Erectile Dysfunction Handbook by Canadian Health&Care Pharmacy

Understanding, Treating And Preventing Erectile Dysfunction With Canadian Pharmacy Mall

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What is considered sexually healthy, where begins a sexual problem and when can it be referred to as a sexual disorder? Learn from Canadian Pharmacy experts how to proceed diagnostically and what treatment options you have. The copy provides a detailed description of different aspects of sexuality with their various forms and disorders, and a practical description of the medical and psychotherapeutic methods for the treatment of individual problem areas and disorders. You should not, however, view this information as intended to substitute professional consulting in the areas of sexual health, sexual medicine and in the treatment of sexual dysfunction.

As a foreword, we remind you that Canadian Pharmacy Mall is a go-to resource for all concerns associated with men’s health, from filling up on useful information to helping you find the best price for Viagra in Canada. Should you have any questions that are not covered by present copy, do not hesitate to contact us for more information. In the meantime, feel free to take a fam tour around the website and checking out our FAQ page.

Erectile Dysfunction Trivia And Common Facts

Erectile dysfunction (erectile impotence) is a man’s sexual dysfunction. Erectile impotence is diagnosed if a man suffers during at least six months or longer from inability to develop or maintain erection that prevents him from having a satisfactory sexual intercourse.

Erectile dysfunction or erectile dysfunction occurs in about one man of 40 years at least temporarily. The proportion of men with impotence increases with age. But men under 40 may be affected by erectile dysfunction. The erectile impotence can reduce both the quality of life and well-being of the affected man, as also burden the partnership.

The causes of impotence are numerous. Psychological factors that can cause erectile dysfunction include stress and fear of failure during sexual activity. Erectile difficulty can be also brought about by a very large number of reasons, including side effects of certain drugs.

Physical risk factors that may promote an erectile dysfunction include:

• Cardiovascular disease
• Neurological diseases
• Diabetes mellitus (diabetes)
• Hormonal imbalances as a testosterone deficiency
• Overweight and obesity (adiposity)
• Alcohol
• Nicotine

The term erectile dysfunction (erectile dysfunction, erectile impotence) refers to a man’s inability to exercise sexual intercourse. The difficulty is expressed in insufficiently rigid for penetration penis or loss of its hardness shortly after penetration. Such situations can happen occasionally in healthy individuals, which in itself does not mean that ED is setting in. Only when the erectile dysfunction occurs regularly for a period of time longer than six months, your doctor can speak of impotence.

Erectile dysfunction occurs in about every second man over 40 years of age, at least temporarily. The number of men who are affected by impotence grows with increasing age. In cases where erectile dysfunction has always been present to some extent, we speak of a primary erectile dysfunction. However, impotence occurs spontaneously or only in certain situations, it is called secondary erectile dysfunction.

Sometimes impotence is accompanied by other types of sexual dysfunctions: for instance, loss of control over ejaculation, which results in premature or delayed ejaculation. Usually, however, premature ejaculation (PE) is more common.

The causes of erectile dysfunction are varied and often occur in combinations with each other. In younger men psychological causes, such as sexual performance pressure, can often lead to erectile dysfunction.  With advancing age, physical causes are often responsible for erectile dysfunction. Overall, however, erectile dysfunction is in most cases based on physical causes.

Physical Causes of Erectile Dysfunction

Among the possible physical causes of erectile dysfunction the following are commonly found:

• Circulatory disorders
• High blood pressure (hypertension)
• Arteriosclerosis (hardening of the arteries)
• High blood sugar (diabetes mellitus)
• Dyslipidemia
• Alcohol
• Nicotine
• Orchitis (orchitis)
• Epididymitis (epididymitis)
• Prostate inflammation (prostatitis)
• Hormonal disorders, as a testosterone deficiency
• Chronic renal failure (chronic renal insufficiency)
• Chronic liver disease
• Previous vascular surgery in the abdominal cavity
• Bladder and bowel surgery
• Radiation in the pelvis
• Neurological disorders (for example, multiple sclerosis, neuropathy, Parkinson’s disease)
• Stroke (apoplexy)
• Paraplegia
• Overweight and obesity (adiposity)

Since many men define their masculinity by their erectile function, erectile dysfunction can greatly affect the self-esteem of the person concerned. Often, impotence therefore affects the quality of life greatly and can lead to a major distress. ED may be distressing also for life partners and family of men affected by erectile dysfunction.

Getting Diagnosed

Only a doctor can establish whether or not a person is affected by ED. For this, one would need to undergo physical examination, give full medical history and answer some questions related to the issue.

The following information, for example, will interest your healthcare provider:

• Since when have you been having erection problems?
• How exactly the erectile dysfunction comes about?
• Have you stopped having spontaneous morning erections?
• Do you take certain medications?
• Are you a regular consumer of alcohol and tobacco?
• Do you have pre-existing conditions, such as cardiovascular disease, diabetes mellitus or neurological disorders?

It is a good strategy to also involve the life partner in the conversation. Standardized questionnaires are commonly used in such conversations. Practitioner may ask specifically for the typical symptoms and accompanying symptoms of sufferers, for example, premature ejaculations (PE) or problems with urination. The results of the questionnaire are then transferred to a scoring system, so that the doctor can assess the severity of symptoms exactly. In addition, he receives first indications of possible causes of erectile dysfunction.

Since erectile dysfunction often has a physical cause, the doctor should first clarify whether possibly a physical illness is the cause of the erectile dysfunction. To this end, takes the doctor usually performs a thorough physical examination to begin with, testing general responsiveness of physical perception system, for example, if necessary, the internal reproductive organs.

The doctor also tests the reflexes in the field of external genitalia and the anus. A blood test shall include information on the hormonal status (for example, to rule out suspected testosterone deficiency), blood sugar levels (in suspected diabetes) and blood lipid levels (for example, to exclude a lipid metabolism disorder).

In healthy man spontaneous erections usually occur at night and in the morning. If such erections still occur, this speaks against a physical cause of impotence. This, however, can not be completely ruled out, because even with morning erections erectile dysfunction can manifest itself due to psychological reasons. Further investigation procedures by which the physician can determine physical causes of erectile dysfunction include:

• Cavernous injection test (SKIT)
• Color Doppler sonography
• Cavernosography
• Neurological examination

Should physical causes be all ruled out, you should also take into account psychological causes of erectile dysfunction. In this case, a psychiatric diagnosis follows.

Intracavernous injection test

During cavernous injection test (intracavernous injection) the doctor injects the person concerned a male sex hormone from the group of prostaglandins in the penile corpora cavernosa. After this manipulation there usually occurs within a short time erection. If for a longer lasting erection low levels of hormone are sufficient, the causes for erectile dysfunction are likely not to be limited by vessel problems. However, this test is very seldom used in practice.

Color Doppler sonography

By means of color Doppler sonography, a form of ultrasound (sonography), the doctor can check the circulation in the penis and thus establish whether the case of impotence is associated with a disease or disorder of the blood vessels. This diagnosing technique will especially apply if the doctor suspects a malformation of the blood vessels in the penis.

Cavernosography

To determine if the flow of blood through the penis vein increased abnormally and an erection therefore is not possible (for example, through a venous leak), the doctor can perform a cavernosography. It is done by injecting a certain drug in the corpora cavernosa, which causes an erection. Subsequently, the physician brings a contrast medium into the corpus cavernosum and traces the blood outflow from the corpora cavernosa using X-ray images at regular intervals (every few seconds). The cavernosography is rarely used, and its use is mostly restricted especially when a suspect damage or disease of the blood vessels.

Neurological examination

Erectile dysfunction can also be caused by impaired nerve supplying blood to the to the penis. To test this possibility, there exist various neurological examinations, such as the electroneurography (ENG), or electromyography (EMG).

Psychiatric diagnosis

If the doctor finds no physical causes of erectile dysfunction, a psychiatric diagnosis and / or a conversation with a psychotherapist or sex therapist can be useful. The aim is to exclude psychiatric illnesses as possible causes of erectile impotence, such as depression.

Using questionnaires and personal interviews the psychiatrist or psychotherapist can also identify and pinpoint psychological causes that erectile dysfunction may cause, for example, fear of failure, psychological conflicts, stress or problems in the relationship.

Should erectile dysfunction have confirmed physical causes, a therapy using drugs or other solutions is possible. If the impotence a specific underlying disease (for example, diabetes mellitus), the doctor must deal with those. Only in rare cases is surgery necessary to fix the impotence. In a psychosomatic erectile dysfunction a psychiatric-psychological therapy is recommended.

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Erectile dysfunction can be treated using various drugs selected individually for every case. In general, these drugs work well and the affected man can again get an erection and maintain it during intercourse. So-called phosphodiesterase (PDE) inhibitors lead to improved blood flow to the penis. The active ingredients in the three flagman medicines are sildenafil (Generic Viagra), tadalafil (Generic Cialis) and vardenafil (Generic Levitra). Those are the best known active compounds from this group which act against erectile impotence. Taking the medication is generally recommended before the planned sexual intercourse and not more frequently than once in 24 hours. Since there may be interactions and side effects, these impotence drugs are available by prescription.

Possible side effects include:

• headache
• dizziness
• redness of face, flushing
• blurred vision
• stuffy nose

Certain other drugs the active ingredient yohimbine comes with erectile impotence used. This is a natural substance that is extracted from the leaves and bark of the West African yohimbe tree and improves circulation of blood. Yohimbine barely plays a role in today’s treatment of erectile dysfunction.

In addition, it should be noted that any sexual activity burdens the cardiovascular system without the use of drugs. Therefore, individuals with the following conditions should refrain from the use of any ED pills and possibly not engage in sexual activity (subject to doctor’s recommendation):

• heart failure
• pain in the chest (angina)
• high blood pressure (hypertension)
• low blood pressure (arterial hypotension)
• cardiac arrhythmia,
• a recent stroke or heart attack

All drugs currently present on the market for erectile dysfunction are available by prescription and should be taken according to the instructions of the physician.

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Other methods of ED treatment: Intracavernous Injection therapy

Intracavernous autoinjector therapy is particularly relevant to people affected by erectile dysfunction, in which insufficient acting drugs in tablet form against erectile dysfunction. In this method, the doctor injects a vasodilator drug (alprostadil) in a corpus cavernosum of the penis. With a little practice, the affected man can also perform the injection himself. A few minutes after the injection there follows an erection that lasts about an hour. When applied correctly, the side effects of the cavernous auto injection therapy are low. The person concerned should be a subject to medical examination and therapy revision every three months. Intracavernous autoinjector therapy is not painful as a rule. It is carried out with an extremely thin cannula. Syringes also facilitate the implementation at home.

In the course of applying the cavernous autoinjection therapy there can occur certain side effects, such as:

• bruising,
• penile erection and pain or
• infection.

In addition, persons who have the following conditions should not apply the cavernous autoinjection therapy:

• cardiovascular disease
• liver and kidney dysfunction
• STDs
• sickle cell anemia
• myocardial infarction within the last year.

In rare cases of cavernous autoinjector therapy priapism occur. It is a painful erection that lasts longer than two hours, and must be treated by a physician. Untreated priapism leads to fibrosis (tissue hardening) and permanent erectile damage and dysfunction.

Transurethral therapy (MUSE)

Transurethral therapy (MUSE; Medical Urethral System for Erection) is another treatment possibility of erectile dysfunction. This form of therapy is appropriate when tablet-taking does not lead to the desired success. In transurethral therapy the affected man uses an applicator made of plastic. The applicator includes a rod with the drug alprostadil. After urination, the man inserts the applicator into the urethra. By pressing a button, the applicator emits is a small drug-containing “suppository” in the urethra. Then the applicator is carefully removed from the urethra. Thus, the active ingredient dissolves in the urethra. In order for the drug to get distributed and absorbed through the urethral wall, the penis should be massaged gently. The drug alprostadil relaxes smooth muscles of the penis, increases blood circulation and a few minutes later causes an erection that lasts about 70 to 80 minutes.

Side effects that are likely to be caused by transurethral therapy are, for example:

• pain in the penis
• headache
• urethral injury
• painful urination
• dizziness
• hypotension
• brief unconsciousness.

In case of previously experienced persistent painful erection (priapism), blood coagulation disorders or inflammation of the urethra, this method should not be used. Transurethral therapy is also not recommended if the sexual partner is pregnant, as the drug alprostadil may pose a risk to the unborn child.

Mechanical aids (vacuum pump)

Vacuum pumps are applicable in all forms of erectile dysfunction. They consist of a transparent plastic cylinder, which is connected via a tube with a hand pump. At the cylinder end of the vacuum, a tightly seated rubber ring is pulled. Then the cylinder should be positioned and adjusted on the penis. The pump creates a vacuum, the penis fills with blood and comes to an erection while still in the cylinder. Next, the plastic cylinder should be detached from the penis, leaving the rubber ring in its place. This prevents the blood flowing away from the penis. In this manner, the erection is maintained. The ring is removed upon completion of the sexual act.

This method may reduce the blood flow in the penis. Therefore vacuum pumps should not be used in the following cases:

• priapism
• circulatory disorders
• other cardiovascular diseases.

Penile prosthesis (penile implant)

Patients with erectile dysfunction in which medical or mechanical treatment methods fail, can resort to a penile prosthesis (penile implant) to fix erectile dysfunction permanently. The doctor uses a surgical prosthesis that is inserted into the erectile tissue of the penis. However, the long-term results of this method are contradictory, which is why this method is used sparingly.

A distinction is made between a so-called semi-rigid penile prosthesis (“semi-rigid”) and prostheses made of plastic and hydraulic prostheses. A semi-rigid penile prosthesis is cosmetically unsatisfactory, because it results in a permanent erection of the individual concerned. In order to engage in sexual intercourse the subject needs to bend the penis upwards.

A hydraulic penile prosthesis means that an inflatable pump is implanted in the scrotum of the person suffering from ED. The liquid passes through the pump from a surgically created reservoir in the abdominal cavity into cylindrical containers in erectile tissue. In order to achieve the erection, the patient needs to press a button on the pump.

These two methods can, too, have certain complications: the insertion of a penile prosthesis for impotence is costly because of the complicated mechanism. Also, there might occur a hardening of the tissue (fibrosis) and infections as adverse effects. In the process of prosthesis implantation, the doctor removes the cavernous partially. Therefore, the results of the operation are irreversible.

Bypass surgery

In rare cases, bypass surgery may be necessary – such as injury or vascular occlusions in the penis. During bypass surgery, the doctor creates a new connection for the failed vessel. This operation successfully addresses the issue of erectile dysfunction but is rarely used due to its complicacy.

Psychiatric-psychological therapy

A psychiatric-psychological therapy is aimed primarily according to whether and what psychological causes of erectile dysfunction are eligible. In a psychiatric illness, e.g. depression, psychotropic drugs are used as a part of therapy (for example, antidepressants).

The most psychological popular causes for ED interpersonal conflicts, individual performance anxiety or psychological stress situations, psychotherapy may be useful. Which form of therapy (for example, cognitive therapy, individual or couples therapy) is in each case suitable doctor and interested parties must decide individually.

The success of erectile dysfunction therapy depends on whether the doctor can treat the cause. In most cases, oral drugs (such as phosphodiesterase inhibitors) are the first-line defence against erectile dysfunction. Unlike impotence which arises due to physical causes, erectile dysfunction occurring for psychological reasons is often transient in nature and usually disappear by themselves if the mental stress situation is solved.

Erectile Dysfunction Prevention

The sooner the treatment begins, the better are the chances to cure erectile dysfunction. Erectile dysfunction can have different causes. Therefore, you can prevent erectile dysfunction only conditionally. Eat a balanced diet and adequate exercise. Try to avoid obesity, nicotine and excessive alcohol consumption, because these are risk factors for erectile dysfunction. Additionally, you should not put neither yourself nor your life partner / sexual partner under sexual performance pressure.

If you experience symptoms of impotence, do not hesitate to seek medical attention. Firstly, the odds of successful treatment are better the earlier it begins. Secondly, there may be other diseases hiding behind erectile dysfunction and (for example, diabetes mellitus, cardiovascular diseases, neurological disorders) that need to be treated without delay.

Disclaimer

The supply of information about the personal health on Canadian Pharmacy Service www.canadianhealthmall.com is for your information and can not replace a personal consultation, examination or diagnosis by a licensed physician. The information available through the site’s content can and can not be used for self-diagnosis and / or self-medication.