Treatment of erectile dysfunction (ED).

What is Erectile dysfunction ??

Erectile dysfunction (ED) is the inability to get or maintain an erection firm enough for sexual intercourse. It can be a temporary or chronic condition and may result from a variety of causes, both physical and psychological.

 

Causes of Erectile Dysfunction Physical Causes:

1. Cardiovascular Diseases: Conditions like atherosclerosis (clogged blood vessels), high blood pressure, and high cholesterol can impede blood flow to the penis.
2. Diabetes: This can damage blood vessels and nerves that control an erection.
3. Obesity: Excess weight can impact cardiovascular health and hormone levels.
4. Hormonal Imbalances: Low testosterone levels or other hormonal issues can contribute to ED.
5. Neurological Disorders: Conditions such as Parkinson’s disease, multiple sclerosis, or spinal cord injuries can affect nerve signals necessary for an erection.
6. Medications: Some medications can cause ED as a side effect, including antidepressants, antihistamines, and medications for high blood pressure.
7. Substance Abuse: Alcohol, tobacco, and illicit drugs can impair erectile function.
8. Peyronie’s Disease: Development of scar tissue inside the penis can cause curved, painful erections.

Psychological Causes:

1. Stress and Anxiety: High levels of stress or anxiety about sexual performance can lead to ED.
2. Depression: This can reduce sexual desire and result in ED.
3. Relationship Problems: Poor communication or other issues within a relationship can lead to ED.

Diagnosis

Diagnosis typically involves a combination of:

1. Medical History: Understanding symptoms and underlying health conditions.
2. Physical Examination: Checking for physical causes of ED.
3. Blood Tests: Measuring hormone levels, cholesterol, and glucose levels.
4. Urinalysis: Checking for signs of diabetes or other underlying health conditions.
5. Ultrasound: Assessing blood flow to the penis.
6. Psychological Examination: Identifying stress, depression, or anxiety.

Treatment Options

1. Lifestyle Changes: Improving diet, exercise, quitting smoking, and reducing alcohol intake.
2. Medications: PDE5 inhibitors like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra).
3. Therapy: Counseling for anxiety, depression, or relationship problems.
4. Vacuum Erection Devices: Mechanical pumps to induce an erection
5. Hormone Therapy: For men with low testosterone levels.
6. Penile Injections: Medications injected directly into the penis to induce an erection.
7. Urethral Suppositories: Medicated pellets inserted into the urethra.
8. Surgery: Penile implants or vascular surgery for severe cases where other treatments are ineffective.

Prevention

While not all cases of ED can be prevented, certain lifestyle choices can reduce the risk:

1. Regular Exercise: Improves cardiovascular health and blood flow.
2. Healthy Diet: Supports overall health and can prevent conditions that contribute to ED.
3. Weight Management: Reduces the risk of diabetes and cardiovascular diseases.
4. Avoiding Tobacco and Excessive Alcohol: Protects vascular and nervous system health.
5. Stress Management: Techniques such as mindfulness, meditation, or therapy can reduce stress and anxiety.
6. Regular Check-ups: Monitoring and managing health conditions that could lead to ED.

When to See a Doctor

If you experience persistent problems with erections, it is essential to consult a healthcare provider. They can help determine the cause and recommend appropriate treatment. Seeking help early can improve the chances of successful treatment and prevent complications.

Mixed Psychogenic and organic ED

Benign prostatic hyperplasia

Treatment of Erectile dysfunction ( ED)

Before going to treatment you should try to find out exact reason of ED. There are many reason behind-

           Try to find out the reason for ED

• Try to understand physical and psychological condition
•  Evaluation the testosterone level
• Check blood glucose level or diabetics condition
• Check blood pressure
• Check BPH

If  patient  have enough  testosterone level  and have no spinal cord injuries and no record of BPH or have not significant diabetics prb or blood pressure.

Check patients  psychological & behavioral activities.

If patient are

• Psychological stress
• Drug addicted
• Anxiety

Medication 1 for the treatment of erectile dysfunction (ED). 

patient should treat

1.1. Antidepressant drug ( eg. fluoxetine, Dapoxetine,  flupentixol + metifracin combination drug etc.)

Dose : Specific

1.2. Calcium + D3

Dose : once a day

1.3. Vitamin E 400 mg

Dose : Twice a day

In this condition no need phosphodiesterase inhibitor ( PDE5). If patient condition does not improve within two months then added  at  low dose ( eg. Sildenafil, tadalafil or vardenafil).

• Sildenafil

Dose : 50- 100 mg  a day 40 minutes before to intercourse for 7 days.

Or

• Tadalafi

Dose : 5mg or 10 mg  twice a week 40 minutes before to intercourse for 1 months.

Contraindication:

Should not use coadministration with Alpha adrenergic blocker drugs ( eg. prazosin ) or Nitroglycerine drugs.

Medication 2

If   patient has no BPH  record or  prostatitis or prostate cancer but  testosterone level below than 325 ng/dl. Medication should be testosterone replacement therapy with co- administration with other Drugs.

Suggested that –

1. Administration testosterone replacement therapy-

It is better to use testosterone intramuscular dose form ( eg. Testosterone cypionate, Testosterone enanthate).

Dose : 50-400 mg two times a month.

Or

A Combination group of testosterone (eg.Testosterone propionate 30 mg + Testosterone Phenylprop 60 mg + Testosterone Isocaproate 60 mg + Testosterone Decanoate 100 mg)

Dose : 1-2 dose a month.

Coadministration other drugs for treatment of erectile dysfunction

1.1.Vardenafil : 20 mg daily 40 minutes before intercourse for 15 days

or

1.2.Sildenafil : 50-100 mg daily 40 minutes before intercourse for 15 day.

or

1.3.Tedalafil : 10-20 mg daily 40 minutes before intercourse for 15 day.

2.1. Calcium + Vitamin D3: (500+200 mg) onec daily for 2 months.

3.1. Vitamin E :  400 mg tow times daily for 2 months.

If patient are suffering in diabetics mellitus or high blood pressure or BPH disease. At first treatment should required for that co-morbidity disease and then treatment for ED. For seeing treatment regimen specifically please click treatment for ED.

 

Here some direct treatment by medicinal prescription is given bellow that may be use according to physical condition who has matched above 18 years old patients.

Prescription No 1

When you use Prescription No 1

• Excess psychological stress
• Anxiety
• Depression
• Relation problem between partner
• Nervousness

It may occurred in any age of any person.

When you haven’t other disease problem like-

• Diabetics disease
• High blood pressure
• Testosterone hormone level
• BPH
• Any spinal cord or neurological injury

In that condition you may use Prescription No 1

 

Again first two days fluoxetine once daily and only 3^rd no day dapoxetine once daily a week for 15 days.

Who can’t use prescription no 1 who is-

• Heart failure patient
• Ischemic heart disease
• Use other antidepressant medicine

If   prescription no 1 is not work well you can use prescription no 2.

 

Again first two days fluoxetine once daily and only 3^rd no day dapoxetine once daily a week with added new tedalafil once daily 5^th and 1^st day a week for 15 days.

 

Who can’t use prescription no 2 who is-

• Heart failure patient
• Ischemic heart disease
• Use other antidepressant medicine
• Hypotensive patients
• Hyper sensitivity

Sometimes above 45 years old patients suddenly feel ED although all physical and mental condition is good. In that condition you may use prescription no 3.  

This medication should take for 15 to 30 days.

Who can’t use prescription no 3 who is-

• Heart failure patient
• Ischemic heart disease
• Use other antidepressant medicine
• Hypotensive patients
• Hyper sensitivity

 

If   prescription no 3 is not work well you can use prescription no 4.

This medication should take for 15 to 30 days.

Who can’t use prescription no 4 who is-

• Heart failure patient
• Ischemic heart disease
• Use other antidepressant medicine
• Hypotensive patients
• Hyper sensitivity
• Suffering myocardial infraction, Stroke and record of life threating arrhythmia within 6 months
• Resting hypotension (BP <90/50) or hypertension (BP >170/110)
• Sickle cell or related anemia.

Note: These type of medication also used premature ejaculation (PE) see more please click here.

Erectile dysfunction is shown someone due to introduce first time sex. Basically you feel highly sexy yourself but in field you do not sex feelings and shown erectile dysfunction. In that moments sex is in your mind but can’t erectile your penis well. At first time introduction to sex nervousness and fear the main reason. When you marriage too late or introduce to sex too late age above 35 years old then you may face ED. In that condition you may use prescription no 3. If   prescription no 3 is not work well you can use prescription no 4.  Here all contraindicate should remain same as prescription no 4.

For above 50 years old patient ED is occurred due to various co-morbidity, co-mortality or others disease. In this state we may suffer various disease conditions. After 30 years old almost all men are losses approximately 1% of total testosterone hormone per year that is most important for ED. Treatment for erectile dysfunction patient above 50 years old should check blood testosterone level with other disease condition. If your testosterone level not below than 325 ng/dl you may use prescription no 4 with increasing dose regiment. When your testosterone level below than 325 ng/dl you should take testosterone hormone therapy with this prescription.

  If you had testosterone level above than 325 ng/dl and no other important disease condition you may use prescription no 5  which is modified prescription no 4.

 

This medication should take for 30 days.

Who can’t use prescription no 5 who is-

• Heart failure patient
• Ischemic heart disease
• Use other antidepressant medicine
• Hypertensive patients
• Hyper sensitivity

If   prescription no 5 is not work well you can use prescription no 6.

 

This medication should take for 30 days.

Who can’t use prescription no 4 who is-

• Heart failure patient
• Ischemic heart disease
• Use other antidepressant medicine
• Hypotensive patients
• Hyper sensitivity
• Suffering myocardial infraction, Stroke and record of life threating arrhythmia within 6 months
• Resting hypotension (BP <90/50) or hypertension (BP >170/110)
• Sickle cell or related anemia.

 

Note: If anyone may suffer prolong erectile of penis like 2 hours with pain due to using above medication you should immediate addition to hospital.   

If anyone are suffering from any co-morbidity or co-mortality disease you should need first treatment of that disease than you may use with prescription no 5 or prescription no 6 as a medication. Treatment like that disease condition are-

• Testosterone replacement therapy
• Diabetics mellitus treatment
• Treatment for BPH
• Abnormal blood pressure treatment like access high or low blood pressure.

Beside the medication you may also treatment for by using natural herbs slightly or a urologist can improve your penis strength with required surgery.

If anyone want to more information please send to me your question through the given email address.

Email address: mallicktarun@rocketmail.com For getting treatment base suggestion please contact or request an appointment.