Education and Communication and other Non-surgical Treatments for Erectile Dysfunction (ED)?

Education and communication

Education about sex, sexual behaviors, and sexual responses may help a man overcome his anxieties about sexual dysfunction.

Talking honestly with your partner about your needs and concerns may also help to overcome many barriers to a healthy sex life.

Medication

Medications such as

- sildenafil (Viagra®),
- vardenafil (Levitra®),
- or tadalafil (Cialis®)

may help improve sexual function in men by increasing blood flow to the penis. Men who are on medicines that contain nitrates such as nitroglycerine should not take oral ED medications. The combination of nitrates and these specific medications can cause low blood pressure (hypotension).

The most common side effects of these medications are indigestion, nasal congestion, flushing, headaches and a temporary visual disturbance.

Mechanical aids

Aids such as vacuum devices and penile constriction rings serve as erectile aids for some men.

A vacuum constriction device (above) is a cylinder that is placed over the penis. The air is pumped out of the cylinder, which draws blood into the penis and causes an erection. The erection is maintained by slipping a band off of the base of the cylinder and onto the base of the penis. The band can stay in place for up to 30 minutes. The vacuum device can be safely used to treat most causes of erectile failure. Lack of spontaneity, discomfort, and cumbersomeness of the device seem to be the biggest concerns of patients.

Penile injection therapy (intracavernosal injection therapy)

Men are taught how to inject medications directly into the erection chambers of the penis to create an erection. Injection therapy is effective in treating a wide variety of erection issues caused by blood vessel, nerve and psychological conditions.

The tissue that causes you to get an erection (erectile tissue) is a muscle. Going long periods of time without an erection is unhealthy for erectile tissue and may damage it.

We believe that having erections keeps erectile tissue healthy. A penile injection helps you have an erection. It works best if it’s given about 5 to 15 minutes before you want an erection.

Using a tiny needle and syringe, the man injects a small amount of medicine into the side of his penis. The medicine relaxes the blood vessels, allowing blood to flow into the penis. This treatment has been widely used and accepted since the early 1980s. The three most common medicines are prostaglandin E1 (alprostadil), papaverine (Papacon®), and phentolamine (Regitine®).

The most common side effects are pain and penile scarring (fibrosis). In extremely rare cases, patients with cerebral and vascular disease or severe cardiovascular diseases might not be able to tolerate the dizziness and high blood pressure occasionally caused by injection therapy.

A painful erection that lasts longer than two to three hours is called priapism and may occur with injection therapy. This can be lessened with proper dosing and by following the treatment guidelines.

The 3 most commonly used medications for injection therapy are Trimix, Bimix, and Papaverine. Most men begin injection therapy with Trimix, which is a mixture of 3 ingredients: alprostadil, phentolamine, and papaverine. These ingredients work by relaxing the smooth muscle and opening the blood vessels in your penis, causing an erection. Your APP will decide whether Trimix or a different medication is best for you.

Psychology and sex therapies

Psychological causes may contribute to erectile failure even when there is a clear organic cause.

Therapy with a trained counselor can help a person address feelings of anxiety, fear or guilt that may have an impact on sexual dysfunction.

Sex therapy can be beneficial to most men when counseling is provided by a skilled sex therapist. Sex therapy also helps a man’s partner accept and cope with the problems.

A patient whose ED has a clear psychological cause should receive sex therapy counseling before any invasive treatments are pursued.

When you seek out sex therapy, you need to look for a relationship or marriage counsellor, psychotherapist or psychologist who uses specialised clinical skills and theoretical knowledge about human sexuality. In addition to having post-graduate training in couples and marriage counselling, we get specific sex therapy training to help you deal with your sexual difficulties or concerns.

Sex therapists are qualified counsellors or healthcare professionals who have had extensive training in human sexuality, in addition to being well-trained couples and marriage counsellors and therapists.

Sexual issues can often cause distress and conflict in relationships and sex therapists can assist you with these difficulties.

Some sexual concerns include:

- - Lack of sexual knowledge or education
  - Believing wrong/harmful information about sex from the media or religious institutions
  - Struggle to understand sex, desire, eroticism, privacy versus secrecy
  - Erectile and/or ejaculation difficulties
  - Performance anxiety and lack of confidence
  - Problems reaching orgasm
  - Low sexual desire concerns for both men and women
  - Intimacy problems
  - Relationship and marriage difficulties
  - Painful sex or intercourse
  - Sexual problems or changes due to illness, ageing, surgery or stress
  - Compulsive sexual behaviours, or out of control sexual behaviours (wrongly called sexual addiction)
  - Sexual trauma
  - Questioning your sexual identity, orientation or preferences
  - LGBTQI issues
  - Gender identity issues
  - Interest in kink
  - Cross dressing or other fetishes

Hormone

Low hormone levels may play a role in ED. Hormone replacement in the form of topical gels, creams, patches, injections and pellets are only used after physician evaluation.

Which Drugs are Good for Erectile Dysfunction?

What are the differences between erectile dysfunction drugs? About half of men ages 40 to 70 have erectile dysfunction (ED) to some degree, although only one in 10 report a complete inability to have erections. Taking an ED drug produces an erection sufficient to start intercourse in about 70% of otherwise healthy men.

Does it make any difference which of the four drugs for erectile dysfunction you take? “Yes, there can be differences,” says Dr. Louis Liou, chief of urology at Harvard-affiliated Cambridge Health Alliance in Boston. “For new patients, I have them try different ones to see what works best.”

Sildenafil (Viagra) is often the first drug your doctor offers. It’s been on the market longest and its side effects and the medications and foods it interacts with are well known.

But the main challenge to finding the best ED drug for you may turn out to be health insurance rules—not biochemistry. It’s a common practice among insurers to limit the number of pills you can obtain per month. After you hit your limit, the out-of-pocket cost for a single pill can be very high. “The main obstacle in my practice is the cost,” Dr. Liou says. You’ll need to work with your doctor to get the pill you need at a price you can afford.

What erectile dysfunction pills are available?

In addition to Viagra, other ED drugs available in the United States include avanafil (Stendra), tadalafil (Cialis) and vardenafil (Levitra). These all improve blood supply to the penis. In combination with sexual stimulation, the drugs can produce an erection sufficient to initiate and complete intercourse.

There is also a fast-dissolving form of Levitra, called Staxyn, that you put under your tongue.

Viagra
Cialis
Levitra

One ED drug, Cialis, is FDA-approved for use daily in a dose of 2.5 or 5 milligrams. This helps to produce erections on demand and may also help relieve urinary problems, like difficulty starting urination, that result from an enlarged prostate.

How well do ED pills work?

ED drugs produce an erection sufficient for intercourse in about 70% of men. But the results vary quite a bit from one individual to another. A man with nerves or arteries damaged by prostate surgery, diabetes, or cardiovascular disease will not respond as strongly to ED drugs. “There are some men in whom none of these drugs work,” Dr. Liou says.

How quickly do ED pills work?

How soon the drugs start working ranges from 15 to 60 minutes. Neither Viagra nor Levitra will work if you take them after a meal, which blocks their absorption. However, neither Cialis nor Stendra interact with food this way. The onset time determines how soon you can engage in intercourse. Stendra and daily-use Cialis are closest to being an “on demand” erectile drug; using the others requires more planning.

How to use ED pills properly

Dr. Liou says that some men come to him after getting a prescription from their primary care doctors, claiming that the drug doesn’t work. Sometimes it’s because they used it incorrectly. “The biggest misconception is that these drugs are an on/off switch for erections,” Dr. Liou says. But the drugs don’t work well without sexual stimulation. “During that time, you need to be with your partner and have foreplay,” Dr. Liou says. “Don’t take it, do the taxes or the dishes, and then meet at the bedroom thinking you’ll be ready to go. It’s not like that.”

How long do ED pills last?

The ED drugs break down at different rates in the body. The durations of action range from four hours to more than a day (for Cialis in the higher doses). Each dose should be sufficient to provide a full cycle of intercourse, from erection to climax.

“Will it last through another cycle? It’s not guaranteed,” Dr. Liou says. To have sex more than once a day, Cialis is your best bet.

What are the side effects of ED pills?

The most common side effects of ED drugs, in order of most to least common are headache, flushing, upset stomach, nasal congestion, vision problems, diarrhea, dizziness, and rash. A man who has an erection that lasts four hours or more needs to get to a hospital or risk permanent damage.

None of the ED drugs is safe to take with cardiac drugs called nitrates because it could cause a dangerous drop in blood pressure. Drugs that many men take for urinary symptoms, called alpha blockers, can also lower blood pressure, so take them at least four hours apart from ED drugs. Your doctor may start you on a smaller dose of the ED drug if you already take an alpha blocker or may recommend the alpha blocker tamsulosin (Flomax), which affects blood pressure less.

Heart health and erectile dysfunction

ED is often an early warning sign of underlying cardiovascular disease, such as clogged arteries (atherosclerosis). “It can predate a diagnosis of cardiovascular disease by at least a few years,” Dr. Liou says. We don’t have strong proof yet that starting to live a healthier lifestyle can reverse erectile problems, but it can’t hurt.

ED drugs: How soon they start working and how long they last
Medication	Onset	Duration
avanafil (Stendra)	15-30 minutes	6-12 hours
sildenafil (Viagra)	30-60 minutes	4-5 hours
tadalafil (Cialis)	30-45 minutes	24-36 hours
tadalafil (Cialis) daily	continuous	continuous
vardenafil (Levitra)	30-60 minutes	4-5 hours

Looking for natural solutions to ED?

Best Alternatives to Viagra: Treatments That Last Longer and What is the Difference Between Cialis and Viagra ?

Viagra is the most popular medication for erectile dysfunction. It was the first medicine approved to treat ED in 1998. It works quickly and can be used to treat men of all age groups. If you cannot use this drug for some reason or just want to try similar medications, you should know that there are good alternatives to sildenafil.

Cialis is the best analogue of Viagra, which has won an excellent reputation among men. The main active ingredient of Cialis is tadalafil, which, like sildenafil, belongs to the category of PDE5 inhibitors. Tadalafil causes an active blood flow to the perineum and penis of a man, due to which a good persistent erection occurs. The drug works only in the presence of natural stimulation, instantly increasing libido and sexual desire. Many men prefer Cialis because this is an ultra-long-acting ED drug – its duration is up to 36 hours;

Levitra is another worthy substitute for Viagra. The main active ingredient of Levitra is vardenafil, This drug is ideal for the symptomatic treatment of male sexual impotence. This medicine, like other drugs for improving potency, is prescribed by the doctor on an individual basis after a thorough examination. Levitra lasts about 8-12 hours and, unlike Viagra, is compatible with alcohol

Stendra is one more medication used to treat erectile dysfunction. It contains the active ingredient avanafil. It has a quick onset of action in comparison to other ED drugs available and starts working just 15 minutes after taking the pill. It is one of the newest drugs to be released for ED. Avanafil remains effective for 6 hours and may maintain benefits longer in some patients.

Compare the information about popular ED drugs in the table below:

Cialis vs. Viagra quick comparison

Cialis (tadalafil) and Viagra (sildenafil) are phosphodiesterase-5 (PDE5) inhibitors used for treating impotence (erectile dysfunction, or ED).
Adcirca is another brand name of tadalafil.
Common side effects of Cialis and Viagra that are similar include flushing (redness or warmth of the face, neck, or chest), headaches, stomach pain or upset, flu-like symptoms (such as stuffy nose, sneezing, or sore throat), memory problems, muscle or back pain, blurred vision and changes in color vision (such as an inability to differentiate between the colors green and blue), dizziness, diarrhea, nausea, low blood pressure, abnormal ejaculation, and prolonged erections (priapism), loss of hearing, and ringing in the ears.
One difference between the drugs is how long they stay in your system. Cialis provides penile hardness (the ability to obtain an erection) over a longer period than Viagra because it lasts up to 18 hours, while Viagra only lasts for about 4 to 6.

What are Cialis and Viagra?

Cialis (tadalafil) and Viagra (sildenafil) are oral drugs that are used for treating impotence (the inability to attain or maintain a penile erection) and benign prostatic hyperplasia (BPH). They are in a class of drugs called phosphodiesterase-5 (PDE5) inhibitors that also includes vardenafil (Levitra, Staxyn ODT), and avanafil (Stendra).

Penile erection is caused by the engorgement of the penis with blood. Under normal conditions, sexual stimulation leads to the production and release of nitric oxide in the penis. Nitric oxide then activates the enzyme, guanylate cyclase, which causes the production of cyclic guanosine monophosphate (cGMP). It is the cGMP that is primarily responsible for the erection by affecting the amount of blood that the blood vessels deliver and remove from the penis. Cialis and Viagra inhibit an enzyme called phosphodiesterase-5 (PDE5) which destroys the cGMP. Thus, Cialis and Viagra prevent the destruction of cGMP and allows cGMP to accumulate and persist longer. The longer cGMP persists, the more prolonged the engorgement of the penis.

What is the dosage of Cialis vs. Viagra?

Cialis

For most individuals, the recommended starting dose of tadalafil is 10 mg per day taken before sexual activity (tadalafil for use as needed).

Depending on the adequacy of the response or side effects, the dose may be increased to 20 mg or decreased to 5 mg a day. The effect of tadalafil may last up to 36 hours. Individuals who are taking medications that increase the blood levels of tadalafil should not exceed a total dose of 10 mg in 72 hours (See drug interactions). For once daily use without regard to sexual activity, the recommended dose is 2.5 to 5 mg daily. Tadalafil should not be taken more than once daily.

The recommended dose for BPH, or BPH and ED is 5 mg daily taken about the same time each day. Tadalafil may be taken with or without food since food does not affect its absorption from the intestine.

The dose of tadalafil may require adjustment for patients with reduced kidney or liver function.

Viagra

The usual recommended dose is 25 to 100 mg 1 hour before sexual activity.
The maximum dose is 100 mg daily.
The elderly (over 65 years of age) should start at 25 mg before sexual activity.
Sildenafil is rapidly absorbed. Maximum observed plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state. When sildenafil is taken with a high fat meal, the rate of absorption is reduced, with an average delay in the time to maximal concentration of 1 hour.

What is Erectile Dysfunction and Why I Get ED ?

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Having erection trouble from time to time isn’t necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

If you’re concerned about erectile dysfunction, talk to your doctor — even if you’re embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.

What happens to the penis during an erection — Flaccid and erect penis

Symptoms

Erectile dysfunction symptoms might include persistent:

Trouble getting an erection
Trouble keeping an erection
Reduced sexual desire

Why I get Erectile Dysfunction ?

Depression – The brain is an often-overlooked erogenous zone. Sexual excitement starts in your head and works its way down. Depression can dampen your desire and can lead to erectile dysfunction. Ironically, many of the drugs used to treat depression can also suppress your sex drive and make it harder to get an erection, and they can cause a delay in your orgasm.

Alcohol – You might consider having a few drinks to get in the mood, but overindulging could make it harder for you to finish the act. Heavy alcohol use can interfere with erections, but the effects are usually temporary. The good news is that moderate drinking — one or two drinks a day — might have health benefits like reducing heart disease risks. And those risks are similar to erectile dysfunction risks.

Medications – The contents of your medicine cabinet could affect your performance in the bedroom. A long list of common drugs can cause ED, including certain blood pressure drugs, pain medications, and antidepressants. But do not stop taking any medicines without talking to your doctor first. Street drugs like amphetamines, cocaine, and marijuana can cause sexual problems in men, too.

Stress – It’s not easy to get in the mood when you’re overwhelmed by responsibilities at work and home. Stress can take its toll on many different parts of your body, including your penis. Deal with stress by making lifestyle changes that promote well-being and relaxation, such as exercising regularly, getting enough sleep, and seeking professional help when appropriate.

Anger – Anger can make the blood rush to your face, but not to the one place you need it when you want to have sex. It’s not easy to feel romantic when you’re raging, whether your anger is directed at your partner or not. Unexpressed anger or improperly expressed anger can contribute to performance problems in the bedroom.

Anxiety – Worrying that you won’t be able to perform in bed can make it harder for you to do just that. Anxiety from other parts of your life can also spill over into the bedroom. All that worry can make you fear and avoid intimacy, which can spiral into a vicious cycle that puts a big strain on your sex life — and relationship.

Middle-Aged Spread – Carrying extra pounds can impact your sexual performance, and not just by lowering your self-esteem. Obese men have lower levels of the male hormone testosterone, which is important for sexual desire and producing an erection. Being overweight is also linked to high blood pressure and hardening of the arteries, which can reduce blood flow to the penis.

Self-Image – When you don’t like what you see in the mirror, it’s easy to assume your partner isn’t going to like the view, either. A negative self-image can make you worry not only about how you look, but also how well you’re going to perform in bed. That performance anxiety can make you too anxious to even attempt sex.

Low Libido – Low libido isn’t the same as erectile dysfunction, but a lot of the same factors that stifle an erection can also dampen your interest in sex. Low self-esteem, stress, anxiety, and certain medications can all reduce your sex drive. When all those worries are tied up with making love, your interest in sex can take a nosedive.

Your Health – Many different health conditions can affect the nerves, muscles, or blood flow that is needed to have an erection. Diabetes, high blood pressure, hardening of the arteries, spinal cord injuries, and multiple sclerosis can contribute to ED. Surgery to treat prostate or bladder problems can also affect the nerves and blood vessels that control an erection.

Causes of Erectile Dysfunction

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction.

Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

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.

Physical causes of Erectile Dysfunction

In many cases, erectile dysfunction is caused by something physical. Common causes include:

Heart disease
Clogged blood vessels (atherosclerosis)
High cholesterol
High blood pressure
Diabetes
Obesity
Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
Parkinson’s disease
Multiple sclerosis
Certain prescription medications
Tobacco use
Peyronie’s disease — development of scar tissue inside the penis
Alcoholism and other forms of substance abuse
Sleep disorders
Treatments for prostate cancer or enlarged prostate
Surgeries or injuries that affect the pelvic area or spinal cord
Low testosterone

Psychological causes of erectile dysfunction

The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

Depression, anxiety or other mental health conditions
Stress
Relationship problems due to stress, poor communication or other concerns

Risk factors

As you get older, erections might take longer to develop and might not be as firm. You might need more direct touch to your penis to get and keep an erection.

Various risk factors can contribute to erectile dysfunction, including:

Medical conditions, particularly diabetes or heart conditions
Tobacco use, which restricts blood flow to veins and arteries, can — over time — cause chronic health conditions that lead to erectile dysfunction
Being overweight, especially if you’re obese
Certain medical treatments, such as prostate surgery or radiation treatment for cancer
Injuries, particularly if they damage the nerves or arteries that control erections
Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions
Psychological conditions, such as stress, anxiety or depression
Drug and alcohol use, especially if you’re a long-term drug user or heavy drinker

Complications

Complications resulting from erectile dysfunction can include:

An unsatisfactory sex life
Stress or anxiety
Embarrassment or low self-esteem
Relationship problems
The inability to get your partner pregnant

Prevention

The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions. For example:

Work with your doctor to manage diabetes, heart disease or other chronic health conditions.
See your doctor for regular checkups and medical screening tests.
Stop smoking, limit or avoid alcohol, and don’t use illegal drugs.
Exercise regularly.
Take steps to reduce stress.
Get help for anxiety, depression or other mental health concerns.

Diagnosis

For many people, a physical exam and answering questions (medical history) are all that’s needed for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist.

Tests for underlying conditions might include:

Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation.
Blood tests. A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.
Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
Ultrasound. This test is usually performed by a specialist in an office. It involves using a wandlike device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems.This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection.
Psychological exam. Your doctor might ask questions to screen for depression and other possible psychological causes of erectile dysfunction.

Treatment

The first thing your doctor will do is to make sure you’re getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.

Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner’s preferences also might play a role in your treatment choices.

Oral medications

Oral medications are a successful erectile dysfunction treatment for many men. They include:

Sildenafil (Viagra)
Tadalafil (Adcirca, Cialis)
Vardenafil (Levitra, Staxyn)
Avanafil (Stendra)

All four medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.

Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing normal penile function in some people. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in people who get normal erections.

The medications vary in dosage, how long they work and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset.

Your doctor will consider your particular situation to determine which medication might work best. These medications might not treat your erectile dysfunction immediately. You might need to work with your doctor to find the right medication and dosage for you.

Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor’s OK. Medications for erectile dysfunction do not work in everyone and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:

Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Dilatrate-SR, Isordil, Bidil)
Have heart disease or heart failure
Have very low blood pressure (hypotension)

Other medications

Other medications for erectile dysfunction include:

Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).Each injection is dosed to create an erection lasting no longer than an hour. Because the needle used is very fine, pain from the injection site is usually minor.Side effects can include mild bleeding from the injection, prolonged erection (priapism) and, rarely, formation of fibrous tissue at the injection site.
Alprostadil urethral suppository. Alprostadil (Muse) intraurethral therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra.The erection usually starts within 10 minutes and, when effective, lasts between 30 and 60 minutes. Side effects can include a burning feeling in the penis, minor bleeding in the urethra and formation of fibrous tissue inside your penis.
Testosterone replacement. Some people have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies.

A battery-powered penis pump — Penis pumps, surgery and implants

Penis pumps, surgery and implants

If medications aren’t effective or appropriate in your case, your doctor might recommend a different treatment. Other treatments include:

Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis.Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device.The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch.If a penis pump is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it’s made by a reputable manufacturer.
Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among those who have tried and failed more-conservative therapies. As with any surgery, there’s a risk of complications, such as infection. Penile implant surgery is not recommended if you currently have a urinary tract infection.

What Should I Do to Treat my Erectile Dysfunction when I get Diabetes ?

Erectile dysfunction (ED) is a common problem amongst men who have diabetes affecting 35-75% of male diabetics. Diabetes mellitus, commonly known as diabetes, is a metabolic disease that causes high blood sugar. The hormone insulin moves sugar from the blood into your cells to be stored or used for energy. With diabetes, your body either doesn’t make enough insulin or can’t effectively use the insulin it does make.

Untreated high blood sugar from diabetes can damage your nerves, eyes, kidneys, and other organs.

Up to 75% of men suffering from diabetes will experience some degree of erectile dysfunction (erection problems) over the course of their lifetime.

Men who have diabetes are thought to develop erectile dysfunction between 10 and 15 years earlier than men who do not suffer from the disease.

Over the age of 70, there is a 95% likelihood of facing difficulties with erectile function.

The Connection Between ED And Diabetes

According to the National Institutes of Health, men with diabetes are 2 to 3 times more likely to have ED than those who do not have diabetes. Men with diabetes experience ED 10 to 15 years earlier on average than others.

ED below the age of 45 can actually be an early sign of type 2 diabetes. The percentage of ED in male diabetics ranges from 20 to 75 percent.

There are factors that increase a man’s risk of developing sexual and urological problems, including:

- - Poor blood glucose control
  - High blood pressure
  - Being older than 40

The Boston University Medical Center studied the link between type 2 diabetes and erectile dysfunction and found that about half of men who receive type 2 diabetes diagnoses will develop ED within five to 10 years.

Type 2 diabetes with heart disease increases the risk of ED even more. Blood circulation and the nervous system affect sexual stimulation and response. When diabetes damages these systems, it can impact a man’s ability to achieve erection.

You may be most at risk of developing ED and other diabetes complications if you’re:

- - Stressed
  - Anxious
  - Depressed
  - Maintaining a poor diet
  - A smoker
  - Not physically active

What causes erectile dysfunction amongst diabetics?

Causes of ED are extremely complex, and are based around changes that occur to the body over time affecting nerve, muscle and blood vessel functions.

In order to obtain an erection, men need to have healthy blood vessels, nerves, male hormones and a desire to have sex

Without blood vessels and nerves that control erection, ED can still occur despite a desire to have sex and normal male hormones.

Factors amongst men

Many other factors bear on erectile dysfunction amongst diabetic men.

These include:

- - Being overweight
  - Smoking
  - Taking too little exercise and other lifestyle factors.

Surgery can damage nerves and arteries linked to the penis, as can some injuries.

Many common medications (including antidepressants and blood pressure drugs) can produce ED.

Psychological factors also have an enormous influence.

Anxiety, guilt, depression, low self-esteem and paranoia about sexual failure are estimated to cause between 10% and 20% of ED cases.

How is ED diagnosed?

Erectile dysfunction is diagnosed using several different methods. Patient history often informs the degree and nature of the ED.

Medical and sexual past often has an influence, as does prescription or illegal drug use. ED patients may be physically examined, and bodily features can give clues to the cause. Laboratory tests can also be key for diagnosing ED.

Further tests such as monitoring nocturnal erection (nocturnal penile tumescence) can help to cancel some causes out.

Furthermore, psychological examination can reveal psychological factors.

Why Does Diabetes Pose a Challenge in Treating ED?

The first step in treating ED is to visit your doctor. You will need a sexual history and physical exam to understand and treat your dual conditions. Blood glucose, blood pressure, and cholesterol can all affect the development of ED.

As a diabetic with ED, adopting a healthier lifestyle may be all you need to reverse or ease the symptoms of erectile dysfunction.

Getting your blood sugar, weight, cholesterol and blood pressure under control by eating healthfully and exercising can reduce diabetes symptoms. These steps would all improve your sexual health as well. You may also want to consider certain medications to control symptoms.

Some drugs that diabetics use to treat high blood pressure, depression and other symptoms may contribute to erectile problems. Men with diabetes often have chronic conditions that make ED worse.

Unfortunately, diabetic patients won’t always see the results that non-diabetic patients see with just an oral ED medication like Viagra. Instead, they will have to use alternate methods or more than one medication in combination.

To get to the bottom of ED with diabetes, you must work with a doctor to make sure you address all related health problems, not just one. Stress can worsen ED, so you may also want to speak to a psychiatrist to learn ways to control stress and anxiety levels.

As a diabetic with ED, your case is unique. You will need a physician who understands both conditions and their connection. Luckily, there are effective treatments for ED in patients with diabetes.

How to Fix Erectile Dysfunction in Diabetics ?

The best way to fix erectile dysfunction in diabetics is through a tailored treatment plan with help from a doctor. Patients should work closely with specialists to find an ED treatment that also takes the diabetes into consideration.

Personalized medical treatment can result in methods such as hormone therapy, or compounded medications. Compounded medications are custom drugs that can include treatments for ED and diabetes in the same pill.

Compounded medications can potentially solve ED issues in diabetes such as retrograde ejaculation – which is caused by poor blood sugar control and related nerve damage. This occurs when semen goes into the bladder instead of out of the tip of the penis during ejaculation, due to the muscles not functioning properly.

If you have diabetes and retrograde ejaculation, there are medications that can strengthen the internal muscles, or sphincters, in the bladder to prevent retrograde ejaculation. Compounded oral medications with sildenafil, tadalafil, vardenafil or other ingredients can increase blood flow to the penis, helping to solve ED and maintain an erection that’s hard enough for penetration.

At the same time, men with diabetes need to take medications that control symptoms of this condition as well, without taking those that could exacerbate the symptoms of erectile dysfunction. A conversation with a primary doctor can elicit the best medications for each particular case, as well as a referral to the right compounding pharmacy.

Are there treatments for men with diabetes and erectile dysfunction?

Men who have diabetes and are having trouble achieving or maintaining an erection can take oral medicine The NHS can provide the following medications on prescription for men with diabetes:

Brand names include:

Viagra
Cialis
Levitra

However, these medicines can all affect the heart rate, and detailed consultation with your doctor is necessary to determine the best course of action.

If pills aren’t a good option for you, your doctor might recommend a tiny suppository you insert into the tip of your penis before sex. Another possibility is medication you inject into the base or side of your penis. Like oral medications, these drugs increase blood flow that helps you get and maintain an erection.

vacuum constriction devices –

This device, also called a penis pump or a vacuum pump, is a hollow tube you put over your penis. It uses a pump to draw blood into your penis to create an erection.

A band placed at the base of the penis maintains the erection after the tube is removed. This hand- or battery-powered device is simple to operate and has a low risk of problems.

If a vacuum-constriction device is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it’s made by a reputable manufacturer.

Intraurethral therapy – Intraurethral agents, sometimes called transurethral agents, are medications that treat ED by increasing blood flow to the penis to achieve and maintain erection. Medicated urethral suppository for erection (MUSE®) is the only intraurethral agent approved by the U.S. Food and Drug Administration (FDA).

Penile implants. In cases where medications or a penis pump won’t work, a surgical penis implant might be an option. Semirigid or inflatable penile implants are a safe and effective option for many men with erectile dysfunction.

Psychotherapy can have an enormous influence on erectile dysfunction.

Further treatment such as surgery and vacuum devices may also have a role to play in some specific cases.

Non-oral treatments for erectile dysfunction

Additional treatments include vacuum constriction devices, intraurethral alprostadil suppository or intracavernous injection therapy and sex therapy.

Vacuum pumps consist of a plastic tube, in which you place your penis. The pump, which may be battery or hand pump operated, creates a vacuum that will draw blood into the penis making it erect. A rubber ring will need to placed around the bottom of the penis to keep it erect. A vacuum pump is not for use if you have a bleeding disorder or take anticoagulants.

Alprostadil is a form of hormone medication that stimulates blood flow to penis, and may be given by two different methods:

Intracavernosal injection – whereby alprostadil is given by injection into the penis
Intraurethral application – whereby a pellet (1.6mm diameter and 6mm length) of alprostadil is inserted into the urethra via a urethral stick

Alprostadil may be prescribed if you do not respond to other treatments, or you are unwilling to try oral medications or vacuum pump therapy. Your health team may provide training on how to inject or insert alprostadil.

Which treatment is the best for diabetes and ED?

The most suitable treatment will depend on the health of the patient and their own ability to tolerate the treatment. Specialists such as urologists can work with individual cases and determine the best treatment.

What is the future of diabetes and erectile dysfunction?

There are frequent advances in this field. Better medications, implants, vacuum devices and suppositories have all increased options for diabetic men with ED.

Gene therapy is not being tested, and at some point may offer a permanent therapeutic approach to tackling diabetes and erectile dysfunction.

How can I get rid of ED when I have diabets ?

Don’t underestimate the difference a few changes can make. Try these approaches to improve erectile dysfunction and your overall health:

Stop smoking. Tobacco use, including smoking, narrows your blood vessels, which can lead to or worsen erectile dysfunction. Smoking can also decrease levels of the chemical nitric oxide, which signals your body to allow blood flow to your penis.If you’ve tried to quit on your own but couldn’t, don’t give up — ask for help. There are a number of strategies to help you quit, including medications.
Lose excess pounds. Being overweight can cause — or worsen — erectile dysfunction.
Include physical activity in your daily routine. Exercise can help with underlying conditions that play a part in erectile dysfunction in a number of ways, including reducing stress, helping you lose weight and increasing blood flow.
Limit or cut out alcohol. Excess alcohol can contribute to erectile dysfunction. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for men older than age 65, and up to two drinks a day for men age 65 and younger.

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Diabetes and Erectile Dysfunction