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PDE-5 selective inhibitor. Inhibition of PDE-5 increases cGMP activity, which increases vasodilatory effects of NO. Effective in men with mild-to-moderate ED. Take on empty stomach approximately 1 h before sexual activity. Sexual stimulation is necessary to activate response. Increased sensitivity for erections may last 24 h. Available as 2.5-, 5-, 10-, and 20-mg tablets. Acts within 15-30 min and can be taken with food, although a high-fat meal can inhibit absorption. Half-life is 4.8-6 h.
STUDY SELECTION AND DATA EXTRACTION: All identified research, review articles, and abstracts were assessed for relevance, and all relevant information was included. Priority was given to the primary medical literature and clinical trial reports.
Vacuum constriction devices vary in cost from $300 to $500, depending on the brand and type. The battery-powered versions tend to be more expensive, but also tend to work a little more quickly. Battery-powered devices are especially helpful for men who do not have good hand strength or coordination, or who have arthritis.
As erectile dysfunction causes begin to move over into awareness, a man can lose his energy and self esteem that results in poor job performance and the distancing of friends and family.
Surgery to repair arteries can reduce ED caused by obstructions that block the flow of blood. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch or fracture of the pelvis. The procedure is almost never successful in older men with widespread blockage.
Prolonged erection (longer than 4 hours)
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If you think you may be depressed, do not suffer in silence. Depression is not a sign of personal weakness. Tell your doctor how you are feeling so that you can start feeling like yourself again.
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But they said their "results indicate that there is no cumulative damage or effect of clinical significance for either 5 milligrams of tadalafil or 50 milligrams of sildenafil taken daily for six months."
Inexpensive Useful only in the few patients with abnormal hormone levels
If an underlying medical condition has been diagnosed, treatment of that disease is appropriate; however, therapy for chronic diseases such as diabetes, hypertension and atherosclerosis does not guarantee the return of erectile function. Any evidence of hypogonadism, hypothyroidism or other endocrine causes should be thoroughly investigated and treated. As a risk factor for atherosclerosis and a common underlying cofactor, smoking should be avoided. If the patient smokes, methods of smoking cessation should be explored. Consideration should be given to changing prescription drugs that could be contributing to the problem (Table 2).
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Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualised by infusing a mixture of saline and x ray contrast medium and performing a cavernosogram.
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