What is hormone replacement therapy?
Hormone treatments, namely testosterone, can be used in men whose production of male hormones is low.Testosterone injections, patches, or gel do not really help men who do not have low levels, and at the initial evaluation, the physician can measure these. Testosterone replacement can stimulate the growth of prostate tissue, which can lead to difficulty empting the bladder. Testosterone cannot be used in patients with known or suspected prostate cancer, as the cancer could grow more rapidly. Other less-common side effects of testosterone use include liver injury and increased blood pressure. Men who take testosterone regularly can become infertile.
What is yohimbine?
Yohimbine is a medication made from the bark of a tree that grows in India and Africa.Yohimbine acts on the nervous system and may also have some effect on increasing the male libido. It is considered homeopathic by medical doctors—that is, no definite uses are proven.The drug is reasonably safe with uncommon side effects, such as mild dizziness, nervousness, headaches, and nausea. Some studies have suggested 10–20% of men will respond to treatment with yohimbine, and it is necessary to take the medicine for a full 2 months before its effectiveness can be determined.
What is self-injection therapy?
Self-injection therapy has been used since the early 1980s.This involves the patient or his partner giving an injection of medication directly into the side of the penis to create an erection. The erection created is natural and usually begins 5 to 15 minutes after the injection. Not all patients respond to this type of treatment, but those that do should develop an erection that lasts anywhere from 30 to 90 minutes. The injections are given with a tiny needle and use very small amounts of medicine. The injections are relatively painless and are easily taught to the patients in 1 or 2 visits with the doctor.
Several medications are available for use, including prostaglandin E1, such as Caverjet® as a single agent, or in combination with papaverine hydrochloride or phentolamine. Each of these medicines achieves erections by causing increased blood flow into the penis through the tiny arteries and also by decreasing the outflow of blood from the penile veins. These drugs are generally considered safe for self-injection therapy. Some risks may include, however, the possibility of bleeding or bruising from the injection, and the small chance of infection. One of the more common risks includes the development of a prolonged erection, or priapism (more than 4 hours), which might require a trip back to the physician or to the emergency room. Not all patients are candidates for self-injection therapy.
How do vacuum devices work?
The vacuum erection device is a simple mechanical tool that allows the man, without medications, to develop an erection that is suitable for sexual intercourse. The vacuum erection device works by bringing blood into the penis and trapping it. The erection can be used for up to 25 to 30 minutes. While serious injuries are rare, bruising is common, and ejaculation can be painful if the tension ring placed around the base of the penis is too tight. The device can usually be tried in the office. Occasionally, this method has been used for penile rehabilitation following prostate surgery.
What are penile prostheses and how do they work?
A treatment option for erectile dysfunction is the placement of prosthetic inner tubes within the penis to mimic the inflation process and create an erection. Penile implants were first used in the 1970s, and as time elapsed, further advances occurred. The success rate when both partners are informed of the nature, and limitations, of the prosthesis is greater than 90%; despite the very high rate of satisfaction, less than 4% of patients agree to have penile implants. Different types of prostheses have been developed, and thousands of men throughout the world have been successfully treated with penile implants. Today, there are 3 types of penile prostheses. These include the semi-rigid implant, the inflatable implant, and a self-contained inflatable implant. The newer prostheses are very reliable, and the chance of mechanical failure is very low.
What is vascular reconstructive surgery?
Vascular reconstructive surgery is technically difficult, relatively expensive, and includes complications of nerve damage and scar tissue formation. Given the relatively low success rate, along with the technical difficulty and expense of this type of procedure, vascular reconstructive surgery generally has not been accepted widely.
Which ED treatments appear not to work?
At this point, there is no evidence that nutritional supplements or vitamins have any significant bearing on sexual performance. The Food and Drug Administration has currently banned the sale or advertising of all nonprescription products for the treatment of male impotence because none had been scientifically shown to be effective.
What can I do to help my sex life?
To improve your sex life:
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Stop smoking
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Limit or avoid alcohol consumption
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Follow a healthy diet
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Exercise regularly
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Get adequate sleep
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Improve communications with your partner
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Talk to your doctor about checking your lipids and other risk factors
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Do not stop any medications that you think might be causing the problem without consulting with your doctor.
Summary
Impotence is a treatable problem that is not the inevitable consequence of aging. Almost all patients with impotence can be treated. The appropriate diagnostic testing can identify causes of impotence, and a multitude of treatment choices is available to assure that each patient has a successful outcome. In terms of determining which therapy is best for each individual, one must be informed of all the various possibilities, including the cause of the impotence, and the type of treatments that are available. None of the treatments will significantly affect the ability to have an orgasm. If needed, psychological support and counseling by a professional sexual counselor should be considered for some patients regardless of the cause of the impotence to help with any adjustments. The first step is to have the courage to talk about it.
