how-to-choose-best-treatment-erection-problems

Starting therapy with the least invasive option seems a logical strategy.
Counseling is recommended because examination, evaluation and choice of therapy can be decided by the same health care professional- Sex Therapist.

Placebo can work wonders along with counseling.

Perineal muscle exercises have to be incorporated in 'Counseling Program', by the Sex Therapist.
Pelvic-floor exercises do not involve any risks, and they are painless. The dropout rate is less than for other interventions and treatment modalities. If treatment is successful, the erection is spontaneous, and this in contrast to injection therapy and use of a vacuum pump or penile prosthesis. The cost of the therapy is low, but the patient needs to be motivated to perform the exercises 90 times daily at home for a period of 4 months.

Results indicate the need for further investigation. Randomized controlled trials are needed to define the efficacy of physical therapy in the treatment of erectile dysfunction.

Conclusion

Comparing the results of a protocol that can be administered by a physical therapist reported here with other interventions shows that a pelvic-floor muscle program is a possible noninvasive alternative to treat patients with erectile dysfunction caused by venous occlusion.

A Controlled Study to Evaluate the Impact of a Psychosexual Assessment on Treatment Adherence and Satisfaction in Men with Erectile Dysfunction
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counseling-best-treatment-erectile-dysfunction

COUNSELING/GUIDANCE/PSYCHOSEXUAL THERAPY/PSYCHOTHERAPY

Counseling is the BEST treatment for Erectile Dysfunctions.
Even if other treatment is used Counseling has to be added to the treatment.

COUNSELING IS BEST

PROS
Psychotherapy may be the intervention of choice for the patient with primarily nonorganic erectile dysfunction, such as that caused by depression. Psychotherapy can be valuable as an addition to medical or surgical interventions.

CONS
Unfortunately, there are very few follow-up studies examining the long-term effect of this intervention. Withdrawal from psychotherapy is common.

Scientifically speaking, the lack of a placebo control group and random allocation of patients to groups in study and in other trials using these approaches limit the usefulness of the results.

A Controlled Study to Evaluate the Impact of a Psychosexual Assessment on Treatment Adherence and Satisfaction in Men with Erectile Dysfunction
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perineal-exercise-treatment-erectile-dysfunction

Excerpt from study on Erectile Dysfunction and Pelvic Floor Exercises.

Different treatment options are available:
psychosexual counseling,
medication,
use of external vacuum devices,
intracavernous injection therapy,
vascular surgery, and use of a
penile prosthesis.

These exercises are known by different names

PELVIC FLOOR
PERINEAL MUSCLE
PUBOCOCCYGEUS MUSCLE
KEGEL'S EXERCISE

RESULTS
In this study, 47% of the patients regained normal erectile function, and 24% had an improved erection after a pelvic-floor re-education program in combination with EMG biofeedback and electrical stimulation. Six out of 51 patients requested another modality of therapy after cessation of the physical therapist intervention.

The results of study are in the line with the findings of

Mamberti-Dias and Bonierbale-Branchereau and Claes and colleagues.
The results of Schouman and Lacroix for patients with erectile dysfunction were less favorable, but their sample size was small.
Colpi et al reported that only 36% of the patients in their study recovered or improved following pelvic-floor muscle exercises for venogenic impotence.


BENEFITS OF PELVIC FLOOR EXERCISES
Physical therapy interventions provide noninvasive methods that are easy to perform, painless, and inexpensive. Studies have shown positive results after a pelvic-floor re-education program for men with erectile dysfunction. However, different programs were used, and some studies had a small sample size. Data from subjects who did not complete the studies were not included in the analyses, and predictive factors were not investigated. The aims of our study were to test an outpatient pelvic-floor re-education program in men with erection problems and to identify factors that could predict therapeutic outcome.

A Controlled Study to Evaluate the Impact of a Psychosexual Assessment on Treatment Adherence and Satisfaction in Men with Erectile Dysfunction
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what-is-erectile-dysfunction

WHAT IS ERECTILE DYSFUNCTION?
Erectile dysfunction is defined as the persistent failure to achieve and sustain erections of sufficient rigidity for penetration during sexual intercourse.

CAUSES OF ERECTILE DYSFUNCTION
Erectile dysfunction often has multiple causes. Therefore, the diagnostic evaluation for this disability should include an evaluation of the findings of an examination of the patient's psychological, hormonal, neurological, and vascular status. (1) In many cases, a combination of factors is involved.

The role of the perineal muscles in the erectile mechanism is still open for debate. Some studies using animal models as well as studies of humans have demonstrated evidence that there is normally increased ischiocavernous and bulbocavernous muscle activity during coitus. This muscle activity contributes to the increase in intracavernosal pressure.

A Controlled Study to Evaluate the Impact of a Psychosexual Assessment on Treatment Adherence and Satisfaction in Men with Erectile Dysfunction
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recent-study-erectile-dysfunction

A Controlled Study to Evaluate the Impact of a Psychosexual Assessment on Treatment Adherence and Satisfaction in Men with Erectile Dysfunction.

Title Annotation: research
Article Type: Brief Article
Geographic Code: 1USA
Date: Feb 1, 2006
Words: 201
Publication: The Journal of Sex Research
ISSN: 0022-4499


A Controlled Study to Evaluate the Impact of a Psychosexual Assessment on Treatment Adherence and Satisfaction in Men with Erectile Dysfunction, Katherine A. Muldoon, Julie F. Larouche, Rhonda Amsel, Yitzchak M. Binik, and Serge Carrier, McGill University

We compared the multidisciplinary assessment model of erectile dysfunction (ED) to the standard medical treatment. All patients were examined by the same urologist and received the same standard of care; however, the experimental group attended a psychosexual assessment prior to the appointment with the urologist. All patients answer a general health and sexual functioning questionnaire and complete the Sexual Health Inventory for Men (SHIM) at baseline. We followed up 3-6 months later and administered a brief structured interview, the SHIM, and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) to assess sexual functioning and treatment satisfaction. Preliminary results suggested that men who underwent a psychosexual assessment before their urology exam report a significantly higher percentage use of prescribed medication treatment and significantly higher treatment satisfaction than men who had the urologist examination alone. A multidisciplinary approach to ED may be the most effective way to assess the condition and facilitate treatment adherence. This supports the conclusions of the NIH Consensus Panel on Impotence (1993).
COPYRIGHT 2006 Society for the Scientific Study of Sexuality, Inc.
Copyright 2006, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.


A Controlled Study to Evaluate the Impact of a Psychosexual Assessment on Treatment Adherence and Satisfaction in Men with Erectile Dysfunction
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references-erectile-dysfunction

References
ERECTILE DYSFUNCTION

McVary, K. T.. Clinical practice. Erectile dysfunction. N Engl J Med. 2007 Dec; 357(24): 2472-81.

Melnik T, Soares BG, Nasselo AG. Psychosocial interventions for erectile dysfunction. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004825.

Update Date: 8/10/2009

Updated by: Reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. Also reviewed by Scott Miller, MD, Urologist, private practice, Atlanta, Georgia.
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other-treatment-erection-problems

Most often KNOWLEDGE AND GUIDANCE of experienced Sex Therapist itself is a POWERFUL treatment and no other treatment is required.

THE SEX THERAPIST SHOULD BE ASKED WHAT IS THE BEST TREATMENT
TREATMENT WITH MINIMUM OR NO SIDE EFFECTS IS ALWAYS PREFERABLE.

If pills,like viagra(R), cialis(R), revitra(R), (sildenafil, tadalafil, vardenafil) do not work, options such as the following are available.

Testosterone replacement using skin patches, topical gel, or injections into the muscle may be prescribed if your blood testosterone level is low. This option is rarely used.

ICIVAD
Injection of VasoActive Drugs in Penis
Eg. CAVERJECT
A medicine called alprostadil, injected into the penis or inserted into the urethra, improves blood flow to the penis. This usually works better than medications taken by mouth.
An external vacuum device can be used to pull blood into the penis. A special rubber band is then used to maintain the erection during intercourse.

For some patients, a surgically-placed penile implant (prosthesis) may also be recommended or needed.

Many herbs and dietary supplements are marketed to help sexual performance or desire. There are several special concerns for people taking alternative remedies for erectile dysfunction. Also, none of these remedies have been proven effective for treating erectile dysfunction.


Source
http://www.nlm.nih.gov/medlineplus/ency/article/003164.htm
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precaution-medicine-erection-treatment

VIAGRA(R) and similar medicines that contain Sildenafil Citrate are called PDE5 inhibitors.
SILDENAFIL
TADALAFIL
VARDENAFIL
are also PDE5 inhibitors

PDE5 inhibitors should be used with caution if you have any of the following conditions:

Recent stroke
Severe heart disease, such as unstable angina, a recent heart attack, or arrhythmia
Severe heart failure
Uncontrolled hypertension (high blood pressure)
Uncontrolled diabetes
Very low blood pressure (hypotension)

http://www.nlm.nih.gov/medlineplus/ency/article/003164.htm
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sex-education-parents-teachers

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treatment-erectile-dysfunction

THE TREATMENT HAS TO BE TAKEN ONLY AFTER QUALIFIED SEX THERAPIST PRESCRIBES IT.

The treatment may depend on the cause. For example, if the problem is caused by a hormonal imbalance, medication to treat the underlying endocrine disorder will be prescribed. However, the same treatment may be used for many different causes. Consult your health care provider for appropriate evaluation and management.

There are many treatment options today. These include medicines taken by mouth, injections into the penis, medicines inserted into the urethra (urinary channel), vacuum devices, and surgery. In order to treat erectile dysfunction effectively, you must be aware of and comfortable with the possible side effects and complications that may occur with each therapy.

Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are medicines prescribed for erection difficulties caused by either physical or psychological problems. The drugs work only when the man is sexually aroused. The effect is usually seen within 15 - 45 minutes.

These drugs are called phosphodiesterase-5 (PDE5) inhibitors.

Although these drugs have become extremely popular, they do not enhance erections if you are not impotent. And they DO have side effects, which can be as serious as a heart attack or as minor as muscle pain or facial flushing.

Source
http://www.nlm.nih.gov/medlineplus/ency/article/003164.htm Read more On "treatment-erectile-dysfunction"!

tests-for-erectile-dysfuntion

Tests:

Blood tests, including complete blood count, metabolic panel, hormone profile, and PSA
Neurological (nerve) testing
Nocturnal penile tumescence (NPT) to check for normal nighttime erections
Penile ultrasound to check for blood vessel or blood flow problems
Psychometric testing
Rigidity monitoring
Urine analysis

The Sex Therapist is best person to decide which tests to do.
Most experienced Sex Therapists do not require the above tests for diagnosis or treatment.

Source
http://www.nlm.nih.gov/medlineplus/ency/article/003164.htm Read more On "tests-for-erectile-dysfuntion"!

how-to-prevent-erection-problems

For many men, lifestyle changes can help:

Cut down on smoking, alcohol, and illegal drugs.
Get plenty of rest and take time to relax.
Exercise and eat a healthy diet to maintain good circulation.
Use safe sex practices, which reduces fear of HIV and STDs.
Talk openly to your partner about sex and your relationship. If you are unable to do this, counseling can help.
Couples who cannot talk to each other are likely to have problems with sexual intimacy. Men who have trouble communicating their feelings may find it difficult to share with their partner any anxieties about their sexual performance. In these circumstances, counseling can be very helpful for both you and your partner.

Source
http://www.nlm.nih.gov/medlineplus/ency/article/003164.htm Read more On "how-to-prevent-erection-problems"!

causes-erection-problems

WHY DO MEN HAVE ERECTION PROBLEMS?

Causes

UNREALISTIC EXPECTATION IS BY FAR THE COMMONEST CAUSE.
INCORRECT KNOWLEDGE CAN LEAD TO ERECTION PROBLEMS
SINCE CORRECT SOURCE OF SEXUAL INFORMATION IS LACKING DOUBTS ARISE IN MIND.
THESE DOUBTS ABOUT ONE'S SEXUAL CAPACITY GIVE RISE TO FEAR AND CAUSES ERECTION PROBLEM

.

An erection requires the interaction of your brain, nerves, hormones, and blood vessels. Anything that interferes with the normal process can lead to a problem.

Common causes of erection problems include:

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)
Medications such as blood pressure medications (especially beta-blockers), heart medications (such as digoxin), some peptic ulcer medications, sleeping pills, and antidepressants
Nerve damage from prostate surgery
Nicotine, alcohol, or cocaine use
Poor communication with your partner
Repeated feelings of doubt and failure or negative communication that reinforce the erection problems
Spinal cord injury
Stress, fear, anxiety, or anger
Unrealistic sexual expectations, which make sex a task rather than a pleasure
Erection problems tend to become more common as you age, but they can affect men at any age and at any time in their lives. Physical causes are more common in older men, while psychological causes are more common in younger men. Read more On "causes-erection-problems"!

erection-problems

ERECTION PROBLEMS
An erection problem is the inability to get or maintain an erection that is firm enough for a man to have satisfactory intercourse. You may be unable to get an erection at all, or you may lose the erection during intercourse before you are ready. If the condition persists, the medical term is erectile dysfunction.

Considerations

Erection problems are common in adult men. In fact, almost all men experience occasional difficulty getting or maintaining an erection. In many cases, it is a temporary condition that will go away with little or no treatment. In other cases, it can be an ongoing problem that can damage a man's self esteem and harm his relationship with his partner, and thus requires treatment.

If you have difficulty having or keeping an erection more than 25% of the time, it is considered a problem.

In the past, erection problems were thought to be "all in the man's mind." Men often were given unhelpful advice such as "don't worry" or "just relax and it will take care of itself." Today, doctors believe that when the problem is not temporary or does not go away on its own, physical factors are often the cause.

One way to know if the cause is physical or psychologic is to determine if you are having nighttime erections. Normally, men have 3 to 5 erections per night, each lasting up to 30 minutes. Your doctor can explain a test to find out if you are having the normal number of nighttime erections.

Source
http://www.nlm.nih.gov/medlineplus/ency/article/003164.htm
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erectile-dysfuncions

ERECTILE DYSFUNCTION (ED)
Male erecticle dysfunction - impotence resulting from a man's inability to have or maintain an erection of his penis
ED, erectile dysfunction
impotence, impotency - an inability (usually of the male animal) to copulate
disfunction, dysfunction - (medicine) any disturbance in the functioning of an organ or body part or a disturbance in the functioning of a social group; "erectile dysfunction"; "sexual relationship dysfunction"
Based on WordNet 3.0, Farlex clipart collection. © 2003-2008 Princeton University, Farlex Inc.
Source
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