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Penile injection therapy No surgery required Prescription drugs: There are over 200 types of prescription drugs that may cause ED. Other adverse events associated with oral PDE-5 inhibitor therapy appear to be few (Table 4). In clinical trials the rates of discontinuation of the drug because of adverse events was low (< 5%) for all of 3 drugs, with few or no cases of priapism.37,53,55,56 Extra caution should be taken for patients who are expected to have reduced clearance of the drug. This group includes men who have severe hepatic or renal insufficiency, men over 65 years old and men taking drugs that inhibit the cytochrome P450 3A4 enzyme (e.g., cimetidine, erythromycin and ketoconazole).57 For these patients it is prudent to start with smaller doses of medication and build up gradually. For sildenafil, it is our experience that a starting dose of 50 mg is safe and effective for all men. 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. There are certain situations in which these drugs may not be safe to take. Before taking them, tell your doctor: Later, it was noticed that Parkinsons patients were regularly having penile erections after their injection. These were clearly being induced by apomorphine and it was soon realized that apomorphine may have an additional medical role. (14) Not surprisingly, it wasnt long before it came to the attention of a pharmaceutical company. The first to bring an ED treatment containing apomorphine to the market, was Abbot Laboratories of the United Kingdom. Their development of a sublingual tablet, under the trade name Uprima is causing a great deal of interest. In fact, emerging research shows that men with a pack-a-day habit are almost 40 percent more likely to struggle with erectile dysfunction than men who don't smoke. canadian cialis Nocturnal penile tumescence (NPT) This is a simple test of normal erections during sleep. Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods used to test for nocturnal erection changes: snap gauge and strain gauge. The presence of NPT tends to signify physically functional systems, but the absence of NPT may not be conclusive. Myth #2: Erectile dysfunction should just be accepted as a natural part of the aging process. Dynamic Infusion Cavernosometry The potential effects of prolonged PDE-5 inhibition on spermatogenesis were evaluated by Hellstrom and colleagues55 in a large cohort of men given daily doses of 10 and 20 mg of tadalafil who were followed up for 6 months. They found no significant effect of the drug on reproductive hormones or sperm parameters. Depending on the cause of a man's ED, treatment can be quick, like Viagra, or take longer, like getting high blood pressure under control. It may even take a while to convince him to see a doctor at all. How well does birth control work? Table 4. Patient demographics. Ranges and percentages are provided in parentheses. Why Do Men With Diabetes Have Erectile Dysnfunction? External vacuum therapy Safe

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