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Premature ejaculation (P.E.) is defined as ejaculation with minimal sexual stimulation and climax occurring before, upon, or shortly after vaginal penetration, prior to a person’s desire to do so, over which the sufferer has little voluntary control. P.E. typically causes the sufferer and partner extreme bother and distress.

This is a very common male sexual dysfunction, occurring in up to 30% of the male population, and affecting men of all ages, ethnicities, and socio-economic groups. P.E. can be devastating, causing embarrassment, frustration and loss of self-confidence for males, and negatively affecting their relationships with their partners. The basis of P.E. can be psychological and/or biological – with guilt, fear, and performance anxiety, but also genetics and certain medical disorders playing possible roles in its occurrence.

P.E. may be classified as either primary (lifelong) or secondary (acquired). Primary P.E. applies to men who have had the problem since becoming sexually active and is thought to have a strong biological component. Psychological or situational stressors may contribute to secondary P.E., but it is also associated with erectile dysfunction, prostatitis and urethritis.

Our society’s cultural emphasis on ejaculation as the focal point of sexual intercourse tends to exacerbate the performance anxiety that can initiate the problem. The occurrence of P.E. has social and psychological consequences that tend to perpetuate the problem as fear of and mental preoccupation with P.E. can actually induce the unwanted ejaculation, creating an unfortunate vicious cycle. But males experiencing P.E. need to know that various types of help are available and that there is no need to suffer in silence. Treatments are varied, consisting of behavior modification techniques, physical and pharmacological interventions, and sexual counseling.

Peripheral Nerve Injury Peripheral nerve injury is another important cause of ED, especially in patients undergoing prostatectomy. Other causes of peripheral nerve injury include bicycle riding and acute pelvic trauma. Several authors have reported genital numbness and increased the incidence of ED among cyclists. The pathophysiological basis for ED in cyclists is thought to be neurogenic as well as vasculogenic.

A recent systematic review of the literature found that the reported incidence of ED after radical prostatectomy with nerve sparing technique varies widely due to methodology. 50% and 34% for bilateral and unilateral nervesparing surgery, respectively.

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Nerve-sparing techniques are based on the seminal study by Walsh and Donkers in which they identified the path of the nerves to the corpus cavernosa.
They identified the branches of the pelvic plexus traveling through the urogenital diaphragm adjacent to the prostatic capsule and then adjacent to and through the wall of the membranous urethra. Not surprisingly, they found that men with tumors that did not invade the prostatic capsule and were amenable to salvage of this structure had reduced rates of ED.

Recovery and improvement in erectile function after radical prostatectomy has been reported to continue up to and beyond 2 years postoperation, perhaps indicating healing of injured nerves.
Loss of erectile function is also related to anatomical changes in the penis, specifically fibrosis of the penis due to prolonged lack of tumescence. In animal models, histological changes occurring after nerve injury are prevented by regular pharmacologically induced erections.

Psychogenic Risk The number of cases of ED attributed purely to psychogenic etiology have greatly declined in the past several decades. Younger men who complain of ED are more likely to have a psychogenic component than older men. Psychogenic ED is generally classified into generalized and situational pathologies and further subclassified.

This classification scheme has been criticized as it fails to account for advances in neurobiology that have linked certain psychiatric illnesses with neurochemical and neurohormonal derangement. Depression Depression and ED are often comorbid conditions. Several epidemiologic studies report men with ED are more likely to report depression, and that this association is independent of associated comorbidities, demographic factors and medications. In a study of men diagnosed with Major Depressive Disorder but not yet treated, almost half had trouble sustaining an erection and reported decreased sexual desire

Respiratory Disease and Erectile Dysfunction: Spinal Cord Injury, Cerebrovascular Accidents

Posted by Ed medications in Erectile Dysfunction - (Comments Off on Respiratory Disease and Erectile Dysfunction: Spinal Cord Injury, Cerebrovascular Accidents)

Spinal Cord Injury The nature of ED caused by spinal cord injury (SCI) is dependent on the acuity and location of the injury. Estimates of the preservation of erectile function vary widely, and are as high as 95% for reflexogenic erection.

Erections in men with SCI are characterized as reflexogenic when the stimulus is tactile or psychogenic when visual, auditory, or memory serve as the stimulus. Since erections are the result of parasympathetic output to the penis arising from S2 to S4, reflexogenic erection is maintained in suprasacral injuries or those not involving the lower motor neurons (LMN).

Cerebrovascular Accidents Cerebrovascular accidents (CVA) are another important cause of sexual dysfunction and, specifically, ED. As with other neurological diseases, the pathophysiology of ED in these patients is multifactorial and related to the physical, psychological, and social consequences of stroke. Sexual complaints in stroke patients include the loss of libido, frequency of sexual intercourse, ED, and sexual satisfaction.

These complaints are most attributable to interpersonal variables, such as the inability to discuss sexuality with a spouse or changed attitude toward sex, but the fear of impotence is a significant variable. Erectile dysfunction increases from 36% prestroke to 76% poststroke, and is associated with the degree of depression poststroke.

In a study that specifically assessed ED in stroke patients, approximately half of stroke patients reported ED.

A more important finding in this study was that preexisting diabetes, hypercholesterolemia, obesity, and smoking increased the prevalence of ED after stroke. The neurogenic component of ED in stroke patients is complex due to the various central structures involved in erectile physiology and the complexity of stroke distributions. Only one study to date has attempted to associate lesions on MRI with sexual dysfunction. Erectile dysfunction was only weakly associated with lesions involving the right pons.

While the specific nature of neurological insults that determine ED in stroke patients is yet to be determined, it is evident that psychosocial factors are an important determinant of sexual dysfunction after stroke.

Neurogenic Factors The proportion of ED that is currently attributed to pathophysiology of the neurological system is likely underestimated. In the central nervous system, the amygdala, medial preoptic area (MPOA) and periventricular nucleus (PVN) of the hypothalamus, and the hippocampus are all involved libido and erection.

Parkinson’s Disease and Alzheimer’s Disease The prevalence of ED in men with Parkinson’s disease (PD) exceeds that of age-matched controls.

The pathophysiology of ED in patients with PD is multifactorial, as PD is characterized by significant psychiatric comorbidities and dysautonomia in addition to the destruction of dopaminergic cells in the substantia nigra.

The specific pathophysiology of ED in Alzheimer’s disease has not been elucidated but appears to be independent of concomitant risk factors such as age. Multiple Sclerosis One case-controlled study found ED to occur five times more often in men with Multiple Sclerosis (MS) compared to those with other chronic diseases. Over 50% of men with MS report either one or more of altered genital sensation, decreased libido, decreased intensity of orgasm, and increased time for arousal. Epilepsy Epileptic men also have an increased prevalence, with 15–57% experiencing ED.

Temporal lobe epilepsy, specifically, may exert its effects on erectile function through a derangement in the hypothalamic–pituitary axis (HPA). More pronounced in times of epileptic discharge, this derangement results in hypogonadotropic hypogonadism and hyperprolactinemia.

Chronic Obstructive Pulmonary Disease There is a clear association between respiratory diseases and ED independent of comorbid conditions, such as peripheral vascular disease or coronary artery disease. Chronic obstructive pulmonary disease (COPD) is a common chronic disease in men. Dyspnea and hypoxemia diminish a patient’s functional capacity and can lead to ED. The prevalence of ED in patients with respiratory disease has been reported as high as 75%.

Several investigators have demonstrated that as pulmonary function tests (i.e., FEV1, FRC, PaO2) worsen, so does a man’s erectile function. Pathophysiology of ED in patients with COPD is multifactorial. Disruption of the hypothalamic– pituitary–gonadal axis has been reported in patients with COPD.

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Reversal of hypoxemia with long-term oxygen has been shown to be effective in improving impotence. Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is also a common chronic disease. It has been reported in as many as 10% of men over 40 years old. Recurrent intermittent hypoxemia and transient increases in sympathetic tone during apneic episodes result in an increased risk of daytime somnolence, hypertension, and ischemic cardiovascular events. Erectile dysfunction has also been found to be associated with OSA.

This association appears to be strongest in the most severe cases of OSA. Causes for ED in these patients include hypoxemiadriven neural damage, microvascular endothelial damage from increased sympathetic tone and hypertension, low gonadotropin secretion, and psychosocial abnormalities, including daytime somnolence and depressed mood

A cohort of nearly 30,000 men evaluated through a screening questionnaire reaffirmed the previous concepts – patients with ED are more likely to suffer from cardiovascular disease. But the study also suggested that it is important to take into account the degree of ED. Authors stated that the greater the severity of ED, the greater the risk of presence of a medical comorbidity in the patient. Degree of ED severity can therefore be used as a prognostic marker for overall health risk, particularly cardiovascular disease risk.

Specific degrees of ischemic coronary disease and their association with ED in male patients were researched in a group of men with an average age of 56. These men underwent coronary angiography for the purpose of documentationof the specificextent of coronary disease in order to compare this with sexual function.

Sexual function was evaluated using an extensive questionnaire focused on sexual desire, erectile function, and ejaculation. A statistically significant correlation was made between ED and the number of coronary vessels involved. Those patients with one-vessel coronary disease were much more likely to achieve erection than those with two- or three-vessel disease.

It is well understood that only a small fraction of men with ED seek treatment. With the positive correlation between ED and cardiovascular risk, this underreporting by male patients to their healthcare providers should be taken seriously. Perhaps all men over a particular age should be screened for the presence of ED, much like the current recommendations for prostate cancer screening. If ED is present, it could be argued that these men should then undergo investigation for underlying subclinical cardiovascular disease. Endothelial dysfunction appears to be the link between the two disease entities. Increased awareness of the association between ED and cardiac disease should lead general practitioners to inquire as to the presence of ED symptoms in their male patients.

An important issue in patients with cardiac risk and ED is the safety of ED treatment. Topics including the risk of sexual activity eliciting a cardiac event and risk of drug interactions were addressed in an algorithm developed by the First Princeton Consensus Panel. They designated patients to low, intermediate, or high risk for the treatment of ED and participation in sexual activity. They support lifestyle interventions in patients with ED, including weight loss and increased physical activity

A piece of sweet, sweet juicy watermelon is a crown for fourth of July and a meal means that researchers have effects similar to Viagra – but do not necessarily expect to keep the fireworks all night.

Watermelons contain an ingredient called citrulline that can trigger production of a compound that helps relax blood vessels of the body, similar to what happens when a man takes Viagra, said scientists in Texas, a leading producer of seeds of the variety. Found in meat and rind of watermelons, citrulline reacts with enzymes in the body when consumed in large quantities and is converted into arginine, an amino acid that benefits the heart and the circulatory and immune system.

“Arginine stimulates nitric oxide, which relaxes blood vessels, the same basis as Viagra to treat erectile dysfunction and even prevent it,” said Bhimu Patil, a researcher and director of the Texas A & M Fruit and Vegetable Improvement Center. “Watermelon may not be as organ specific as Viagra, but it is a great way to relax blood vessels without the side effects of drugs.”

Todd Wehner, who studies watermelon breeding at the University of North Carolina State, said anyone taking Viagra should not expect the same result from watermelon. “It seems that this is an effect that would be interesting but not a substitute for medical treatment,” Wehner said. Nitric oxide can also help with angina pectoris, hypertension and other cardiovascular problems, according to the study, which was paid by the U.S. Department of Agriculture.

More citrulline – about 60 percent – is found in the rind of the watermelon in the flesh, Patil said, but may vary. But scientists may be able to find ways to increase the concentration in the flesh, he said. Citrulline is found in all colors of watermelon and is highest in the yellow flesh types, said Penelope Perkins-Veazie, a USDA researcher in Lane, Oklahoma. She said Patil research is valid, but with a caveat: One would have to eat about Six Cups of Watermelon to get enough citrulline to boost the body arginine level.

– “The problem you have when you eat a lot of watermelon is that they tend to run to the bathroom more.”
Watermelon is a diuretic and a homeopathic treatment for kidney patients before extended dialysis.

– Another problem is the amount of sugar that the amount of water released into the bloodstream – a jolt that could cause cramping.
Patil said he would like to do future studies on how to reduce the sugar content in watermelon.

The relationship between citrulline and arginine might also prove useful for those who are obese or suffer from type 2 diabetes. The beneficial effects – among them the ability to relax blood vessels, like Viagra – are beginning to be revealed in research.

There are variants of Generic Cialis available in the market – they are called generic Cialis or generic Tadalfil. They have the same composition as the branded Cialis. One can buy generic drugs as they only may look different because in the US, FDA does not allow it to look the same. Cialis is generally used to treat the difficulties in having and preserving an erection, encountered by men, which also beares the name of impotence.

What does Cialis exactly?

What Cialis does is creating some effects produced by some substances in one’s body, during the sexual arousal. This has as a result a growth of the blood flow into one’s penis. This is what an erection is: the increase of blood flow into the internal areas of the penis.

What is the difference between Cialis and other products used for treating the same problems?

The one difference between Cialis and some other products approved by ED is the fact that it persists longer in one’s body. Other differences regarding safety or effectiveness which could separate Cialis from other products of its kind have not been studied yet.

How should one take Cialis?

Cialis is ought to be taken orally before any sexual act, but it is not advisable to take it more than once a day.

One should consult his health care provider if taking Cialis because in the case of heart problems the doctor or health care provider must know when Cialis was last taken.

One should know that after having used one talet of Cialis, the ingredients may persist in his body for more than two days in the case of liver or kidneys problems, or whenever using other treatment.

What should one say to his doctor if he considers it is necessary to take Cialis?

Taking into the fact that the sexual activity is ought to provoke a growth in the heart’s work, your doctor should definitely whether Cialis is or is not good for one’s heart. In the case of the heart disease named ‘left ventricular outlet obstruction’ from valvular issues or heart muscles enlargement side effects may appear: fainting, strokes or headaches. Patients who have suffered of heart diseases: anginas, heart failure or strokes, recently, should not take Cialis as long and painful erections may appear. This condition is extremely serious and needs urgent medical attention. In the case of an erection which lasts for more than 4 hours medical attention is needed.

What persons are forbidden to take Cialis?

Patients who are using nitrates(nitroglycer) or alpha blockers( excepting for FLOMAX) should not take Cialis because there may appear lower blood pressure which is the cause of fainting or even death in some cases.

What if the patient is taking other type of drugs?

In this case, one should discuss with his health care provider or doctor because he is the person who could best advice in this case. However, Cialis is not recommended for persons who are using Nitroglycerins or alpha-blockers.

How will one find Cialis?

Cialis can be found as oral tablets in 5mg, 10mg and 20mg strength.

In conclusion, we hope this article comes in hand for the persons who are intending to use Cialis because it is very important to take into account all the facts so that no problems should be en countered.

This enables an boost of blood flow into the penis major to an erection.

So, do not wallow in self-pity. Get down to brass tracks. Buy Generic Cialis and banish impotence from your existence.

The mechanism of the FDA authorized anti-impotency medications found till date is comparable in the perception that all of them inhibit phosphodiesterase sort 5(PDE5) enzyme and improve blood flow to the penis which further more help the affected person to cause off erections necessary for satisfactory physical intercourse. But leaving apart the working procedure of the anti-impotency drugs, every single and each one particular of them has particular unique attributes that mark their private individuality.

Turning the aim of the discussion over to Cialis, it is worthy of mentioning that the drug is different from other anti-impotency medicines for the simple fact that it works on the entire body for a complete 36 hrs and as these kinds of the erectile dysfunction individuals can administer Cialis in the early morning and put together themselves for nocturnal revelry. Because of to this unique Cialis advantage, Cialis utilization remains a solution and the sufferers falling in the grip of male impotency are additionally emboldened to have on with their anti-impotency regimen.

The other distinct Cialis advantages that make your Cialis program far more useful are thorough below:

You can pop up Cialis tablets on an empty as well as on a total belly. A eating plan large with fats are unable to impact Cialis effects in the program.

Due to the tremendous reputation of Cialis all around the entire world, floodgates of facts on Cialis is quickly available on the internet and you can effortlessly entry the intensive tidbits on the drug by logging into an genuine Cialis pharmacy straight from your dwelling.

As far as the bills incurred in the acquire of Cialis is anxious, the cost of Cialis is not significant at all. In comparison to other anti-impotency medicines, Cialis is comparatively more cost-effective and therefore it is also addressed as inexpensive Cialis.

Cialis (Tadalfil) is in a class of medications known as phophodiesterase inhibitors. FDA authorized Tadalfil – Cialis in 2003 for the treatment method of guys who practical experience problems acquiring and retaining an erection.

Cialis (Tadalfil), an oral treatment method for Erectile Dysfunction (ED) in males, is a selective inhibitor of cyclic quanosine monophosphate (cGMP) – distinct phophodiesterase style five (PDE 5).

Cialis is readily available in the form of tablets which consists of 5, 10 or twenty mg of Tadalfil and inactive elements like croscarmellose sodium, hydroxpropyl cellulose, hypromellose, iron oxide, lactose monohydrate, magnesium stearate, microcrystalline cellulose, sodium lauryl sulphate, talc, titanium dioxide and triacetin.

Suggested dose of Cialis in most individuals is 10mg taken prior to sexual intercourse. The two Cialis and Viagra operate in the identical way, by helping blood vessels in the penis to loosen up making it possible for blood to flow into the penis causing an erection.

Cialis is somewhat distinct from the other ED drugs readily available in the sector as it may perhaps do the job up to 36 hrs after dosing.

Cialis (Tadalafil) ” Erectile dysfunction medicine

Erectile dysfunction also called male impotence is the constant inability to achieve or maintain an erection. The most common symptoms of erectile dysfunction are soft erection, loss of erection before sexual intercourse, or no erection at all.

Cialis is one of the oral treatments, which is commonly taken by men with erectile dysfunction problems. It is a prescription drug and you should buy Cialis after a medical consultation. Pharmaceutical company Eli Lilly manufactures Cialis, which is available in licensed pharmacies in many countries worldwide.

How does Cialis work?

Cialis works by improving the flow of blood to penis. The blood supply to penis may become slow due to many reasons causing erectile dysfunction in men. This problem can worsen the sex life of men. However, treatment drugs such as Cialis provide hope for men to revive their sex life. Cialis contains Tadalafil as main ingredient, which works in the body to produce multiple effects. It restores the ability to achieve an erection and have satisfactory sexual intercourse.

What are dosages of Cialis?

Cialis comes in tablet form in strengths of 10mg, and 20mg. You should only take the dosage recommended by your doctor. You need not worry about food restrictions while taking Cialis. It can be taken with or without food.

The recommended dosage of Cialis should be taken 30 minutes before sexual intercourse. It starts showing its effects within 30 minutes and the same can last up to 36 hours. Some men may assume that erection continues for 36 hours, which is totally wrong. It means that effects of Cialis can become visible anytime up to 36 hours after taking the dosage.

What are side effects of Cialis?

Since Cialis is a prescription drug, it is bound to have some side effects. The most common side effects of Cialis are headache, indigestion, back pain, muscle aches, facial flushing, and runny nose. These side effects usually vanish after some hours. However, if they persist for a long time you should talk to your GP.

Some rare side effects of Cialis may include priapism, which is continuous erection for a period extending to four hours or more. Cialis may also cause vision problems, some users may face difficulty in distinguishing colours. If you experience such problems, then taking medical is must. The combination of Cialis with nitrate drugs can result in steep fall of blood pressure to unsafe levels, which may also prove fatal.

How to buy Cialis online?

You need to have a valid prescription before you buy Cialis online or from any licensed pharmacy. You can get this prescription after consulting a registered medical practitioner.

You have another option to obtain a prescription through Cialis online consultation. If you opt for an online consultation from any website, then you need to fill in a questionnaire citing your personal and medical details. A registered doctor evaluates these details and issues a prescription only if you are found eligible to take Cialis. You can research about licensed online clinics and try any reliable one for getting Cialis medication, which can help treat your erectile dysfunction problem.