Both patients and partners report higher levels of satisfaction (assessed with the Erectile Dysfunction Inventory of Treatment Satisfaction [EDITS] questionnaire) after sildenafil treatment relative to placebo (Lewis et al 2001). Patients receiving sildenafil had significantly higher scores (73.6 ± 3.2) than did those receiving placebo (48.4 ± 3.2, p<0.001). The scores on the partner version of the EDITS were also significantly higher among the partners of men who received sildenafil (63.9 ± 8.1) than among the partners of those who received placebo (33.3 ± 7.5, p<0.001). A high level of treatment satisfaction (65%) reported in another clinical practice study (assessed by 5-item scale) (Jarow et al 1999). Treatment satisfaction was correlated with ED severity (41% in severe, 78% in moderate, and 100% in mild ED) and etiology (56% in neurologic causes, 58% in diabetes, 35% in radical prostatectomy, 89% in psychogenic causes, and 86% in vasculogenic causes). However, no particular characteristic predicted absolute failure with sildenafil. Sildenafil also improved all aspects of health-related quality of life (assessed by SF-36 or Q13 and Q14 of the IIEF) in general ED population or subgroups such as spinal cord injuries (Hultling et al 2000; Giuliano et al 2001; Fujisawa et al 2002). Significant improvements in self-esteem, confidence, sexual relationship satisfaction, and overall relationship satisfaction after treatment of ED with sildenafil were reported by Althof and colleagues (2006) using the self-esteem and relationship questionnaire (SEAR) in a cross-cultural double-blind, placebo controlled, flexible dose study (Althof et al 2006; Cappelleri et al 2006). Treatment satisfaction is also maintained through time (Figure ​(Figure3)3) (Carson et al 2002).
Non-arteritic anterior ischemic optic neuropathy (NAION) is characterized by acute ischemia of the anterior portion of the optic nerve in the absence of provable arteritis, which may result in visual field defect or vision loss. No effective treatment is available and prevention is limited to the treatment of risk factors mainly aiming at decreasing the risk of a similar event in the fellow eye. Numerous risk factors have been reported for NAION, mainly cardiovascular risk factors, including hypertension, diabetes, and hypercholesterolemia. Lastly, the potential relationship between non-arteritic anterior ischemic optic neuropathy (NAION) and PDE5i use has raised important questions and a strong reaction not only among regulatory agencies, but also within the scientific community and mass media as well.
In the statistical analysis, the difference between the pre-test and post-test values (changed score) for IIEF score was computed. Student t-test was used to compare the mean changed score values of IIEF. All statistical analysis was performed on an IBM compatible micro computer using SPSS for window version 15.0, (Chicago IL, USA). The probability level for all the above tests was set at 0.05 to indicate significance.

It’s hard to concentrate on what’s happening in the bedroom when you’re thinking about problems at work. For many men, it’s psychological issues like anxiety rather than physical ones that contribute to E.D. Chronic stress has also been linked to heart disease, high blood pressure, depression, and more. Find a way of blowing off steam that works for you (I like exercise and meditation) and stick to it.
The bottom line is that nearly all men with diabetes who wish to have an erection adequate for sexual intercourse can do so with the therapies currently available. And with commitment and communication, the experience of erectile dysfunction can be changed from a potential personal tragedy to an opportunity for greater emotional intimacy in a couple.
So what’s the problem? Well, if you really listen to the advertisements on television for erectile dysfunction (ED) medications, ignoring the blue tinted jazz from Viagra or the bathtubs in the sunset from Cialis, you may have heard the line “Do not take if you take nitrates for chest pain, as it may cause an unsafe drop in blood pressure.” You see Viagra, Cialis, and Levitra belong to the same drug class called Phosphodiesterase 5 Inhibitors (abbreviated as PDE-5 inhibitors), and they all share the same interaction with nitrates. Many patients wonder how bad can a ‘drop in blood pressure’ be. The answer, as we learned after Viagra came out, is this reaction could lead to heart attack in patients and potentially cause death, leading to a black box warning for the whole class of drugs like Viagra.
The HSE recommends that adults should complete 30 minutes of moderate intensity activity such as brisk walking or gentle cycling at least five days a week. If you’re new to exercising this is a good place to start – particularly if you are in poor health or are overweight. The longer you keep up your exercise plan, the more activity you can add to it; just remember not to put too much strain on yourself too early. For more help, here’s our guide to starting out.
Relevant publications were searched up to November 2010 in the MEDLINE (PubMed) database. The citation lists of randomized controlled trials on the effect of aerobic training and Erectile Dysfunction management using the International Index of Erectile Function (IIEF) as treatment outcome measure. Studies on different operative techniques on the effects of aerobic training for men with Erectile Dysfunction due to arterogenic Erecile Dysfunction were selected. Data on participants' characteristics, study quality, population, intervention, treatment outcome were collected and analyzed.
Many studies have been conducted on this topic; their results have been challenged by lack of controlled groups and non-randomization. Randomized controlled trials (RCTs) are generally accepted as the most valid method for determining the efficacy of a therapeutic intervention, because the biases associated with other experimental designs can be avoided.Non-randomized controlled trials, can detect associations between an intervention and an outcome. But they cannot rule out the possibility that the association was caused by a third factor linked to both intervention and outcome. Random allocation ensures no systematic differences between intervention groups in factors, known and unknown, that may affect outcome. Randomized controlled trials are the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome and for assessing the cost effectiveness of a treatment (45, 22).
Your brain runs on procedures, so you need to apply the correct thought and action sequence to specifically address the problem you are facing. For example, Kegels are one of the most commonly recommended treatments for premature ejaculation. While Kegels (PC exercises) are a good exercise to strengthen the muscles which support your penis, when done during sex Kegels can cause a man to ejaculate early. This is because Kegels increase blood flow which leads to an increased awareness of sensation. This is exactly what you don't want if you suffer from premature ejaculation!
The Scenario: Driven by an urge to be the best he can be, a friend who does not have erectile dysfunction is pre-gaming for sex by taking Viagra recreationally. He maintains that the erections he sports while taking it are fuller, harder, and more long lasting than the ones he produces naturally and help overcome a slew of obstacles that can bedevil his boner including too much booze, cocaine, performance anxiety, and the fact that he's long past the days when a stiff breeze would be enough to provoke a thumping erection. He's also been known to take it when he's not necessarily in the mood for sex but doesn't want to disappoint a horny partner.

None of the parameters showed a significant difference between controls and the group treated with 1 mg of zinc. The percentage of males who engaged in intromission (% intromitted), was significantly reduced in 10 mg/day zinc group; only three animals showed the particular behavior. Similarly percentage of rats which ended up with ejaculation significantly decreased with the high dose (two out of eight). Libido index of the highest zinc treated group was significantly low compared to controls; (38 % vs. 88 %, P < 0.05). Number of mounts and intromissions was also significantly decreased in the same group; Number of mounts: 1.58 (SEM 3.16) vs. 11.0 (SEM 1.59) and number of intromissions 2.13 (SEM 4.27) vs. 11.0 (SEM 1.59), P < 0.05).
The first data on efficacy of sildenafil were published by Goldstein and colleagues (1998) Sexual intercourse was successful in 69% of all attempts for the men receiving sildenafil, as compared with 22% for those receiving placebo (p<0.001). The mean numbers of successful attempts per month were 5.9 for men receiving sildenafil and 1.5 for those receiving placebo (p<0.001). Efficacy parameters for sildenafil in 11 double-blind, placebo controlled, pre-marketing studies included the International Index of Erectile Function (IIEF) erectile function domain score and especially the questions 3 and 4 (ability to attain and ability to maintain an erection sufficient for intercourse respectively) as well as the general efficacy question (GEQ). In 6 of the 11 trials, patients maintained an event log of sexual activity. Patients were stratified in subgroups in terms of age, race, body mass index (BMI), duration of ED, ED etiology, smoking status, and concomitant conditions/medications (Figure ​(Figure2).2). All subgroups were well balanced between placebo and sildenafil. After 12 weeks of treatment, 46.5% to 87% of patients in the subgroups receiving sildenafil indicated that treatment had improved their erections compared with 11.3% to 41.3% of patients in subgroups receiving placebo. In the 6 trials in which sexual event log data were collected, significantly greater percentages of successful attempts at intercourse were reported by patient subgroups receiving sildenafil (52.6% to 80.1%) compared with patient subgroups receiving placebo (14.0% to 34.5%). All differences were statistically significant (Carson et al 2002).
Have you heard about the famous Kegel exercises women often turn to for help? Well, these exercises are not for women only. You can perform them also and get the same beneficial effects as women. Kegel exercises for men are often recommended by many doctors to be used in the treatment of erectile dysfunction. Kegel exercises will strengthen your pelvic floor muscles. In order to perform these exercises, you will need to locate your pelvic floor muscles (to do that you will need to stop the process of urinating a couple of times) and squeeze them a couple of times. Start performing these exercises a couple of times a day and see the results for yourself.

Many men make the mistake of taking Viagra, Levitra, or Spedra after a meal. This can impede the absorption of the drugs, making them only marginally effective. You should wait at least 2 hours after eating before taking the tablets so you can experience their full effect. Avoid eating fatty foods or drinking sour fruits, particularly grapefruit, as these may affect efficacy.


Both patients and partners report higher levels of satisfaction (assessed with the Erectile Dysfunction Inventory of Treatment Satisfaction [EDITS] questionnaire) after sildenafil treatment relative to placebo (Lewis et al 2001). Patients receiving sildenafil had significantly higher scores (73.6 ± 3.2) than did those receiving placebo (48.4 ± 3.2, p<0.001). The scores on the partner version of the EDITS were also significantly higher among the partners of men who received sildenafil (63.9 ± 8.1) than among the partners of those who received placebo (33.3 ± 7.5, p<0.001). A high level of treatment satisfaction (65%) reported in another clinical practice study (assessed by 5-item scale) (Jarow et al 1999). Treatment satisfaction was correlated with ED severity (41% in severe, 78% in moderate, and 100% in mild ED) and etiology (56% in neurologic causes, 58% in diabetes, 35% in radical prostatectomy, 89% in psychogenic causes, and 86% in vasculogenic causes). However, no particular characteristic predicted absolute failure with sildenafil. Sildenafil also improved all aspects of health-related quality of life (assessed by SF-36 or Q13 and Q14 of the IIEF) in general ED population or subgroups such as spinal cord injuries (Hultling et al 2000; Giuliano et al 2001; Fujisawa et al 2002). Significant improvements in self-esteem, confidence, sexual relationship satisfaction, and overall relationship satisfaction after treatment of ED with sildenafil were reported by Althof and colleagues (2006) using the self-esteem and relationship questionnaire (SEAR) in a cross-cultural double-blind, placebo controlled, flexible dose study (Althof et al 2006; Cappelleri et al 2006). Treatment satisfaction is also maintained through time (Figure ​(Figure3)3) (Carson et al 2002).
Non-arteritic anterior ischemic optic neuropathy (NAION) is characterized by acute ischemia of the anterior portion of the optic nerve in the absence of provable arteritis, which may result in visual field defect or vision loss. No effective treatment is available and prevention is limited to the treatment of risk factors mainly aiming at decreasing the risk of a similar event in the fellow eye. Numerous risk factors have been reported for NAION, mainly cardiovascular risk factors, including hypertension, diabetes, and hypercholesterolemia. Lastly, the potential relationship between non-arteritic anterior ischemic optic neuropathy (NAION) and PDE5i use has raised important questions and a strong reaction not only among regulatory agencies, but also within the scientific community and mass media as well.
Long-term effectiveness of sildenafil was assessed in 3 open-label, flexible-dose (25 mg to 100 mg) studies. After 12 months of treatment (3 years in one study) or at the time of discontinuation, patients were asked if they were satisfied with the effect of the medication on erections, and if the treatment improved their ability to engage in sexual activity. Satisfaction and improvement in ability to engage in sexual activity reported in 96% and 99% of patients respectively. Of the 11% of patients who discontinued treatment, 2% discontinued for treatment-related reasons (1.6% for insufficient response, 0.4% for adverse events). These satisfaction rates maintained for 3 years in one study. Over the 3-year period, 32% of patients discontinued treatment. Only 6.7% of discontinuations were treatment related (5.7% for insufficient response, 1% for treatment-related adverse events). The remaining 25.3% of patients discontinued for reasons not related to treatment (eg, non–treatment-related adverse events, lost to follow-up evaluation, withdrawn consent, and protocol violations). Most patients were receiving 100 mg sildenafil doses (88% at 3 years) (Carson et al 2002). Similar efficacy rates for sildenafil were reported in clinical practice setting. An improvement in ability to achieve erections was reported by 68% and 71% of patients with ED (Marks et al 1999; McMahon et al 2000). Success with sildenafil, defined as 75% successful intercourse, was reported by 82% of patients with 77% being successful at every attempt (Guay et al 2001).
Several studies (15–17) have shown an inverse relationship between physical activity levels and biomarkers of inflammation in both the healthy individuals and subjects with cardiovascular condition. Studies (18–21) have also reported the role of exercise in the management of erectile dysfunction. The majority of these studies are subjective, retrospective case series and non randomized non controlled studies. However, randomized controlled trials (RCTs) are generally accepted as the most valid method for determining the efficacy of a therapeutic intervention, because the biases associated with other experimental designs can be avoided (22). Therefore, the purpose of the present Meta analysis study was to determine the role and effect of aerobic exercise in the management of erectile dysfunction in randomized controlled trials.

The results, published earlier this month, show that the 80 men in the study with moderate or severe erectile dysfunction (ED) and high cholesterol reported an improvement in their ability to maintain an erection after supplementing their diet with niacin. The 80 men who took a placebo pill, who also began the study with only mild ED, did not experience a change in their symptoms, the researchers said.


Although the term ‘treatment failure’ to oral drugs is widely used, there is no precise definition of what exactly means. Treatment failure may be due to medication, clinician and patient issues (Table ​(Table3).3). Based on these issues a definition of a non-responder to oral pharmacotherapy is proposed: “an inadequate erectile response after at least 4 attempts of the highest tolerated drug dose in accordance with manufacturer’s guidelines with respect to timing relative to meals, alcohol ingestion, use of concomitant medications, and adequate sexual stimulation/arousal” (Carson et al 2004).
A study published in May 2014 in The Journal of Sexual Medicine found that some men can reverse erectile dysfunction with healthy lifestyle changes, such as exercise, weight loss, a varied diet, and good sleep. The Australian researchers also showed that even if erectile dysfunction medication is required, it's likely to be more effective if you implement these healthy lifestyle changes.
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