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The American Society for Pharmacology and Experimental Therapeutics
Methods: Published literature on this topic was identified by using MEDLINE (1966 to May 2007), EMBASE (1980 to week 22 of 2007), Cochrane Central Register of Controlled Trials (second quarter of 2007), PsycINFO (1985 to June 2007), AMED (1985 to June 2007), and SCOPUS (2006). The literature search was updated by searching for articles in MEDLINE and EMBASE published between May 2007 and April 2009. Searches were limited to English-language publications. This guideline grades the evidence and recommendations by using the American College of Physicians' clinical practice guidelines grading system.
Diseases and conditions such as diabetes, high blood pressure, heart or thyroid conditions, poor blood flow, depression, or neurologic disorders (such as multiple sclerosis or Parkinson's disease)
If unsuccessful, does not interfere with other treatments
Penile prosthesis: Pain medications and anti-inflammatory drugs are indicated.
Is the difficulty in achieving erections or maintaining the erection?
The treatment sometimes lasts up to 3 months. The first effects are unlikely to show earlier than two weeks and the manufacturer warns that the primary results will be expected only after a month or so of continuous treatment.
How Does an Erection Occur?
Some authors advocate measuring prolactin and free testosterone levels as part of the initial evaluation.4,5 The value of this routine testing is uncertain, however, because the incidence of endocrinopathy presenting as erectile dysfunction is reportedly only 2 percent.8 A reasonable strategy is to obtain a free testosterone level in all men aged 50 and older and in those younger than 50 who have symptoms or signs of hypogonadism such as decreased libido, bilateral testicular atrophy or a reduced amount of body hair.9 The prolactin level should be measured if the free testosterone level is low, the patient has a substantial loss of libido or a prolactinoma is suspected on the basis of a history of headache with visual field cuts.10 Measurement of luteinizing hormone levels can be reserved for use in distinguishing primary from secondary hypogonadism in men with low testosterone levels.9
The vaginal contraceptive ring (brand name: NuvaRing) is a thin, flexible ring that is inserted into the vagina. It releases hormones that keep you from getting pregnant. These hormones are the same ones used in most birth control pills. The ring is left in the vagina for 3 weeks. It doesn't have to be in a specific position in the vagina. You remove the ring after 3 weeks and your period will start. After 7 days, you insert a new ring.
In addition to healthy blood circulation, the male sex hormone testosterone is important for erections and for sex drive. Men with erectile dysfunction may have low testosterone levels.
Watchful waiting means a "wait-and-see" approach. A single episode of an erection problem is often a temporary and easily reversible problem. Do not assume it will happen again. If possible, forget about it and expect a more successful experience the next time. If you or your partner is concerned about it, talk about the problem and openly discuss your fears and anxieties.
Yohimbine improves erections for a small percentage of men. It stimulates the parasympathetic nervous system, which is linked to erection, and may increase libido. It is necessary to take the medication for 6 to 8 weeks before determining whether it will work or not.
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