Exploring Your Treatment Options
Virtually any man who wishes to have an erection can obtain it, regardless of the underlying cause of his problem.
Many reasonable nonsurgical treatment options exist for erectile dysfunction (also called male impotence), including external vacuum devices, medications (oral and topical), hormonal therapy, penile injection therapy, and intraurethral pellet therapy. Sex counseling is another option and is discussed in Living With Erectile Dysfunction.
In selected cases and under the supervision of an experienced urologist who treats erectile dysfunction, therapy combining several of these methods can be used. If none of these therapies is satisfactory, surgical treatment, such as a penile prosthesis, can be considered.
External Vacuum Devices
Specially designed vacuum devices to produce erections have been used successfully for many years. Vacuum devices are safe, relatively inexpensive, and reliable. Vacuum devices do not require surgery.
The typical vacuum device consists of a plastic cylinder that is placed over the penis, tension rings of various sizes, and a small hand pump. Air is pumped out, causing a partial vacuum, which draws blood into the penis and creates the erection.
Once an erection is obtained, a tension ring, which acts like a tourniquet to keep the blood in the penis and to maintain an erection, is placed around the base of the penis.
Using the correct size of tension ring is critical in obtaining the best possible result from this type of treatment. If the ring is too tight, it can be uncomfortable. If too large a ring is used, the erection may not last. The tension ring should not be left in place longer than 30 minutes.
Although these devices are generally safe, bruising can occur and the erect penis may lack some support. Other possible side effects include:
Pain
Lower penile temperature
Numbness
No or painful ejaculation
Pulling of scrotal tissue into the cylinder
Many of these side effects can be helped by proper selection of the tension rings and cylinder size, use of adequate lubrication, adequate practice with the device, and proper technique.
Vacuum devices are effective in a majority of men. About half of the men who use a vacuum device obtain good or excellent erections with them, but only half of these men consistently use the device over long periods of time.
The most common cause of failure is improper use of or unfamiliarity with the device. Other drawbacks to the use of vacuum devices include the need to assemble the equipment and the difficulty in transporting it. Many men also lose interest in the device because of:
Necessary preparations (may need to interrupt foreplay)
Inability to hide the tension ring
Relative lack of spontaneity
Although vacuum devices can be operated and used quickly with experience, they still are perceived by many to be less "romantic" than other nonsurgical treatment options.
Medications
Medications can be used to treat erectile dysfunction, some of which are discussed below. For a more complete discussion, see Erectile Dysfunction Medications.
Viagra, Levitra, Cialis, and Stendra
Since the introduction of Viagra (sildenafil citrate) in March 1998, no other therapy for erectile dysfunction has achieved such wide public recognition.
Viagra is the first oral medicine (a pill you take by mouth) available that has been proven to improve erections in men who have difficulty achieving or maintaining erections sufficient for sexual intercourse due to erectile dysfunction. Viagra does not improve erections in healthy men. It is not an aphrodisiac and will not increase sexual desire.
Since its introduction, the Food and Drug Administration (FDA) has approved two additional drugs in the same class as Viagra:
Levitra (vardenafil), Cialis (tadalafil), and Stendra (avanafil) have essentially the same activity as Viagra.
Cialis has a longer duration of increased sensitivity to develop an erection (up to 24-36 hours) compared with Viagra and Levitra (up to 4-16 hours). Stendra can work as rapidly as 15-30 minutes and can be taken with alcohol.
Viagra, Levitra, Stendra, and Cialis work by blocking an enzyme found mainly in the penis that breaks down a chemical created during stimulation that increases blood flow in the erectile bodies of the penis, which then produces erections. Viagra, Levitra, and Cialis allow this chemical of arousal to survive longer and greatly improve erectile function. Viagra, Levitra, and Cialis will not have any effect without sexual stimulation.
Viagra, Levitra, Stendra and Cialis work successfully in a majority of all men with erectile dysfunction.
Of those men with diabetes or with spinal cord injury, a majority reported being successfully treated with these medications.
In men who became impotent after radical prostate cancer surgery, almost half reported improved erections with Viagra, particularly if they had the "nerve-sparing" type of prostate surgery. These medications are most effective if there is some erectile function; if there is no erectile function, these medications are not usually beneficial.
Viagra is available in 3 strengths: 25 mg, 50 mg, and 100 mg. Viagra works best if taken on an empty stomach about 30-45 minutes before sexual activity. Optimal results may not be realized until the medication has been tried 6-8 times. Viagra may be used cautiously with alpha-blocker medications as long as sufficient time has passed between their dosing.
Levitra is available in 2 strengths: 10 mg and 20 mg. It is not necessary to take it on an empty stomach. Currently, Levitra cannot be used with any alpha-blocker medication because of potentially dangerous drops in blood pressure. Many people who fail Viagra therapy have found Levitra to be effective.
Cialis is available in 2 strengths: 10 mg and 20 mg. Cialis can work in 30 minutes, but peak results usually take longer. Cialis has the advantage of a much longer period (24-36 hours) during which sexual ability is increased. Cialis may be used with the alpha-blocker medication Flomax but not with other alpha-blocker medications.
Stendra is available in 3 strengths: 50mg, 100 mg, and 200 mg. Stendra can work as rapidly as 15-30 minutes and can be taken with food or alcohol.
Side effects of Viagra, Levitra, Stendra and Cialis can occur but are generally mild. They include:
Headache
Hypotension (a drop in blood pressure)
Transient dizziness
Facial flushing
Indigestion
Nasal congestion
Lower back pain (unique to Cialis)
Visual disturbance (eg, blurred vision, increased light sensitivity, persistence of a bluish tinge, temporary loss of the ability to distinguish between blue and green)
Your physician will determine which of these medications is most appropriate for you and the optimal dosage. Never give any of these medications to anyone else as they can cause serious problems due to drug interactions if not monitored by a physician.
Medications, such as ketoconazole (an antifungal medication known as Nizoral), erythromycin (an antibiotic), and cimetidine (a drug to reduce stomach acid known as Tagamet), can interfere with the chemical processing of medications like Viagra by the liver.
Alpha-blocker type medications (eg, Hytrin, Cardura, Uroxatral, Flomax, Rapaflo) may have potentially dangerous interactions with Viagra, Levitra, Stendra and Cialis. If you are taking any of these medications, check with your physician or pharmacist about potential drug interactions.
Certain street drugs (eg, ecstasy) can also cause serious problems if taken with Viagra, Levitra, Stendra or Cialis.
Viagra, Levitra, Stendra and Cialis should absolutely not to be taken by:
Men with heart conditions who are taking nitrates, such as nitroglycerine (Combining Viagra, Levitra, Stendra or Cialis with nitrate-based medications can cause a severe and dramatic drop in blood pressure with potentially very dangerous consequences.)
Men with serious heart disease or exertional angina (chest pain)
Men who are taking multiple drugs for high blood pressure
Yohimbine
Yohimbine, an herbal product, comes from the bark of a West African tree. Its use in treating erectile dysfunction is questionable, and, in studies, yohimbine is only slightly better than placebo (no drug at all).
Nonetheless, yohimbine is considered safe with few known side effects. The usual daily dose is a 5.4-mg tablet taken 3 times a day.
Hormonal Therapy
Men with low sex drive and erectile dysfunction may have low levels of testosterone (the male hormone). As a general guideline, a testosterone level of 300 ng/dL or less is considered low, but this varies depending on the laboratory that does the testing and the time of day the sample is taken.
Hormone replacement may be beneficial, especially when used in combination with other therapies for erectile dysfunction; however, testosterone supplementation alone is not particularly effective in treating erectile dysfunction.
Sexual desire (libido) and an overall sense of well-being are likely to improve when serum testosterone levels (the level of the male hormone in the blood) are restored.
Replacement testosterone is available in the following forms:
Injections: Injections are a reliable way to restore testosterone levels, but this therapy requires periodic injections (usually every 2 weeks) to sustain an effective level. It also causes high hormone levels right after the injection and low hormone levels just before the next shot. This is thought to be slightly more risky than other methods that maintain a moderate hormone level throughout the treatment period.
Skin patches and gels: Skin patches and gels that are rubbed into the skin deliver a sustained dose and are generally well accepted. A strip that is placed in the mouth on the gums is also available. With the patches and the gels, skin rashes and irritation are the most common problems.
Injectable pellets (Testopel) are injected under the skin every 4-6 months. Testosterone levels are maintained at an effective level, but the injection can be uncomfortable and cause bruising.
Oral therapy (pills): This is the least effective therapy. Pills are also associated with a small risk of liver problems. Testosterone pills are not recommended.
If your doctor prescribes long-term testosterone replacement therapy, you will have follow-up visits to assess your testosterone levels, to periodically monitor your blood counts, and to undergo regular prostate checks, including digital rectal examinations and prostate specific antigen (PSA) blood tests
Penile Injection Therapy
Although many substances are touted as male sexual boosters, the modern age of such drug therapies began in 1993.
At that time, papaverine, a drug that produces vasodilatation (widening of the blood vessels), was shown to produce erections when injected directly into the penis. Soon afterward, other vasodilators were demonstrated to be effective as a treatment of erectile dysfunction.
Alprostadil is currently the most commonly used drug for injections into the penis. Alprostadil works well in most men who try it.
TriMix (a combination of alprostadil, phentolamine, and papaverine) has roughly twice the effectiveness of alprostadil alone. However, it is relatively expensive and usually not covered by insurance, whereas alprostadil is often covered by most insurance plans.
Self-injection of these drugs has been very beneficial. Penile injection therapy represents the most effective way to achieve erections in a wide variety of men who would otherwise be unable to obtain adequate rigid erections. In fact, if the vascular structure of the penis is healthy, the use of injectable drugs is almost always effective. Men on anticoagulant medications (blood thinners) cannot use this therapy.
Your doctor will determine an appropriate dose. The dose is adjusted to achieve an erection with adequate rigidity for no more than 90 minutes. The injection cannot be done more than 3 times per week.
Side effects include:
Pain from the medication (not from the injection)
Priapism
Priapism is a persistent or abnormally prolonged erection that lasts 4 hours or more.
Priapism is a urologic emergency. If an erection lasts for 4 hours or more, you must either contact your urologist or go to an emergency department for immediate treatment.
Scarring or bleeding at the site of the injection
If you choose this therapy, your doctor will teach you how to perform the injections. Even though the injection itself is painless, many men are still uncomfortable with penile injection therapy.
Intraurethral Pellet Therapy
Intraurethral pellet therapy, also called the medicated urethral system for erections (MUSE), is a useful alternative for men who do not want to use self-injections or for men in whom oral medications have failed.
Intraurethral pellet therapy is effective in a majority of men.
Intraurethral pellet therapy may be effective in men with vascular disease or with diabetes and in those who have undergone prostate surgery.
Intraurethral pellet therapy has been successful when used together with Viagra; however, this type of combination treatment should only be done under the supervision of a urologist who is experienced in treating erectile dysfunction.
Alprostadil, a drug also discussed in Penile Injection Therapy, has been formulated into a small suppository. This suppository is inserted into the urethra (the canal through which urine and semen are excreted). Because of this, urinating immediately before use is important in order to moisten the passage.
A temporary tourniquet is often helpful in allowing the medication to stay in the erectile tissue a little longer and seems to give a somewhat better response.
Few side effects occur with intraurethral pellet therapy. The most common side effect is pain at the site where the pellet is deposited. A small amount of bleeding may also occur.
Sunday, July 12, 2015
Treatments and drugs
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 (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 men to function normally. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in men 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 fix 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 might not work or might be dangerous if you:
Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Minitran, Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Dilatrate-SR, Isordil)
Have very low blood pressure (hypotension) or uncontrolled high blood pressure (hypertension)
Have severe liver disease
Have kidney disease that requires dialysis
Other medications
Other medications for erectile dysfunction include:
Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject Impulse, 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 papaverine, alprostadil and phentolamine.
Each injection generally produces an erection that lasts about an hour. Because the needle used is very fine, pain from the injection site is usually minor.
Side effects can include bleeding from the injection, prolonged erection (priapism) and formation of fibrous tissue at the injection site.
Alprostadil urethral suppository. Alprostadil intraurethral (Muse) 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 lasts between 30 and 60 minutes. Side effects can include pain, minor bleeding in the urethra and formation of fibrous tissue inside your penis. Testosterone replacement. Some men 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.
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. Penis pumps available in magazines and sex ads might not be safe or effective.
Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or semirigid rods. Inflatable devices allow you to control when and how long you have an erection. The semirigid 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 men who have tried and failed more-conservative therapies. As with any surgery, there's a risk of complications, such as infection. Blood vessel surgery. Rarely, leaking or obstructed blood vessels can cause erectile dysfunction. In this case, surgical repair, such as vascular stenting or a bypass procedure, might be needed.
Psychological counseling
If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship tension — your doctor might suggest that you, or you and your partner, visit a psychologist or counselor.
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 (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 men to function normally. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in men 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 fix 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 might not work or might be dangerous if you:
Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Minitran, Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Dilatrate-SR, Isordil)
Have very low blood pressure (hypotension) or uncontrolled high blood pressure (hypertension)
Have severe liver disease
Have kidney disease that requires dialysis
Other medications
Other medications for erectile dysfunction include:
Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject Impulse, 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 papaverine, alprostadil and phentolamine.
Each injection generally produces an erection that lasts about an hour. Because the needle used is very fine, pain from the injection site is usually minor.
Side effects can include bleeding from the injection, prolonged erection (priapism) and formation of fibrous tissue at the injection site.
Alprostadil urethral suppository. Alprostadil intraurethral (Muse) 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 lasts between 30 and 60 minutes. Side effects can include pain, minor bleeding in the urethra and formation of fibrous tissue inside your penis. Testosterone replacement. Some men 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.
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. Penis pumps available in magazines and sex ads might not be safe or effective.
Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or semirigid rods. Inflatable devices allow you to control when and how long you have an erection. The semirigid 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 men who have tried and failed more-conservative therapies. As with any surgery, there's a risk of complications, such as infection. Blood vessel surgery. Rarely, leaking or obstructed blood vessels can cause erectile dysfunction. In this case, surgical repair, such as vascular stenting or a bypass procedure, might be needed.
Psychological counseling
If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship tension — your doctor might suggest that you, or you and your partner, visit a psychologist or counselor.
Erectile Dysfunction Treatment
Erectile dysfunction (ED), sometimes referred to as impotence, is the inability of a man to achieve or maintain an erection hard enough for sexual intercourse. Millions of men in the U.S. have erectile dysfunction. It may be caused by diseases, complications from surgery, side effects of certain medications, lifestyle factors, and psychological factors.
Erectile dysfunction can be treated at any age. Treatment depends on your overall health and the underlying cause of the problem. If erectile dysfunction is a problem for you, talk to your doctor. Significant strides have been made in the last decade for treating erectile dysfunction. There are a number of therapies to choose from today. Your doctor can help you choose the best and safest one.
How Is Erectile Dysfunction Treated?
In some cases, simple lifestyle changes, such as losing weight, drinking less alcohol, or quitting smoking, may improve erectile dysfunction.
If the erectile dysfunction is caused by a certain medication, your doctor may suggest reducing the dose or trying an alternative drug. Certain blood pressure medications, allergy drugs, antidepressants, sedatives, appetite suppressants, and an ulcer drug called cimetidine may make it hard for a man to get a firm erection.
Most men with erectile dysfunction, however, will need further treatment. Treatment options for erectile dysfunction include:
Psychotherapy (counseling)
Medications (drug therapy)
Vacuum devices (pumps)
Surgery
Psychotherapy for Erectile Dysfunction
Talk therapy may be the initial treatment option for men with anxiety or stress-related erectile dysfunction. Relationship difficulties, work problems, financial woes, and other, everyday stressors can trigger erectile dysfunction. Talking about worries and stressors to a licensed therapist can ease sexual anxiety and provide strategies to boost intimacy. Usually only three to four sessions are needed. Including your partner in therapy can also be helpful.
Medications for Erectile Dysfunction
Men have different options in the types of drugs for ED. Medicines can be taken orally, inserted into the urethra, or injected into the penis.
The first medications usually prescribed to men with erectile dysfunction are called phosphodiesterase (PDE) type 5 inhibitors. These include:
sildenafil (Viagra)
tadalafil (Cialis)
vardenafil hydrochloride (Levitra, Staxyn)
avanafil (Stendra)
Medications for Erectile Dysfunction
They are generally taken by mouth anywhere from 15 minutes to one hour before having sex -- depending on the drug -- and should not be used more than once a day. One medication, Cialis, may be taken up to 36 hours before sexual activity. Staxyn dissolves in the mouth, but the other medications are swallowed.
PDE-5 inhibitors relax smooth muscles in the penis, which increases blood flow to the area, helping the penis become erect during sexual activity. About 80% of men who take PDE-5 inhibitors have firmer and longer-lasting erections. However, if your erection lasts more than four hours, seek emergency medical help.
Side effects of PDE-5 inhibitors are usually mild but may include headache, stuffy nose, flushing, muscle aches, and rarely, a temporary blue-green shading of your vision.
You should not take PDE-5 inhibitors if you take nitrate drugs, such as nitroglycerin tablets for heart disease. Doing so can cause a dangerous drop in blood pressure. Men taking alpha-blockers for prostate problems or blood pressure should also be cautioned. Always make sure your doctor knows about all the medications you are taking, including over-the-counter drugs, herbs, and supplements.
Injections and Suppositories for Erectile Dysfunction
If the medications taken by mouth do not improve erection quality, or you cannot safely take such medications, your doctor may recommend a drug called alprostadil. It helps boost blood flow to the penis, automatically triggering an erection within minutes.
Alprostadil may be given in two ways:
Intracavernous drug injection. The medication is injected into the side of the penis. It involves sticking a needle directly into the penis, and it raises your risk for dangerously prolonged erections (called priaprism) and scarring.
Intraurethral suppositories. Pellets containing alprostadil are placed into the urethra at the tip of the penis. Such treatment is called MUSE (which means medicated urethral system for erections). This therapy may be less successful than injections.
Not Recommended for Erectile Dysfunction
These therapies are not recommended for the treatment of ED:
Testosterone. Testosterone is a male hormone, or androgen. It is not recommended as a treatment for erectile dysfunction when blood tests reveal the man has a normal testosterone level.
Trazodone. Trazodone is an antidepressant. Some studies report slightly better sexual function in men who took the drug. But follow-up trials yield conflicting or unconvincing results. Current guidelines do not recommend trazodone for the treatment of erectile dysfunction.
Yohimbine. Yohimbine is obtained from the bark of certain evergreen trees. It is not recommended for the treatment of erectile dysfunction. Well-conducted studies have not been done to determine how well it improves sexual function in men.
Supplements for Erectile Dysfunction
Various over-the-counter products have been promoted as all-natural ways to enhance a man's sexual performance or promote erections. Yet clinical evidence suggesting that herbs and supplements effectively treat erectile dysfunction is lacking. Herbal therapies, including yohimbine bark and L-arginine, are not recommended as a treatment for erectile dysfunction, according to the most recent treatment guidelines by the American Urological Association.
The FDA warns that some products may contain unlisted and harmful substances or the active ingredient in some prescription medications. Some of the so-called over-the-counter dietary supplements for ED have been found to contain sildenafil (the active ingredient in Viagra) or a substance similar to that prescription or another called vardenafil (the active ingredient in Levitra and Staxyn). These FDA-approved prescriptions can be dangerous for patients who take nitrates to treat chest pain or heart disease.
In recent years, the FDA has seized many over-the-counter products for male sexual dysfunction because they contained dangerous or undeclared ingredients.
The FDA says you should AVOID the following products:
4EVERON
Actra-Rx
Actra-Sx
Adam Free
Blue Steel
Energy Max
Erextra
Hero
HS Joy of Love
Lady Shangai
Libidus
Liviro3
Lycium Barbarum L.
Nasutra
Naturalë Super Plus
NaturalUp
Neophase
Rhino V Max
Shangai Regular, also marketed as Shangai Chaojimengnan
Shangai Ultra
Shangai Ultra X
Strong Testis
Super Shangai
True Man
V.Max
Vigor-25
Xiadafil VIP tablets (Lots 6K029 and 6K209-SEI only)
Yilishen
Zimaxx
Vacuum Devices for Erectile Dysfunction
A vacuum device improves firmness by increasing blood flow to the penis. About 80% of men who use the device correctly obtain an erection hard enough for sexual intercourse.
Vacuum erection devices (VED), also called vacuum constriction devices (VCD), are made of three parts:
A clear, plastic tube (cylinder) that slides over the penis. A manual or battery-operated pump that sucks air out of the cylinder, sending more blood to the penis. An elastic ring that is placed around the base of the penis after an erection is obtained. The rubber band-like ring helps maintain firmness by preventing blood from leaking out of the penis. The ring comes in different sizes for an individual fit.
A vacuum device can be cumbersome and interfere with a man's ability for sexual spontaneity. The elastic ring may lead to skin irritation, bruising, loss of feeling or sensitivity, or pain.
Vacuum devices are available with or without a prescription. Talk to your doctor before buying or using a vacuum device purchased without a prescription.
Surgery for Erectile Dysfunction
If all other treatments for erectile dysfunction have failed, your doctor may recommend surgery. Surgery is usually only done if you have severe erectile dysfunction and no response from nonsurgical treatments.
Erectile dysfunction surgery falls into two categories:
Placement of an implant (prosthesis) in the penis.
Vascular reconstruction surgery to improve blood flow to or reduce blood leakage from the penis and surrounding structures.
Implants, or prostheses, help restore firmness for many men with erectile dysfunction. There are two types of implants: malleable and inflatable.
Malleable implants are a pair of adjustable rods placed inside the penis. You manually move your penis, and therefore rods, into a position suitable for intercourse. Such implants do not affect penis size.
Inflatable implants are a pair of tubes placed in the penis connected to a squeezable pump inside the scrotum. You squeeze the pump to get an erection. Inflatable implants can also help slightly increase length and width.
Once you have a penile implant, you must always use it to get an erection. Implants may cause infection in some men. Men who have a urinary tract infection, skin infection, or systemic (body-wide) infection should not get a penile implant. Other problems with implants may include auto-inflation, mechanical breakdown of the device, and shifting of the pump.
Surgery for Erectile Dysfunction
Vascular reconstruction surgery may be done to:
Repair blood vessel blockages to improve blood flow to the penis.
Block veins to prevent blood from leaking out of the penis and surrounding tissues.
Blood vessel repair is best done in younger men who have a subtle blockage due to an injury. This type of surgery usually is not successful in older men, who tend to have more widespread blood flow blockages.
Vein blockage, called ligation, is the opposite of penile blood vessel repair. A vein is intentionally blocked to reduce blood loss from the penis and surrounding tissues. Blood loss from the penis can lead to a decrease in firmness. This procedure is rarely used, however, because its long-term effectiveness is unclear.
Future Treatments for Erectile Dysfunction
Advances in erectile dysfunction treatment are being made every day. Gene therapy for erectile dysfunction is being widely studied and could provide a longer-lasting treatment for men with erectile dysfunction.
Scientists are also researching whether a substance made from spider venom could lead to the development of new drugs for erectile dysfunction. Certain poisonous spider bites can trigger priapism, which is a dangerously prolonged erection.
Erectile dysfunction can be treated at any age. Treatment depends on your overall health and the underlying cause of the problem. If erectile dysfunction is a problem for you, talk to your doctor. Significant strides have been made in the last decade for treating erectile dysfunction. There are a number of therapies to choose from today. Your doctor can help you choose the best and safest one.
How Is Erectile Dysfunction Treated?
In some cases, simple lifestyle changes, such as losing weight, drinking less alcohol, or quitting smoking, may improve erectile dysfunction.
If the erectile dysfunction is caused by a certain medication, your doctor may suggest reducing the dose or trying an alternative drug. Certain blood pressure medications, allergy drugs, antidepressants, sedatives, appetite suppressants, and an ulcer drug called cimetidine may make it hard for a man to get a firm erection.
Most men with erectile dysfunction, however, will need further treatment. Treatment options for erectile dysfunction include:
Psychotherapy (counseling)
Medications (drug therapy)
Vacuum devices (pumps)
Surgery
Psychotherapy for Erectile Dysfunction
Talk therapy may be the initial treatment option for men with anxiety or stress-related erectile dysfunction. Relationship difficulties, work problems, financial woes, and other, everyday stressors can trigger erectile dysfunction. Talking about worries and stressors to a licensed therapist can ease sexual anxiety and provide strategies to boost intimacy. Usually only three to four sessions are needed. Including your partner in therapy can also be helpful.
Medications for Erectile Dysfunction
Men have different options in the types of drugs for ED. Medicines can be taken orally, inserted into the urethra, or injected into the penis.
The first medications usually prescribed to men with erectile dysfunction are called phosphodiesterase (PDE) type 5 inhibitors. These include:
sildenafil (Viagra)
tadalafil (Cialis)
vardenafil hydrochloride (Levitra, Staxyn)
avanafil (Stendra)
Medications for Erectile Dysfunction
They are generally taken by mouth anywhere from 15 minutes to one hour before having sex -- depending on the drug -- and should not be used more than once a day. One medication, Cialis, may be taken up to 36 hours before sexual activity. Staxyn dissolves in the mouth, but the other medications are swallowed.
PDE-5 inhibitors relax smooth muscles in the penis, which increases blood flow to the area, helping the penis become erect during sexual activity. About 80% of men who take PDE-5 inhibitors have firmer and longer-lasting erections. However, if your erection lasts more than four hours, seek emergency medical help.
Side effects of PDE-5 inhibitors are usually mild but may include headache, stuffy nose, flushing, muscle aches, and rarely, a temporary blue-green shading of your vision.
You should not take PDE-5 inhibitors if you take nitrate drugs, such as nitroglycerin tablets for heart disease. Doing so can cause a dangerous drop in blood pressure. Men taking alpha-blockers for prostate problems or blood pressure should also be cautioned. Always make sure your doctor knows about all the medications you are taking, including over-the-counter drugs, herbs, and supplements.
Injections and Suppositories for Erectile Dysfunction
If the medications taken by mouth do not improve erection quality, or you cannot safely take such medications, your doctor may recommend a drug called alprostadil. It helps boost blood flow to the penis, automatically triggering an erection within minutes.
Alprostadil may be given in two ways:
Intracavernous drug injection. The medication is injected into the side of the penis. It involves sticking a needle directly into the penis, and it raises your risk for dangerously prolonged erections (called priaprism) and scarring.
Intraurethral suppositories. Pellets containing alprostadil are placed into the urethra at the tip of the penis. Such treatment is called MUSE (which means medicated urethral system for erections). This therapy may be less successful than injections.
Not Recommended for Erectile Dysfunction
These therapies are not recommended for the treatment of ED:
Testosterone. Testosterone is a male hormone, or androgen. It is not recommended as a treatment for erectile dysfunction when blood tests reveal the man has a normal testosterone level.
Trazodone. Trazodone is an antidepressant. Some studies report slightly better sexual function in men who took the drug. But follow-up trials yield conflicting or unconvincing results. Current guidelines do not recommend trazodone for the treatment of erectile dysfunction.
Yohimbine. Yohimbine is obtained from the bark of certain evergreen trees. It is not recommended for the treatment of erectile dysfunction. Well-conducted studies have not been done to determine how well it improves sexual function in men.
Supplements for Erectile Dysfunction
Various over-the-counter products have been promoted as all-natural ways to enhance a man's sexual performance or promote erections. Yet clinical evidence suggesting that herbs and supplements effectively treat erectile dysfunction is lacking. Herbal therapies, including yohimbine bark and L-arginine, are not recommended as a treatment for erectile dysfunction, according to the most recent treatment guidelines by the American Urological Association.
The FDA warns that some products may contain unlisted and harmful substances or the active ingredient in some prescription medications. Some of the so-called over-the-counter dietary supplements for ED have been found to contain sildenafil (the active ingredient in Viagra) or a substance similar to that prescription or another called vardenafil (the active ingredient in Levitra and Staxyn). These FDA-approved prescriptions can be dangerous for patients who take nitrates to treat chest pain or heart disease.
In recent years, the FDA has seized many over-the-counter products for male sexual dysfunction because they contained dangerous or undeclared ingredients.
The FDA says you should AVOID the following products:
4EVERON
Actra-Rx
Actra-Sx
Adam Free
Blue Steel
Energy Max
Erextra
Hero
HS Joy of Love
Lady Shangai
Libidus
Liviro3
Lycium Barbarum L.
Nasutra
Naturalë Super Plus
NaturalUp
Neophase
Rhino V Max
Shangai Regular, also marketed as Shangai Chaojimengnan
Shangai Ultra
Shangai Ultra X
Strong Testis
Super Shangai
True Man
V.Max
Vigor-25
Xiadafil VIP tablets (Lots 6K029 and 6K209-SEI only)
Yilishen
Zimaxx
Vacuum Devices for Erectile Dysfunction
A vacuum device improves firmness by increasing blood flow to the penis. About 80% of men who use the device correctly obtain an erection hard enough for sexual intercourse.
Vacuum erection devices (VED), also called vacuum constriction devices (VCD), are made of three parts:
A clear, plastic tube (cylinder) that slides over the penis. A manual or battery-operated pump that sucks air out of the cylinder, sending more blood to the penis. An elastic ring that is placed around the base of the penis after an erection is obtained. The rubber band-like ring helps maintain firmness by preventing blood from leaking out of the penis. The ring comes in different sizes for an individual fit.
A vacuum device can be cumbersome and interfere with a man's ability for sexual spontaneity. The elastic ring may lead to skin irritation, bruising, loss of feeling or sensitivity, or pain.
Vacuum devices are available with or without a prescription. Talk to your doctor before buying or using a vacuum device purchased without a prescription.
Surgery for Erectile Dysfunction
If all other treatments for erectile dysfunction have failed, your doctor may recommend surgery. Surgery is usually only done if you have severe erectile dysfunction and no response from nonsurgical treatments.
Erectile dysfunction surgery falls into two categories:
Placement of an implant (prosthesis) in the penis.
Vascular reconstruction surgery to improve blood flow to or reduce blood leakage from the penis and surrounding structures.
Implants, or prostheses, help restore firmness for many men with erectile dysfunction. There are two types of implants: malleable and inflatable.
Malleable implants are a pair of adjustable rods placed inside the penis. You manually move your penis, and therefore rods, into a position suitable for intercourse. Such implants do not affect penis size.
Inflatable implants are a pair of tubes placed in the penis connected to a squeezable pump inside the scrotum. You squeeze the pump to get an erection. Inflatable implants can also help slightly increase length and width.
Once you have a penile implant, you must always use it to get an erection. Implants may cause infection in some men. Men who have a urinary tract infection, skin infection, or systemic (body-wide) infection should not get a penile implant. Other problems with implants may include auto-inflation, mechanical breakdown of the device, and shifting of the pump.
Surgery for Erectile Dysfunction
Vascular reconstruction surgery may be done to:
Repair blood vessel blockages to improve blood flow to the penis.
Block veins to prevent blood from leaking out of the penis and surrounding tissues.
Blood vessel repair is best done in younger men who have a subtle blockage due to an injury. This type of surgery usually is not successful in older men, who tend to have more widespread blood flow blockages.
Vein blockage, called ligation, is the opposite of penile blood vessel repair. A vein is intentionally blocked to reduce blood loss from the penis and surrounding tissues. Blood loss from the penis can lead to a decrease in firmness. This procedure is rarely used, however, because its long-term effectiveness is unclear.
Future Treatments for Erectile Dysfunction
Advances in erectile dysfunction treatment are being made every day. Gene therapy for erectile dysfunction is being widely studied and could provide a longer-lasting treatment for men with erectile dysfunction.
Scientists are also researching whether a substance made from spider venom could lead to the development of new drugs for erectile dysfunction. Certain poisonous spider bites can trigger priapism, which is a dangerously prolonged erection.
Saturday, July 11, 2015
Erectile Dysfunction, Natural Treatment
June is Men's Health Month, and a good time to examine the common male condition known as erectile dysfunction, or ED. According to the American Urological Association, more than 25 million men in the U.S. suffer from some sort of ED, but because the level of distress is so variable with this condition, only 5 percent of them have sought treatment.
Symptoms and Causes
Commonly called male impotence, ED is the inability to achieve or maintain penile erections sufficient for intercourse. ED often has a psychological component, and counseling with a psychotherapist or sex therapist often resolves the problem. ED can also be a symptom of cardiovascular disease and diabetes, both of which can impair blood supply to the penis. In addition, many medications, including those prescribed for high blood pressure and mental health conditions, can interfere with sexual functioning. Tobacco, cocaine, stimulants and alcohol may also play a role.
Suggested Lifestyle Changes
Bear in mind that some of the problems leading to erectile dysfunction may lend themselves to the following non-drug (and cost-free) solutions:
Stop smoking. Nicotine can reduce genital blood flow and impair potency.
Check your meds. ED and sexual dysfunction are unfortunate side effects of many drugs. Consult with your pharmacist or doctor regarding substituting alternate medication without these effects.
Limit alcohol consumption. Alcohol’s depressive effects can have a negative impact on sexual functioning.
Shape up. ED is often linked with restricted blood flow to the penis. Keep your heart and arteries in good condition by maintaining a healthy weight, and following a diet high in fruits, vegetables and whole grains. Avoid saturated fats and trans fats. Regular aerobic exercise can both improve blood flow to the genitals and reduce the stress that can contribute to ED.
Deal with anxiety, depression and stress. These feelings may undermine desire and potency. Practice a daily stress-reduction technique such as breath work, meditation or yoga. Talk with your partner openly and honestly about your needs – and their needs – to help ease relationship tensions and avoid resentment and misunderstandings.
Don’t worry about your age. Sexual activity needn’t end because of age – that’s a myth you can discard.
Supplements
Ginkgo. This herb may improve arousal in both men and women, perhaps by increasing blood flow to the genitals. It should not be used by those on blood thinners such as coumadin.
Yohimbe. This comes from the bark of an African tree, Pausinystalia yohimbe, is the basis of several pharmaceutical drugs used to treat impotence. It contains an alkaloid, yohimbine, which previously was the only drug listed in the Physician's Desk Reference as a sexual booster. This herb, however prized as an aphrodisiac, can have some side effects (agitation, anxiety and insomnia) that make many men prefer not to use it. Yohimbe bark and extracts are occasionally available in health food stores, but I do not recommend them.
As an alternative, try taking ashwagandha or a standardized extract of Asian ginseng. Ashwagandha, from the roots of a plant in the nightshade family called Withania somnifera, is reputed to be a mild aphrodisiac and has long been popular in India. Asian ginseng, or Panax ginseng, is a good general stimulant and sexual energizer. For either, follow the dosage on the package, and give it a six or eight week trial to have an effect. Both ashwagandha and Asian ginseng are generally safe (but Asian ginseng can raise blood pressure and cause irritability and insomnia in some people).
Symptoms and Causes
Commonly called male impotence, ED is the inability to achieve or maintain penile erections sufficient for intercourse. ED often has a psychological component, and counseling with a psychotherapist or sex therapist often resolves the problem. ED can also be a symptom of cardiovascular disease and diabetes, both of which can impair blood supply to the penis. In addition, many medications, including those prescribed for high blood pressure and mental health conditions, can interfere with sexual functioning. Tobacco, cocaine, stimulants and alcohol may also play a role.
Suggested Lifestyle Changes
Bear in mind that some of the problems leading to erectile dysfunction may lend themselves to the following non-drug (and cost-free) solutions:
Stop smoking. Nicotine can reduce genital blood flow and impair potency.
Check your meds. ED and sexual dysfunction are unfortunate side effects of many drugs. Consult with your pharmacist or doctor regarding substituting alternate medication without these effects.
Limit alcohol consumption. Alcohol’s depressive effects can have a negative impact on sexual functioning.
Shape up. ED is often linked with restricted blood flow to the penis. Keep your heart and arteries in good condition by maintaining a healthy weight, and following a diet high in fruits, vegetables and whole grains. Avoid saturated fats and trans fats. Regular aerobic exercise can both improve blood flow to the genitals and reduce the stress that can contribute to ED.
Deal with anxiety, depression and stress. These feelings may undermine desire and potency. Practice a daily stress-reduction technique such as breath work, meditation or yoga. Talk with your partner openly and honestly about your needs – and their needs – to help ease relationship tensions and avoid resentment and misunderstandings.
Don’t worry about your age. Sexual activity needn’t end because of age – that’s a myth you can discard.
Supplements
Ginkgo. This herb may improve arousal in both men and women, perhaps by increasing blood flow to the genitals. It should not be used by those on blood thinners such as coumadin.
Yohimbe. This comes from the bark of an African tree, Pausinystalia yohimbe, is the basis of several pharmaceutical drugs used to treat impotence. It contains an alkaloid, yohimbine, which previously was the only drug listed in the Physician's Desk Reference as a sexual booster. This herb, however prized as an aphrodisiac, can have some side effects (agitation, anxiety and insomnia) that make many men prefer not to use it. Yohimbe bark and extracts are occasionally available in health food stores, but I do not recommend them.
As an alternative, try taking ashwagandha or a standardized extract of Asian ginseng. Ashwagandha, from the roots of a plant in the nightshade family called Withania somnifera, is reputed to be a mild aphrodisiac and has long been popular in India. Asian ginseng, or Panax ginseng, is a good general stimulant and sexual energizer. For either, follow the dosage on the package, and give it a six or eight week trial to have an effect. Both ashwagandha and Asian ginseng are generally safe (but Asian ginseng can raise blood pressure and cause irritability and insomnia in some people).
Natural Remedies for Erectile Dysfunction
From acupuncture to arginine, from ginseng to pomegranate juice, men have tried all sorts of natural remedies for erectile dysfunction (ED) -- which doctors define as the repeated inability to get or maintain an erection firm enough for sexual intercourse. But are these alternative remedies safe? Do they really work?
The scientific evidence to support the use of natural remedies for impotence is sketchy; many of the studies that seem to give the remedies a thumbs-up were so poorly designed that their findings are suspect.br>
"Just because there is evidence doesn't mean it's good evidence," says Andrew McCullough, MD, associate professor of clinical urology at New York University Langone Medical Center in New York City, and one of the original clinical investigators for the ED drug Viagra (sildenafil). "And before men with ED start down the naturopathic route, it's smart to make sure that there isn't some underlying medical condition that needs to be corrected."br>
That's good advice. An estimated 30 million American men have erectile dysfunction, and seven out of 10 cases are caused by a potentially deadly condition like atherosclerosis, kidney disease, vascular disease, neurological disease, or diabetes. ED can also be caused by certain medications, surgical injury, and psychological problems.br>
Experts who spoke with WebMD agree that treating erectile dysfunction on your own, without consulting a doctor, is a dangerous game. "If you have ED, the first thing you need is a diagnosis," says impotence expert Steven Lamm, MD, a New York City internist and the author of The Hardness Factor (Harper Collins) and other books on male sexual health. He says men with severe erectile dysfunction probably need one of the prescription ED drugs, which include Levitra (vardenafil) and Cialis (tadalafil) as well as Viagra. But, he says, mild ED -- including the feeling that "you're not as hard as you could be" -- often responds to natural remedies. But which remedies? Here's a look at the evidence for and against six of the most popular ones:br>
Acupuncture. Though acupuncture has been used to treat male sexual problems for centuries, the scientific evidence to support its use for erectile dysfunction is equivocal at best. In 2009 South Korean scientists conducted a systematic review of studies on acupuncture for ED. They found major design flaws in all of the studies, concluding that "the evidence is insufficient to suggest that acupuncture is an effective intervention for treating ED."br>
Arginine. The amino acid L-arginine, which occurs naturally in food, boosts the body's production of nitric oxide, a compound that facilitates erections by dilating blood vessels in the penis. Studies examining L-arginine's effectiveness against impotence have yielded mixed results. A 1999 trial published in the online journal BJU International found that high doses of L-arginine can help improve sexual function, but only in men with abnormal nitric oxide metabolism, such as that associated with cardiovascular disease. In another study, published in 2003 in the Journal of Sex & Marital Therapy, Bulgarian scientists reported that ED sufferers who took L-arginine along with the pine extract pycnogenol saw major improvements in sexual function with no side effects.br>
Arginine can be helpful, says Geo Espinosa, ND, director of the Integrative Urological Center at NYU Langone Medical Center. Espinosa says that men with known cardiovascular problems should take it only with a doctor's supervision; L-arginine can interact with some medications.br>
DHEA. Testosterone is essential for a healthy libido and normal sexual function, and erectile dysfunction sufferers known to have low testosterone improve when placed on prescription testosterone replacement therapy. Similarly, studies have shown that taking over-the-counter supplements containing DHEA, a hormone that the body converts to testosterone and estrogen, can help alleviate some cases of ED. But DHEA can cause problems, including suppression of pituitary function, and its long-term safety is unknown, says McCullough. For this reason, many experts discourage use of the supplements.br>
Ginseng. Korean red ginseng has long been used to stimulate male sexual function, but few studies have tried systematically to confirm its benefits. In one 2002 study involving 45 men with significant ED, the herb helped alleviate symptoms of erectile dysfunction and brought "enhanced penile tip rigidity." Experts aren't sure how ginseng might work, though it's thought to promote nitric oxide synthesis. "I would recommend ginseng [for men with ED]," says Espinosa. Discuss with your doctor before taking it since ginseng can interact with drugs you may already be taking and cause allergic reactions.br>
Pomegranate juice. Drinking antioxidant-rich pomegranate juice has been shown to have numerous health benefits, including a reduced risk for heart disease and high blood pressure. Does pomegranate juice also protect against ED? No proof exists, but results of a study published in 2007 were promising. The authors of this small-scale pilot study called for additional research, saying that larger-scale studies might prove pomegranate juice's effectiveness against erectile dysfunction. "I tell my patients to drink it," says Espinosa. "It could help ED, and even if it doesn't, it has other health benefits."br>
Yohimbe. Before Viagra and the other prescription erectile dysfunction drugs became available, doctors sometimes prescribed a derivative of the herb yohimbe (yohimbine hydrochloride) to their patients suffering from ED. But experts say the medication is not particularly effective, and it can cause jitteriness and other problems. "It's not a great drug," says McCullough. "And I suspect the herb is not as potent as the pharmaceutical version." What's more, evidence shows that yohimbe is associated with high blood pressure, anxiety, headache, and other health problems. Experts discourage its use.br>
Horny Goat Weed . Horny goat weed and related herbs have purportedly been treatments for sexual dysfunction for years. Italian researchers found that the main compound in horny goat weed, called icariin, acted in a similar way as drugs like Viagra.br>
Ginkgo biloba . Known primarily as a treatment for cognitive decline, ginkgo has also been used to treat erectile dysfunction -- especially cases caused by the use of certain antidepressant medications. But the evidence isn't very convincing. One 1998 study published in the Journal of Sex and Marital Therapy found that it did work. But a more rigorous study, published in Human Pharmacology in 2002, failed to replicate this finding. "Ginkgo has come out of fashion in the past few years," says Ronald Tamler, MD, assistant professor of medicine and co-director of the men's health program at Mount Sinai Medical Center in New York City. "That's because it doesn't do much. I can say that in my practice, I have not seen ginkgo work -- ever."br>
No matter what erectile dysfunction treatment or treatments a man ultimately decides upon, experts say it's important to eat healthfully and to avoid smoking and heavy drinking. In addition, says Lamm, "A loving, receptive, and responsive partner is a home run. After all, this is still a couple's issue."
The scientific evidence to support the use of natural remedies for impotence is sketchy; many of the studies that seem to give the remedies a thumbs-up were so poorly designed that their findings are suspect.br>
"Just because there is evidence doesn't mean it's good evidence," says Andrew McCullough, MD, associate professor of clinical urology at New York University Langone Medical Center in New York City, and one of the original clinical investigators for the ED drug Viagra (sildenafil). "And before men with ED start down the naturopathic route, it's smart to make sure that there isn't some underlying medical condition that needs to be corrected."br>
That's good advice. An estimated 30 million American men have erectile dysfunction, and seven out of 10 cases are caused by a potentially deadly condition like atherosclerosis, kidney disease, vascular disease, neurological disease, or diabetes. ED can also be caused by certain medications, surgical injury, and psychological problems.br>
Experts who spoke with WebMD agree that treating erectile dysfunction on your own, without consulting a doctor, is a dangerous game. "If you have ED, the first thing you need is a diagnosis," says impotence expert Steven Lamm, MD, a New York City internist and the author of The Hardness Factor (Harper Collins) and other books on male sexual health. He says men with severe erectile dysfunction probably need one of the prescription ED drugs, which include Levitra (vardenafil) and Cialis (tadalafil) as well as Viagra. But, he says, mild ED -- including the feeling that "you're not as hard as you could be" -- often responds to natural remedies. But which remedies? Here's a look at the evidence for and against six of the most popular ones:br>
Acupuncture. Though acupuncture has been used to treat male sexual problems for centuries, the scientific evidence to support its use for erectile dysfunction is equivocal at best. In 2009 South Korean scientists conducted a systematic review of studies on acupuncture for ED. They found major design flaws in all of the studies, concluding that "the evidence is insufficient to suggest that acupuncture is an effective intervention for treating ED."br>
Arginine. The amino acid L-arginine, which occurs naturally in food, boosts the body's production of nitric oxide, a compound that facilitates erections by dilating blood vessels in the penis. Studies examining L-arginine's effectiveness against impotence have yielded mixed results. A 1999 trial published in the online journal BJU International found that high doses of L-arginine can help improve sexual function, but only in men with abnormal nitric oxide metabolism, such as that associated with cardiovascular disease. In another study, published in 2003 in the Journal of Sex & Marital Therapy, Bulgarian scientists reported that ED sufferers who took L-arginine along with the pine extract pycnogenol saw major improvements in sexual function with no side effects.br>
Arginine can be helpful, says Geo Espinosa, ND, director of the Integrative Urological Center at NYU Langone Medical Center. Espinosa says that men with known cardiovascular problems should take it only with a doctor's supervision; L-arginine can interact with some medications.br>
DHEA. Testosterone is essential for a healthy libido and normal sexual function, and erectile dysfunction sufferers known to have low testosterone improve when placed on prescription testosterone replacement therapy. Similarly, studies have shown that taking over-the-counter supplements containing DHEA, a hormone that the body converts to testosterone and estrogen, can help alleviate some cases of ED. But DHEA can cause problems, including suppression of pituitary function, and its long-term safety is unknown, says McCullough. For this reason, many experts discourage use of the supplements.br>
Ginseng. Korean red ginseng has long been used to stimulate male sexual function, but few studies have tried systematically to confirm its benefits. In one 2002 study involving 45 men with significant ED, the herb helped alleviate symptoms of erectile dysfunction and brought "enhanced penile tip rigidity." Experts aren't sure how ginseng might work, though it's thought to promote nitric oxide synthesis. "I would recommend ginseng [for men with ED]," says Espinosa. Discuss with your doctor before taking it since ginseng can interact with drugs you may already be taking and cause allergic reactions.br>
Pomegranate juice. Drinking antioxidant-rich pomegranate juice has been shown to have numerous health benefits, including a reduced risk for heart disease and high blood pressure. Does pomegranate juice also protect against ED? No proof exists, but results of a study published in 2007 were promising. The authors of this small-scale pilot study called for additional research, saying that larger-scale studies might prove pomegranate juice's effectiveness against erectile dysfunction. "I tell my patients to drink it," says Espinosa. "It could help ED, and even if it doesn't, it has other health benefits."br>
Yohimbe. Before Viagra and the other prescription erectile dysfunction drugs became available, doctors sometimes prescribed a derivative of the herb yohimbe (yohimbine hydrochloride) to their patients suffering from ED. But experts say the medication is not particularly effective, and it can cause jitteriness and other problems. "It's not a great drug," says McCullough. "And I suspect the herb is not as potent as the pharmaceutical version." What's more, evidence shows that yohimbe is associated with high blood pressure, anxiety, headache, and other health problems. Experts discourage its use.br>
Horny Goat Weed . Horny goat weed and related herbs have purportedly been treatments for sexual dysfunction for years. Italian researchers found that the main compound in horny goat weed, called icariin, acted in a similar way as drugs like Viagra.br>
Ginkgo biloba . Known primarily as a treatment for cognitive decline, ginkgo has also been used to treat erectile dysfunction -- especially cases caused by the use of certain antidepressant medications. But the evidence isn't very convincing. One 1998 study published in the Journal of Sex and Marital Therapy found that it did work. But a more rigorous study, published in Human Pharmacology in 2002, failed to replicate this finding. "Ginkgo has come out of fashion in the past few years," says Ronald Tamler, MD, assistant professor of medicine and co-director of the men's health program at Mount Sinai Medical Center in New York City. "That's because it doesn't do much. I can say that in my practice, I have not seen ginkgo work -- ever."br>
No matter what erectile dysfunction treatment or treatments a man ultimately decides upon, experts say it's important to eat healthfully and to avoid smoking and heavy drinking. In addition, says Lamm, "A loving, receptive, and responsive partner is a home run. After all, this is still a couple's issue."
5 Natural Treatments for ED
What Is Erectile Dysfunction?
Erectile dysfunction (ED) affects as many as 30 million men in the United States. Almost half of men over age 75 experience ED, according to the National Institutes of Health.
ED is commonly called “impotence.” It’s a condition in which a man can’t achieve or maintain an erection during sexual performance. Symptoms may also include reduced sexual desire or libido.
These kinds of issues can happen at any time and to any man. Causes mainly include:
fatigue
stress
relationship issues
performance anxiety
alcohol consumption
Your doctor is likely to diagnose you with ED if the condition lasts for more than a few weeks or months.
Standard treatments include pharmaceutical medications, vacuum pumps, implants, and surgery, but many men prefer natural options. Research has found that some natural options can improve your ED symptoms.
What Causes Erectile Dysfunction?
A number of factors can increase your risk of ED. Attaining an erection involves the brain, hormones, muscles, nerves, and blood vessels. A problem with any of these components can block the normal functioning of the penis.
Some common causes of ED include:
heart disease
diabetes
obesity
multiple sclerosis
tobacco use
Parkinson’s disease
enlarged prostate gland
One study found that persistent alcohol use induced ED as well. Seventy-two percent of men diagnosed with alcohol dependence syndrome were diagnosed with sexual dysfunction. This includes premature ejaculation and ED.
Why You Need to See Your Doctor
It’s important to check with your doctor because ED may be a sign of additional health problems. For example, if you have heart disease, you can take a number of steps that will likely improve both your heart health and your ED. This includes lowering your cholesterol, reducing your weight, or taking medications to unclog your blood vessels.
Your doctor will likely prescribe some common treatments if other health issues aren’t found to be the cause of your ED. However, you may also choose natural options.
Common Treatments for ED: Medications
Standard treatments for ED include lifestyle changes, such as:
exercising
losing weight
stopping smoking
curbing alcohol intake
Medications like Viagra, Cialis, or Levitra increase blood flow to the penis. But they can also cause side effects, including:
nasal congestion
headache
upset stomach
vision changes
facial flushing
dizziness
Men who have experienced a stroke or have uncontrolled diabetes or low blood pressure should not take ED medications.
Testosterone replacement and erection-inducing injections are also available. Side effects may include:
acne
breast enlargement
increased urination
aching in the penis
scarring
gum or mouth irritation
Common Treatments for ED: Non-Drug Options
Non-drug treatments for ED include penile vacuum pumps, penile implants, and blood vessel surgery. A pump is used right before intercourse to pull blood into the penis. However, this method can cause bruising. Implants must be surgically inserted into the penis. They can then be inflated when necessary. Risks include those typically associated with surgery, such as infections.
Blood vessel surgery is recommended only when leaking vessels cause ED. Even though all these methods may help some men, natural alternatives can be just as effective, but less invasive.
Natural Solution #1 and #2: Panax Ginseng and Rhodiola Rosea
Called the “herbal Viagra,” Panax ginseng (“red ginseng”) has solid research behind it. Researchers reviewed seven studies of red ginseng and ED in 2008. Dosages ranged from 600 to 1,000 mg three times daily. They concluded there was “suggestive evidence for the effectiveness of red ginseng in the treatment of erectile dysfunction.”
One small study also indicated Rhodiola rosea may be helpful. Twenty-six out of 35 men were given 150 to 200 mg a day for three months. They experienced substantially improved sexual function.
Natural Solution #3: DHEA
Dehydroepiandrosterone (DHEA) is a natural hormone produced by the adrenal glands. It can be converted to both estrogen and testosterone in the body. Scientists make the dietary supplement from wild yam and soy.
The influential Massachusetts male aging study showed that men with ED were more likely to have low levels of DHEA. Forty men with ED participated in another study published in 1999, in which half received 50 mg DHEA and half received a placebo once a day for six months. Those receiving the DHEA were more likely to achieve and maintain an erection.
Natural Solution #4: L-Arginine
L-arginine is an amino acid naturally present in the body. It helps make nitric oxide. Nitric oxide relaxes blood vessels to facilitate a successful erection. Researchers studied the effects of L-arginine on ED in 1999. Thirty-one percent of men with ED taking 5 grams of L-arginine a day experienced significant improvements in sexual function.
A second study showed that L-arginine combined with pycnogenol, a plant product from tree bark, restored sexual ability to 80 percent of participants after two months. Ninety-two percent had restored sexual ability after three months.
Natural Solution #5: Acupuncture
Though studies are mixed, many show positive results when acupuncture is used to treat ED. A 1999 study, for example, found that acupuncture improved the quality of erections and restored sexual activity in 39 percent of participants.
A later study published in 2003 reported that 21 percent of ED patients who received acupuncture had improved erections. Other studies have shown conflicting results, but this treatment has potential and may work for you.
Other Potential Natural Treatments
Other alternative therapies thought to help ED may include zinc supplements (especially for men who are low in zinc), the herb ashwagandha (also called “Indian ginseng”), and gingko, but more studies are needed to know with certainty.
In the meantime, talk with your doctor about your options, and don’t give up. ED is a common condition that’s very treatable. With some trial and error, you’re likely to find what works for you and your partner.
Erectile dysfunction (ED) affects as many as 30 million men in the United States. Almost half of men over age 75 experience ED, according to the National Institutes of Health.
ED is commonly called “impotence.” It’s a condition in which a man can’t achieve or maintain an erection during sexual performance. Symptoms may also include reduced sexual desire or libido.
These kinds of issues can happen at any time and to any man. Causes mainly include:
fatigue
stress
relationship issues
performance anxiety
alcohol consumption
Your doctor is likely to diagnose you with ED if the condition lasts for more than a few weeks or months.
Standard treatments include pharmaceutical medications, vacuum pumps, implants, and surgery, but many men prefer natural options. Research has found that some natural options can improve your ED symptoms.
What Causes Erectile Dysfunction?
A number of factors can increase your risk of ED. Attaining an erection involves the brain, hormones, muscles, nerves, and blood vessels. A problem with any of these components can block the normal functioning of the penis.
Some common causes of ED include:
heart disease
diabetes
obesity
multiple sclerosis
tobacco use
Parkinson’s disease
enlarged prostate gland
One study found that persistent alcohol use induced ED as well. Seventy-two percent of men diagnosed with alcohol dependence syndrome were diagnosed with sexual dysfunction. This includes premature ejaculation and ED.
Why You Need to See Your Doctor
It’s important to check with your doctor because ED may be a sign of additional health problems. For example, if you have heart disease, you can take a number of steps that will likely improve both your heart health and your ED. This includes lowering your cholesterol, reducing your weight, or taking medications to unclog your blood vessels.
Your doctor will likely prescribe some common treatments if other health issues aren’t found to be the cause of your ED. However, you may also choose natural options.
Common Treatments for ED: Medications
Standard treatments for ED include lifestyle changes, such as:
exercising
losing weight
stopping smoking
curbing alcohol intake
Medications like Viagra, Cialis, or Levitra increase blood flow to the penis. But they can also cause side effects, including:
nasal congestion
headache
upset stomach
vision changes
facial flushing
dizziness
Men who have experienced a stroke or have uncontrolled diabetes or low blood pressure should not take ED medications.
Testosterone replacement and erection-inducing injections are also available. Side effects may include:
acne
breast enlargement
increased urination
aching in the penis
scarring
gum or mouth irritation
Common Treatments for ED: Non-Drug Options
Non-drug treatments for ED include penile vacuum pumps, penile implants, and blood vessel surgery. A pump is used right before intercourse to pull blood into the penis. However, this method can cause bruising. Implants must be surgically inserted into the penis. They can then be inflated when necessary. Risks include those typically associated with surgery, such as infections.
Blood vessel surgery is recommended only when leaking vessels cause ED. Even though all these methods may help some men, natural alternatives can be just as effective, but less invasive.
Natural Solution #1 and #2: Panax Ginseng and Rhodiola Rosea
Called the “herbal Viagra,” Panax ginseng (“red ginseng”) has solid research behind it. Researchers reviewed seven studies of red ginseng and ED in 2008. Dosages ranged from 600 to 1,000 mg three times daily. They concluded there was “suggestive evidence for the effectiveness of red ginseng in the treatment of erectile dysfunction.”
One small study also indicated Rhodiola rosea may be helpful. Twenty-six out of 35 men were given 150 to 200 mg a day for three months. They experienced substantially improved sexual function.
Natural Solution #3: DHEA
Dehydroepiandrosterone (DHEA) is a natural hormone produced by the adrenal glands. It can be converted to both estrogen and testosterone in the body. Scientists make the dietary supplement from wild yam and soy.
The influential Massachusetts male aging study showed that men with ED were more likely to have low levels of DHEA. Forty men with ED participated in another study published in 1999, in which half received 50 mg DHEA and half received a placebo once a day for six months. Those receiving the DHEA were more likely to achieve and maintain an erection.
Natural Solution #4: L-Arginine
L-arginine is an amino acid naturally present in the body. It helps make nitric oxide. Nitric oxide relaxes blood vessels to facilitate a successful erection. Researchers studied the effects of L-arginine on ED in 1999. Thirty-one percent of men with ED taking 5 grams of L-arginine a day experienced significant improvements in sexual function.
A second study showed that L-arginine combined with pycnogenol, a plant product from tree bark, restored sexual ability to 80 percent of participants after two months. Ninety-two percent had restored sexual ability after three months.
Natural Solution #5: Acupuncture
Though studies are mixed, many show positive results when acupuncture is used to treat ED. A 1999 study, for example, found that acupuncture improved the quality of erections and restored sexual activity in 39 percent of participants.
A later study published in 2003 reported that 21 percent of ED patients who received acupuncture had improved erections. Other studies have shown conflicting results, but this treatment has potential and may work for you.
Other Potential Natural Treatments
Other alternative therapies thought to help ED may include zinc supplements (especially for men who are low in zinc), the herb ashwagandha (also called “Indian ginseng”), and gingko, but more studies are needed to know with certainty.
In the meantime, talk with your doctor about your options, and don’t give up. ED is a common condition that’s very treatable. With some trial and error, you’re likely to find what works for you and your partner.
Friday, July 10, 2015
8 Lifestyle Changes and Natural Treatments for ED
What's Causing Erectile Dysfunction in Your Life?
Erectile dysfunction can be triggered by a variety of sources — a health condition, emotional or relationship problems, some medications, smoking, drugs, or alcohol. Though treatment options include medications and surgery, there are also non-invasive options that may help.
One new study found that some men can reverse erectile dysfunction with lifestyle changes. The study, from Australian researchers and published in May 2014 in The Journal of Sexual Medicine, also showed that, even if medication is required, it's likely to be more effective if you implement these lifestyle changes.
Get Moving
“There are many lifestyle changes that can help treat erectile dysfunction (ED), but among them, exercise is the change that can have the greatest impact,” says Zachary R. Mucher, MD, a board certified urologist in Sugar Land, Texas. “Exercise works on several fronts to combat the development of ED and help reverse it once it has become a problem.”
Exercise improves blood flow, which is vitally important to a strong erection, and improves blood pressure by increasing nitric oxide in blood vessels, which he says is exactly how Viagra works. Weight-bearing exercise can increase the natural production of testosterone, a significant factor in erectile strength and sex drive.
Eat A Balanced Diet
The foods you eat can have a direct impact on erectile dysfunction, Dr. Mucher says. A diet rich in fruit, veggies, whole grains, and fish, and with fewer servings of red meat and refined grains, decreases the risk for ED.
A healthy diet also helps to maintain a healthy body weight, which is important because men who have a 42-inch waist are 50 percent more likely to have ED than men with a 32-inch waist. Also, obesity increases the risk for vascular disease and diabetes, two factors that contribute to ED.
Stick to a Sleep Schedule
Poor sleep patterns can be a contributing factor for erectile dysfunction, Dr. Mucher says. One study, published in Brain Research in 2011, explored the impact of sleep loss on testosterone levels in men, confirming that low concentrations of sex hormones are associated with sexual dysfunction. Hormone secretion is controlled by the body’s internal clock, and sleep patterns help the body determine when to release certain hormones.
Adhering to a set sleep schedule is a natural treatment for ED in that it can help ensure that those signals are clear and consistent.
Quit Smoking
Erectile dysfunction can be the result of vascular disease, which occurs when blood supply to the penis becomes restricted because of blockage or narrowing of the arteries. Smoking and even smokeless tobacco can also cause the narrowing of important blood vessels and have the same negative impact.
If you smoke, talk to your doctor about quitting and whether prescription aids can help you.
Limit the Alcohol
“Alcohol is a depressant and can cause both temporary and long-term erectile dysfunction,” Mucher cautions.
The central nervous system is responsible for releasing nitric oxide, an essential chemical for producing and maintaining an erection, and heavy alcohol consumption depresses the central nervous system, causing it to function less efficiently. Not enough nitric oxide translates to erectile dysfunction.
Monitor Your Meds
Erectile dysfunction can occur as a side effect of medication taken for another health condition. Common culprits are high blood pressure meds, antidepressants, some diuretics, beta-blockers, heart medications, cholesterol meds, anti-psychotic drugs, hormone drugs, corticosteroids, chemotherapy, and medications for male pattern baldness, among others.
If you think your medication might be causing ED, talk to your doctor, but don't discontinue using it on your own. Some medications must be tapered off under a doctor's supervision.
Acupuncture
Research is mixed on the effectiveness of acupuncture, but one study published in the Journal of Alternative and Complementary Medicine found that acupuncture can be beneficial for men experiencing erectile dysfunction as a side effect of antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs).
Sexual side effects of these drugs happen to at least half of all people taking them and by some counts up to 90 percent.
Herbal Remedies
“There are many herbal remedies that tout improvement in erectile function, but most have little effect and may actually have detrimental side effects,” Mucher says. Two natural treatments for ED that have shown promise are red ginseng and pomegranate juice.
“Ginseng is thought to increase nitric oxide production, leading to improved blood flow," he says. "Pomegranate juice is a potent antioxidant and can help prevent atherosclerosis." Always talk to your doctor before taking any supplements, however, as they might interfere with other medications you're taking.
Erectile dysfunction can be triggered by a variety of sources — a health condition, emotional or relationship problems, some medications, smoking, drugs, or alcohol. Though treatment options include medications and surgery, there are also non-invasive options that may help.
One new study found that some men can reverse erectile dysfunction with lifestyle changes. The study, from Australian researchers and published in May 2014 in The Journal of Sexual Medicine, also showed that, even if medication is required, it's likely to be more effective if you implement these lifestyle changes.
Get Moving
“There are many lifestyle changes that can help treat erectile dysfunction (ED), but among them, exercise is the change that can have the greatest impact,” says Zachary R. Mucher, MD, a board certified urologist in Sugar Land, Texas. “Exercise works on several fronts to combat the development of ED and help reverse it once it has become a problem.”
Exercise improves blood flow, which is vitally important to a strong erection, and improves blood pressure by increasing nitric oxide in blood vessels, which he says is exactly how Viagra works. Weight-bearing exercise can increase the natural production of testosterone, a significant factor in erectile strength and sex drive.
Eat A Balanced Diet
The foods you eat can have a direct impact on erectile dysfunction, Dr. Mucher says. A diet rich in fruit, veggies, whole grains, and fish, and with fewer servings of red meat and refined grains, decreases the risk for ED.
A healthy diet also helps to maintain a healthy body weight, which is important because men who have a 42-inch waist are 50 percent more likely to have ED than men with a 32-inch waist. Also, obesity increases the risk for vascular disease and diabetes, two factors that contribute to ED.
Stick to a Sleep Schedule
Poor sleep patterns can be a contributing factor for erectile dysfunction, Dr. Mucher says. One study, published in Brain Research in 2011, explored the impact of sleep loss on testosterone levels in men, confirming that low concentrations of sex hormones are associated with sexual dysfunction. Hormone secretion is controlled by the body’s internal clock, and sleep patterns help the body determine when to release certain hormones.
Adhering to a set sleep schedule is a natural treatment for ED in that it can help ensure that those signals are clear and consistent.
Quit Smoking
Erectile dysfunction can be the result of vascular disease, which occurs when blood supply to the penis becomes restricted because of blockage or narrowing of the arteries. Smoking and even smokeless tobacco can also cause the narrowing of important blood vessels and have the same negative impact.
If you smoke, talk to your doctor about quitting and whether prescription aids can help you.
Limit the Alcohol
“Alcohol is a depressant and can cause both temporary and long-term erectile dysfunction,” Mucher cautions.
The central nervous system is responsible for releasing nitric oxide, an essential chemical for producing and maintaining an erection, and heavy alcohol consumption depresses the central nervous system, causing it to function less efficiently. Not enough nitric oxide translates to erectile dysfunction.
Monitor Your Meds
Erectile dysfunction can occur as a side effect of medication taken for another health condition. Common culprits are high blood pressure meds, antidepressants, some diuretics, beta-blockers, heart medications, cholesterol meds, anti-psychotic drugs, hormone drugs, corticosteroids, chemotherapy, and medications for male pattern baldness, among others.
If you think your medication might be causing ED, talk to your doctor, but don't discontinue using it on your own. Some medications must be tapered off under a doctor's supervision.
Acupuncture
Research is mixed on the effectiveness of acupuncture, but one study published in the Journal of Alternative and Complementary Medicine found that acupuncture can be beneficial for men experiencing erectile dysfunction as a side effect of antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs).
Sexual side effects of these drugs happen to at least half of all people taking them and by some counts up to 90 percent.
Herbal Remedies
“There are many herbal remedies that tout improvement in erectile function, but most have little effect and may actually have detrimental side effects,” Mucher says. Two natural treatments for ED that have shown promise are red ginseng and pomegranate juice.
“Ginseng is thought to increase nitric oxide production, leading to improved blood flow," he says. "Pomegranate juice is a potent antioxidant and can help prevent atherosclerosis." Always talk to your doctor before taking any supplements, however, as they might interfere with other medications you're taking.
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