The All-inclusive Guide to Erectile Dysfunction: Symptoms, Causes, Diagnosis, Treatment methods, Prevention Measures, My Canadian Pharmacy Services and FAQ

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Erectile dysfunction (commonly also referred as impotence/erectile disorder/ED) stands for a certain type of the sexual disorder with the main symptom being the inability to achieve or provide an erection hard enough to have a satisfactory sexual intercourse. ED impacts as many as 30 million of males worldwide. The majority of men get issues with erections occasionally. But if such issue occurs more than in 50% of instances, then such issue might be classified as ED.

Erectile dysfunction is already very widespread and becomes even more widespread as a man grows older. The latest survey showed – 1 male in 5 who is over 40 years has erectile issues and about 1 in 10 individuals is totally unable to get erections. Older men have even higher risks of erectile issues.

This guide surveys the big picture of erectile dysfunction – how does ED start, how to manage it and treat such widespread sexual disorder which occurs to every 5th man in the world?

I. How to recognize Erectile Dysfunction?

When a person suffers from ED it is getting harder for him to achieve and then keep an erection firm enough for having a sexual intercourse. Most men get trouble with erections from time to time, but in few men it’s the regular and more bothersome issue. But there are certain signs which point to erectile dysfunction and not just temporary issues.

Symptoms of ED

1. You may not have it

Erectile dysfunction is a recurrent inability to achieve and provide penile erection good enough for sexual activity. Inability to achieve erection, not just being unable to keep it, is the most evident sign of ED. Controversially, it means that an occasional failure to keep erection is not a reason for concern.

2.  How can you evaluate your erections?

• Mild stage of ED – achieving a productive erection 7-8 times in 10 tries;
• Moderate stage of ED – achieving a productive erection 4-5 times in 10 tries;
• Severe ED stage – achieving a productive erection 0-2 times in 10 tries.

3. Not only you have this conditions

Statistics indicate more than 50% of males over 40 years had episodes of ED – the issue can start at an even younger age.

4. As your age increases, you need to test for ED more often.

Testing for ED

The proven fact is that the likelihood of ED development enhances with age. In compliance with the American Urological Association, 4 in 10 men aged above 40 go through ED, 6 in 10 men have it at the age and older 65 and 8 in 10 males at the age above 75.

1.1 Erection Hardness Score (EHS) is the best way to self-diagnose ED

Erection Hardness Score (EHS) as one of regular ED tests was offered by The National Institutes of Health in 1998. EHS might be a helpful test to evaluate ED – the man’s disability to get or maintain an erection hard enough for having a sexual intercourse. According to EHS, there are five stages of erections a man can have:

• 1 – Penis does not enlarge at all;
• 2 – Penis is bigger, but not firm;
• 3 – Penis is firm, but not hard enough for penetration;
• 4 – Penis is hard enough to penetrate, however, not totally firm;
• 5 – Penis is totally hard and fully rigid.

For many males, EHS test is a handy solution since it’s not time-consuming and simple to apply. With just one question, a person can easily assess his erection hardness and get the ready with the first answer for an in-person examination with a physician.

IIEF is another test considered as the standard for assessing a patient’s erections. The IIEF is the 15-item self-showed questionnaire which evaluates 5 points: erectile option, orgasmic option, sexual desire, intercourse satisfaction and overall satisfaction from having sex. The IIEF lets clinicians to testing erectile dysfunction and determine how severe the case may be.

II. How does a man get an erection?

To figure out the causes behind ED, it helps to understand how an erection happens corporeally. In the case you’re not aroused, the penis turns to be limp. During sexual arousal, the nerve messages discharge the chemical enhancing blood flowing into the penis. The blood fills two chambers of spongy tissue (a.k.a. the corpus cavernosum) located right in the penis.

How does erection appear

The “smooth muscles” in these chambers then loosen for the blood to enter and stay in them. The blood pressure makes the penis firm, giving you an erection. After you’ve had an orgasm, the blood streams out of the chambers and erection subsides.

The essential substances for great erections:

• Collagen is the major part in providing firm tissues in the body, including your genitalia;
• Oxygen-rich blood is the essential part for erectile health;
• Testosterone and various male hormones. The standard levels of hormones, specifically testosterone, are essential for erectile option.

III. Causes of Erectile Dysfunction

3.1 Vascular reasons of ED

1) Atherosclerosis

ED might be triggered by atherosclerosis –thickened walls of the arteries cause the arteries to narrow and lose elasticity, restricting the regular blood stream. The tinier arteries located in the penis are commonly impacted by atherosclerosis – damage to the lining of the arteries – as even a small number of narrowing in such arteries can impact on blood’s circulation.

2) Hypertension

ED can in addition be triggered by the most common cardiovascular factor – hypertension. The AHA (The American Heart Association) gives a detailed explanation as to why hypertension can provoke ED: the condition damages arteries, impairing the blood stream essential for achieving an erection.

3.2 Physical triggers of ED

It’s always worth consulting the physician about persistent erection issues as the reason of ED can be attributed to a number of critical medical conditions:

• Obesity and metabolic syndrome;
• Any complications after prostate disorder;
• Parkinson’s disorder;
• Diabetes provokes neuropathy, being a widespread neurological cause of ED;
• Injuries in the pelvic location/spinal cord;
• Multiple sclerosis;
• Heart disorder and narrowing of arteries;
• Increased cholesterol level;
• Hormonal disorders including thyroid conditions and testosterone deficiency;
• Hypertension;
• Smoking, alcohol and substance abuse, especially cocaine and heroin use;
• Peyronie’s disorder;
• Surgical complications (radical prostatectomy, cystectomy, rectal cancer surgery);
• Radiation therapy to the pelvic regions;
• Traumas of various origin.

3.3 Drug-triggered Erectile Dysfunction

Numerous Rx medical preparations are listed in addition to organic causes of ED. The list of orally taken pills that can cause or worsen ED include:

• Anticholinergics – medical preparations with a wide range of uses which block the neurotransmitter impacting on muscle tones;
• Some diuretics (“water pills”);
• Some cancer medical preparations;
• Heart medical preparations like Digoxin;
• Prostate therapies;
• Opioid painkillers;
• Medical preparations acting on your CNS, including some sleeping pills and amphetamines;
• Hormone meds, including estrogens and meds acting on luteinizing hormone-releasing hormone;
• Medical preparations assigned to manage hypertension (beta-blockers and Clonidine);
• Antidepressants, including MAOIs, SSRIs and tricyclic antidepressants;
• Peptic ulcer meds like Cimetidine;
• Anxiolytics for anxiety treatment.

3.4 Mental reasons of ED

In rare cases, erectile dysfunction can be caused exclusively by psychological triggers like:

• Fear of intimacy;
• Severe anxiety;
• Guilt;
• No emotional connection with the sexual partner;
• Depressive condition;
• Social phobia and/or functionality anxiety – repeated feelings of doubt and failure, where the worrying itself about getting an erection can trigger severe episodes of ED;
• Stress caused by work, financial and emotional issues.

However, psychological reasons can’t explain an inability to achieve erections over a long time.

3.5 Prostate disorder & Erectile Dysfunction

Therapy of prostate cancer may trigger ED, although the cancer itself never causes the issue. Prostate surgery to remove the tumor can result in ED, as well as radiation therapy used as prostate cancer treatment.

A trauma of the delicate nerves and arteries found in the genitals can be a serious cause of erectile difficulty and can bring on a permanent ED, so be careful during treatment of prostate cancer. For many males, the power to get erections returns withing the primary few months after therapy, as the nerves and arteries can heal.

Therapy of non-cancerous benign prostate disorder can in addition trigger ED. Medical preparations – 5α-reductase inhibitors – can also provoke an onset of ED.

The trauma of the delicate nerves & arteries essential for erections can trigger permanent ED, so be careful during treatment of prostate cancer. For many males, the power to get erections returns inward the primary few months after therapy, as the nerves & arteries can heal.

Therapy of non-cancerous, benign prostate disorder can in addition trigger ED. Medical preparations – 5α-reductase inhibitors – can also trigger ED.

3.6 Other widespread reasons of Erectile Dysfunction:

• Smoking usually causes vascular disorders – many people suffer and die from vascular consequences of cigarettes than from smoking-related cancer instances;
• Radical prostatectomy, which is a surgery for prostate cancer, frequently provokes ED, since the nerves and arteries found in the penis are very close to the prostate.
• Radiation therapy for prostate cancer frequently provokes ED. Such effect may occur after either external beam radiation or radioactive seed implantation;
• Alcoholic beverages inhibit erections directly, but an excessive use can be another reason for a long-term damage which significantly worsens the quality of erections.

IV. Are you at risk of having Erectile Dysfunction?

Give the truthful answers to the following questions to self-evaluate the risks of having ED:

1. Are you undergoing through diabetes or similar endocrine disorders?

Diabetes-related testosterone deficiency is the reason of ED in 36% of all diagnosed cases.

2. Do you have a heart disorder, high cholesterol or hypertension? Are you a smoker?

Disorders of such sort cause narrow arteries or drop blood stream. They affect males in 40% of all ED cases.

3. Are you exposed to anxiety or stress?

Oftentimes, ED is triggered by a combination of corporeal and emotional factors. Stress, guilt, anxiety, depressive condition and low self-esteem get all linked to ED and in about in one out of 10 cases, an emotional issue is the only reason to this disorder.

Aging is also considered to be a risk factor, but it is not directly linked to ED onset. Rather, the overall decrease of health parameters causes impotence as a comorbidity.

4. Have you sustained nerve damages inflicted by surgeries, injuries or radiation therapy?

Damage to any nerves leading to or from the penis is the contributing factor in 24% of ED cases.

5. Are you using sleeping pills, antidepressants or medical preparation for hypertension?

ED can be an adverse reaction of many widespread medical preparations.

6. Are you using drugs or alcohol recreationally? Are you are binge drinker?
Medical preparations and alcoholic beverages are recognized to diminish sex drive and trigger ED.

7. Are you obese?

According to the official research, every 9 kg of excessive weight bring 3% of decline possibility in erectile functionality.

V. Tests & diagnosis for ED by My Canadian Pharmacy

Note that a medical in-person examination should follow up any self diagnosis and tests should be taken in order for a diagnosis to be established. Here is what you can expect from an urologist who will examine you at the hospital. Before considering the diagnosis of ED and appointing therapy, your therapist will look for symptoms that have been persistent for at least 3 last months. Prepare for a short interview about personal issues and the following tests:

5.1 Physical examination

A corporeal exam checks overall health quality. Such may involve checking your blood pressure, penis and testicles. You may get the rectal exam to check prostate. Such tests are not painful and may give meaningful information about the trigger of your ED. Physical tests include:

• Pulse examination;
• Neurological examination;
• Rectal exam;
• Abdominal examination.

5.2. Lab tests

To test for disorders which trigger ED, your healthcare supervisor may order blood tests and collect urine samples. Some simple laboratory tests may be performed:

• Renal and hepatic functions;
• Testosterone deficiency test;
• Thyroid functioning;.
• Blood tests;
• Urinalysis;
• Lipid profiles and triglyceride levels, possibly indicating arteriosclerosis;
• Blood sugar levels for diabetes screening.

Your health care provider will test to see how the arteries, nerves, muscles and tissues of your penis are working. Normal nocturnal penile tumescence (NPT) tested during sleep shows the functioning of the blood vessels located in the penis.

5.3. Vascular testing

• Duplex ultrasound is the form of ultrasound which allows to assess the blood vessel structure and blood stream through arteries;
• Injection testing – agents enhancing blood stream are injected into the erectile chamber of the penis to provoke an erection and check its quality;
• Dynamic infusion cavernosometry – an elaborate penile blood stream test conducted in special conditions on men having ED and other penile abnormalities.

To sum up, therapist should carry out the following tests and steps to test ED correctly:

• Asking questions about your sex life, disorders you’ve had and medical preparations assigned to you;
• Carrying out a complete corporeal exam (including the abdomen, penis, prostate, rectum, and testicles);
• Taking routine lab tests including urine analysis, blood counts, lipid profile and evaluation of liver enzymes;
• Performing nocturnal penile tumescence testing that monitors if you experience erections while asleep;
• Assessing penile arteries;
• Taking prolonged nervous system’s tests;
• Subjecting you to psychological tests for measuring your emotional condition and the level of stress.

You and the therapist will use the results of the examination and tests in order to work out a therapy plan which may include medical preparations, non-surgical therapy or surgery.

VI. Erectile Dysfunction can be treated: learn how to do this

In this section we will focus on the existing ED therapies from medical preparations to vacuum devices, surgery therapies and dietary supplements.

6.1 Oral drugs for ED

The primary ED treatment – once the condition has been established as a persistent issue – is the group of medical preparations medically referred to as PDE5 (phosphodiesterase 5) inhibitors.

The best recognized therapies for ED are sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis).

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Here you can see how PDE5 inhibitors work:

These particular drugs are applied 30-60 minutes before sex. PDE5 inhibitors should be assigned by therapist, who should also assess your general condition and usage of other medical preparations. For instance, cardiologist may be needed do instruct on the best timing for the usage of ED drugs in individuals using nitrate medical preparations for rare occasions such as angina (chest pain caused by coronary artery disorder).

6.2 Dietary supplements

There are few safe dietary supplements that can prevent ED:

• Chlorophytum arundinaceum;
• Dehydroepiandrosterone (DHEA);
• Tribulus terrestris;
• Korean red ginseng (Panax ginseng);
• Mucuna prurins;
• Withania somnifera;
• Asparagus racemosus.
• Yohimbe;
• Ginkgo biloba;
• Horny goat weed;
• L-arginine.

6.3 Drugs injected directly into penis

If other oral medical preparations don’t work, there is a medical preparation called Alprostadil. This medication was confirmed for the use in males suffering from ED. Such medical preparation comes in two forms, depending on the intended use: urethral suppositories or injection drug.

Injective ED drugs

1) Transurethral therapy for impotence

The medical preparation is injected into the side of penis. The success rate for getting an erection firm enough to get sex is 86%. The tiny medicated pellet of the medical preparation is placed in the urethra. Applying the medical preparation in such way allows skipping self-injecting, but makes it less probably to work. The most widespread side effects of Alprostadil are the burning feeling in the penis, as well as priapism.

2) MUSE Local ED Therapy
While there’re few therapy settings for ED, few of them are more effectual or tolerable than other pills. MUSE (a.k.a. Medicated Urethral System for Erection) assisted many males who never responded well to oral medical preparations.

6.4 Surgical therapy

When other therapies do not improve ED, your healthcare supervisor may offer you surgery.

1) Vacuum erection device a.k.a. vacuum pumps
A vacuum erection device stands for a plastic tube slipping over the penis, creating a sort of the seal within the body. An elastic ring is then slipped onto the penile basis. Such device holds the blood in genitalia (and keeps your penis firm) for 30 mins.

2) Penile prosthesis

Penile prosthesis are devices which are implanted in your body. Such devices provide stiff penis which lets you experience normal sex. Penile implants can be the great therapy choice for men who never responded to other ways of treatment. There exist two kinds of such implants:

• Bendable implant consisting of two rods made of silicone and inserted to your penis to provide firm erections;
• Inflatable implant – these are fluid-filled cylinders located alongside the full length of penis.

3) Vascular surgery

The American Urological Association presents it as the setting only for healthy males with a recently acquired ED brought on by the focal arterial occlusion.

4) Penile Arterial Revascularization

Younger individuals (who are under 45 years of age) who had injuries to the pelvis or penis are most likely to be treated by this method. Such surgery fixes issues with blocked or injured arteries in the penis.

6.5 Seed Brachytherapy

Prostate or seed brachytherapy is a special type of radiation treatment involving spreading mild radiation rays to the prostate cancer cells. Such therapy can be provided in two rather painful ways:

• temporary – through wires;
• permanent – with radioactive seeds remaining in the prostate.

Brachytherapy is recommended as a single method or in conjunction with other ED therapy methods. Side consequences of such procedure usually feature blood in stool or urine, issues with urination and diarrhea.

6.6 Acupuncture

This method has in addition been suggested as the replacement therapy for ED, but there’s currently insufficient evidence accessible to decide upon the benefits or risks of such interference. the systematic review of trials looking at the safety and efficacy of acupuncture for ED is underway and is expected to be published in the British Medical Journal in 2016.

VII. What are the most associated issues with erectile dysfunction?

1. Premature ejaculation (learn more about how to treat PE)

It is the most common associated disorder that comes along with permanent or regular episodes of ED. According to the clinical trials, almost 60% of males suffering from ED also have one or another form of premature ejaculation (PE).

ED-linked diseases

2. Infertility

About 15% of all U.S gets difficulties with fertility. This disorder (infertility) affects approximately 3.5 million people in the U.S. ED can significantly decrease the chances to impregnate your partner.

3. Priapism

It is a persistent and oftentimes painful erection which lasts for a few hours. The erection is not necessarily connected to sexual stimulation or excitement and never subsides after ejaculation (when sperm is ejected from your penis). Priapism has to be attended to immediately by medical personnel – you should seek immediate professional help in the case your erections are very painful and last more than 4 hours without subsiding.

4. Prostate issues

Prostate conditions are notably spread in men over 50 years of age. These issues include:

• prostatitis (inflammation of the prostate);
• prostate enlargement;
• prostate cancer.

5. Low libido

Low libido is usually recognized as nothing else than the lack of interest in any sexual acts. Many factors of the biological nature build the person’s libido. Its intensity is quite different for everyone and may drastically change depending on certain life changes. Low libido is commonly caused by stress or certain disorders like diabetes and if it is complicated by ED you should definitely visit your healthcare supervisor.

VIII. Can I do anything to prevent erectile dysfunction?

ED becomes more probable as a man ages. But it’s not necessarily the normal part of aging. How can you avert ED?

1. Drink alcoholic beverages in moderation or not at all.

No more than two glasses of wine per 24 hours will make you feel better and improve your erections.

2. You are what you eat.

The latest studies show which ED is relatively non-widespread among males who follow the major principles of the Mediterranean diet, what includes vegetables, fruits, whole grains and healthy fats like olive oil, nuts, fish and red wine.

 

There are certain foods that can significantly boost libido:

Try to keep healthy weight.

Being obese provokes a lot of problems with health, including diabetes type II, that in its turn can trigger nerve damaging throughout the body and lead to ED.

4. Prevent high blood pressure and increased cholesterol levels

These conditions can damage arteries, including those supplying blood to your penile area. Gradually, such effect may provoke permanent ED. Make sure your therapist checks blood pressure and cholesterol levels.

5. Exercise regularly

Running, swimming and aerobic exercise can significantly improve your health condition. One form of exercise which doesn’t seem helpful is Kegel exercises, what involve repeatedly contracting and loosening the muscles in the pelvis. Kegel exercises can be helpful for men and women suffering from incontinence. But there is no evidence on their positive effect on ED.

6. Avoid using anabolic steroids

Such medical preparations that are frequently abused by athletes and bodybuilders can shrink the testicles and decrease their power to produce testosterone.

7. Keep your testosterone levels in check

Even in healthy men, testosterone levels frequently take a nosedive around the age of 50. Every year after the age of 40 a man’s testosterone level typically falls about 2%. Signs like the low sex drive, moodiness, lack of stamina, or trouble making decisions suggests testosterone deficiency, as do lackluster erections. Yours therapist pinpoint the cause for low testosterone .

8. In case you smoke, try to quit this habit.

Smoking cigarettes can harm arteries and prevent blood stream from entering freely the penis. and nicotine makes arteries contract, what can hamper blood stream to the penis.

9. Decrease stress.

Emotional stress boosts levels of the hormone adrenaline that makes arteries contract. This does not exactly help to have great erections. Anything a man can do to ease tension and feel better emotionally is going to give his sex life a big boost.

IX. Fast facts about Erectile Dysfunction

• The most widespread therapies include counseling, oral medical preparations, vacuum devices, penile injections and implants;
• ED is the barometer of cardiovascular health.
• Typical primary-line therapy of ED involves the usage of medical preparations called PDE5 inhibitors – Levitra, Cialis and Viagra;
• ED causes are usually physical ones but can in addition be mental;
• Men with diabetes are at the greater risk of ED than men without diabetes;
• ED is defined as persistent difficulty achieving and maintaining erection sufficient to engage in sex;
• Men having bad teeth are more probable to go through ED. The periodontal disorder or chronic gum disorder can be the cause of ED onset;
• It’s normal for man to get occasional cases of ED, perhaps from tiredness or drinking too much alcohol;
• Drinking just two cups of coffee a day should be the man’s abilities and improve erections;
• Half of all males between the ages of 40 and 70 go through ED in certain degrees;
• ED is not an over-treated condition, despite media representations. On the contrary, studies get showed which 90% of those suffering from ED, never go for therapy;
• Persistent ED should be investigated by the therapist or it can become a chronic condition;
• Professional diagnosis is necessary.

If you have any questions left about ED, watch this video featuring the key facts about this disorder:

X. My Canadian Pharmacy services for treating Erectile Dysfunction

Therapy of occasional ED episodes is crucial for avoiding permanent and chronic erectile disorder a.k.a. impotence for lifetime. While the surgery may seem like a radical way of therapy (which is mostly applied in the most severe cases of impotence) the usage of medically confirmed and tested oral medical preparations is a first-line defence. As has been mentioned above, there are basically three substances (all belong to the class of PDE5 inhibitors) which in one way or another assist in coping with ED and are effective in 98% of cases. Those are sildenafil/Viagra, tadalafil/Cialis and vardenafil/Levitra.

With the main solutions for ED being outlined, the next problem to tackle is where to buy ED drugs? Chronic ED condition calls for regular refills, which are very taxing for any budget if you shop for brand drugs. Generic ED drugs can effectively and inexpensively substitute brand medications.

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XI. Frequently Asked Questions about Erectile Dysfunction

1. Can I combine several oral therapies for my ED problem?

Such combinatory method is usually the best choice – but only if you alternate between several ED pills. Do not take more than one oral agent within the indicated time period (for all of ED pills this timeframe is 24 hours). Ask your therapist for proper guidelines.

2. Can young men be affected with ED?

Yes, but ED manifests itself much more frequently in older men. In America about 10% of males are presumed to be affected. The frequency rises with age: about 5% of individuals at the age of 40 and between 15 and 25% of males at the age of 65 go through ED. As a man ages, they typically display a decline in sexual desire as well.

3. Is it normal to get ED?

Yes, it is, in the sense that many individuals get erectile issues, specifically at times of great changes in their lives. In fact it’s probably more widespread than people realize, as proven by numerous studies. It has also been established that persons with erectile issues tend to postpone a visit to healthcare specialist for 5 years on average. This condition should not be ignored, as erectile difficulty frequently points to other corporeal issues like diabetes.

4. Does riding bicycle trigger ED?

Some research has raised concerns about individuals who regularly cycle for long hours as being exposed to greater risk of ED, in addition to other men’s health issues like infertility and prostate cancer.

The latest trial has established that there is no connection between cycling and ED, but it did find a link between longer hours of cycling and the risk of prostate cancer. However, in the case you ride a bike during more than 3 hours per day you should occasionally check your prostate.

5. Can ED be prevented?

Many erection issues might be stopped in their tracks if you decide to change your lifestyle for better – like losing weight, quitting smoking and drinking, having healthy and supportive sexual relationships. In case you and your partner discuss the issues you will immediately notice that your stress and anxiety decrease and you become more comfortable during sexual intercourses. Many people avoid talking about problems in sex life. But such therapy can be very useful for both partners. In addition, foreplay and self-confidence can enhance the chances for normal erections, regardless of person’s age.

6. Is there any good home therapy for ED?

In case you only experience occasional episodes of ED, you may be able to address those at home without therapist’s help. Some of the reasons of erection failure are in your control, like smoking, stress and drinking alcohol without moderation. Special pelvic-floor exercises may become helpful for most men having erection issues. Such exercises do not involve any risks. Don’t be embarrassed about seeking professional assistance in case home strategies don’t help and erection issues are persistent and troublesome.

7. Is impotence the same as ED?

Yes, it is. Though another sexual disorder – premature ejaculation – is frequently confused with ED. Premature ejaculation occurs when the entire process of arousal, erection, ejaculation and climax happens rapidly, often in just a few minutes, and a man can’t make it last longer. Premature ejaculation may come alongside an erection issue like ED but it is, as a rule, treated in a different way.

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This Online Guide is created by the research group of My Canadian Pharmacy www.mycanadianpharmacyrx.com and is strictly informative. Best Regards, My Canadian Pharmacy RX Team.