Causes Of Erectile Dysfunction - Other culprits

Other problems that can lead to erectile dysfunction include the following:

Prostatitis.

This inflammation of the prostate gland can be either acute (usually caused by a bacterial infection) or chronic (usually not caused by an infectious agent). Symptoms include pain during urination, more frequent urination, and -- possibly -- a discharge from the penis or fever. Severe prostatitis can cause erectile dysfunction directly. In milder forms, the condition can produce painful ejaculation, which can certainly interfere with sexual pleasure and may lead to erectile dysfunction. Your doctor may prescribe antibiotics to treat the problem, but it can take several weeks for the infection to clear and for normal erections to return.

Peyronie's disease.

In this uncommon disorder, some of the connective tissue inside the penis thickens, causing the penis to bend at an angle when erect. When the condition affects the tissue involved in erections, it can cause erectile dysfunction. Peyronie's disease is most common in men over age 40. Many treatments -- including oral vitamin E, verapamil injections, and ultrasound -- have been tried, but their effectiveness is uncertain, in part because the problem sometimes improves on its own. When the problem is severe enough to cause pain during intercourse or prevent penetration, surgery may be needed to straighten the penis.

Injury.

An injury to any of the nerves and arteries necessary for an erection can lead to erectile dysfunction. A pelvic fracture can cause these kinds of injuries because many nerves and arteries run along the pelvic bones. In addition, injury to the brain, spinal cord, abdomen, or, of course, the penis can impair nerves or blood vessels involved in erections. Such a problem may be temporary or permanent, depending on the severity of the injury. Even something as commonplace as prolonged exercising on a rowing machine or bicycling on a seat that's too hard can cause erectile dysfunction by injuring some of the nerves or arteries in and around the penis In many cases, cutting back on such forms of exercise or, for example, switching to a softer, wider bicycle seat will solve the problem.

Avid bikers beware

Can riding your bike for long periods cause temporary erectile difficulties? One study suggests that in certain circumstances, bike riding can damage nerves and compress arteries in the penis, possibly leading to erectile problems. The Massachusetts Male Aging Study found that the risk was highest among men who cycled more than three hours a week. The reason avid bikers sometimes get erectile dysfunction is that the seat puts pressure on the perineum, the area between the genitals and anus. This pressure can harm nerves and temporarily impede blood flow, causing tingling or numbness in the penis and, eventually, erectile dysfunction. However, a different type of bike may help: A German study found that riding a conventional bicycle caused a dramatic (though temporary) drop in oxygen supply to the penis, but that riding a recumbent bicycle did not.
If you don't want to switch bikes, you may be able to prevent cycling-related erectile problems by taking a few simple precautions:
Consider wearing padded biking pants for extra protection.
Raise the handlebars so that you're sitting relatively upright. This position will shift the pressure away from the perineum to the buttocks.
Get a wide, well-padded bicycle seat to absorb the impact of the ride. A gel-filled seat is a good choice. Narrow seats place the most pressure on the perineum.
Position the seat so that it puts minimal pressure on the perineum. Make sure the seat is not so high that your legs are fully extended at the bottom of your pedal stroke. Don't tilt the seat up.
If you feel tingling or numbness in your penis, stop riding for a week or two. These are warning signs that your bike ride could lead to erectile problems. Even if you don't feel any warning symptoms, it's a good idea to change your position and take breaks during long rides.

Causes Of Erectile Dysfunction - Alcohol and substance abuse

Some men with erectile dysfunction find that having a drink helps them relax. In fact, light to moderate drinkers (men who average one to two drinks a day) are 33% less likely to have erectile dysfunction than nondrinkers, according to the Health Professionals Follow-up Study. But heavy drinking can make matters worse. For one thing, it can inhibit sexual reflexes by dulling the central nervous system. Drinking large amounts of alcohol over a long period of time can also damage the liver, leading to a hormonal imbalance (in this case, raising levels of estrogen, a female sex hormone normally present in small amounts in men). For good health, in general, limit yourself to two drinks or fewer per day. Illegal drugs such as marijuana, cocaine, heroin, barbiturates, and amphetamines can trigger problems by acting on the central nervous system in the same way that alcohol

Causes Of Erectile Dysfunction - Smoking

The more cigarettes you smoke per day, the higher your risk of erectile dysfunction, according to several studies. One, which involved more then 4,700 Chinese men, found that smoking a pack a day (20 cigarettes) increased the risk of erectile dysfunction by 60%. The effect of smoking remained significant even after researchers considered other risk factors such as age, blood pressure, and body mass index (a measure of body fat based on height and weight).

Causes Of Erectile Dysfunction - Weight control and exercise

Given that excess weight is a major risk factor for vascular disease, it's perhaps not surprising that close to 80% of men with erectile dysfunction are overweight or obese. Now, there's evidence that lifestyle changes -- namely, losing weight and exercising -- can improve erectile dysfunction, just as they lower the risk of vascular disease. A 2004 report in the Journal of the American Medical Association described a study of 110 obese men with erectile dysfunction. Half the men received detailed advice on weight loss and exercise; the others got only general advice on healthy food choices and exercise. After two years, almost a third of those who received detailed advice reported improvement in sexual function, compared with just a few in the other group.
A study in 2006 by the same research team suggested that food choices may also affect the risk of erectile dysfunction. Men without erectile dysfunction are more likely to follow a diet rich in fruit, vegetables, whole grains, and fish, while low in red and processed meat and refined grains (the so-called Mediterranean diet). In addition, two findings from the Harvard Health Professionals Follow-up Study, a long-term study involving nearly 32,000 men, lend further support for keeping trim and fit. Researchers found that men who exercised 30 minutes a day were 41% less likely to have erectile dysfunction compared with sedentary men. And a man with a 42-inch waist is 50% more likely to have erectile dysfunction than a man with a 32-inch waist.

Causes Of Erectile Dysfunction - Psychological factors

Psychological factors are the root cause of erectile dysfunction in about 10%--20% of cases. In such circumstances, a patient is said to have psychogenic erectile dysfunction. Stress, relationship problems, or psychological illnesses can impair the signals from the brain that initiate the chain of biological events needed for an erection. Often, the fundamental problem is anxiety or depression. One study found that erectile dysfunction is nearly twice as common among depressed men as it is among those who aren't depressed (see "Erectile dysfunction and depression"). Other causes include stress, guilt, low self-esteem, and fear of sexual failure.
Keep in mind, though, that psychological factors play a contributing role in most cases of erectile dysfunction. Even if the cause is purely physical or medical, erectile difficulty is almost certain to have an emotional and psychological impact. These emotional consequences can lead to the kind of performance anxiety that triggers more severe erectile dysfunction. When this happens, a man may begin to avoid his partner or make excuses for not having sex -- actions that can perpetuate anxiety or depression. At this stage, the role of the psychological difficulties may in fact overshadow the original medical or physical cause. To cure the problem, you'll need to address the physical problem and the psychological one.
When psychological disorders alone are to blame, there are some clear signs (see Table 2). For one thing, erectile dysfunction tends to emerge suddenly. And it's likely to occur with just one partner, often because of tension in the relationship. Another sign that the problem is mainly psychological is the ability to achieve an erection with masturbation and, perhaps most importantly, while sleeping. Most healthy men have three to five erections during each night's sleep. Nocturnal erections are impaired by physical problems, like disease or nerve damage, but not by psychological disorders.

Relationship problems, such as anger or distrust, can also contribute to erectile dysfunction. If either partner is unhappy with the other, it can dampen sexual desire, an important component of erectile function. Inhibitions that result from undisclosed sexual fantasies or preferences can also be at the root of the problem. If a man feels too embarrassed to tell his spouse or sexual partner about his preferences, he may have trouble becoming aroused. As all these examples illustrate, intimacy and open, honest communication play a vital role

Premature ejaculation
Doctors used to think that young men with premature ejaculation had an increased risk for erectile dysfunction later in life. Although doctors now know that there is no cause-and-effect relationship, the two conditions do share a common treatment.
Unlike men with erectile dysfunction, those with premature ejaculation are able to maintain an erection long enough to have intercourse. The problem is that they climax too early, either during foreplay or just after penetration. Premature ejaculation is common, affecting about 25%--40% of American men. Some men ejaculate early whenever they have sex, while others experience this only in certain situations, such as when they're anxious or overstimulated. Men who fall into the second category are more likely to have erectile dysfunction, too.
Many men can learn to control premature ejaculation with the squeeze technique. The method is simple -- if you feel an orgasm coming on during foreplay, you use a thumb and two fingers to squeeze the area just below the head of your penis for 20 seconds. This inhibits ejaculation and slightly reduces the erection. After about half a minute, resume sexual foreplay to regain your erection. Use this technique as often as necessary until you can enter your partner without ejaculating too soon. With practice, your body will learn to delay ejaculation without the squeeze.
If this technique doesn't work for you, the PDE5 inhibitors used to treat erectile dysfunction might be helpful. If you don't respond to those drugs, you may find that one of the selective serotonin reuptake inhibitors, a class of antidepressants, will help.

Causes Of Erectile Dysfunction - Hormonal disorders

Because testosterone helps spark sexual interest, one might assume that low levels of the hormone are to blame for erectile dysfunction. It's true that when hormone deficiency is a factor in erectile dysfunction, sexual desire also suffers. And according to some estimates, 10%--20% of men with erectile dysfunction have hormonal abnormalities. However, the exact role that testosterone plays in erectile dysfunction remains unclear.
The most common hormonal cause of erectile dysfunction is hypogonadism, or testicles that don't produce enough testosterone. More rarely, an abnormally high level of prolactin, a hormone that can lower testosterone levels, is to blame. Elevated prolactin is usually caused by a tumor of the pituitary gland, which lies at the base of the brain. Diseases of the thyroid or adrenal glands can also lead to erectile dysfunction.

Causes Of Erectile Dysfunction - Medications

One reason erectile dysfunction becomes more common with age is that older men are more likely to be on medication. Indeed, it's been estimated that 25% of all erectile dysfunction is a side effect of medication. Many drugs can produce erectile difficulties, especially antihypertensives, antidepressants, and tranquilizers, as well as the prostate drug finasteride. Propecia, a low-dose preparation of finasteride used to counteract baldness, is reported to cause erectile dysfunction in 1.3% of men.
But not all drugs are equally problematic. Among the blood pressure medications, for example, erectile dysfunction is an occasional side effect of thiazide diuretics, loop diuretics, beta blockers, and central nerve-acting agents, but rarely results from use of alpha blockers, ACE inhibitors, and angiotensin II receptor blockers

When you see a doctor about erectile dysfunction, it's important that you report all prescription and over-the-counter medications that you take on a regular basis. If your doctor suspects that a medication is to blame, he or she may be able to substitute another one. It can take anywhere from several days to several weeks after stopping a medication for erections to return.

Causes Of Erectile Dysfunction - Benign prostatic hyperplasia

Many men who have benign prostatic hyperplasia (BPH), a noncancerous enlargement of the prostate, also experience erectile dysfunction. Although BPH does not itself cause this condition, some of the treatments used for BPH can do so. For example, finasteride (Proscar), an antitestosterone drug prescribed for BPH, has been linked to erectile dysfunction in 3.7% of men who use it and to diminished libido in 3.3%. But alpha blockers such as terazosin (Hytrin), tamsulosin (Flomax) and doxazosin (Cardura) can improve the symptoms of BPH with a lower risk of sexual side effects. Transurethral resection of the prostate, a surgical technique often used when medication fails, also causes erectile dysfunction in a small percentage of men.

Causes Of Erectile Dysfunction - Prostate cancer

Surgery for prostate cancer can sever some of the nerves or arteries that are needed for an erection. For men who undergo a radical prostatectomy (removal of the prostate gland), the estimates of how many men will regain their ability to have erections vary widely, from 25% to 80%. Even so-called nerve-sparing surgical techniques lead to erectile dysfunction in up to half of all cases. The results depend on such variables as a patient's age, the surgeon's skill, and the tumor locations (if a tumor is too close to the nerve bundle, the nerves can't be spared). Even when the nerves are not permanently impaired, it can still take 6--18 months for the tiny nerve fibers to recover from the trauma of surgery and restore sexual function.
Radiation treatment for prostate cancer can also harm erectile tissues. Both external beam radiation and radiation-emitting seeds implanted in the prostate (brachytherapy) lead to erectile dysfunction in about half of men who receive these therapies. However, these changes may not occur for up to two years after treatment.
Erectile dysfunction is sometimes a side effect of some hormone therapy medications prescribed for men with prostate cancer that has spread beyond the prostate. Among such hormone-based medications are leuprolide (Lupron), goserelin (Zoladex), flutamide (Eulexin), and bicalutamide (Casodex). Even prostate cancer itself, in its advanced stages, can spread to the nerves and arteries that are necessary for an erection.

Causes Of Erectile Dysfunction - Diabetes

Men with diabetes are twice as likely to experience erectile dysfunction as men without the disease, making diabetes one of the most common causes of erectile dysfunction. Diabetic men also confront this problem at younger ages than men in the general population. Both forms of diabetes -- type 1 and type 2 -- increase the risk. Among men with diabetes, erectile dysfunction usually develops gradually over a period of months or years. At first, the erection may not be as rigid as it once was or, perhaps, cannot be sustained. Sometimes erectile dysfunction is the first sign that a man has diabetes.
Diabetes can cause erectile dysfunction in at least two ways: It can harm the nerves that instruct the arteries in the penis to dilate, and it can restrict blood flow to the penis by damaging blood vessels. People with diabetes often have high blood pressure, high cholesterol, and high blood sugar -- all conditions that can further impair blood vessels and blood flow.
Carefully controlling blood sugar can help prevent the vascular and neurological complications that contribute to erectile dysfunction. One study of men with diabetes and erection problems found that the worse their blood sugar control, the more their sex lives suffered.
Many men with diabetes can take Viagra and related drugs. Early studies found that these medications seemed to be less effective when erectile dysfunction was diabetes-related than when it had other causes. However, more recent studies suggest that's not necessarily true. In any case, other therapies -- including drugs in injection or suppository form, vacuum erection devices, and penile prostheses -- work well in men with diabetes.

Causes of Erectile dysfunction - Neurological problems

Damage to any of the nerves that produce sensation or relay messages to arteries in the penis can also cause impotence. Diabetes is the most common cause of this kind of nerve damage. But degenerative diseases of the nervous system (such as multiple sclerosis or Parkinson's disease) and substance abuse can also harm the nerves involved in erections.
Likewise, erectile dysfunction can result from a spinal cord injury or as a side effect of various kinds of surgery. Because the nerve pathways to the penis travel near the prostate, bladder, and rectum, removing any of these organs to treat cancer can sever some of these nerves, leading to problems. In addition, vitamin B12 deficiency, which is a cause of anemia, can damage the spinal cord, causing neurological problems throughout the body.

Causes of erectile dysfunction - Vascular disease

Vascular disease

Since erections depend on the blood vessels that serve the penis, it's not surprising that vascular disease is the leading cause of erectile dysfunction. The most common type of vascular disease is atherosclerosis, which occurs when fatty deposits build up on artery walls, narrowing and clogging them. Most people think of atherosclerosis as occurring mainly in the heart's arteries. But in fact, it can occur in arteries throughout the body -- including those in the penis. High blood pressure, high cholesterol, diabetes, and smoking all lead to atherosclerosis.

Another vascular problem that can cause erectile dysfunction is a venous leak, in which blood seeps out of the penis during an erection instead of remaining trapped inside. In this case, a man may be able to get an erection, but he cannot sustain it. Doctors aren't sure what causes venous leakage.
An abdominal aortic aneurysm, or a ballooning of the aorta, is another vascular problem associated with erectile dysfunction. The aorta, which delivers blood from the heart to the abdomen, is the body's main artery. An aneurysm forms when a blood vessel, weakened by a disease like atherosclerosis or hypertension, balloons outward under the pressure of blood flowing through it. The nerves and arteries leading to the penis lie next to the aorta. As the abdominal aorta expands, it can squeeze and damage these nerves and blood vessels, causing erectile dysfunction.

Hypertension, drugs, and erections

Men with erectile dysfunction are about 38% more likely to have high blood pressure than those without erectile dysfunction, according to a 2005 study that examined the medical records of more than 1.9 million men. This finding supports observations that erectile dysfunction often occurs in men who smoke or are overweight -- both common risk factors for high blood pressure. In fact, erectile dysfunction might serve as a warning sign that a man has high blood pressure or heart disease.
Complicating matters is the fact that some drugs used to treat high blood pressure -- especially beta blockers -- can cause erectile dysfunction. But the effect may be at least partly psychological, rather than physical: When erectile dysfunction occurs after a man starts taking a new medication, it's possible that fears about his health, rather than the medication itself, are triggering the problem. In addition, being aware of possible side effects may make a person more likely to recognize them as abnormal. One study looked at men newly diagnosed with heart disease but without erectile dysfunction who started treatment with the beta blocker atenolol (Tenormin). Among those who were told about the drug's sexual side effects, almost a third reported erectile dysfunction. In contrast, of those who were not told the drug's name or its side effects, only 3% said they experienced erectile dysfunction.
Although all blood pressure medications can cause erectile dysfunction, the problem seems to be greater with diuretics and beta blockers than with ACE inhibitors (see Table 1 for common examples). If you experience erectile dysfunction shortly after starting treatment with any of these drugs, it may make sense to ask your doctor if you can try a different one.

What to do about erectile dysfunction

Until the late 1990s, people rarely spoke openly about erectile dysfunction (also called impotence). But all that changed in 1998 when sildenafil (Viagra), the "little blue pill," hit the market. The first safe, effective, and easy-to-use treatment for erectile dysfunction, Viagra brought the problem out of the bedroom and into the doctor's office.
Since then, more than 750,000 physicians have prescribed Viagra to more than 23 million men worldwide. The trend expanded further in 2003, when the FDA approved two closely related drugs, vardenafil (Levitra) and tadalafil (Cialis). Some have even dubbed this phenomenon a second sexual revolution, the first being the advent of birth control pills. Both medications fostered major changes in sexual behavior and the ways in which people think and talk about sexuality.
This isn't to say that talking about erectile dysfunction is easy. In fact, a 2003 study of men ages 50 and older who went to a urologist for other, unrelated problems found that 74% of those who later admitted to having erectile dysfunction were too embarrassed to discuss the problem with their physician.
If you are concerned about erectile function, it's important to understand what erectile dysfunction really is. Failing to have an erection one night after you've had several drinks -- or even for a week or more during a time of intense emotional stress -- is not erectile dysfunction. Nor is the inability to have another erection soon after an orgasm. Nearly every man occasionally has trouble getting an erection, and most partners understand that.
Erectile dysfunction is the inability to attain and maintain an erection sufficient for sexual intercourse at least 25% of the time. The penis doesn't get hard enough, or it gets hard but softens too soon. The problem often develops gradually. One night it may take longer or require more stimulation to get an erection. On another occasion, the erection may not be as firm as usual, or it may end before orgasm. When such difficulties occur regularly, it's time to talk to your doctor.
Erectile dysfunction can have many causes. Often, the culprit is clogged arteries (atherosclerosis), which can affect not only the heart but also other parts of the body. In fact, in up to 30% of men who see their doctors about erectile dysfunction, the condition is the first hint that they have heart disease.
Other possible causes of erectile dysfunction include medications and prostate surgery, as well as illnesses and accidents. Stress, relationship problems, or depression can also lead to erectile dysfunction.
Regardless of the cause, this problem can often be effectively addressed. For some men, simply losing weight may help. If medications aren't effective for you, a number of other options, including injections and vacuum devices, are available. The possibility of finding the right solution is now greater than ever.

When is it Erectile Dysfunction and When Should You Seek Help

Modern men have become aware of the term and condition of erectile dysfunction, which is typically known as impotence. A healthy young man does not experience erectile dysfunction. With age, a man may notice some changes like requiring more coaxing to get erect than it used to, it may take more direct stimulation of the penis, while merely a daydream or the proposition of sex was once enough. At times, the erection isn't quite as firm as it once was, but it's still good enough. These are considered as normal changes. So, it is important for all the males to know when is it erectile dysfunction and when should one seek help? Dr. Brunilda Nazario, MD, considers the scenarios given below:

Scenario 1 You come home one evening after a long and stressful day at work. Your partner wants to have sex. You think you'd like to also, but you have a problem getting an erection. The next time you try, everything is fine. In this case, your problem probably doesn't need medical treatment, as long as it happens rarely. If it starts to happen more often, you may want to talk to your doctor about it.

Scenario 2 Sometimes when you try to have sex, you get only partially erect. Your erection isn't rigid enough to enter your partner. In the most severe cases of erectile dysfunction, a man isn't able to get even a slight erection. But there are degrees of this condition. Even mild erectile dysfunction is worth discussing with your doctor.

Scenario 3 You can get a good erection during foreplay, but after you start to have intercourse you lose it. This can be very frustrating for you and your partner. Even though you are able to get an erection, if it doesn't last long enough to complete sexual intercourse you may have erectile dysfunction.

Scenario 4 Your doctor prescribes a new medication, and you notice that it's now more difficult to get an erection than it was before you started taking it. Side effects of drugs cause up to 25% of erectile dysfunction cases. Blood pressure medicines are lifesavers, but erection problems are sometimes a side effect. Other medications that can cause erectile dysfunction include: Antidepressants, Antipsychotic drugs, Sedatives, Seizure medication.
Talk to your doctor about switching to a different drug that's less likely to cause problems. Also ask about treatment options specifically for erectile dysfunction.

Scenario 5 You typically have several alcoholic drinks every night. It's difficult for you to get an erection when you've been drinking. While a glass of wine may help you and your partner get in the mood, heavy drinking can really hamper your sexual performance as alcohol depresses the nervous system, which may cause erection problems if you've had too much to drink. If it only happens when you drink and the effect is temporary, you should limit your drinking and avoid treating the problem with erectile dysfunction medication. Keep in mind that alcohol also has long-term toxic effects on the nerves that can cause erectile dysfunction, even at times when you're not drinking. Scenarios discussed above are the common situations in which men normally experience erectile dysfunction. Follow the advices to seek help before ED ruins the pleasure of your conjugal life.

The Importance Of Identifying The Causes and Symptoms of Erectile Dysfunction

For many men, erectile dysfunction is one of their greatest fears. Masculinity is defined as many things by different people, but suffering from erectile dysfunction, or ED, is a blow regardless of other defining factors. Fortunately there are many ways to treat and reverse ED. But before treatment can begin, you must first determine if you are indeed showing signs of ED and distinguish the cause or causes.

Symptoms of Erectile Dysfunction

The most obvious symptom of erectile dysfunction is failure to achieve an erection. The technical boundaries for ED are failure to achieve the erection more than fifty percent of the time. This means that the occasional mishap is nothing to worry about, and failing to perform even every third time may still not be a medical problem.
The other primary symptom of ED is failing to maintain the erection. You might initially not have a problem, but as intimacy increases, you're unable to perform consistently. Again, if this is happening more than half of the time, you should visit with your doctor to work toward a diagnosis.
To determine if you are indeed suffering from ED, your general physician will first complete a full physical profile and ask many questions about your overall lifestyle including your sex life. He may then refer you to an urologist who specializes in diagnosing and providing treatment for erectile dysfunction.
The urologist has a litany of tests at his disposal. He will most likely perform a blood count and test for hormone levels in the blood stream. He might also test the function of your thyroid and liver. A duplex ultrasound might be what finally determines the cause of your erectile dysfunction, or there are dozens of other tests available that can also determine the cause of the problem.

Causes of Erectile Dysfunction

ED can be caused by many things. One thing that does not cause ED is old age. Impotence is considered unusual and something worth speaking to the doctor about at any age. It is never normal.
One cause of ED that doctors will often check for first is your lifestyle. If you drink, smoke or take other drugs - both prescriptions or not, these chemicals in the body might be causing your ED. A lack of exercise or poor nutrition might also be contributing, and a great deal of ED is linked, if not entirely caused, by stress and other physiological things.
Once these have been ruled out, the physical possibilities are tested. Hormone levels can play a part so blood will be taken and examined. One of the more common reasons for ED is blocked or leaking vessels in or near the groin. There are many tests that can determine if and which vessels are the cause. Nerve damage is also a possibility as well as an enlarged prostate.
There are many possible problems leading to ED. Only a doctor can make a complete diagnosis. If you are having difficulty in intimacy, consult your doctor to be on your way to a complete recovery.

Viagra boosts feel-good "love" hormone: study

Impotence drugs such as Viagra may do more than help men physically have sex -- they may also boost levels of a hormone linked with feelings of love, U.S. researchers reported on Thursday.
Viagra, known generically as sildenafil, raised levels of the hormone oxytocin in rats; the team at the University of Wisconsin-Madison reported the Journal of Physiology. This hormone is involved in nursing and childbirth, and also in orgasm and feelings of sexual pleasure.
It appears that Viagra and related drugs act on the part of the brain that controls release of oxytocin, said Wisconsin physiology professor Meyer Jackson.
"This is one piece in a puzzle in which many pieces are still not available," Jackson said in a statement. "But it raises the possibility that erectile dysfunction drugs could be doing more than just affecting erectile dysfunction."
Viagra, made by Pfizer Inc., is an inhibitor of an enzyme called phosphodiesterase type 5. Related drugs such as Eli Lilly and Co.'s Cialis, known generically as tadalafil, and Levitra or vardenafil, sold by GlaxoSmithKline, Bayer AG and Schering-Plough, are also PDE-5 inhibitors.
They block this enzyme, which in turn breaks down other compounds. This increases blood flow in the muscles and it also affects a brain structure known as the posterior pituitary.
This, in turn, boosts oxytocin, at least in the rats. It probably does the same thing in people, Jackson said. "It does the same thing it does in smooth muscle -- instead of (levels) coming down in a minute or two, they stay up a little longer," Jackson said in a telephone interview.
Oxytocin was known for years to be involved in labor and it is the hormone that stimulates the production of milk for breastfeeding. Only in recent decades has it been found to have a function in men -- in sexual arousal and function.
This could suggest other uses for Viagra and related drugs, Jackson said -- perhaps promoting social bonding.
Hopefully, people who read our paper will test these ideas in animals and humans, Jackson said. "I hope that this doesn't cause some wild orgy of inappropriate recreational use."
Some groups have complained that people use the impotence drugs for fun, instead of using them as prescribed for sexual dysfunction.
The drugs can cause fatal side effects if used in combination with some other drugs, and some studies also suggest they may affect the vision in some patients.

Erectile dysfunction in diabetic men may predict silent heart disease

Men with type 2 diabetes who have difficulty achieving an erection could have heart disease and not realize it, according to a report in today’s rapid access issue of Circulation: Journal of the American Heart Association.
Men who had silent, or symptomless, coronary artery disease (CAD) and type 2 diabetes were nine times as likely to have erectile dysfunction (ED) as were diabetic men who did not have silent heart disease.
“If our findings are confirmed, erectile dysfunction may become a potential marker to identify diabetic patients to screen for silent CAD,” said lead researcher Carmine Gazzaruso, M.D., an internal medicine specialist at Maugeri Foundation Hospital in Pavia, Italy.
Erectile dysfunction and coronary atherosclerosis (narrowing of the coronary arteries) are frequent complications of diabetes, and the association between erectile dysfunction and overt or symptomatic CAD is well documented. However, many diabetic patients have asymptomatic (silent) CAD and are unaware of their heart disease risk. This is the first study to evaluate the prevalence of erectile dysfunction among men with type 2 diabetes and silent heart disease, researchers said.
“Silent CAD is a strong predictor of coronary events and early death, especially in diabetic patients,” the investigators noted. “So, it is of interest to know clinical conditions associated with silent CAD to identify subjects who should be screened for CAD.”
To evaluate potential associations between ED and silent coronary artery disease, the Italian group studied 133 men who had uncomplicated diabetes and silent coronary artery disease documented by coronary angiography, a test that produces images inside the heart’s blood vessels. They were compared with 127 diabetic men who did not have silent heart disease, as verified by a series of tests.
Men in the two groups were evaluated for ED by means of the International Index of Erectile Function (IIEF), a widely used questionnaire to determine a man’s ability to achieve erections. The IIEF was administered to all of the men as part of routine ED screening in the year prior to diagnosis or exclusion of silent CAD.
Diabetic men with and without silent CAD did not differ with respect to current forms of treatment. They also had similar rates of diabetic retinopathy, a diabetes complication that correlates with the severity of the disease.
Among the diabetic men with silent CAD, 33.8 percent had ED, compared to 4.7 percent of diabetic men who did not have silent CAD. A statistical analysis that evaluated potential risk factors for silent CAD showed that ED was a better predictor than more traditional risk factors for CAD. Risk factors for silent CAD were apolipoprotein(a) polymorphism (genetic alteration affecting cholesterol), smoking, microalbuminuria (protein loss related to kidney function), and levels of HDL (good) and LDL (bad) cholesterol.
The findings have several potential implications for the evaluation and management of diabetic patients, Gazzaruso said. First, erectile dysfunction warrants consideration with other CAD risk factors, such as high blood pressure and cholesterol abnormalities, in deciding whether a diabetic man requires more extensive evaluation for coronary artery disease.
A second implication relates to treatment of erectile dysfunction in diabetic men. The availability of oral medications for ED has raised questions about their use in men with cardiovascular disease, not only because the drugs can affect blood pressure, but also because they permit formerly impotent men with heart disease to resume sexual activity. Gazzaruso and his associates suggest that diabetic men with erectile dysfunction might require an exercise test or other evaluation for silent CAD before starting erectile dysfunction medication.

Herbal Remedies for Erectile Dysfunction

About 300,000 men each year are diagnosed with erectile dysfunction in the United States alone. A third of these men do not respond to the conventional treatment with drugs such as Viagra, Cialis and Levitra. A smaller percentage cannot be prescribed with drugs due to pre-existing medical conditions such as hypertension, diabetes and hyperthyroidism. All these men are essentially left with the option of penile devices that help them maintain erections - or, of course, they could turn to herbal remedies.
As populations within the developed world are increasingly turning to traditional medicine for overall healthcare, they have come to realize the fact that herbalism is not a "quack science." Modern medicine is also starting to be more accepting of herbal remedies for treating sexual dysfunctions. A few studies indicate that Gingko Biloba has great potential for treating erectile dysfunction as it increases blood flow to the penis. However, this herb can be fatal if it interacts with blood thinning drugs such as Coumadin (Warfarin) or natural foods like garlic and vitamin E. The herb Aswagandha (Withania somnifera), also called Indian ginseng, has been known for centuries as a tonic for stress relief. It works by decreasing performance anxiety and aiding better circulation.
Mexican natives are known to use the plant damiana (Turnera diffusa) as a male aphrodisiac -- however, the active compound in the herb is similar to cyanide and may be toxic in large doses. Saw palmetto (Serenoa repens) has received some attention in the past years as an effective treatment for libido loss for its ability to help the body retain testosterone levels. One of the most popular herbal remedies to emerge that has gained considerable acceptance in recent years is Ginseng. Although the term ginseng has been used to refer to a variety of unrelated plants, many of them show remarkably similar properties and thereputic values. Among them, Chinese ginseng (Panax ginseng), Siberian ginseng (Eleutherococcus senticosus) and Female ginseng (Angelica sinensis or Dong Quai) show poptential as treatments for erectile dysfunction.
The FDA does not approve herbal remedies, as they do not fall under their jurisdiction, and this includes remedies for erectile dysfunction. Men interested in these medications should consult their physicians or herbalists in order to determine the appropriate herb and dosage.

Penile Prostheses for Erectile Dysfunction

Penile Prostheses for Erectile Dysfunction

Erectile dysfunction (ED) is the inability of a man to attain and/or maintain an erection sufficient for sexual activity. Fortunately, most men who have ED only lose the ability to have satisfactory erections. In other words, for most of these men, penile sensation is normal and the ability to have an orgasm and ejaculate remains. Today, there are several treatment options available to men suffering from this disorder. Lifestyle changes are the first line of treatment with weight loss, smoking cessation and exercise associated with improved erections. For most men, the initial medical treatment will be an oral medication such as sildenafil citrate. If this treatment is unsuccessful, second-line treatment options are ordinarily considered. These include using a vacuum erection device, intraurethral medication or penile injection therapy. If these second-line treatments fail or if the patient and his partner reject them, then the third-line treatment option, penile prosthesis implantation, is considered.

What are penile prostheses?

Penile prostheses are devices that are implanted completely within the body. They produce an erection-like state that enables the man who has one of these implants to have normal sexual intercourse. Neither the operation to implant a prosthesis nor the device itself will interfere with sensation, orgasm, ejaculation or urination.

What are the different types of penile prostheses?

There are two erection chambers (corpora cavernosa) in the penis. All penile prostheses have a pair of components that are implanted within both of these erection chambers. The simplest penile prostheses consist simply of paired flexible rods that are usually made of medical-grade silicone, and produce a degree of permanent penile rigidity or firmness that enables the man to have sexual intercourse. These devices are either malleable or inflatable. A malleable rod prosthesis can be bent downward for urination or upward for intercourse. Inflatable penile prostheses are fluid-filled devices that can be inflated for erection. They are the most natural feeling of the penile implants, as they allow for control of rigidity and size.
The inflatable devices have fluid-filled cylinders that are implanted within the erection chambers. Tubing connects these cylinders to a pump that is implanted inside the scrotum, the sac that contains the testicles. In the simplest of these inflatable devices, the pump transfers a small amount of fluid into the cylinders for erection, which then transfers out of the cylinders when erection is no longer needed. These devices are often referred to as two-component penile prostheses. One component is the paired cylinders and the second component is the scrotal pump.
Three-component inflatable penile prostheses have paired cylinders, a scrotal pump and an abdominal fluid reservoir. With these three-component devices, a larger volume of fluid is pumped into the cylinders for erection and out of the cylinders when erection is no longer needed.

What does penile prosthesis implantation involve?

Penile prostheses are usually implanted under anesthesia. Usually one small surgical cut is made either above the penis where it joins the abdomen or under the penis where it joins the scrotum. No tissue is removed, blood loss is small and blood transfusion is almost never required. A patient will typically spend one night in the hospital.
Most men have pain after penile prosthesis implantation for about four weeks. Initially, oral narcotic pain medication is required and driving is prohibited. If men limit their physical activity while pain is present, it usually resolves sooner. Men can often be instructed in using the prosthesis for sexual activity one month after surgery, but if pain and tenderness are still present, this is sometimes delayed for another month.

What are the complications of penile prosthesis surgery?

Infection occurs in 1 to 5 percent of cases. This is a significant complication because in order to eliminate the infection, it is almost always necessary to remove the prosthesis. In 1 to 3 percent of cases, erosion occurs when some part of the prosthesis protrudes outside the body. Erosion often is associated with infection and removal of the device is frequently necessary.
Mechanical failure is more likely to occur with inflatable than with rod prostheses. The fluid present inside the inflatable prosthesis leaks into the body; however, these prostheses contain normal saline that is absorbed without harm. After mechanical failure, another operation for prosthesis replacement or repair is necessary if the man wants to remain sexually active.

Biking and Erectile Dysfunction: A Real Risk? Part 2

Police Bike Patrol Study
Some new saddle designs take the weight off the perineum, according to Steven Schrader, PhD, of the National Institute for Occupational Safety & Health (NIOSH). Schrader triggered an explosion of research on the link between cycling and ED in 2002 when he published a study involving members of a police bicycle patrol. He found that the more hours the officers spent in the saddle, the more likely they were to experience a decrease in the quality of nighttime erections.
All this research spurred the development of several no-nose bicycle seats, and Schrader has tested several.
"We recruited police officers and gave them no-nose seats to use for six months," Schrader says. "We're still doing data analysis, but the striking thing is that of the 91 men who completed the study, only three had returned to a traditional saddle. When we went back and found those three guys, two of them said their saddle had broken and they wanted a new one. Only one said he didn't like it."
No-nose seats have a wide rear that distributes the rider's weight on his sit bones on the buttocks. One study in Germany found that oxygen levels in blood flow to the penis dropped by only about 20% when riders were on a no-nose seat. A traditional bicycle saddle reduces oxygen in blood flow by around 80%.
The Grooved Seat
Bike saddles that feature a groove down the middle or holes in the center to alleviate pressure can actually make the problem worse by increasing pressure on either side of the groove.
"They feel better," Schrader said of the grooved seats. "With the traditional saddle you're sitting on your internal penis. You can feel it. When it drops into the groove it feels better, but if you're increasing the pressure on either side, you're still compressing the artery and the nerves. The wider the seat, the farther back you sit, the better off you're going to be."
The problem affects women too, although not as conspicuously. Schrader recently participated in a study that found the genitalia of competitive female cyclists were desensitized by long hours of riding.
"Some gynecologists say it doesn't hurt their sex life so who cares," Schrader says, "but I say if they're causing physiologic damage, that should be a concern."
Cycling has been commonplace for well over a century. Yet the relationship to ED wasn't widely noticed until 1997 when Ed Pavelka, former executive editor of Bicycling magazine, acknowledged his own erectile difficulties after a year of high-mileage cycling.
Historical Perspective
Why did it take so long for this problem to come to light?
Actually, it didn't. "Cyclists were talking about numbness in the groin as far back as the 1890s," says Schrader. "Ads used to say that this bicycle saddle is the only one that doesn't cause permanent damage. This has been known about for a long time."
After Pavelka brought the problem to public attention, research has consistently supported the connection between cycling and ED. Yet despite ample research showing that a traditional bike seat and improper cycling position can reduce blood flow and compress nerves, some cycling enthusiasts continue to argue that the health benefits of bike riding outweigh the dangers of ED.
But Schrader contends that evidence to the contrary is overwhelming. True, not every man who rides a bicycle will experience a problem. "One would not expect that every bicyclist would suffer from ED any more than one would expect every smoker would get lung cancer," he wrote in a recent editorial in The Journal of Sexual Medicine. Nevertheless, the time has come to develop effective strategies to reduce this danger. "The health benefits from having unrestricted vascular flow to and from the penis are self-evident," he says.

Biking and Erectile Dysfunction: A Real Risk? Part 1

Some experts say ED may be an unwelcome side effect of bicycle riding.

For men, the health benefits of bicycling may involve a troublesome trade-off. While riding a bicycle burns calories and improves cardiovascular fitness, too many hours on a bicycle saddle can compress the artery and vital nerves leading to the penis.
The result? A risk of numbness, pain, and erectile dysfunction.
A male cyclist can place a significant percentage of his weight on his perineum, an area between the scrotum and the anus where the nerves and arteries to the penis pass. This pressure -- and a narrow saddle seat -- can injure the arteries and nerves.
"The earliest warning sign is numbness or tingling," says Irwin Goldstein, MD, director of San Diego Sexual Medicine.
Even a young man may lose the ability to achieve an erection, says Goldstein, who pioneered an operation that restores blood flow and sexual potency in 65%-75% of cases.
How much riding does it take to put a man at risk? The Massachusetts Male Aging Study found that the risk was highest among men who cycled more than three hours a week.
The 'No-Nose' Seat
Goldstein encourages men to sit upright when they ride and replace the traditional bicycle saddle with a "no-nose" seat that redistributes a man's weight to the sit bones of the buttocks.
Serious cyclists who lean forward in a racing position when they ride claim they need the nose to achieve more power and control.
"I don't think you can be a competitive rider and be protected from erectile dysfunction," says Goldstein. "They need that nose between their thighs, and that produces nerve and artery compression."
The evidence that riding a bicycle can be harmful to men is very persuasive, but it should be kept in perspective, says John M. Martinez, MD.
"If someone comes in and says, 'Should I not cycle because of the danger of erectile dysfunction?' I say, 'You have a 50% chance of developing and dying from heart disease, so your primary focus should be exercise and diet -- the two main components of fighting heart disease and ED,'" says Martinez, a primary care sports medicine physician and the medical director at Coastal Sports and Wellness Center, San Diego.
"I wouldn't tell anyone to give up cycling because of fear of ED. If there is ED from cycling, it's almost always temporary and reversible. Other causes of ED, such as hypertension and diabetes -- the No. 1and No. 2 causes of ED -- tend to be fairly permanent. If there are problems, they're usually treatable with proper bike fit and bike seat selection."
A proper-fitting bicycle can help prevent these injuries; appropriate frame size, handlebar height, and seat position are all important. A rider may consider changing the angle of the seat, which should be angled parallel to the ground or slightly forward, to help alleviate pressure on the perineum. Wider seats or those designed with a central cutout also help reduce perineal pressure and can help redistribute weight.
A change in riding style may also help reduce pressure. Standing on the pedals during long rides can prevent pressure and help re-establish blood flow.

Cialis Eases Erectile Dysfunction After Spinal Cord Injury

The drug Cialis (tadalafil) appears to help treat erectile dysfunction (ED) in men with spinal cord injuries, according to a French study of 197 male spinal cord injury patients.
The researchers, from Raymond Poincare Hospital in Garches, noted that only about 25 percent of men with spinal cord injuries are able to have erections that are adequate for intercourse.
For the first four weeks of the study, the men received no treatment. They were then randomly assigned to receive Cialis or a placebo for 12 weeks. The men, who averaged 38 years of age, were instructed to take the drug/placebo as needed before sexual activity, with a maximum of one dose daily.
After the 12-week treatment period, all the men filled out a questionnaire to assess erectile dysfunction. Men who took the drug had an average score of 22.6 (mild ED), while those who took the placebo had an average score of 13.6 (moderate ED).
On average, men who took Cialis were 75.4 percent successful when attempting penetration and 47.6 percent successful when attempting intercourse, compared with 41.1 percent and 16.8 percent, respectively, for men who took the placebo.
The most common side effects among the men who took Cialis were headache (8.5 percent) and urinary tract infection (7.7 percent).

How effective is testosterone in treating erectile dysfunction?

In patients with hypogonadism, testosterone treatment can improve libido and erectile dysfunction, but the response of erectile dysfunction in men with hypogonadism to testosterone is not complete; many men still may need additional oral medications such as sildenafil, vardenafil or tadalafil.
In men 40 years of age or older, a breast examination, digital examination of the prostate and a PSA level (prostate specific antigen) should be done to exclude breast and prostate cancer before starting testosterone treatment since testosterone can aggravate breast and prostate cancers. Patients who have breast and prostate cancers or are suspected of having them should not use testosterone.

Intracavernosal injections

What are intracavernosal injections?

Medications can be injected directly into the corpora cavernosa to attain and maintain erections. Medications such as papaverine hydrochloride, phentolamine, and prostaglandin E1 can be used alone or in combinations to attain erections. Combining small amounts of each drug is preferred over using a single drug because of increased efficacy and fewer side effects. Even though such injections can be effective, they are not widely used because the injections are painful, there may be scarring of the penis, and there is a risk of developing priapism.

What are intraurethral suppositories?

Prostaglandin E1 can be inserted in a pellet (suppository) form into the urethra to attain erections. This technique also is not popular because of occasional side effects of pain in the penis and sometimes in the testicles, mild urethral bleeding, dizziness, and vaginal itching in the sex partner. Men also need to remain standing after inserting the pellet in order to increase blood flow to the penis, and it may take 15-30 minutes to attain an erection. Prostaglandin can cause uterine contractions and should not be used by men having intercourse with pregnant women unless condoms or other barrier devices are used.

What are vacuum devices?

Mechanical vacuum devices cause an erection by creating a vacuum around the penis that draws blood into the penis, engorging it and expanding it. The devices have three components:
1. A plastic cylinder, in which the penis is placed;
2. A pump, which draws air out of the cylinder; and
3. An elastic band, which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body
One variation of the vacuum device involves a semirigid rubber sheath that is placed on the penis and remains there after attaining erection and during intercourse

Surgery for erectile dysfunction may have as its goal:
1. To implant a device that causes the penis to become erect;
2. To reconstruct arteries in order to increase the flow of blood to the penis, or
3. To block veins that drain blood from the penis.
Implantable devices, known as prostheses, can cause erections in many men with impotence.
Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa, the twin chambers running the length of the penis. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.
Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and pump, which also are surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.
Possible problems with prostheses include mechanical breakdown and infection. Mechanical problems have diminished in recent years because of technological advances.
Surgery to repair arteries can reduce impotence caused by obstructions that block the flow of blood to the penis. The best candidates for such surgery are young men with discrete blockage of an artery because of a physical injury to the pubic area or a fracture of the pelvis. The procedure is less successful in older men with widespread blockage of arteries.

What about psychological therapy?

Experts often treat psychologically based impotence using techniques that decrease anxiety associated with intercourse. The patient's partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical impotence is being treated.

Tadalafil (Cialis)

What is tadalafil (Cialis)?

Tadalafil (Cialis) is the third oral medicine approved by the United FDA in the US for the treatment of erectile dysfunction. Like sildenafil (Viagra) and vardenafil (Levitra), tadalafil inhibits PDE5

How effective is tadalafil (Cialis)?

The safety and efficacy of tadalafil in the treatment of erectile dysfunction was evaluated in 22 clinical trials involving more than 4,000 men. Seven of these trials were randomized, prospective, placebo-controlled studies of 12 weeks' duration. Two of these studies (involving 402 men) were conducted in the Untied States, and the other five studies (involving 1112 men) were conducted outside the Untied states. Two of these trials were conducted in special erectile dysfunction populations; one in men with diabetes mellitus, another in men who developed erectile dysfunction after nerve-sparing prostate cancer surgery.
Effectiveness of tadalafil in these studies was assessed using a sexual function questionnaire. Study participants also were asked if they were able to achieve vaginal penetration and to maintain erections long enough for successful intercourse.
In all seven trials, tadalafil was significantly better than placebo in improving men's ability to achieve and maintain erections. Improvements in erectile function was observed in some patients at 30 minutes after taking a dose; and improvements can last for up to 36 hours after taking Cialis when compared to placebo.

How should tadalafil (Cialis) be administered?

The recommended starting dose of tadalafil for most patients is 10 mg taken orally approximately 1 hour before sexual activity. The dose may be adjusted higher to 20 mg or lower to 5 mg depending on efficacy and tolerability. The maximum recommended dosing frequency is once per day, although for many patients tadalafil can be taken less frequently since the improvement in erectile function may last 36 hours. Tadalafil may be taken with or without food.

What are the side effects of tadalafil (Cialis)?

Tadalafil is generally well tolerated with only mild side effects. The most common side effects reported include headache, indigestion, back pain, muscle aches, facial flushing, and nasal congestion.
Back pain and muscle aches occurred in less than 7% of patients, and usually occurred at 12 to 24 hours after taking tadalafil. The back pain and muscle aches associated with tadalafil were characterized by mild to moderate muscle discomfort in the lower back, buttocks and thighs, often aggravated by lying down. The back and muscle aches resolved in most patients without treatment within 48 hours. When treatment was necessary, acetaminophen (Tylenol) and non-steroidal antiinflammatory drugs (NSAIDs) such as Motrin, Advil, or Aleve were effective. Approximately 0.5% of all the patients using tadalafil discontinued the drug due to back pain or muscle aches.
Reports of abnormal vision were rare, it occurred in less than 0.1% of patients using tadalafil.
There have been rare reports of priapism (prolonged and painful erections lasting more than 6 hours) with the use of oral PDE5 inhibitors such as vardenafil, sildenafil and tadalafil. Patients with blood cell diseases such as sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks of developing priapism. Priapism untreated can cause injury to the penile tissue and lead to permanent loss of potency. If there is prolonged erection (longer than 4 hours), immediate medical assistance should be sought.

Who should not use tadalafil (Cialis)?

Tadalafil can cause hypotension (abnormally low blood pressure, which can lead to fainting and even shock) when given to patients who are taking nitrates. Patients taking nitrates daily, even patients taking nitrates only once a day, should not take tadalafil. Most commonly used nitrates are medications to relieve angina (chest pain due to insufficient blood supply to heart muscle because of narrowing of the coronary arteries). These include nitroglycerine tablets, patches, ointments, sprays, pastes, and isosorbide dinitrate and isosorbide mononitrate. Other nitrates such as amyl nitrate and butyl nitrate are found in some recreational drugs called "poppers".
Tadalafil should not be used with alpha-blockers (except Flomax), medicines used to treat high blood pressure and benign prostate hypertrophy (BPH), because the combination of tadalafil and an alpha-blocker may lower the blood pressure greatly and lead to dizziness and fainting. Examples of alpha-blockers include tamsulosin (Flomax), terazosin (Hytrin), doxazosin (Cardura), alfuzosin (Uroxatrol), and prazosin (Minipress). The only alpha-blocker that can be used safely with tadalafil is tamsulosin (Flomax). When tadalafil (20 mg) was given to healthy men taking 0.4 mg of Flomax daily, there was no significant decrease in blood pressure and so patients on this dose of tamsulosin (Flomax) can be prescribed tadalafil. The only alpha blocker that has not been tested with tadalafil is alfuzosin (Uroxatrol) and no recommendations can be made regarding the interaction between the two.
Tadalafil is not recommended for men with the following conditions:
Unstable angina (chest pain due to coronary artery disease that occurs at rest or with minimal physical exertion)
Low blood pressure (a resting systolic blood pressure less than 90mm Hg)
Uncontrolled high blood pressure (greater than 170/110 mm Hg)
Recent stroke or heart attack (within 6 months)
Uncontrolled, potentially life-threatening abnormal heart rhythms
Severe liver disease
Severe heart failure or disease of the heart's valves, for example, aortic stenosis
Retinitis pigmentosa
Therefore, men with these conditions should not use tadalafil without having these conditions evaluated and stabilized first. For example, men with uncontrolled high blood pressure should have their blood pressure controlled; and men with potentially life-threatening abnormal heart rhythms should have these rhythms controlled.
When there is angina or heart failure, the doctor may need to determine whether the heart has enough reserve to safely carry out the work necessary for sexual activity by performing cardiac treadmill stress testing.

What precautions should be taken when using tadalafil?

In most healthy men, some of the drug will remain in the body for more than 2 days after a single dose of tadalafil. Metabolism (clearing of the drug from the body) of tadalafil can be slowed by liver disease, kidney disease, and concurrent use of certain medications (such as erythromycin, ketoconazole, and protease inhibitors). Slowed breakdown allows tadalafil to stay in the body longer and potentially increase the risk for side effects. Therefore, the dose and frequency of tadalafil has to be lowered in the following examples:
Medications such as erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox), ritonavir (Norvir), and indinavir (Crixivan) can slow the breakdown of tadalafil. Therefore men taking these medications should not take more than 10 mg of tadalafil and should not take tadalafil more frequently than every 72 hours.
No tadalafil dose adjustment is necessary for men with only mild kidney disease. Men with moderately severe kidney impairment should start tadalafil at 5 mg every 24 hours, and not to exceed the maximum dose of 10 mg taken every 48 hours. In men with severe kidney disease and on dialysis, the maximum dose should not exceed 5 mg. Men with severe liver disease should not take tadalafil. Men with mild to moderate liver disease should not exceed tadalafil dose of 10 mg once daily

Vardenafil (Levitra)

What is vardenafil (Levitra)?

Vardenafil (Levitra) was the second oral medicine approved by the United FDA in the US for the treatment of erectile dysfunction. Like sildenafil (Viagra), vardenafil (Levitra) inhibits PDE5 which destroys cGMP (as discussed earlier).

How effective is vardenafil (Levitra)?

Vardenafil was evaluated in four multicenter, randomized, placebo-controlled trials involving more than 2400 men (78% white, 7% black, 2% Asian, 3% Hispanic) with erectile dysfunction. Two of these trials were conducted in special erectile dysfunction populations; one in men with diabetes mellitus, another in men who developed erectile dysfunction after prostate surgery. The doses of vardenafil in the four studies were 5 mg, 10 mg, and 20 mg.
In all four studies, vardenafil was significantly better than placebo in improving men's ability to achieve and maintain erections in all age categories (less than 45, 45-65,and greater than 65 years of age) and in all races.

How should vardenafil (Levitra) be administered?

The recommended starting dose of vardenafil is 10 mg taken orally approximately 1 hour before sexual activity. The dose may be adjusted higher or lower depending on efficacy and side effects. The maximum recommended dose is 20 mg, and the maximum recommended dosing frequency is no more than once per day. Vardenafil can be taken with or without food.

What are the side effects of vardenafil (Levitra)?

Vardenafil is generally well tolerated with only mild side effects. These side effects include headache, flushing, nasal congestion, dyspepsia, body aches, dizziness, nausea, and increased blood levels of the muscle enzyme creatine kinase.
There have been rare reports of priapism (prolonged and painful erections lasting more than 6 hours) with the use of oral PDE5 inhibitors such as vardenafil, sildenafil and tadalafil. Patients with blood cell diseases such as sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks of developing priapism. Priapism untreated can cause injury to the penis tissue and lead to permanent loss of potency. If there is prolonged erection (longer than 4 hours), immediate medical assistance should be sought.

Who should not use vardenafil (Levitra)?

Vardenafil (Levitra) can cause hypotension (abnormally low blood pressure, which can lead to fainting and even shock) when given to patients who are taking nitrates. Patients taking nitrates daily, even patients taking nitrates only once a day, should not take vardenafil. Most commonly used nitrates are medications to relieve angina (chest pain due to insufficient blood supply to heart muscle because of narrowing of the coronary arteries). These include nitroglycerine tablets, patches, ointments, sprays, pastes, and isosorbide dinitrate and isosorbide mononitrate. Other nitrates such as amyl nitrate and butyl nitrate are found in some recreational drugs called "poppers".
Vardenafil should not be used with alpha-blockers, medicines used to treat high blood pressure and benign prostate hypertrophy (BPH), because the combination of vardenafil and an alpha-blocker may lower the blood pressure greatly and lead to dizziness and fainting. Examples of alpha-blockers include tamsulosin (Flomax), terazosin (Hytrin), doxazosin (Cardura), alfuzosin (Uroxatrol), and prazosin (Minipress).
Men with a rare heart condition known as long QT syndrome should not take vardenafil since this may lead to abnormal heart rhythms. The QT interval is the time it takes for the heart's muscle to recover after it has contracted. The QT interval is measured with an electrocardiogram (EKG). Some patients have longer than normal QT intervals, and they may develop potentially life-threatening abnormal heart rhythms, especially when given certain medications. Since long QT syndrome can be inherited, men with a family history of long QT syndrome should not take vardenafil. Furthermore, vardenafil is not recommended for men who are taking medications that can affect the QT interval such as quinidine (Quinaglute, Quinidex), procainamide (Pronestyl; Procan-SR; Procanbid), amiodarone (Cordarone), and sotalol (Betapace).
There is insufficient information on the safety of vardenafil in men with the following conditions:
Unstable angina (chest pain due to coronary artery disease that occurs at rest or with minimal physical exertion)
Low blood pressure (a resting systolic blood pressure less than 90mm Hg)
Uncontrolled high blood pressure (greater than 170/110 mm Hg)
Recent stroke or heart attack (within 6 months)
Uncontrolled, potentially life-threatening abnormal heart rhythms
Severe liver disease
Severe kidney failure requiring dialysis
Severe heart failure or disease of the heart's valves, for example, aortic stenosis
Retinitis pigmentosa
Therefore, men with these conditions should not use vardenafil without having these conditions evaluated and stabilized first. For example, men with uncontrolled high blood pressure should have their blood pressure controlled; and men with potentially life-threatening abnormal heart rhythms should have these rhythms controlled.
When there is angina or heart failure, the doctor may need to determine whether the heart has enough reserve to safely carry out the work necessary for sexual activity by performing cardiac treadmill stress testing.

What precautions should be taken when using vardenafil (Levitra)?

Metabolism (breakdown) of vardenafil can be slowed by aging, liver disease, and concurrent use of certain medications (such as erythromycin, ketoconazole (Nizoral), and protease inhibitors). Slowed breakdown allows vardenafil to accumulate in the body and potentially increase the risk for side effects. Therefore, in men over age 65, with liver dysfunction, or who are also taking medication(s) that can slow the breakdown of vardenafil, the doctor will initiate vardenafil at low doses to avoid its accumulation. For example:
Men taking erythromycin or ketoconazole should not take more than 5 mg of vardenafil in a 24-hour period.
Men taking high doses of ketoconazole (Nizoral) should not take more than 2.5 mg of vardenafil in a 24-hour period.
Men with moderately severe liver disease also should not take more than a 5 mg dose of vardenafil in a 24-hour period.
Men taking the protease inhibitor (for the treatment of HIV/AIDS) indinavir (Crixivan ) should not take more than 2.5 mg of vardenafil in a 24-hour period. Men taking another protease inhibitor ritonavir (Norvir) should not take more than 2.5 mg of vardenafil every 72 hours