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Nor is the inability to have another erection soon after an orgasm. Nearly every man occasionally has trouble getting an erection, and most partners understand that. The problem often develops gradually. One night it may take longer or require more stimulation to get an erection. On another occasion, the erection may not be as firm as usual, or it may end before orgasm. Erectile dysfunction can have many causes, including some forms of prostate disease and medications and surgery for prostate cancer.

Fortunately, in many cases, this problem can often be effectively addressed. Some men find relief by taking medications to treat erectile dysfunction. The possibility of finding the right solution is now greater than ever. This article explores why men may develop erectile dysfunction as a consequence of some prostate diseases, and details the current treatment options to restore sexual functioning.

At its most basic level, an erection is a matter of hydraulics. Blood fills the penis, causing it to swell and become firm. But getting to that stage requires extraordinary orchestration of body mechanisms. Blood vessels, nerves, hormones, and, of course, the psyche must work together. Problems with any one of these elements can diminish the quality of an erection or prevent it from happening altogether. Nerves talk to each other by releasing nitric oxide and other chemical messengers.

These messengers boost the production of other important chemicals, including cyclic guanosine monophosphate, prostaglandins, and vasoactive intestinal polypeptide. These chemicals initiate the erection by relaxing the smooth muscle cells lining the tiny arteries that lead to the corpora cavernosa, a pair of flexible cylinders that run the length of the penis see Figure 1. The penis is made up of three cylindrical bodies, the corpus spongiosum spongy body —which contains the urethra and includes the glans head of the penis—and two corpora cavernosa erectile bodiesthat extend from within the body out to the end of the penis to support erection.

Blood enters the corpora cavernosa through the central arteries. As the arteries relax, the thousands of tiny caverns, or spaces, inside these cylinders fill with blood. Blood floods the penis through two central arteries, which run through the corpora cavernosa and branch off into smaller arteries. The amount of blood in the penis increases six-fold during an erection. The blood filling the corpora cavernosa compresses and then closes off the openings to the veins that normally drain blood away from the penis.

In essence, the blood becomes trapped, maintaining the erection. Some al — usually an orgasm, but possibly a distraction, interruption, or even cold temperature — brings an erection to an end. This process, called detumescence, or deflation, occurs when the chemical messengers that started and maintained the erection stop being produced, and other chemicals, such as the enzyme phosphodiesterase 5 PDE5destroy the remaining messengers.

Blood seeps out of the passages in the corpora cavernosa. Once this happens, the veins in the penis begin to open up again and the blood drains out. The trickle becomes a gush, and the penis returns to its limp, or flaccid, state. A young, sexually active man in good health may be able to get an erection after just a few minutes, whereas a man in his 50s or older may have to wait 24 hours.

One reason may be that nerve function slows with age. Indeed, erections may work on a use-it-or-lose-it principle. Some research suggests that when the penis is flaccid for long periods of time — and therefore deprived of a lot of oxygen-rich blood — the low oxygen level causes some muscle cells to lose their flexibility and gradually change into something akin to scar tissue. In the past, it was thought that most cases of erectile dysfunction were psychological in origin, the result of such demons as performance anxiety or more generalized stress.

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Such conditions include diabetes, kidney disease, multiple sclerosis, atherosclerosis, vascular disease, and alcoholism. However, some types of prostate disease and treatments particularly for prostate cancer may also be responsible. Surgery for prostate cancer can sever some of the nerves or arteries that are needed for an erection. Even so-called nerve-sparing surgical techniques lead to erectile dysfunction in up to half or more of all cases.

Even when the nerves are not permanently impaired, it can still take six to 18 months for the tiny nerve fibers to recover from the trauma of surgery and restore sexual function. Radiation treatment for prostate cancer can also harm erectile tissues. Both external beam radiation and radiation-emitting seeds implanted in the prostate brachytherapy lead to erectile dysfunction in about half of men who receive these therapies.

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However, these changes may not occur for up to two years after treatment. Erectile dysfunction is sometimes a side effect of some hormone therapy medications prescribed for men with prostate cancer that has spread beyond the prostate. Among such hormone-based medications are leuprolide Lupronand goserelin Zoladex.

Others, such as flutamide Eulexin and bicalutamide Casodex may cause erectile dysfunction to a lesser degree. Even prostate cancer itself, in its advanced stages, can spread to the nerves and arteries that are necessary for an erection. Men who have benign prostatic hyperplasia BPHa noncancerous enlargement of the prostate, may also experience erectile dysfunction and ejaculatory problems. For example, finasteride Proscaran anti-testosterone drug prescribed for BPH, has been linked to erectile dysfunction in 3.

But alpha blockers such as tamsulosin Flomaxalfuzosin Uroxatraland silodosin Rapaflo can improve the symptoms of BPH with a lower risk of sexual side effects. Transurethral resection of the prostate, a surgical technique often used when medication fails, also causes erectile dysfunction in a small percentage of men.

Testosterone levels tend to decrease with age. Sometimes an abrupt fall occurs because of an injury or illness such as an infectionchemotherapy or radiation treatment, or certain medications. The hormone testosterone plays a big part in men's health, but perhaps its most meaningful role is to fuel sex drive.

If testosterone levels drop too low, men can experience erectile dysfunction as well as lackluster libido. This inflammation of the prostate gland can be either acute usually caused by a bacterial infection or chronic usually not caused by an infectious agent.

Symptoms include pain during urination, more frequent urination, and — possibly — a discharge from the penis or fever. Severe prostatitis can cause erectile dysfunction directly. In milder forms, the condition can produce painful ejaculation, which can certainly interfere with sexual pleasure and may lead to erectile dysfunction.

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Such a conversation is never easy, but thanks in part to greater publicity about this problem and its treatment, many obstacles have been toppled. In reality, your doctor must diagnose the cause of your erectile dysfunction in order to recommend an effective treatment. While therapy usually does involve medication, erectile dysfunction is sometimes a symptom of an underlying condition that requires its own treatment.

Also, medication is more effective for some causes of erectile dysfunction than for others. And if a psychological condition is ificantly involved, you may benefit from counseling with a mental health professional trained in sex therapy. At first, the doctor will probably ask you about your medical history.

Do you have any chronic illnesses?

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What illnesses and operations have you had in the past? What medications are you taking, if any? Your doctor is also likely to ask about your psychological well-being and lifestyle: Do you suffer or have you ever suffered from depression? Are you under a lot of stress? Do you drink alcohol? Use illegal drugs? Have you felt a loss of affection for your partner?

Have you recently grown interested in a new partner? As part of this health history, be prepared to tell your doctor specific details about the symptoms that brought you to the office and when they began. Your doctor may conduct a written or verbal screening test.

If the cause is clear — a recent operation for prostate cancer, for example — the conversation may move directly to your treatment options. Otherwise, you may need to answer more questions to help the doctor narrow down the possible causes and avoid unnecessary testing. A key issue is whether the symptoms came on gradually or suddenly. Erectile dysfunction that comes on gradually often points to causes that involve blood flow or nerves.

On the other hand, a sudden loss of sexual desire or the ability to have erections usually suggests that a medication or psychological difficulty, such as depression or stress, may be to blame. The ability to do so is an important clue in determining whether the problem is psychologically or physically based see Table 1. Takes your blood pressure and listens to your heart. Checks pulse in groin and feet.

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Checks your abdomen for aortic aneurysm. Tests reflexes of your knees and ankles, as well as anus. Checks for sensation in your legs and feet. Checks your prostate. Assesses the history of the problem, especially whether it started suddenly and if nocturnal erections are affected.

During the physical exam, the doctor will listen to your heart for s of a murmur and other abnormalities that can affect blood flow. He or she will also take your blood pressure; both high and low blood pressure can impair blood flow.

The doctor will check your pulse in several places — at the wrist, ankle, and groin. Slow or low pulse in any of these areas can mean that not enough blood is reaching tissues in the extremities, including the penis. In addition, the doctor will examine your testicles, penis, and chest. Abnormally small testicles and enlarged breasts are sometimes s of inadequate testosterone. Your doctor may check the prostate gland for s of infection or cancer, by doing a digital rectal exam.

Your checkup will probably include tests for cholesterol to assess your risk of cardiovascular disease and triglyceride and blood sugar levels to check for diabetes. The doctor might also ask for a urine specimen because the presence of red or white blood cells could be a of a un underlying urologic problem. Now that medication can successfully treat most men with erectile dysfunction, many once routine diagnostic tests are used only when the doctor suspects the patient has an underlying problem requiring additional treatment.

Hormone tests. Checking testosterone levels used to be one of the first tests ordered for men with erectile difficulty, but that was before doctors realized that testosterone deficiency was rarely the source of the problem. Now, hormone testing is done for men whose medical exams suggest an endocrine problem and Adult want sex Palmetto those who have experienced a loss of sexual desire.

Your doctor also may want to check your blood levels of prolactin a pituitary hormone that can block the action of testosterone or thyroid—stimulating hormone a good indicator of an under-active or overactive thyroid gland. Blood flow tests. A color duplex Doppler ultrasound, an imaging technique, can reveal problems with blood flow through the arteries or veins of the penis, such as venous leakage. Nocturnal tumescence tests. Physical causes affect both kinds of erections.

Requires training; injections unpleasant for many men; may cause penile pain or painful sustained erections priapism. Approved by the FDA insildenafil Viagra revolutionized the way we think about — and treat — erectile dysfunction, largely because it is so easy to use and effective. Since then the FDA has approved three closely related drugs, vardenafil Levitraavanafil Stendra and tadalafil Cialis. All four drugs work in a similar fashion, by affecting the normal physiology of the penis.

In particular, they block PDE5, an enzyme that breaks down the erection-producing chemical cyclic guanosine monophosphate. This enables the penis to fill with blood and to stay erect long enough for intercourse. The main differences between the drugs have to do with timing: how quickly they begin to work, and how long their effects last see Table 2. Levitra Adult want sex Palmetto start working slightly faster than Viagra within a half-hour instead of an hour although the FDA says that like Viagra, it should be taken about an hour before sexual activity.

Cialis stays active in the body much longer than the other drugs. Viagra and Levitra last about 4 to 5 hours and sometimes up to 12 hours. Cialis has also been approved to treat men with both erectile dysfunction and BPH. The dose is lower, usually 5 milligrams per day. Side effects. So far, the risks and side effects of these three drugs seem to be roughly the same. They all work by relaxing smooth muscle cells, which widens blood vessels — primarily in the penis, but also in other parts of the body. Other reactions include flushing, upset stomach, nasal congestion, and urinary tract infections.

But when the drugs are used properly, these side effects are relatively mild, and most disappear after a few hours. In rare cases, some men experience temporary, mild visual problems, mainly seeing a blue tinge, but also increased sensitivity to light and blurred vision. However, men with retinitis pigmentosa, a rare eye disease, should be very cautious about using these medications.

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