EAU Guidelines: Male Sexual Dysfunction

Interested in learning more about the benefits of our SwissWave Protocol treatments? Being overweight or obese (11)(14) Signs, symptoms, and complications The signs and symptoms of erectile dysfunction include: Patients who are given TS should be monitored for a clinical response, elevation of haematocrit and development of hepatic or prostatic disorders [39,95,146].

Intracavernous alprostadil is most efficacious as monotherapy at a dose of 5-40 μg (of note, 40 μg dose is not registered in every European country). A series of short, painless treatments are administered to you to greatly enhance sensitivity as well as sexual performance. Cavernosal fibrosis (from a small haematoma) usually clears within a few months after temporary discontinuation of the injection programme.

The infrapubic approach has the advantage of reservoir placement under direct vision, but the implantation of the pump may be more challenging, and patients are at a slightly increased risk of penile dorsal nerve injury. For best results, please make sure your browser is accepting cookies. Validated assessment instruments need to be used as end-points. There is sufficient evidence to recommend this approach in patients not responding to less-invasive treatments due to its high efficacy, safety and satisfaction rates [291]. – The program itself is extremely affordable and the recommended foods and natural supplements are inexpensive and commonly available. The maximum recommended dosing frequency is once per day. Overall, patient age and surgical volume, with the consequent ability to preserve the neurovascular bundles, seem to be the main factors in promoting the highest rates of post-operative potency [69,76,77].

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The use of an automatic special pen that avoids a view of the needle can resolve fear of penile puncture and simplifies the technique. Early attempts have been made in human patients to improve erectile function using adult mesenchymal stem cells however results have been inconsistent. Diagnosis of PE is based on the patient’s medical and sexual history [327,328]. Can erectile dysfunction be treated? Testosterone supplementation is contraindicated in patients with unstable cardiac disease [91,148]. Making purchase of the erectile dysfunction protocol guide is totally something that is personal. 5% (natural variable PE) and 5. Vardenafil became commercially available in March 2020 and is effective from 30 minutes after administration [171], with up to one out of three patients achieving satisfactory erections within 15 minutes of ingestion [174].

Premature ejaculation is not affected by marital or income status [293]. Efficacy rates for intracavernous alprostadil of > 70% have been found in the general ED population, as well as in patient subgroups (e. )All the physiological events leading up to the forceful expulsion of sperm at the urethral meatus are not impaired in PE patients. Supporters of the program claim that the growing popularity and glowing reviews of the protocol are a reflection of its success in curing ED permanently. (TRUS-guided prostate biopsy, etc.) Assesses control, frequency, minimal stimulation, distress and interpersonal difficulty [339,340].

5 mg), and papaverine (8-16 mg) plus phentolamine (0.

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However, this classification should be used with caution since most cases are actually of mixed aetiology. 4 reasons why you might want to try a prostate massage, in some cases, the erection can be established but is only temporary, and in other cases, the erection doesn’t happen at all. Infection requires removal of the prosthesis and antibiotic administration. In most cases, numerous pathophysiology pathways can be comorbid and concomitant negatively impacting on erectile function. As modern medicine continues to improve our life expectancy, incidents of men experiencing erectile problems will only continue to increase given its increasing prevalence in aging males. Call your local hospital or university medical center to see if it has a sex therapy clinic. Likewise, ED may be associated with concomitant and underlying conditions (such as, endocrine disorders and metabolic disorders - e. )It must be emphasised that post-RP, ED patients are poor responders to PDE5Is.

  • Each sexual dysfunction has its own diagnostic criteria, assessment, and treatment.
  • Vasoactive intestinal peptide (25 μg) plus phentolamine mesylate (1-2 mg Invicorp TM ), currently licensed in Scandinavia, is a combination of two active components with complementary modes of action.
  • The use of IELT alone is not sufficient to define PE, as there is significant overlap between men with and without PE [332,333].
  • Validated psychometric questionnaires, such as the International Index for Erectile Function (IIEF) [87] or its short version the Sexual Health Inventory for Men (SHIM) [88], help to assess the different sexual function domains (i.)
  • Of the 76 cited papers that met the inclusion criteria, 51 papers had level of evidence of 1a–2b, whilst 25 had level of evidence of 3–4.

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Sex therapy clinics tend to be less expensive than private therapists. Whether you’ve started experiencing ED recently or you haven’t had a successful erection for months — or even years — you may be a candidate for the groundbreaking AWT Protocol. Degenerative disc disease, muscle relaxants decrease the muscle tone and may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. Although some authors reported improved erectile function when long-term tadalafil 5 mg once daily is combined with sildenafil as needed [134], more safety analyses are required to recommend such a therapy. When clinically indicated [144], testosterone supplementation (TS) (intramuscular, oral, or transdermal) is effective, but should only be used after other endocrinological causes for testicular failure have been excluded [39,95,145]. This vasculopathy is often associated with age but strongly related to atherosclerosis, diabetes, hypertension, high cholesterol and cerebrovascular and peripheral vascular disease.

– Chapter 2 (Misconceptions) describes many misconceptions and myths about ED which typically can discourage a man with erectile issues from seeking help and exacerbate his condition. However, following guidelines recommendations will not necessarily result in the best outcome. 9% < 2% none Back pain 6. All available material can be viewed at the EAU website, which also includes a selection of translations produced by national urological associations:

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There is controversial evidence suggesting that, in patients with testosterone deficiency, TS might improve a patient’s response to a PDE5I [95,215-218]. Published data report that efficacy, in terms of erections satisfactory for intercourse, is as high as 90%, regardless of the cause of ED and satisfaction rates range between 27% and 94% [222,223]. As far as this particular natural treatment protocol is concerned scientific studies conducted at Columbia University and other Ivy League universities have established that the one cause of virtually all erection issues lies in the failure of the blood vessels in the penis relaxing fully to let the blood flow in. He started looking for a noninvasive, holistic approach to this problem many years ago in pursuit of the best option to offer his patients.

No data exists for a human population. Be anxious no more. It is a painless, nonsurgical option that delivers fast results without the risk. Erections sufficient for intercourse are achieved in 30-65. The vasoactive agent alprostadil can be administered per urethra in two different ways.

What causes erectile dysfunction? They should only be directed by specific findings from history or physical examination. Book your appointment with Wasatch Medical Clinic today! 6% in men less than eighteen years of age [ 7 ] increasing up to 42% in men more than eighteen years of age [ 8-11 ]. 2b Lifestyle modification (regular exercise and decrease in BMI) can improve erectile function. Contraindications include men with a history of hypersensitivity to alprostadil, men at risk of priapism, and men with bleeding disorders.

Instead, you are able to rise to the occasion through a painless treatment performed at our confidential clinic.

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A peak systolic blood flow > 30 cm/s, an end-diastolic velocity of < 3 cm/s and a resistance index > 0. Among others, the Massachusetts Male Aging Study (MMAS) [28] reported an overall prevalence of 52% ED in non-institutionalised men aged 40-70 years in the Boston area; specific prevalence for minimal, moderate, and complete ED was 17. This protocol works best within the context of ongoing couple therapy and sex therapy. Thanks for Sharing! Intraurethral pellets and intracavernosal (penile injectable agents) are also available if oral medications fail. Pharmacological therapies have completely changed the diagnostic and therapeutic approach to ED.

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Rhodiola rosea: There is a large counterfeit market in PDE5Is. Its efficacy is reduced after a heavy, fatty meal due to delayed absorption. Men who use nitrate medications for heart disease cannot even try ED pills, and some men have adverse reactions or simply do not want to use medication for ED. It is known for reviewing products to help solve common everyday problems and is written by a reviewer with 3 decades of experience. The efficacy of avanafil in many groups of patients with ED, including difficult-to-treat subgroups (e. )It is possible to wait too long after taking the medication before attempting sexual intercourse.

What has been shown in the research to help and what is the root cause we are working to improve? Significant improvement compared to placebo was recorded for IIEF-EF domain score, SEP2 and SEP3 in a broad range of patients with mild-to-severe ED [228]. 9% Dizziness 1. Hormonal tests include an early morning total testosterone. Most patients notice results quickly, usually after just two or three visits. 5 mg or 5 mg might be considered suitable, based on patient choice and the physician’s judgement. The evidence-based botanical herbs used in the following protocol have been associated with improved sexual function in men with ED. 4 ED is common after RP, irrespective of the surgical technique used.

Some recent reports confirm that the possibility of achieving erectile function recovery is about twice as high for RARP compared with the open RP [72]. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions - also taking personal values and preferences/individual circumstances of patients into account. Research has shown that 25-75% of men experience post-RP ED [69].

  • There are several modifications of these techniques making comparison difficult.
  • It is therefore suggested to use the terms primary organic or primary psychogenic.
  • What HRT and erectile dysfunction have in common (such as testosterone, or pituitary dysfunction) and how to properly deal with them both.

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Our staff is composed of caring professionals who are here to guide you, providing you with the safest, most effective treatment [link to: In a comparative study, alprostadil monotherapy had the lowest discontinuation rate (27. )Early use of high-dose sildenafil after RP has been suggested to be associated with preservation of smooth muscle within the corpora cavernosa [122]. ED protocol book download provides the secret to fully functional penile. The team is proud to be an exclusive local provider of our cutting-edge Acoustic Wave Therapy (AWT) Protocol, which stimulates nerve endings and opens blood vessels in the penis, enhancing sexual function and gratification. Guidelines are not mandates and do not purport to be a legal standard of care. MI = myocardial infarction; NYHA = New York Heart Association.

Premature Ejaculation

As a whole these studies suggest that LI-SWT could significantly improve the IIEF and Erection Hardness Score of mild ED patients [241]. Adverse event Sildenafil Tadalafil Vardenafil Avanafil, 200mg Headache 12. Doses of 5, 10 and 20 mg have been approved for on-demand treatment of ED. The response rate to sildenafil treatment for ED after RP in different trials has ranged from 35% to 75% among those who underwent NSRP and from 0% to 15% among those who underwent non-NSRP [67,121].

A recent study reported that only 40% of men with PEDT-diagnosed PE and 19% of men with probable PE self-reported the condition [342]. Limited data suggest that some patients might respond better to one PDE5I than to another [219]. 18 million men in the United States alone are estimated to be affected by ED, yet these figures are believed to be conservative due to the number of cases which go unreported. There has got to be a better way! ED Protocol is a digital ebook (PDF) available for purchase and immediate download directly from Jason Long’s website. Penile implants are an effective solution for patients who do not respond to more conservative therapies.

Many of these men have reported noticeable positive results within 48 hours of commencing the treatment protocol. The two currently available classes of penile implants include inflatable (2- and 3-piece) and semi-rigid devices (malleable, mechanical, soft flexible) [67,139,258-260]. However, the threshold of testosterone required to maintain an erection is low and ED is usually a symptom of more severe cases of hypogonadism [39,94-96]. Check that the medication has been properly prescribed and correctly used. Patient and partner education is an essential part of ED management [115,116]. The strength rating forms will be made available online. Intracavernous administration of vasoactive drugs was the first medical treatment for ED introduced more than twenty years ago [211,245].

Item 1 Erectile Dysfunction Protocol Book by Dr. Dan Purser MD. -Erectile Dysfunction Protocol Book by Dr. Dan Purser MD.

Erectile dysfunction significantly increases the risk of CVD, coronary heart disease, stroke, and all these cause mortality, and the increase is probably independent of conventional cardiovascular risk factors [31,32,103,104]. ED can be a sensitive subject, and it can cause embarrassment, but the condition is relatively common and can strike at any age. Complications of intracavernous alprostadil include penile pain (50% of patients reported pain only after 11% of total injections), prolonged erections (5%), priapism (1%), and fibrosis (2%) [211,245,246]. The usual stimulus for NO release is sexual stimulation, and without adequate sexual stimulation (and NO release), the medication is ineffective. Recently, an orally disintegrating tablet (ODT) of sildenafil citrate at a dosage of 50 mg has been developed mainly for the benefit of patients who have difficulty swallowing solid dosage forms. Overall, ED can improve the sensitivity of screening for asymptomatic CVD in men with diabetes [101,102]. As with other chronic diseases, we want to get ahead of the problem before it starts. The intracavernous injection test gives limited information about the vascular status.

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D sufferers can employ resources shared in the e d protocol Jason Long pdf to permanently eliminate ed forever by increasing enzymes, amino acids in the body that automatically relax blood vessels while increasing blood volume. (1), irrespective of age [167]. Adverse events are generally mild in nature (Table 6) [180,182]. The most common is mild hypotension, especially when using higher doses. Priapism may occur at all ages.

This treatment protocol involves the taking of all natural foods and supplements which have been scientifically proven to be safe and are commonly found in the human diet. 503 first byte timeout, since use of non-VA pharmacies may be unknown to VA providers, these veterans may be at a higher risk of adverse events or drug interactions. Surgical correction may be needed in patients with ED and penile abnormalities (e. )Erectile dysfunction (E. )According to the four PE subtypes proposed by Waldinger et al.

Doses of 50 mg, 100 mg, and 200 mg have been approved for on-demand treatment of ED [180]. 75 hours T1/2 2. ‘Variable PE’ is characterised by inconsistent and irregular early ejaculations, representing a normal variation in sexual performance. The first EAU Guidelines on Erectile Dysfunction were published in 2020 with subsequent updates in 2020, 2020, 2020, 2020, 2020, 2020 and 2020. Erectile dysfunction (ED) is diagnosed when a man is unable to achieve or maintain an erection, and also may include a decreased desire for sexual intercourse. As a whole, growing evidence exists that the risk of penile prosthesis infection has reduced over the decades with device improvement and surgical expertise [284]. The advice of an endocrinologist may be beneficial for managing patients with hormonal abnormalities [98]. Studies have found a substantial reduction in symptoms of ED as well as improving energy levels in men using Rhodiola three times daily.

  • In many cases, natural alternatives can be the most effective route.
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26% with placebo [125]. Have your health care provider check your hormone levels before starting; if numbers get too high this can lead to hair loss and acne. In these patients, the recommended dose is 5 mg, taken once a day at approximately the same time. Learn how lack of hormones is one of only a few erectile dysfunction causes. This is my magazine of eBook related to Health and Fitness and Relationships. The highest prevalence rate of 31% (men aged 18-59 years) was found by the USA National Health and Social Life Survey (NHSLS) study [293]. – Chapter 4 (Getting Help – Short Session Of Questions) comprehensively answers a series of common questions regarding ED providing an invaluable resource for anyone who suffers from the condition.

Dosage adjustments are not warranted based on renal function, hepatic function, age or gender [182]. (4 mg) plus alprostadil (10-20 μg), have been widely used with improved efficacy rates, although they have never been licensed for ED [253,254]. Erectile dysfunction is also a common sequela after external beam radiotherapy and brachytherapy for PCa [79-81]. 5 hours, so the window of efficacy is much longer at ~36 hours. Data suggest that almost half of patients abandon first-generation PDE5Is within one year, with no single specific factor playing a major role in PDE5Is dropout rates [214]. Also, ask your doctor if he or she can recommend a therapist. These factors may be modified either before, or at the same time as, specific therapies are used. Penile revascularization surgery has mostly fallen out of favor due to poor outcomes in most patients.

Structured psychosexual counselling may improve sexual activities and erotic functions in both patients and their partners after penile implants [274]. Gnc men's sexual health, it is a product from Leading Edge Health. In patients with favourable oncologic prognosis after RP for PCa, combination surgery for treatment of ED, with the implant of a penile prosthesis, and stress urinary incontinence (male sling or artificial urinary sphincter) is effective and durable and has an established, definitive role to address this problem [67,139,271-273]. 5% < 2% Myalgia 5.

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The recommended starting dose is 100 mg taken as needed approximately 15 to 30 minutes before sexual activity and the dosage may be adapted according to efficacy and tolerability [180,182,183]. Revision surgery is associated with decreased outcomes and may be more challenging. Vacuum erection devices may be the treatment of choice in well-informed older patients with infrequent sexual intercourse and comorbidity requiring non-invasive, drug-free management of ED [222,223,225]. Acquired curvature is mainly due to Peyronie’s disease but can also be due to the development of fibrosis following penile fracture. The amount of active drug in these medications varies enormously and it is important to check how and from which source the patient has obtained his medication. Hypotension is more likely to occur within four hours following treatment with an -blocker. The duration of interaction between organic nitrates and PDE5Is depends upon the PDE5I and nitrate used. Following bilateral NSRP, erectile function improved by 71% and 60% with 10 and 20 mg vardenafil, respectively.

Medico-legal reasons (e. )Unassisted erectile function was not improved after cessation of active therapy for nine months [128]. You submitted the following rating and review. Modification of other risk factors may also be beneficial as discussed in section 3. Various behavioural techniques have been beneficial in treating PE and are indicated for patients uncomfortable with pharmacological therapy. As a rule, ED can be treated successfully with current treatment options, but it cannot be cured. Javascript is not enabled in your browser. Other modern treatments are available, but since ED is an age-old problem, some gents prefer to try old remedies instead of new therapies.

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Questionnaires are a significant step in simplifying the methodology of PE drug studies, although further cross-cultural validation is needed [343]. Various mechanical external vacuum pump devices are helpful also in patients who are comfortable with assisted devices. Laboratory or physiological testing should be directed by specific findings from history or physical examination and is not routinely recommended [327]. An approximately 5% prevalence of acquired PE and lifelong PE in general populations is consistent with epidemiological data indicating that around 5% of the population have an ejaculation latency of less than 2 minutes [297]. 3% (lifelong PE), 3.

Accordingly, erectile dysfunction treatments often focus on manipulating testosterone levels. The aim of the third section is to provide the practicing urologist with the most recent evidence on the diagnosis and management of penile curvature in order to assist in their decision-making. – The Erectile Dysfunction Protocol is available for instant download on any computer, tablet or smartphone. Of clinical relevance, the rate of unassisted post-operative erectile function recovery is in the range between 20 and 25% in most studies; (these rates appear not to have been substantially improved or changed over the past seventeen years [70]. )However, fibrosis is more common (5-10%) when papaverine is used (depending on total dose). There have previously been two official definitions of PE, neither of which have been universally accepted: However, with this approach, the reservoir either placed blindly into the retropubic space, which can be a problem in patients with a history of major pelvic surgery (mainly radical cystectomy) or a separate incision in the abdomen is used to insert the reservoir under direct vision.

We can answer any questions you have about how we treat erectile dysfunction, so that you can fully understand that there is a solution to your current condition. Recent data suggested that response to sildenafil treatment was also dependent on polymorphism in the PDE5A gene, which encodes the principal cGMP-catalysing enzyme in the penis, regulating cGMP clearance, and it is the primary target of sildenafil [212]. Sex therapy is unlikely to work if a man drops out of treatment after only one or two sessions. Our treatment is needle free, surgery free and drug free. Daily tadalafil has also been licensed for the treatment of LUTS secondary to BPH. The science behind the Erectile Dysfunction Protocol is therefore supported by well-renowned findings from respected experts in the field.

Psychosexual therapy requires ongoing follow-up and has had variable results [159].

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A few articles without long-term data have addressed new technologies that included: How to discover YOUR particular Intracellular erectile dysfunction vitamin deficiency and How to Treat. Sexual dysfunction is a very vast area of study. The program comes with an electronic book that is very easy to comply with yet the video clips make points also a lot better. Avanafil is a highly-selective PDE5I that became commercially available in 2020 [180]. Most high-risk patients have moderate-to-severe symptomatic heart disease.


This is a valid point, but it is worth remembering that alternative natural remedies have been around much longer than modern medicine. It is administered in doses of 25, 50 and 100 mg. Practicing better sexual communication skills Sex therapy may be useful for treating erectile dysfunction if a man is able to have a normal erection during sleep, the results of his physical exam and blood tests are normal, and he is generally in good health. The team at our erectile dysfunction clinic respects the privacy of our patients. Tobacco use (this, among many others, is a big reason for men to quit!) In pre-marketing studies, after twelve weeks of treatment in a dose-response study, improved erections were reported by 67% and 81% of a general ED population taking 10 and 20 mg tadalafil, respectively, compared to 35% of men in the control placebo group [168].

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