In general, the cause of erectile dysfunction is divided into two types. Many men will have both
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Liver toxicity has generally been associated with oral forms of TRT, but does not appear to be a risk in injection or transdermal therapy.39 In patients with marked obstructive sleep apnoea or untreated severe congestive heart failure, these issues should be resolved before initiating TRT.37
Erectile dysfunction (ED), also known as impotence, is the inability to achieve or sustain a hard enough erection for satisfactory completion of sexual activity. Erectile dysfunction is different from other health conditions that interfere with male sexual function, such as: lack of sexual desire (decreased libido), problems with ejaculation release of the fluid from the penis (ejaculatory dysfunction), problems with orgasm/climax (orgasmic dysfunction), and penile curvature (Peyronie's disease). Picture of arteries and veins involved in erectile dysfunction (ED); SOURCE: NIH
Over the years, the medical management of erectile dysfunction has evolved greatly. For instance, before oral phosphodiesterase inhibitors (PDESi) like Cialis, Standra, Viagra, Levitra and related medications were introduced, doctors could administer one of only two effective treatments for erectile dysfunction: surgical penile revascularization and implantation of a penile prosthesis.
Nearly 1000 years later, the Egyptian Papyrus Ebers, a medical Egyptian document dated 1600 BC, describes a cure for impotence in which baby crocodile hearts were mixed with wood oil and applied topically to the penis.4
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Kiely, E. A., Ignotus, P. & Williams, G. (1987a) Penile function following intracavernosal injection of vasoactive agents or saline. British Journal of Urology, 59, 473–476.CrossRefGoogle ScholarPubMed
All Saints' Hospital London Leicester Urology Department Norfolk and Norwich Hospital St Paul's Hospital London St Peter's Hospital for Stone London St Phillip's Hospital London The Shaftesbury Hospital
Cameron, L. & Woodruff, P. (1985) Cavernosal alpha blockade: a treatment for erectile impotence. British Journal of Psychiatry, 147, 107.Google Scholar
Some doctors may prescribe more than one medication, depending on a patient's response and ability to tolerate the various medications. Medically reviewed by Michael R. Wolff, MD; Board Certification in Urology "The management of erectile dysfunction (2005)." American Urological Association.
Psychosexual counselling, or sex therapy, is an appropriate recommendation especially for men who are experiencing discord with their partner especially if the conflict is related to the man’s ED. Counselling usually consists of 5–20 sessions with counsellor. It is our recommendation that referral doctors treating men with ED make a referral to a psychotherapist or sex therapist who is certified by AASECT (American Association of Sexuality Educators, Counselors and Therapists) of certified sexuality educator.43
There are hundreds of medications that have the side effect of ED and/or decreased libido. Examples of drugs implicated as a cause of ED include hydrochlorothiazides and beta-blocking agents. Medications used to treat depression, particularly the SSRIs such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly, Sarafem), fluvoxamine (Luvox, Luvox CR), paroxetine (Paxil, Paxil CR, Pexeva) and sertraline (Zoloft), may also contribute to ED.9 Bupropion (Wellbutrin) which has a predominant effect on blocking the reuptake of dopamine is an antidepressant with lower incidence of ED.10 The side effects of 5ARIs occurring in fewer than 5% of patients can include gynaecomastia, ED, loss of libido and ejaculatory dysfunction.11
The population included diabetics, non-diabetics, and men who'd had bilateral, nerve-sparing radical prostatectomy, and about a third of patients had severe ED.
Andrology and Genito-Urethral Surgery Endourology Female, Neurological and Urodynamic Urology Oncology