a condition known as atherosclerosis. So, clogged arteries can cause ED.

Cholesterol builds up on vessel walls, which causes them to narrow and slow down blood flow. If left untreated, flow can come to a screeching halt. Clogged arteries can cause ED and this condition can also cause angina, heart attacks, strokes, and claudication (pain in the legs with walking). In some cases, erectile dysfunction could be a warning sign that a heart attack or stroke may happen down the road.

Atherosclerosis and Erectile Dysfunction

Atherosclerosis is commonly defined as the hardening of the arteries responsible for pushing blood to various regions throughout the body. As healthy arteries are an essential part of daily health, individual who do develop atherosclerosis may be at a risk for a variety of potentially harmful conditions, one of which is erectile dysfunction.

Men who suffer from atherosclerosis may notice that it is increasingly difficult to develop and sustain an erection. The arousal process may take substantially longer than it has previously, and the strength and quality of an erection will most likely be noticeably reduced. Additionally, men may find that their erections subside quickly, leaving them a very little window of opportunity in which they can engage in sexual intercourse.

The presence of erectile dysfunction in a man’s life can be heartbreaking. And in the most literal sense it can mean that his physical heart is experiencing a lower level of performance.

In his research, Dr. Faysal Yafi, Director of the Men’s Health Services at the UCI Health Center for Urological Care, found that there is a connection between erectile dysfunction and heart disease.

Atherosclerosis, which can cause a penile blood clot, can develop from a variety of risk factors. These include:

Diabetes
Smoking
Alcohol abuse
High blood pressure
Certain medications (such as thiazide diuretics)
High levels of LDL cholesterol
Obesity
Low testosterone
Advanced age
Family history of the condition

How to Improve Blood Flow to the Penis

As a man interested in being at your best, you are not one to accept defeat when victory can be as close as the next move. You know that poor circulation in the penis can cause ED, but you also know that there are specific actions you can take to reduce your risk of heart disease which produces the clogs that can cause your ED. Here is a list of steps you can take to unclog penile arteries:

Quit Smoking. Smoking is on the decline but if you are one of the holdouts your smoking habit is likely not doing you any favors in the bedroom. And stopping can help reduce your risk of ED, which is what can happen when arteries in the penis constrict.
Reduce Your Blood Pressure. There are many ways to do this and the lifestyle changes in this list will help unclog penile arteries. But if you are living a stress-filled life now might be the time to take up some new hobbies that provide relaxation and connection with nature.
Communicate with Your Partner. Set aside some time every day to communicate with your partner about whatever is going on in your life. If you are feeling stress in any area of your life, being able to talk about it openly and honestly will reduce the potential negative effects of whatever may be going wrong.
Lose Weight. Your weight may not be affecting your performance now, but combined with other risk factors it may be only a matter of time; losing weight can help unclog penile arteries.
Manage Your Diabetes. Diabetes affects a lot of things in your body including your circulation. You don’t have to cure your diabetes to improve blood flow and reduce the risk of erectile dysfunction.
Improve Your Eating Habits. Focus on fresh ingredients and limit over processed and chemical laden foods. A sensible diet packed with leafy greens and multi colored vegetables, lean proteins, and healthy oils can become your best friend.
Reduce Inflammation. Inflammation of any kind can negatively impact one’s health.
Check Your Testosterone. A healthy testosterone level is key to healthy erections and many of the items on this list support healthy testosterone levels.
Move Your Body. A solid exercise regimen will improve your overall health, give you more energy and be an aide in reducing inflammation which can help unclog penile arteries.
Get Enough Sleep. Sleep is not just a time to disconnect from the world. It is the time when your body works to repair and replenish itself to set you up for success tomorrow.

What You Need To Know If Your ED Is Caused By a Clog

First, you are not alone. Over 50 percent of American men between the ages of 40 and 70 will experience mild, moderate, or severe erectile dysfunction in their lifetime. It’s pretty clear that atherosclerosis can cause erectile dysfunction. Atherosclerosis by itself accounts for 50-60 percent of ED cases in men over the age of 60. On a related note, experts estimate that 35 to 50 percent of diabetics experience ED.

Second, contrary to popular perception, ED doesn’t just affect older men. One in four men who sought help at an outpatient clinic for the condition were under the age of 40, nearly half of whom had severe symptoms. While these men in some ways appeared healthier than their older counterparts – less weight, more testosterone, fewer medications – they also smoked or used illegal drugs more regularly. Perhaps of most concern is the fact that a majority of men, regardless of age, do not seek treatment for erectile dysfunction.

Third, there is a non-invasive treatment that is ideal for clog caused ED. It’s called GAINSWave® and it offers a unique solution that can achieve impressive results. This simple in-office procedure uses low-intensity acoustic soundwaves to break up plaque and stimulate the release of growth factors, which can lead to the development of new blood vessels in the penis.

The procedure also awakens dormant stem cells and encourages blood flow, an essential component for normal erectile function. GAINSWave is an effective alternative for men who seek to address ED or simply improve their overall sexual performance.

The man who is committed to upping his game recognizes that a clog can cause ED and he takes action to unclog his penile arteries.

The Early Warning Signs

The best way to judge whether or not an individual is at risk for either atherosclerosis or endothelium damage is to observe their lifestyle habits and men who have high cholesterol, smoke regularly, have diabetes or are obese have a significantly higher risk of developing these conditions than those who do not.

Temporary Treatments

Although the development of atherosclerosis cannot be reversed, a variety of pharmaceutical products can be used to dramatically slow the progress of this condition. That being said, the most valuable tool at any man’s disposal for countering the unwanted effects of atherosclerosis is simple lifestyle adjustments. It is absolutely imperative that men engaging in high-risk behavior change their lifestyle immediately in order to ensure that they do not place themselves further in harm’s way.

As stated previously, men who believe they may be suffering from atherosclerosis are advised to discuss these problems with their doctors immediately in order to ensure the real cause of low sexual stamina so that they have the information they need to effectively combat this illness. Good luck!

Treating clogged arteries

Doctors can prescribe medicines to treat atherosclerosis. These include:

antiplatelet medication, such as aspirin or clopidogrel, to reduce blood clotting
anticoagulants, such as warfarin or heparin, to thin the blood
cholesterol-lowering medicines, such as statins
blood pressure medicines

Sometimes, a doctor needs to perform surgery for atherosclerosis. This may include balloon angioplasty or a stent to open a blocked artery. Healthcare professionals can treat angina with a coronary artery bypass. The doctor grafts a piece of a healthy vein to an area above the blockage to allow blood to flow.

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How Clogged Arteries Cause Erectile Dysfunction & What You Can Do About It

What is the Connection of Erectile Dysfunction and the Heart?

What is the connection of Erectile Dysfunction and the Heart?

Erectile dysfunction (ED) is when you are unable to get or keep an erection suitable for sexual intercourse or another chosen sexual activity. The most common cause of ED is a lack of blood supply to the penis. The lining of the blood vessels (arteries) that supply blood to the penis is called the endothelium (pronounced en- do- thee- lee- um).

This controls the speed with which blood enters the penis. If the endothelium does not work properly, blood can not enter fast enough or stay there long enough to get a firm erection that lasts sufficient time for satisfactory sexual intercourse (see our factsheet ‘Erectile dysfunction’).

With aging, particularly when combined with an unhealthy lifestyle, the arteries become narrowed and damaged by a process known as atherosclerosis, which is similar to a pipe furring up. The link between ED and disease of the coronary arteries (those that supply the heart) is that they share the same endothelium, so atherosclerosis in the penile arteries is also likely to be present in the coronary arteries.

This is why up to two-thirds of men with coronary artery disease (CAD) also have ED. The problem is that over half the men with ED may have CAD they don’t know about. Finding and treating atherosclerosis early can help stop it from getting worse, so this is important.

Can ED come before CAD?

Yes! The arteries in the penis are smaller in diameter (1-2mm) than the coronary arteries (3-4mm). This means that while atherosclerosis in the coronary arteries may not currently be causing any heart problems, the same disease in the smaller penile arteries causes them to become narrowed earlier, leading to ED.

It takes longer for the bigger coronary arteries to be affected by the narrowing process, but if it is allowed to continue, a man with ED and no heart complaint may develop a heart complaint within 3-5 years of his ED starting. This is why the penis has been described as ‘the window to the hearts of man’. It means ED can help identify someone at future risk of a heart attack, giving us a chance to prevent it from occurring by lowering cholesterol and treating high blood pressure. The early detection and treatment of diabetes is also important.

What are the risk factors for ED and CAD?

They are the same. High blood pressure, raised cholesterol, cigarette smoking, obesity, diabetes, physical inactivity, low testosterone, depression and stress. So it is easy to see why ED and CAD often occur together – it is really a matter of which comes first.

What if you have ED and no sign of CAD?

It is very important to see your GP to assess your health and see if you have any of the risk factors described above. Lifestyle issues are important. Losing weight if needed, eating a healthy Mediterranean-style diet and increasing physical activity are the easiest changes to make, and these will benefit both ED and CAD (see our factsheets ‘Body Mass Index (BMI)’ and ‘The Mediterranean diet’).

By reducing your risk factors for ED and CAD, you reduce your chances of a serious health problem in the future. You may have had your ED successfully treated by tablets given to you by a friend or bought online, but getting your erection back without a check on the heart is asking for trouble.

What Foods Can Help Erectile Dysfunction ? Which Foods Can Increase Sperm Quantity ?

We know pills, pumps, and surgeries work for erectile dysfunction, but what about food?

Are there things you can eat that can help with ED? There are reasons to think there may be, even if more evidence is needed to confirm the potential of the following foods.

Goji berries have a long history tied to sexual fertility. The long history uses of Goji showed that goji berries significantly:

- increased sperm quantity and movement
- shortened erection, capture, and ejaculation response
- improved sexual ability
- improved recovery of testosterone levels

Research suggests that goji berries may be an alternative to prescriptions for erectile dysfunction, like Viagra.

Longan

Longan is the fruit of the longan tree (which is scientifically known as Dimocarpus longan). It looks like a berry or a grape and tastes mildly juicy and sweet.

Longan tonics have been popular since time immemorial with Chinese women to increase their sensuality and appearance. The fruit helps to increase energy and stave off fatigue.

Chives

Chives, aka those little green disks you can find in most Chinese dishes, not only taste great but are full of vitamins, minerals, protein and sugar often used in medicine to cure illness. In Chinese, Chives are nicknamed “grow man health,” which translates to “the grass that raises your man health” Chives actually possess sulfides that, when combined with vitamin B1, help reduce fatigue and recover strength, hence increasing male stamina and virility.

Quail Eggs

Quail eggs are delicious and nutritious. They are chalk full of amino acids that the body needs, whatever those are. Traditional Chinese medicine says quail eggs mend the human body’s “five viscera” (heart, liver, spleen, lungs and kidneys), benefits the essence of blood and increases male virility. It is said that men who eat quail eggs on a regular basis will have increased sexual capabilities, strength and muscles…all night long.

Lamb Kidney

In order to increase your kidney yang, you sometimes have to eat the kidney of another animal. Lamb kidneys have tons of protein and vitamins needed to get the blood flowing. In China, men who are impotent believe eating lamb kidney will restore their virility. Lamb supposedly warms the joints and strengthens the lower back and legs, increasing your sexual ability.

Okra

Ripe okra is used in traditional Chinese medicine for its leaves that contain healing ingredients. Not only does okra increase male virility, it can be used to treat certain urinary problems. No wonder okra has earned its name “the plant Viagra.”

Watermelon

This sweet, refreshing fruit has a compound that can have effects similar to ED meds on your blood vessels. It may even rev up your sex drive, studies say. Most of watermelon is water, but the rest is loaded with lycopene, an antioxidant that’s good for your heart, prostate, and skin.

Oysters

These shellfish may boost your testosterone levels, and that can help with sex drive. They’re also chock-full of zinc, a nutrient your body needs. But you may save yourself problems by making sure they’re cooked. Make sure you know where they come from, and that they’re cooked properly.

Coffee

Your morning cup of joe is more than a satisfying pick-me-up. It may give your love life a boost, too. Men who drank two or three cups’ worth of caffeine a day were less likely to have erectile dysfunction, one study found. That’s because caffeine helps boost blood flow. Not a java fan? Many teas, sodas, and sports drinks also have caffeine.

Dark Chocolate

This treat may have perks below the belt. An ounce a few times a week can help your ticker — and what’s good for your heart could be good for other parts, too. Chocolate is rich in flavanols, plant nutrients that can increase blood flow and lower blood pressure. It also helps your body make more of nitric oxide, which can help with erections and is in many ED medications.

Nuts

Walnuts have lots of arginine, an amino acid your body uses to make nitric oxide. They’re also good sources of vitamin E, folic acid and fiber. Don’t add more than a few small handfuls to your daily diet, though. Nuts are high in calories.

Juice

Maybe you enjoy an adult beverage made from grapes, but here’s a reason to drink the stuff kids like. Nutrients in Concord grape juice also increase the amount of nitric oxide in your body. If you’re not wild about drinking grape juice, try pomegranate juice. It appears to have the same effect.

Garlic

The strong-smelling bulb may help between the sheets. If plaque forms on the walls of the arteries, blood flow could be cut off or reduced. That could cause a problem when it comes to romance. Garlic in your diet may help keep your arteries healthy and clear as you age.

Fish

Salmon and other fatty fish are great sources of heart-healthy omega-3 fatty acids, which may boost nitric oxide in your body. They’ll lower your blood pressure and your risks for heart attack and blood clots. Aim for 8 ounces of salmon a week. Sardines, fresh albacore tuna, and mackerel are other good sources of omega-3s.

Greens

Kale is also a nitric-oxide booster. Aside from the possible benefits to your sex life, leafy greens are nutritional powerhouses. They’re packed with vitamins, minerals and omega-3s.

Peppers

You might spice up your love life by adding some chili peppers to your diet. The stuff in cayennes, jalapenos, habaneros, and other peppers that give them their heat relaxes the arteries — and that helps blood flow to the heart and other organs, including the penis. Chilies can also help lower blood pressure and cholesterol and prevent blood clots.

Olive Oil

Olive oil may help your body make more testosterone. It’s also full of the good-for-you monounsaturated fat, which can help get rid of the bad cholesterol in your body. Opt for extra-virgin olive oil — that means the olives were pressed without chemicals or high heat, which preserves the healthy antioxidants.

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