What is the average age of male impotence

In patients who take 50 mg of sildenafil or more and use alpha blockers, sildenafil dosing should be avoided for at least 4 hours after the dose of the alpha blocker. In patients who take 25 mg of sildenafil, use of any alpha blockers is considered safe. Dose-adjustment is recommended in patients with hepatic failure and with co-administration of drugs also metabolized by the cytochrome p enzymes.

Although the association is controversial, it is prudent to consider alternative treatments for ED in patients with NAION or at risk for it. It is extremely important to take a complete drug history for patients reporting ED. Medications that may cause or contribute to ED include: Alcohol, nicotine, and illicit drugs Analgesics Anticonvulsants Antidepressants Antihistamines Antihypertensives Antiparkinson Antipsychotics Cardiovascular agents Cytotoxic agents Diuretics Hormones and hormone-active agents Immunomodulators Tranquilizers.

Antihypertensive drugs, such as diuretics eg, spironolactone, thiazides and beta blockers, may be associated with ED. Discontinuation or switching to alternative drugs, such as angiotensin-converting enzyme inhibitors or calcium channel blockers eg, diltiazem, nifedipine, amlodipine , may reduce ED. The newer angiotensin II receptor antagonists may be less problematic with respect to ED, but long-term data is needed to evaluate this.

Of the drugs used for depression, tricyclic antidepressants may be associated with erectile problems and other drugs may be substituted to prevent this complication. Currently available substitutes include bupropion, nefazodone, and trazodone. The selective serotonin reuptake inhibitors eg, fluoxetine, sertraline, paroxetine, citalopram can also cause difficulties with ED, but they might also have other significant sexual side effects, including decreased libido and anorgasmia.

Clinical experience in switching medications to improve ED has been disappointing in that improvement does not often occur. Nonetheless, it is important to try to discontinue possible offending medications before proceeding to more invasive ED treatment options. Oral ED medications have changed the way clinicians discontinue medications in patients with ED and has improved the approach. For example, a patient may develop ED on a thiazide diuretic.

The diuretic may be withdrawn, but a trial of oral ED therapy can be initiated during the observation period while the patient is waiting to see if any spontaneous improvement in ED occurs after drug withdrawal. Alternatively, if diuretic therapy is effective, well tolerated, and controlling blood pressure, oral ED therapy can be used on an ongoing basis to treat the side effect of ED.

If a trial of oral ED therapy and withdrawal of offending medications prove to be ineffective in restoring erectile function, it is appropriate for most primary care practitioners to consider referral to a specialist for additional evaluation and discussion of alternative treatment options.

These include intracavernous injection therapy, vacuum constriction devices, intraurethral therapy, and possible surgery. If a trial of oral therapy and withdrawal of offending medications do not restore erectile function or if a patient has medical or financial contraindications to pharmacologic therapy, most primary care practitioners should consider referring the patient to a specialist for additional evaluation and discussion of alternative treatment options.

However, some primary care practitioners may recommend vacuum constriction devices. The device consists of an acrylic cylinder placed over the penis that uses a lubricant to achieve a good seal between the penile body and cylinder. An erection is then achieved by creating a vacuum inside the cylinder with a pump connected to the cylinder.

Once an erection is achieved, a constriction band is applied to the base of the penis to maintain the erection. The cylinder can then be removed and the patient can engage in intercourse with the constriction band at the base of the penis maintaining the erection.

The band can remain on for approximately 30 minutes and then must be removed. The erection produced by the device differs from a normal erection likely because of venous occlusion from the constriction band resulting in generalized swelling of the entire penis, with probable preservation of arterial inflow. Clinical studies have suggested that these devices are effective and acceptable to a large number of patients with ED of varying causes, including psychogenic erectile failure.

There are relatively few contraindications to the use of vacuum devices. Some conditions can predispose to priapism or perhaps bleeding with constriction, such as sickle cell disease, polycythemia, and other blood dyscrasias. Patients taking anticoagulants can safely use vacuum constriction devices but need to accept a higher risk of bleeding ecchymosis. Good manual dexterity is also needed to use the device; if manual dexterity is impaired, a willing sexual partner can learn to apply the device.

Complications from the use of a vacuum constriction device are relatively minor. They include the development of petechiae or ecchymosis, numbness or coolness of the penis, trapping of the ejaculate, and pivoting of the penis at the base.

Alprostadil also known as prostaglandin E1 [PGE1] is the prominent known smooth-muscle dilator of the corpus cavernosum. Its mechanism of action is believed to be the promotion of intracellular accumulation of cyclic adenosine monophosphate, thereby causing decreased intracellular accumulation of calcium and resulting smooth muscle relaxation.

Alprostadil can be delivered to the erectile tissue either via an intraurethral suppository that is massaged and then absorbed across the corpus spongiosum of the urethra to the corpora cavernosa, or directly injected into the corpora cavernosa.

When administered urethrally, doses are substantially higher than when directly injected typical dosing is mcg to 1 mg intraurethral compared with 2.

Side effects include lightheadedness, fainting, priapism, urethral bleeding intraurethral , dyspareunia in the partner intraurethral , hematoma intracavernosal or penile curvature secondary to scar intracavernosal.

Pinsky et al 33 reported an extensive review of the benefits and drawbacks of the combinations of these drugs. Given the high risk of priapism during escalation of therapy for intracorporeal injection, it is recommended that the drugs be administered in a supervised office visit initially and that the patient be given a well-articulated plan for treatment of priapism if it occurs.

Escalation guidelines for alprostadil alone vary, but a general guideline is to start at 2. If there is no response to the initial 2. Several treatments were promoted in the pre-PGE1, pre-prostaglandin era, including yohimbine, trazodone, testosterone, and various herbal remedies.

None of these is currently recommended under the updated American Urological Association Guidelines for the Treatment of Erectile Dysfunction. Implantation of penile prosthesis remains an important option for men with ED if medical treatment fails or is inappropriate.

Prostheses are available as a saline-filled silicone device or a malleable device. The benefit of the former is a more natural appearance in the deflated state, closely approximating the appearance of a flaccid penis. The trade-off is a higher mechanical failure rate and higher cost. Risks of these devices include surgical and anesthetic risk, device infection, and device malfunction. Mechanical failure rates depend on the specific device being investigated. All devices that are currently approved by the FDA are considered safe for use in magnetic resonance imaging environments.

However, 2 previously approved devices—the OmniPhase and the DuraPhase penile prostheses—are not considered safe in this environment. Other surgical procedures—including venous ligation to limit penile venous outflow and penile revascularization procedures—are rarely successful and are not recommended. Treatment Summary References. Back to Top Definition Erectile dysfunction or disorder ED is the inability to develop and maintain an erection for satisfactory sexual intercourse or activity.

Back to Top Pathophysiology The development of an erection is a complex event involving integration of psychologic, neurologic, endocrine, vascular, and local anatomic systems. Back to Top Signs and Symptoms Some self-administered measures may be useful in the primary care setting to screen for and evaluate the degree of ED. Back to Top Diagnosis If it is determined that ED is a problem, the patient evaluation should include a detailed sexual and medical history and a physical exam.

Back to Top Treatment The American Urological Association Guidelines for the treatment of Erectile Dysfunction recommend a complete history and physical and lifestyle modifications followed by a shared-decision-making approach for the existing medical treatments Figure 1. But ED is not a natural part of aging that older men just have to accept and learn to live with NIH, n.

But even younger men in their 20s and earlier experience ED. A real, U. Age-related health conditions may also increase your risk of ED, including:. ED can also occur as a side effect of certain medications, including antidepressants. They might be able to adjust your dose or substitute another medication. Other lifestyle factors that can contribute to ED include: Having excess weight or obesity, not getting enough exercise, smoking or using tobacco products, drinking excessively having more than two alcoholic drinks a day , and using recreational drugs.

The good news is that there are many options for treating ED. Oral medications for ED are highly effective at improving sexual function. Several are available, including sildenafil brand name Viagra , tadalafil brand name Cialis , and vardenafil brand names Levitra and Staxyn.

Non-oral medications have been helpful for some men, including alprostadil, papaverine plus phentolamine brand name BiMix and papaverine, phentolamine, and alprostadil brand name TriMix.

These are medications that can be injected directly into the penis, causing an erection. Some men have found natural remedies for ED to be effective at improving their erections, and some research backs that up: Studies have shown that certain supplements such as DHEA, ginseng, L-arginine, L-carnitine, and yohimbe may be helpful for relieving ED.

If low testosterone is responsible for your ED, testosterone replacement therapy TRT can boost your testosterone levels via injection, a wearable patch, or a gel applied to the skin.

Erectile dysfunction ED is caused by different factors, including poor heart health. Since high cholesterol levels can affect heart health, can…. Here's how to shop Viagra smartly. VigRX Plus is marketed as a safe supplement to enhance sexual performance, but does it actually work?

We review the research. Health Conditions Discover Plan Connect. Medically reviewed by Daniel Murrell, M. Learn more about the risks and treatment options. What is erectile dysfunction? Hope, no matter your age. Medical causes of ED. Other causes of ED. Lifestyle changes and other treatments. Read this next. Erectile Dysfunction Causes and Treatments. Medically reviewed by Graham Rogers, M.

Medically reviewed by Alana Biggers, M.