Erectile dysfunction (ED) affects the lives of many middle-aged men and their partners. The term erectile dysfunction covers a range of disorders, but usually refers to the inability to obtain an adequate erection for satisfactory sexual activity.
Although erectile dysfunction, formerly called impotence, is more common in men older than 65, it can occur at any age. An occasional episode of erectile dysfunction happens to most men and is normal. As men age, it's also normal to experience changes in erectile function. Erections may take longer to develop, may not be as rigid or may require more direct stimulation to be achieved. Men may also notice that orgasms are less intense, the volume of ejaculate is reduced and recovery time increases between erections. Erectile dysfunction may also be a sign of a physical or emotional problem that requires treatment.
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Erectile dysfunction was once a taboo subject, but more men are seeking help. Doctors are gaining a better understanding of what causes erectile dysfunction and are finding new and better treatments.
This Website discusses all about erectile dysfunction, physiology of the normal erection and the pathophysiology, and treatment of ED.
What is Erectile Dysfunction?
Erectile dysfunction or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. There are various underlying causes, such as diabetes, many of which are medically reversible.
The causes may be physiological or psychological. Psychological impotence can often be helped by almost anything that the patient believes in; there is a very strong placebo effect.
Due to its embarrassing nature and the shame felt by sufferers, the subject was taboo for a long time, and is the subject of many urban legends. Folk remedies have long been advocated, with some being advertised widely since the 1930s. The introduction of perhaps the first pharmacologically effective remedy for impotence, sildenafil (trade name Viagra), in the 1990s caused a wave of public attention, propelled in part by the news-worthiness of stories about it and heavy advertising.
The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina. It is now mostly replaced by more precise terms.
Signs and symptoms:
Erectile dysfunction is characterized by the inability to maintain erection. Normal erections during sleep and in the early morning suggest a psychogenic cause, while loss of these erections may signify underlying disease, often cardiovascular in origin. Other things leading to erectile dysfunction are diabetes mellitus (causing neuropathy) or hypogonadism (decreased testosterone levels due to disease affecting the testicles or the pituitary gland).
Here are some causes of Erectile Dysfunction:
* Arousal: The first step is sexual arousal, which men obtain from the senses of sight, touch, hearing and smell, and from thoughts.
* Nervous system response: The brain communicates the sexual excitation to the body's nervous system, which activates increased blood flow to the penis.
* Blood vessel response:. A relaxing action occurs in the blood vessels that supply the penis, allowing more blood to flow into the shafts that produce the erection.
Physiology of normal erections:
Penile erections involve an integration of complex physiologic processes involving the CNS, peripheral nervous system, and hormonal and vascular systems. Any abnormality involving these systems, whether from medication or disease, has a significant impact on the ability to develop and sustain an erection, ejaculate, and experience orgasm. Tumescence, the vascular filling of the cavernous bodies, relies on neural and hormonal mechanisms operating at various levels of the neural axis. This is unique among visceral functions because it requires central neurological input.
Andersson et al summarized some of the information related to the pathways involved in erectile function. The degree of contraction of corpus cavernosal smooth muscle determines the functional state of the penis. The balance between contraction and relaxation is controlled by central and peripheral factors that involve many transmitters and transmitter systems. At the cellular level, smooth muscle relaxation occurs following the release of acetylcholine from the parasympathetic nerves.
Pathophysiology of erectile dysfunction:
Erectile Dysfunction is essentially a vascular disease. It is often associated with other vascular diseases and conditions such as diabetes, hypertension, and coronary artery disease. Other conditions associated with Erectile Dysfunction include neurologic disorders, endocrinopathies, benign prostatic hyperplasia, and depression. Conditions associated with reduced nerve and endothelium function, such as aging, hypertension, smoking, hypercholesterolemia, and diabetes, alter the balance between contraction and relaxation factors. These conditions cause circulatory and structural changes in penile tissues, resulting in arterial insufficiency and defective smooth muscle relaxation. In some patients, sexual dysfunction may be the presenting symptom of these disorders.
Treatment:
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Vardenafil is used in the treatment of erectile dysfunction. It can assist men with this disorder in achieving and maintaining an erection during sexual activity. It is commonly marketed under the trade name Levitra.
Vardenafil is closely related in function to Cialis and Viagra: it increases the blood flow to the penis to achieve and maintain an erection. However, in the clinical studies that were conducted as part of the FDA approval process, Levitra was shown to take effect faster, and last longer than Viagra. Vardenafil is usually taken with or without food 60 minutes before sexual activity.
Vardenafil relaxes muscles and increases blood flow to particular areas of the body.
Vardenafil is used to treat erectile dysfunction (impotence).
Vardenafil may also be used for purposes other than those listed in this medication guide.
What should I discuss with my doctor before taking vardenafil?
Do not take vardenafil if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"). Taking vardenafil with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.
A small number of patients have had a sudden loss of eyesight after taking vardenafil. This type of vision loss is caused by decreased blood flow to the optic nerve of the eye. It is not clear whether vardenafil is the actual cause of such vision loss. Sudden vision loss with vardenafil use has occurred most often in people with heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old.
Before taking vardenafil, tell your doctor if you have:
heart disease or heart rhythm problems;
a recent history (in the past 6 months) of a heart attack, angina (chest pain), or congestive heart failure;
a history of stroke or blood clots;
a personal or family history of "Long QT syndrome";
high or low blood pressure;
liver disease;
kidney disease (or if you are on dialysis);
a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;
a bleeding disorder such as hemophilia;
a stomach ulcer;
retinitis pigmentosa (an inherited condition of the eye);
a physical deformity of the penis (such as Peyronie's disease); or
if you have been told you should not have sexual intercourse for health reasons.
If you have any of these conditions, you may not be able to use vardenafil or you may need a dosage adjustment or special tests during treatment.
FDA pregnancy category B: Although vardenafil is not for use in women, this medication is not expected to be harmful to an unborn baby. Do not use vardenafil without telling your doctor if you are pregnant or plan to become pregnant during treatment.
Although vardenafil is not for use in women, it is not known if vardenafil passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
You may need a lower dose of this medication if you are older than 65. Follow your doctor's instructions.
How should I take vardenafil?
ake each dose with a full glass of water.
Avoid taking High-fat food before taking Levitra as it may cause the medicine to take more time to start working.
Vardenafil is usually taken only when needed, 30 - 90 minutes before sexual activity. The medication can help achieve an erection when sexual stimulation occurs. An erection will not occur just by taking a pill.
Do not take vardenafil more than once a day. Allow 24 hours to pass between doses.
Store this medication at room temperature away from moisture and heat.
What happens if I miss a dose?
Since vardenafil is used as needed, you are not likely to be on a dosing schedule.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine.
Symptoms of a vardenafil overdose may include back pain, muscle pain, or vision problems.
What should I avoid while taking vardenafil?
Avoid drinking alcohol, which can increase some of the side effects of vardenafil.
Grapefruit and grapefruit juice may interact with vardenafil. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
What are the possible side effects of vardenafil?
If you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw during sexual activity, stop and call your doctor right away. You could be having a serious side effect of vardenafil.
Stop using vardenafil and get emergency medical help if you have sudden vision loss.
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Stop using vardenafil and call your doctor at once if you have any of these serious side effects:
chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
irregular heartbeat;
swelling in your hands, ankles, or feet;
shortness of breath;
vision changes;
feeling light-headed, fainting; or
penis erection that is painful or lasts 4 hours or longer.
Continue taking vardenafil and talk with your doctor if you have any of these less serious side effects:
warmth or redness in your face, neck, or chest;
stuffy nose;
headache;
upset stomach; or
back pain.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What drug(s) may interact with vardenafil?
Do not take vardenafil if you are taking the following medications:
nitroglycerin-type drugs for the heart or chest pain such as amyl nitrite, isosorbide dinitrate, isosorbide mononitrate, nitroglycerin, even if these are only taken occasionally. This includes some recreational drugs called 'poppers' which also contain amyl nitrate and butyl nitrate.
Vardenafil may also interact with the following medications:
alpha blockers such as alfuzosin (UroXatral®), doxazosin (Cardura®), prazosin (Minipress®), tamsulosin (Flomax®), or terazosin (Hytrin®), used to treat high blood pressure or an enlarged prostate.
arsenic trioxide
bosentan
certain antibiotics such as clarithromycin, erythromycin, sparfloxacin, troleandomycin
certain medicines used for seizures such as carbamazepine, phenytoin, and phenobarbital
certain medicines for the treatment of HIV infection or AIDS
certain medicines to control the heart rhythm (e.g., amiodarone, disopyramide, dofetilide, flecainide, ibutilide, quinidine, procainamide, propafenone, sotalol)
chloroquine
cisapride
diltiazem
grapefruit juice
medicines for fungal infections (fluconazole, itraconazole, ketoconazole, voriconazole)
methadone
nicardipine
pentamidine
pimozide
rifabutin, rifampin, or rifapentine
some medicines for treating depression or mood problems (amoxapine, maprotiline, fluoxetine, fluvoxamine, nefazodone, pimozide, phenothiazines, tricyclic antidepressants)
verapamil
What is the shelf life of the pills?
The expiry date is mentioned on each blister. It is different for different batches. The shelf life is 2 years from the date of manufacture and would differ from batch to batch depending on when they were manufactured.
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