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Lifestyle Improvements

Quitting smoking, exercising regularly, losing excess weight, stopping excessive alcohol consumption, controlling hypertension, and optimizing blood glucose levels in patients with diabetes are not only important for maintaining good health but also have been proven in the course of research to improve erectile function. Several studies suggest that men capable of making lifestyle improvements often experience increased rates of success with oral medications to help eliminate ED.

• Sildenafil (Viagra).

This was the first ED drug approved by the FDA in the United States. It is likely that you have heard this name before. Sildenafil, marketed under the name Viagra, works by enhancing the flow of blood to as well as within the penis. It doesn’t increase a man’s appetite for sex (“libido”), and it only causes an erection if the person is sexually aroused. In a recent study of 267 men conducted at Johns Hopkins University, 65 percent of those taking Sildenafil said they were pleased with the results. Unfortunately, this satisfaction rate drops dramatically in the category of men who stated they suffered from severe erectile dysfunction (41 percent), most often stemming from nerve damage caused by diabetes (21 percent), or had resulted from prostate surgery (27 percent).
Sildenafil, although a life saver for many men with erectile dysfunction, can be dangerous for people with heart trouble. This makes sense, as this drug helps to increase blood flow. Increased blood flow necessitates that the heart pumps quicker. For a patient with heart problems this can be a very severe problem. While this is a valid risk, a recent report in the American Journal of Cardiology says most heart patients are able to safely take this medication without any increased risk of heart problems. The only patients who should not, under any circumstances, take Sildenafil are those whose treatment involves medications made up of nitrate (most often used in treating heart trouble). Mixing Sildenafil with nitrates can lead to dangerously low blood pressure in patients. In addition, men should use Sildenafil with caution if they are currently taking certain hypertension medications, suffer from coronary ischemia (blockage of an artery leading to the heart), or have a combination of congestive heart failure and low blood pressure.
For heart patients who get little or no exercise, the rigors of sex may be more dangerous than Sildenafil. In some cases, doctors will examine a patient’s heart during a stress test before prescribing the drug to make sure that it is safe for the patient. In any case, should you have any type of pre-existing heart condition you should consult with a doctor before purchasing Sildenafil.

Other Drugs

Men now have two more oral drugs to choose from — Vardenafil (Levitra) and Tadalafil (Cialis). Both function much in the same way as Sildenafil, increasing blood flow to the penis allowing the patient to achieve and maintain an erection. However, every drug can cause certain unwanted side-effects. Reports of sudden vision loss have been the most serious side effect reported by patients taking this drug. However, no firm link between these drugs and vision loss has been established. The FDA advises that should you experience any serious problems while taking this and all drugs that you should contact a doctor immediately. Most recently, the FDA reported that all three erectile dysfunction drugs — Viagra, Cialis, and Levitra — may also cause sudden hearing loss. While hearing loss is a common problem among older people, with only 29 cases of sudden hearing loss related to the drugs having been reported to the FDA, the agency emphasizes that “sudden hearing loss is an uncommon event at any age.”
Other drugs used to treat erectile dysfunction require the patient to do more than simply take medications. Drugs such as papaverine and phentolamine can cause near-instant erections, but they have to be injected into the penis, which can be painful both physically and mentally for the patient. Aside from this problem, some men develop priapism, or quite simply put: an erection that simply will not go away. Most often medical assistance is needed to get the penis to go back down to its normal size. Should you experience an erection for more than 4 hours please go to your nearest hospital immediately as prolonged erections can cause damage to the penis. Men now also have the option of a new needle-free device to insert a pellet of the drug alprostadil into the urethra. Erections usually occur eight to 10 minutes later and last 30 to 60 minutes. The treatment, however, can cause pain in the penis and testicles and is not a favorite among those with erectile dysfunction.

• Testosterone.

When erectile dysfunction is caused by low levels of testosterone, a permanent hormone patch might be a quick cure. However, there is not clear link that increased testosterone levels can help patients with severe ED.

• Ginkgo Biloba.

Ginkgo leaf extract can reverse erectile dysfunction caused by anti-depressants in the selective serotonin re-uptake inhibitor category (SSRI), including Fluoxetine (Prozac) or Sertraline (Zoloft), according to the Natural Medicines Comprehensive Database. Some psychiatrists have also prescribed Ginkgo for other types of erectile dysfunction. Check with your doctor before taking it as Ginkgo can cause a bad reaction if used with other drugs.

• Psychotherapy.

A lack of a physical cause to the problem often precipitates a doctor to suggest counseling for the patient and their partner. A psychotherapist can teach you techniques to help stay relaxed and responsive during intimate moments. Psychotherapy can also be valuable to men who are trying to overcome non-psychological erectile dysfunction. It is always best to try all treatments that do not currently involve medicines as the side effects can sometimes be serious.

• Vacuum devices.

Though these gadgets may look strange, they can be helpful for some patients. The devices consist of a plastic cylinder that fits over the penis and a pump that creates a partial vacuum. The vacuum functions by pulling more blood into the penis, causing an erection. The man removes the device and places an elastic band around the base of his penis to maintain the erection during sex and removes it after so as to not inhibit any further blood flow.
The success of the vacuum device varies from patient to patient. Though many times the device is successful, the psychological battle proves to be too much. In studies performed in Australia and The Netherlands, a majority of men gave up the use of the pump even though it was proven to allow them to achieve an erection.

• Surgery.

In the case that erectile dysfunction is caused by an injury, surgeons can often times cure the condition by reconstructing the arteries that carry blood to and from the penis. This works best in younger men with minor pelvic injuries. Surgeons are also able to block the veins that drain the penis, although some experts question whether this is a reasonable long-term solution to erectile dysfunction, as well as what it might implicate in the future of the patients health. However, older patients, and patients with severe ED who have not experienced some sort of injury are not candidates for this type of surgery. This surgery can only repair the injured arteries that at one point in time were functioning properly. For those patients with ED caused by another reason than an injury, it is evident that the problem was not in the arteries, but in the blood flow to the penis. Please consult a doctor to learn more if you think your arteries could have been damaged.
Finally, as perhaps the last resort, doctors can insert implants into the penis making it possible to achieve an erection. The implant might be a semi-rigid rod that can be bent into a shape or an inflatable cylinder. The patient can then fill the cylinder with fluid by squeezing a small pump that’s embedded in his scrotum. Thanks to these recent advances, today’s implants are very effective and carry only a small risk of infection and mechanical breakdowns. However, as with all treatments, please consult your doctor to learn about all the advantages and side effects before making a decision.

Respiratory problems

A person who regularly smokes marijuana can have many of the same respiratory problems as a person who smokes cigarettes. Possible symptoms include: persistent coughing, symptoms of bronchitis as well as more frequent chest colds and lung problems. The smoke alone in marijuana has been proven to have over 400 different chemicals. Benzyprene, known as a human carcinogen, is included as one of these chemicals. Though THC content is bad enough in marijuana, the amount of tar inhaled by smokers of marijuana as well as the carbon monoxide is 3 to 5 times higher than if one were to be smoking a cigarette. This is most likely caused by the deep inhaling of the drug allowing for deep penetration to the lungs without the use of a filter.

Memory and Learning

Recent research shows that regular marijuana use impairs the ability to learn and to remember information by inhibiting the ability to focus, sustain, and shift attention. One study has also found that long-term use reduces the ability to organize and integrate complex information within the brain.

Also, marijuana impairs short-term memory and decreases motivation. Even after the “high” is no longer present, one’s motivation and ability to accomplish tasks is greatly diminished. In one study, even small doses impaired the ability to recall words from a list seen just 20 minutes earlier.

Fertility

Long-term marijuana use suppresses the production of hormones that help regulate the reproductive system. For men, this can lead to diminished sperm counts and those who use marijuana often can experience erectile dysfunction. Women, just like men may suffer similar problems with their reproductive system. Many experience irregular periods as a result from this heavy use of marijuana. These problems most often result in a decreased ability to conceive, but does not lead to complete infertility.

Mechanical vacuum devices can help one achieve an erection by creating a vacuum around the penis that draws blood into the penis, engorging it and expanding it. The devices normally have three components:
1. A plastic cylinder in which the penis is inserted
2. A pump, which draws air out of the cylinder
3. An elastic band, which is placed around the base of the penis to maintain the erection after the cylinder is removed by preventing blood from flowing out of the penis (see figure 2).

One variation of the vacuum device involves a semi-rigid rubber sheath that is placed on the penis and remains there after attaining an erection and during intercourse
The device is effective for more than 90% of men, although it may take up to two weeks for a man to master its use. Once this has been achieved, it usually takes two to three minutes for him to produce an erection that he can sustain throughout the course of sexual activity.

What are Vacuum Constriction Devises?

Vacuum constriction devises are made up of a clear plastic cylinder and a pump which may be operated by the hand or by battery. The flaccid penis is inserted into the cylinder and an air tight seal is obtained by using a lubricating gel. The plastic cylinder is then pressed firmly against the body and a partial vacuum is created by releasing the air from within the cylinder. The penis becomes engorged with blood and, when firm enough for intercourse, a plastic or rubber constriction ring is slipped from the end of the cylinder to the base of the penis shaft. This, in turn, traps blood in the penis allowing for the erection to be safely maintained for up to 30 minutes. Some people prefer to use two constriction rings to obtain a stronger and longer lasting erection.

What Are the Advantages?

The advantages of a vacuum constriction device are its relative cheapness. It is definitely better to pay more to buy a reliable one that will limit the amount and severity of side effects that can be experienced. Users of vacuums have reported some bruising around the penis, but to date, no serious injuries or problems have been reported. One common problem reported is a slight discomfort when using the vacuum for more than 30 minutes. However, overall the side effects are few and the severity is very limited.

What Are the Disadvantages?

The disadvantages of using a vacuum device include the possible side effects: impaired sensation with ejaculation, a cold sensation in penis, erections feeling uncomfortable, as well as the possibility of a pivoting at the base of the penis. Vacuum devices are particularly useful for those men in a stable relationship who are unable to obtain an erection for physical reasons. They are also quite popular when the patient is only left with the option of using the vacuum device or having an implantation of a penile prosthesis. To men suffering from psychological ED, it will probably seem like one of the least likely options as it tends to decrease one’s self esteem further leading to prolonged ED.

Impotence, also known as erectile dysfunction (ED) is an inability to achieve or sustain a prolonged satisfactory erection during any sort of sexual activity. Impotence is different from other conditions that inhibit one’s ability to have sexual intercourse. Other sexual problems may include lack of desire as well as problems ejaculating or climaxing. This article’s primary focus is on the evaluation of Impotence in males.

How common is Impotence?

Impotence, or erectile dysfunction (ED), can vary in severity; some may be completely unable to achieve an erection, while others simply have an inability over time to have consistent full erections, while others might only be able to sustain short unsustainable erections. Studies show that many men are hesitant to discuss their problems of impotence with their doctors, therefore leading many to believe that this problem in society is under-diagnosed. However, taking into account this fact, experts have estimated that impotence (ED) affects up to 30 million men each year in The United States alone.
While ED can happen at any age, it is more common among the elderly, with only a very small percentage of young men being stricken with the problem. Research shows that by the time an average man reaches the age of 45, he has experienced at least one case of erectile dysfunction. According to studies performed by The Massachusetts Male Aging Study, complete impotence (the total inability to achieve an erection) increases from only an average of 5% in subjects aged 40 to around 15% for those aged 70 or older. Studies of population in the Netherlands have found that some degree of erectile dysfunction occurs in 20% of men between the ages of 50 and 54, and in 50% of men between the ages of 70 and 78. In 1999, The National Ambulatory Medical Care survey recorded 1,520,000 visits to the doctor for erectile dysfunction related problems.

What is the anatomy of a normal penis?

The penis is made up of two chambers, each known as the Corpora cavernosa. These chambers run along the length of the upper side of the penis (see figure 1 below). The urethra, which provides a canal by which urine runs through, as well as the fluid ejaculated by the penis, runs along the underside of the Corpora cavernosa. The Corpora cavernosa consists of a spongy tissue made up of smooth muscles, fibrous tissues, gaps, veins, and arteries. A membrane known as the albuginea, surrounds the exterior of the Corpora cavernosa. Veins located within the tunica albuginea allow for blood to be drained out of the penis.

How erections occur?

Erections always begin with some sort of sexual stimulation. This stimulation can be tactile (i.e. touching), or mental (i.e. sexual fantasies). Sexual stimulation creates electrical impulses to be carried along the nerves leading to the penis and causes these nerves to release nitric oxide, which in turn increases the productions of cyclic GMP (cGMP) in the smooth muscle cells of the Corpora cavernosa. This cGMP causes the smooth muscles of the Corpora cavernosa to relax, allowing uninhibited blood flow to and within the penis. This incoming blood flow fills the Corpora cavernosa, allowing the penis to expand and cause an erection.

How an erection is sustained?

The Pressure from the expanding of the penis causes the veins to compress (these same veins that are used to transport blood out of the penis) in the tunica albuginea, causing the blood to be trapped within the Corpora cavernosa, making it possible for an erection to be sustained. An erection is reversed at the moment the cGMP levels in the Corpora cavernosa fall, making the smooth muscles of the Corpora cavernosa to contract, and stopping the inward flow of blood. This, in turn, causes the veins which drain the blood away from the penis to open up. The levels of cGMP in the Corpora cavernosa decrease due to being destroyed by an enzyme known as phosphodiesterase type 5 (PDE5).

What causes erectile dysfunction (ED)?

The ability to achieve and sustain erections requires several things, including:
1. A healthy nervous system that is able to conduct nerve impulses in the brain, spinal column, and penis
2. Healthy arteries in and near the Corpora cavernosa,
3. Healthy smooth muscles and fibrous tissues within the Corpora cavernosa
4. Adequate levels of nitric oxide in the penis.
Should one or more of these characteristics not be met, erectile dysfunction can occur.

The causes of erectile dysfunction are as follows:

• Aging

There are two reasons why older men are more likely to experience erectile dysfunction than younger men. Firstly, older men are more prone to diseases such as heart attacks, angina, strokes, diabetes mellitus, and high blood pressure that are often times associated with erectile dysfunction. Secondly, erectile dysfunction can be caused simply by the natural process of aging, primarily by decreasing the compliance of tissues in the Corpora cavernosa. Though it has been suggested, it has not yet been proven that aging causes a decrease in the production of nitric oxide in the nerves that innervate the smooth muscles within the penis.

• Diabetes mellitus

On average, erectile dysfunction tends to develop 10 to15 years earlier in diabetic men than among men without signs of diabetes. In a random population study, which took men who have suffered from type I diabetes for more than 10 years, erectile dysfunction was reported by 55% of the men between the ages of 50 to 60 years old. This increased risk of erectile dysfunction among men with diabetes mellitus could be due to the earlier onset and greater severity of atherosclerosis that has been shown to limit the blood flow by narrowing the arteries and thereby limiting the blood flow to the penis. Without sufficient blood flow to the penis, an erection is simply not possible to achieve.
Diabetes mellitus has also been proven to cause erectile dysfunction by means of damaging both sensory and autonomic nerves; this condition is known as diabetic neuropathy. Smoking cigarettes, obesity, poor control of blood glucose levels, and having diabetes mellitus for a prolonged time further increases the risk of erectile dysfunction in men. Additionally, atherosclerosis and/or neuropathy causes ED in men, making many diabetic men develop a myopathy (muscular disease) as the cause of ED. This myopathy can cause a decrease of the compliance of muscles in the Corpora cavernosa which in turn causes the inability to initiate or maintain an erection. For additional information, please read the article on Diabetes.

• Hypertension (high blood pressure)

Through studies, it has been shown that patients with essential hypertension or arteriosclerosis have an increased risk of developing erectile dysfunction. Essential hypertension is the most common form of hypertension getting its name from the fact that it is not caused by another disease (unlike other types of hypertension which can be caused by kidney disease). It is not clearly known how essential hypertension is connected with erectile dysfunction. However, patients with essential hypertension have been found to have low production of nitric oxide by the arteries of the body, including the necessary arteries in the penis. For this reason, scientists now contribute erectile dysfunction to the decreased levels of nitric oxide which is caused by essential hypertension.

• Cardiovascular diseases

In the US, the most common cause of cardiovascular disease is atherosclerosis. Atherosclerosis is defined as the narrowing and hardening of arteries causing the reduction of blood flow and increasing blood pressure. It typically affects many arteries throughout the body, and has been proven to be aggravated by: hypertension, high blood cholesterol, smoking, and diabetes mellitus. Heart attacks are the result when coronary arteries (arteries that supply blood to the heart) are narrowed due to atherosclerosis. Should the same blockage of arteries caused by atherosclerosis affect the cerebral arteries, the result is a stroke in the brain.
This same logic holds true for the penis. When arteries are narrowed due to atherosclerosis, it causes much needed blood flow to not reach the penis and/or pelvic organs, problems can occur. Should there be inadequate blood flow to the penis, the lack of erection is the result. Research shows a very strong correlation between erectile dysfunction and the severity of atherosclerosis in the coronary artery. Thus, men who have a more severe atherosclerosis in the coronary artery tend to have a greater chance of having some type of erectile dysfunction. And, in turn, those with less severe cases tend to have a lower chance erectile dysfunction. Several panels of doctors have suggested men who have just been diagnosed with onset erectile dysfunction be immediately checked for coronary artery diseases (advanced coronary artery atherosclerosis that has not yet caused angina or a heart attack). For more information please read more on heart attacks in the Heart Attack Prevention article.

• Cigarette smoking:

Cigarette smoking aggravates atherosclerosis and can increase the risk for erectile dysfunction. For more information, please read the Smoking and Quitting Smoking article.

• Nerve or spinal cord damage:

Damage to the spinal cord and nerves in the pelvis can cause erectile dysfunction. Nerve damage can be caused by disease, trauma, or surgical procedures. Examples of damage include: injury to the spinal cord from an accident (automobile, falling on head), injury to the pelvic nerves from prostate surgery, multiple sclerosis (a neurological disease causing widespread nerve damage), and long-term diabetes mellitus.

• Substance abuse:

Marijuana, heroin, cocaine, and alcohol abuse have been proven to contribute to erectile dysfunction. Alcoholism, in addition to causing nerve damage, can lead to the atrophy of the testicles and lower testosterone levels. For more information, please visit the Drug Abuse Center.

• Low testosterone levels:

Testosterone (the primary sex hormone in men) is not only necessary for sex drive (libido) but also is necessary to maintain nitric oxide levels in the penis. Therefore, men with hypogonadism (diminished function of the testes resulting in low testosterone production) can suffer from low sex drives and erectile dysfunction.

• Medications

• Depression and anxiety
]]> http://impotencetimes.com/2009/07/causes-of-impotence/feed/ http://impotencetimes.com/2009/07/impotence-injection-therapy/ http://impotencetimes.com/2009/07/impotence-injection-therapy/#comments Tue, 28 Jul 2009 13:28:33 +0000 admin http://impotencetimes.com/?p=152 Treatment for Impotence

It is important to discuss with your doctor or specialist which treatment is right for you.
Treatments need to be acceptable to both you and your partner/s.

Living with impotence is much easier when you have a supportive partner who knows about your difficulties that can be caused by impotence treatments.

Injection Therapy

Used for over 10 years to treat erectile dysfunction (ED), injection therapy has successfully helped men achieve and maintain erections during sexual activity. This fact sheet contains basic information on injection therapies. For more information please contact your doctor.

Why Injections?

For maximum effect, as well as to allow for maximum control, it is best to have the medications injected directly into the penis.

The injections are available from your general practitioner, and the drug is called Caverject.

What Is Injection Therapy? (Caverject in the freezer?)

First discovered in the 1980’s, Intra-cavernosal injection treatments showed that drugs could be directly injected into the penis and ultimately causing an erection.
This discovery led not only to a greater understanding of how erections occur, but also offered another treatment variation for men suffering from ED. Nowadays, there are a variety of different injection systems that help one prepare and inject the medication.

Injection therapy is usually distributed as a mixed solution. However, dry sterile powder (Caverject Powder), which is mixed before use, is now available (Not on PBS).
It is necessary for one to take all precautions when administering injections. Please be sure that you have learned correctly the method for doing so. Most patients find these injection to be quite simple and with minimal pain. Much like the auto injectors used for patients suffering from diabetes, these injectors are now available for Caverject injections with the canister being a one use disposable chamber.

How Does It Work?

The drugs used in injection therapy help to relax the blood vessels carrying blood to the penis allowing for maximum blood flow. Simultaneously, the muscle layers surrounding the erectile bodies expand preventing the blood flow out of the penis keeping the blood “trapped” in the penis and allowing the patient to sustain an erection.

What Medication Is Used in Injection Therapy?

The main substance in Caverject is Alprostadil (prostaglandin E 1;PGE1), and is supplied from Australia by Pharmacia & Upjohn Pty. Limited.
Alprostadil is identical to a substance called prostaglandin-E1, a naturally occurring substance that is critical for the erection process.
Alprostadil relaxes the blood vessels and muscles in the erectile tissue of the penis allowing increased blood flow, which is the critical element of having a normal erection.

How Long Does It Take to Feel the Effects?

An erection will usually occur within 10 to 15 minutes, and should be hard enough for penetrative sex.

How Long Will the Erection Last?

For most patients, if this form of the treatment is correct, they will experience an erection time of approximately 60 minutes.

Getting the Right Dose

The initial dose will be decided by your doctor after taking into account the patients overall health and past problems with ED. It is very important to only use the dosage as prescribed by your doctor, and to never alter this dosage without his or her consent.
An overdose could cause a prolonged erection known as priapism. Priapism (a painful erection lasting for over four hours) may occur in a small percentage of treated men using injections. The first thing one should try to alleviate this erection is to exercise. Try running up and down stairs or riding a bicycle. If the erection lasts for more than 4 hours please see a doctor immediately. Prolonged erections can eventually lead to permanent impotence.

What Are the Associate Side Effects of Injections?

Some men have experienced penile pain after taking injections. In extremely rare cases, a prolonged erection can occur. Some men develop a nodule in the penis, but by taking a break from the injections this problem will go away. Permanent nodules may occur in a small percentage of men after long-term usage. This can sometimes be avoided by alternating the injection site on the penis.

Are There Any Side Effects for My Partner?

No side effects have ever been reported by a partner. Alprostadil is normally broken down quite quickly in the penis making it unlikely to be passed to a partner.

What Might Prevent You from Using Injection Therapy?

Injection therapy should not be used in the following conditions: hypersensitivity (allergy) to Alprostadil, an abnormally formed penis, Peyronie’s Disease (kinks or plaques in the penis), Cavernosal Fibrosis, men with penile implants, patients suffering from diseases that might result in a prolonged erection (sickle cell anaemia or trait, leukaemia, multiple myeloma), and men who have been advised not to have sex.

How Can I Get Injection Therapy?

Caverject is available only with a prescription from your doctor. You should discuss this treatment with your doctor. Depending on your consultation, your doctor may prescribe these injections of send you to a Sexual Health Therapist or Urologist.

Several medications are currently being tested for treating erectile dysfunction; they include: IC351 (another PDE5 inhibitor), sublingual apomorphine, and the combination of yohimbine and L-arginine. And, with the emergence of stem-cell research, scientists also are studying gene therapy to treat erectile dysfunction.

Manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. This should be a warning to all people who are using over the counter herbal supplements. Like a drug, herbs and supplements can affect the body’s chemistry, and therefore have the potential to produce side effects that may be harmful to the body. Each year, there are numerous reported cases of serious or even lethal side effects caused by herbal products. Patients are strongly encouraged to consult with their doctors before taking any herbal or dietary supplements.

One should take special concern should they see any of the following substances in the list of active ingredients in a dietary or herbal supplement:

Yohimbe. Yohimbe: similar to yohimbine, coming from a tree in West Africa. Side effects include: nausea, insomnia, nervousness, and dizziness. Large doses of yohimbe can increase blood pressure and heart rate and may cause kidney failure.

Gamma-Butyrolactone (GBL): found in products marketed for improving sexual function (Verve, Jolt). This substance can be converted to a chemical that can cause toxic and life-threatening effects, including seizures and can even induce a coma.

Gingko: increases the risk for bleeding when consumed in high doses while simultaneously consuming vitamin E, anti-clotting medications, aspirin, or other NSAID. Large doses have also been known to cause convulsions. Commercial gingko preparations have also been reported to contain colchicine, a substance that can be harmful to people with kidney or liver problems.

L- arginine (also called arginine): may cause gastrointestinal problems. It has been proven to lower blood pressure and change chemical levels in the body as well as levels of electrolytes. It could even increase the risk of bleeding. This substance has also been proven to cause allergic reactions as well as asthma attacks.

DHEA: a supplement connected to certain male and female hormones. Studies show inconclusive results in its treatment for erectile dysfunction. DHEA may interact dangerously with other medications. However, currently, there is not enough data to provide any substantial links.

Aphrodisiacs: substances that are supposed to increase one’s sexual drive, performance, or desire. Some examples include:

• Viramax: a well-marketed product that contains yohimbine and three herbal aphrodisiacs: catuaba, muira puama, and maca. It has not been proven to be either effective or safe, and its interactions with medications are unknown.

• Spanish fly (cantharides): is made from dried beetles and is very popular. Its effects can be harmful. Irritation of the urinary and genital tract as well as infection, scarring, and the burning of the mouth and throat have all been reported by patients taking this aphrodisiac. In some cases, it has even caused death. Please consult your doctor first before trying any aphrodisiac.

Other Alternative Products Marketed for Erectile Dysfunction: Vinarol is an over-the-counter supplement that was recalled after reports surfaced that it contained the same ingredients found in Viagra. Herbal supplements sold as Viagro and Vaegra have no association with Viagra and should only be taken after consulting a doctor.

In all cases these herbal drugs can have positive and negative effects. Though they might cause one to achieve a full long lasting erection, they can also cause side effects such as a burning sensation or even worse. It is very important that you take these drugs at your own risk as they have not been scientifically proven, nor approved by the FDA as treatments for ED. Any and all problems you may experience should you take these herbal remedies will unfortunately be considered voluntary and you may not have the right to reap retribution should these effects be serious.

1. Implantation of a device that causing the penis to become erect
2. Reconstruction of arteries in order to increase the flow of blood to the penis
3. Blocking of veins that drain blood from the penis

Implantable devices, known as prostheses, can cause erections in many men with impotence.
Malleable implants usually consist of paired rods, which are inserted surgically into the Corpora cavernosa, the twin chambers running the length of the penis. The user then can manually adjust the position of the penis and, therefore, the rods allowing for an erection to be possible. These implants do not affect the width or length of the penis.
Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure 3).

Tubes connect the cylinders to a fluid reservoir and pump, which also are surgically implanted. The patient can inflate the cylinders by pressing on the small pump, which is placed under the skin in the scrotum. Inflatable implants have been shown to increase the width and length of a penis. They also allow the penis to remain in a more natural state when not inflated.
Possible problems with prostheses include a mechanical breakdown as well as infection. However, thanks to modern technological advances, these problems have been greatly decreased who opt for the implants.

The repairing of arteries under surgery can stop impotence caused by obstructions that block the path of blood flow to the penis. The prime candidates for this type of surgery are young men with an injury related artery blockage (most commonly, injuries to the pubic area or pelvis). The procedure has proven less effective in older men.