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While many substances are touted as aphrodisiacs, the modern age of pharmacotherapy began in 1993 when the injection of papaverine, an alpha-receptor blocker that produces vasodilatation, was shown to produce erections when injected directly into the corpora cavernosa. Soon afterwards, other vasodilators, such as PGE1 and phentolamine (Regitine), were demonstrated to be effective either as single agents or in combination.
The penis is a complex organ, with nerve, muscle and vascular cells all needing to work together to achieve and maintain an erection. During an erection, smooth muscle tissue relaxes, allowing blood to flow into the penis. Endothelial cells, which line blood vessels, trigger the process by releasing nitric oxide.
To use the device:
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If unsuccessful, does not interfere with other treatments
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A number of specialized investigations exist for the evaluation of erectile dysfunction but need not be part of the routine evaluation. The penile brachial index involves measuring penile pressure and comparing it with arm pressure. It has limited clinical utility because the data are based on superficial and deep penile arterial pressure, whereas erectile function depends on the deep arteries exclusively. Duplex ultrasonography allows for refined assessment of the penile circulation. The information it provides, however, is operator dependent and rarely alters patient management. Selective pudendal arteriography combined with intracavernous injection of a vasoactive drug should be limited to the small group of patients who are candidates for penile revascularization surgery. These patients include nonsmoking men less than 40 years old with a history of pelvic trauma who have sustained a penile arterial disruption.30
Beware of commercial claims of what herbal products can do. Look for scientific-based sources of information.
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A vacuum constriction device (VCD) is an external pump with a band on it that a man with erectile dysfunction can use to get and maintain an erection.
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Psychogenic Nocturnal erections; sudden onset; history of depression; anhedonia; poor relationship with partner; anxiety; life crisis Sad or withdrawn affect; tearful; psychomotor retardation Nocturnal penile tumescence (stamp test; Snap-Gauge)
The major difference between tadalafil and the other PDE-5 inhibitors is its prolonged half-life of 17.5-21 h compared with sildenafil (4-5 h) and vardenafil (4.8-6 h). In those who respond, coitus has been recorded from 30 min to 36 h after administration.
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Before you are given any of these tests, your doctor will explain what is involved. If you have any questions, do not hesitate to ask your doctor.
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