A diet rich in fruits, vegetables, whole grains, and lean proteins can improve cardiovascular health, which is closely linked to erectile function. These changes not only improve erectile function but also contribute to overall health and well-being. While medical and psychological interventions can be highly effective, lifestyle modifications often play a crucial role in managing erectile dysfunction. Chronic stress can have a significant negative impact on sexual function, so learning effective stress reduction strategies can be beneficial. The psychological impact of erectile dysfunction cannot be overstated. In another meta-analysis, PAE was consistently shown to exhibit a reduced prevalence of sexual dysfunction compared to TURP, with an odds ratio of 0.24 . The study’s findings further supported the notion that PAE does not have a detrimental impact on sexual function. These investigations provide crucial insights into the sexual function outcomes for patients undergoing PAE 114,115. Over time, hyperglycemia can damage the heart, eyes, nerves, and blood vessels. Diabetes is a metabolic disease that affects insulin production and function. It also shows potential as an anti-oncogenic (anti-cancer) therapy. Therefore, central regulation/activation of the female sexual response could mark an alternative approach for treating FSD. This area of investigation has gained momentum by recent publication demonstrating that several hypothalamic nuclei are activated in rodent sexual response . Labrie and colleagues recently demonstrated that, following a 1-week treatment with Vagifem® (25 μg/pill) and Premarin® (0.625 mg; topical cream), these compounds caused an approximately fivefold increase in serum estradiol in postmenopausal women . The findings from the Woman’s Health Initiative raised concerns on estrogen replacement therapy, however the benefits of estrogen in normal function are well accepted. Additionally, Androsorb® (Novavax), a testosterone cream is in early stages of clinical trials and preliminarily has shown heightened libido in postmenopausal women . If anxiety, depression, or relationship troubles continue even after getting medical help, counseling or therapy can be helpful. Getting help from a professional is a good idea if ED harms mental health, self-esteem, or relationships. Creating a supportive space can lead to better treatment results and help both partners work together on managing ED. Learn how to create healthy personal and relationship boundaries. Whether you're struggling with outstanding debt or just want to improve your credit health, this book delivers easy-to-follow advice to get you back on track. This comprehensive guide offers practical tips on fitness, diet, and mental health for men of all ages. EMDR is now recognized as one of the most effective treatment modalities for trauma, PTSD, anxiety, depression, addiction, and beyond. In addition, chronic pain, spasticity, autonomic dysreflexia (AD), and bladder/rectal dysfunction induced by SCI can cause problems in some patients' sexual lives (57). Genital sensory disturbance (GSD) caused by spinal cord injury (SCI) has a severe impact on the patients’ sexual function but has garnered little research focus. This improvement covered four out of the five dimensions (desire/frequency, desire/interest, arousal/erection, and orgasm) and all three phases (desire, arousal, and orgasm) of sexual functioning. Generally, the incidence of TESD with moclobemide treatment does not exceed 10%, and in fact the drug can have a stimulating effect on sexual function . 1. Search Strategy and Risk-of-Bias Assessment GLP-1 agonists are pivotal in obesity care, promoting weight loss and addressing related health issues, with a focus on personalized, holistic treatment. Similar effects have been observed after combination treatment with adipose tissue-derived stem cells and platelet lysate. Importantly, studies have established a link between platelet-rich plasma therapy and nerve regeneration. This process typically includes a physical exam, a review of medical history, and blood and urine tests to check for related urinary tract infections. If the procedure isn’t effective, the implants can be removed if other treatment options are attempted. The treatment works on more than 90 percent of men with an enlarged prostate who are considered good candidates for UroLift®. The UroLift® System treatment involves the placement of an implant with a device called the UroLift® Delivery Device into the lobes of the prostate gland. Being dissatisfied with your sex life can leave you feeling lonely and frustrated. At present, sexual dysfunction in the ageing male is poorly investigated and understood, and current treatment strategies aim at improving sexual desire and erectile function with limited data on ejaculatory and orgasmic dysfunctions.So, it is important that future randomized controlled trials focus on sexual function after prostatic arterial embolization, according to the authorsThis is why a personalized approach to ED therapy is so crucial.Testosterone replacement therapy (TRT) is the only approved medical treatment that improves libido in hypogonadal men with sexual dysfunction .Severe prostatitis can cause erectile dysfunction directly.There are data suggesting that silicone-based lubricants might improve sexual satisfaction during intercourse more effectively than water-based options in a randomized controlled trial in women following treatment for breast cancer (43). In order to study the publication bias, Funnel plot, and also the Egger’s regression intercept and Begg and Mazumdar rank correlation were used. By qualitative analysis of the investigated studies, the following results were obtained. In the early screening of titles and abstracts, 2756 studies were excluded due to not being of related topics. The flowchart presented in Figure 1 shows the process of selecting studies. The funnel plots, the Begg and Mazumdar Rank Correlation (Duval and Tweedie, 2000 ▶) and Egger’s Regression Intercept (Egger et al., 1997 ▶) were used to determine the publication bias in these studies. A non-randomized study of 91 men following BNSRP investigated 56 men with MUSE therapy (three times per week for 6 months) and 35 men with no treatment.For example, clinical experience suggests that patients with a higher level of conservative beliefs related to sexual health may be more receptive to a marital device versus a vibrator.Of note, PDE5 inhibitors do not seem to significantly improve endothelial function compared to placebo both in the general population and in patients with diabetes (D’Andrea et al., 2019).But this must not lead, for ethical reasons, to the withholding from patients plausible and clinically tried and tested treatments.Many men being treated for ED also are taking medication for treatment of hypertension or lower urinary tract symptoms.In addition, the duplicate articles retrieved from different databases were removed. Desire disorders Additionally, this practice may lead to medication nonadherence and relapse in patients who fail to restart the medication.32 Finally, to optimize treatment outcomes, collaboration with the patient and shared decision making is necessary. Although patients who present with one of these symptoms often present with others,6,11 there are a few notable differences across phases. UPMC HealthBeat is the publishing website for UPMC, an integrated health care system based in Pittsburgh. The average initial IIEF-EF domain score of the 29 men who were recruited for this second study was 8.8 ± 1. The protocol consisted of two treatment sessions per week for 3 weeks, a 3-week no-treatment interval, and a second 3-week treatment period of two treatment sessions per week. Our treatment protocol was based on the described methodology used in cardiac LI-ESWT Kikuchi et al. 2010, with modifications according to the depth of the target tissue (corpora) and to anatomical differences. This section will describe techniques currently in use and the challenges that investigators face studying FSD. Therefore, the treatment of FSD as purely a lifestyle disorder may severely underestimate the seriousness of the situation. Significant improvements in overall clinical care have allowed the management of quality of life complications and not just the treatment of life-threatening diseases. Appreciating the uniqueness of each FSD facet is critical in our understanding and potential treatment of FSD in general terms. There are numerous treatment options for restoring sexual function in ED, which include medical and surgical treatments. Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors. Association of body weight with sexual function in women. Esposito K, Giugliano F, Ciotola M, De Sio M, D’Armiento M, Giugliano D. Obesity and sexual dysfunction, male and female. Diagnosing erectile dysfunction involves having a physical exam and answering questions about your medical and sexual history. However, based on pooled data from many different studies, around 3-8% of men on any dose of finasteride have issues with erectile dysfunction thought to be caused by the drug. Many studies³ have shown a link⁴ between finasteride and erectile dysfunction (ED), a condition that involves ongoing difficulties getting or maintaining an erection. About 35% to 50% of people with untreated major depression experience some type of sexual dysfunction prior to treatment. Psychedelics and sexual functioning: a mixed-methods study In studies that did not report standard deviation, we applied an estimate of pooled standard deviation of two groups. Articles that were finally included in this study were chosen based on inclusion and exclusion criteria followed by an evaluation discussion among all investigators. Two investigators (SR Shim and JH Kim) independently analyzed titles and abstracts looked at full-text articles, and then independently extracted data using a data-extraction form. Moreover, erectile dysfunction has been shown to cause the development of coronary artery disease and adverse cardiovascular events.18 However, nebivolol, a newer agent, significantly improves erectile dysfunction by increasing generation of nitric oxide.49 Owing to the smaller size of the penile vasculature, the same burden of atherosclerotic plaque and endothelial dysfunction has a greater impact on blood flow. There remain concerns, however, about the safety of l-arginine, with arguments against its use centering on the increased production of nitric oxide, which may have potentially negative effects, including diarrhea, elevated blood urea nitrogen and serum creatinine levels, flushing, and hypotension, The combined treatment demonstrated substantially increased vaginal response to the erotic stimuli compared with placebo, but subjective reports of sexual arousal did not differ among the three groups (12). Premenopausal women receiving the supplement demonstrated statistically significant improvement in level of sexual desire (72%), satisfaction with overall sex life (68%), frequency of sexual desire (60%), and frequency of intercourse (56%) compared with the women receiving placebo (p11). Restorative therapies are an exciting avenue for this work, as they utilize regenerative medicine technologies to re-establish organ function. However, the SMSNA strongly supports the development of novel erectogenic therapies, given that many men with ED either fail currently available treatments or find them unpalatable. Methods to improve recruitment include opening up study design (ie, cross over with appropriate delayed interval) and multi-institutional collaborations. Prior studies have analyzed ingredients contained within popular supplements available on various online marketplaces 7,9. Here we review the literature on the use of these ingredients and their efficacy and safety as treatments for ED. Despite these advancements, PDE5 therapy has a 50% discontinuation rate, with no single identifiable factor accounting for the drop-off. Furthermore, significant advancements in ED treatment have resulted from the development of sildenafil citrate and other phosphodiesterase type 5 (PDE5) inhibitors. The availability of these products through the internet and over the counter in local grocery stores places has a huge clinical challenge to health care. Unfortunately, as reported by patient he went home after discharged and he continued to abuse ED supplements. He was found unresponsive in his apartment by his home health aide; he had saliva drooling from the mouth, and was unresponsive to questioning from the admitting physician. This undeclared substance may interact with Nitrate, as does Sildenafil, and can cause a dangerous drop in blood pressure . This product as per FDA website has the undeclared ingredient “Sildenafil” and FDA has issued warning Patient reported he is also using “Mojo Risen” which has been shown to contain Noracetildenafil as confirmed by FDA laboratory analysis. Furthermore, sexual satisfaction also improved in proportion to the improvement in LUTS. First, the small number of patients and the relatively short-term follow-up indicate that further large-scale, prospective randomized controlled studies with long-term follow-up are needed. We also evaluated the relationship between improvements in LUTS and the amelioration of sexual satisfaction. Although 21 (35.0%) of our 60 patients had baseline erectile scores 5 in the satisfaction domain of the MSHQ. These authors also reported on the erection scores (patient group vs control group, 6.6 ± 3.5 vs 8.3 ± 2.9, respectively), ejaculation scores (13.9 ± 5.4 vs 16.9 ± 4.1), satisfaction scores (21.0 ± 5.6 vs 24.2 ± 4.5) and evaluated the discriminant validity of the MSHQ. In addition, apart from the use of taurine alone, combinations of taurine and other elements may produce better effects. For example, a previous study (57) showed that taurine (25mM) could protect ram sperm from oxidative damage when stored at a lower temperature (i.e., 4°C) for up to 72 h. Encouragingly, several studies have shown that taurine may be an effective additive to improve the quality of short-term semen preservation in vitro. The latest study found that TauT expression in the sperm of dyszoospermia is lower than normal (52), possibly inhibiting the uptake of cellular taurine and thus leading to abnormal increases in sperm production. Common substances include alprostadil, which helps increase blood flow. These treatments involve injecting medication directly into the penis. Patients should be aware of potential side effects, such as headaches or indigestion. From innovative oral medications to non-invasive options, we uncover new developments in ED treatments set to change lives. We have a physician dedicated to the treatment of male sexual dysfunction and our support staff is also specially trained in testing and patient education. Taking high doses of L-arginine helps against erectile dysfunction by boosting blood flow, some studies show. Low-intensity extracorporeal shockwave therapy improves erectile dysfunction by stimulating the formation of new blood vessels (angiogenesis). A penile implant or penile prosthesis is a device that is placed inside the penis to help men with erectile dysfunction (ED) get an erection. Waynberg J. Yohimbine vs. muira puama in the treatment of sexual dysfunction. Other prospective studies by Darson and Dixon report similar findings with no significant changes in IIEF and MSHQ-EjD scores after intervention with no de novo cases of ED reported post-procedure 65, 70. A 2015 study by Dixon et al. showed that 36 out of 65 patients required catheterization prior to discharge with a mean duration of 5.6 days and an additional 11 required catheterizations after discharge, mainly due to urinary retention . Symptomatic relief from LUTS was achieved within 2 weeks of PUL while erectile and ejaculatory functions were preserved up to 5 years after PUL. The largest prospectively collected PUL data from the LIFT study by Roehrborn et al. demonstrated no significant changes in MSHQ and IIEF scores when compared to baseline during annual follow-ups. It is involved in many important physiological processes, including immune system function, wound healing, taste, and smell. Zinc is a mineral that is essential for the proper functioning of the human body. A total of 11 randomized controlled trials (RCTs) on 337 women, 472 men, and 35 couples were included. Stay on top of latest health news from Harvard Medical School. Penis pumps and penis extenders The treatment for erectile dysfunction (ED) was revolutionized with the development of phosphodiesterase type 5 (PDE5) inhibitors. If you're ready to treat your erectile dysfunction symptoms and get your sex life back on track, take the quiz today. If you have any concerns or questions — either about taking L-arginine or about erectile dysfunction in general — your best bet will always be to speak with a health professional directly. In another study, Verit et al.35 reported exercise as an alternative treatment option for reducing menopausal symptoms such as psychological, mediational, physical, and sexual symptoms. Accordingly, the percentage of sexual dysfunctions increased as the quality of couples' relationships in these groups reduced since 100% of the cases had sexual dysfunction in a group with a very bad relationship with their spouses. Articles that investigated the sexual function and its effective factors in menopause and review of the original and review studies were considered as inclusion criteria. Furthermore, some studies proposed that employed women have a greater sexual desire than housewives, which can affect sexual satisfaction and is considered important in other studies.39,61 However, Blumel et al.52 found that housewives had a better quality of life in terms of sex than employed women, while employed women were more likely to be self-confident due to financial independence.62,63 The women with low income can have fewer sexual attraction, leading to a decrease in their sexual activities.35 Jokinen et al.64 focused on the occupation of women and sexual disorders. Graziottin and Basson,55 in their study, reported that sexual behaviors are complex and diverse and are influenced by interpersonal relationships, lifestyle and cultural conditions. In another study, increased sexual activity was observed among women with lower body mass index.50 Other factors are related to physical activity. The results confirmed that sexual function was generally various at different stages of menopause. Despite sexual dysfunction (SD) not being classified as a core symptom of MDD in the DSM-5 criteria, it frequently presents itself in MDD cases, reported most frequently as decreased libido, arousal difficulties and absent or delayed orgasms in both women and men10. In this trial, patients treated with psilocybin reported positive changes in sexual functioning after treatment, while patients treated with escitalopram did not. While sexual functioning and satisfaction are generally regarded as an important aspect of human wellbeing, sexual dysfunction is a common symptom of mental health disorders. In 2017, scientists demonstrated that a significant proportion of erectile dysfunction patients have low levels of L-arginine, which is needed to produce nitric oxide to promote blood flow. Compelling research demonstrates that certain nutrients boost levels of nitric oxide, which relaxes blood vessels and enables efficient blood flow—critical for both healthy male sexual function and overall vascular health. Melanotan II is a cyclic α-MSH peptide derivative that underwent clinical investigation for ED treatment. So far, the only drugs targeting the central nervous system that have been used for the ED treatment in men are apomorphine (see ), the α2-adrenoceptor antagonists yohimbine and delequamine 113,114,115, the α-melanocyte-stimulating hormone (α-MSH) receptor agonist melanotan II and the serotonin reuptake inhibitor trazodone 117,118. Prostaglandin E1 activates the AC/cAMP pathway, thus increasing cAMP levels, which activates protein kinase A, facilitating Ca2+ mobilization from intracellular stores and the relaxation of cavernous smooth muscles . Prostaglandins exert numerous effects on cavernous smooth muscles, depending on the type of prostaglandin. Although one study with ginkgo reported improvement in erectile function of men with SSRI-induced ED, further analysis of the study demonstrated poor methodology and no conclusions can be drawn from the results. The paucity of data examining the effects of saw palmetto on erectile function highlights the importance of undertaking further research to assess whether or not it should be included in ED-oriented nutraceuticals. Thus, further studies are needed to more definitively determine the effects of muira puama alone on erectile function. A 2015 animal study involving use of muira puama in conjunction with L-citrulline, ginger, and Paullinia cupana demonstrated improvement in age-related erectile function and NOS expression comparable to that observed with PDE5 inhibitor therapy in rat models. Fewer studies on the effects of tribulus on erectile function have been conducted in humans. If the gynecomastia is severe the dose may be reduced or an aromatase inhibitor can be used concomitantly with testosterone replacement therapy (Table 1). Crops of acne are usually related to higher serum levels of testosterone and are less common if relatively stable serum testosterone levels are maintained in the mid-adult male range. There are reports that testosterone replacement therapy increases mood, energy and vitality in hypogonadal men 33,75-77, but placebo controlled trial with well-defined patient-related outcomes are lacking in particular in older men. Small studies have demonstrated that testosterone causes coronary vasodilation, improves performance in cardiac stress tests and heart failure 71-74. While the significant weight loss requires careful confirmation, randomized controlled trials showed that testosterone replacement therapy reduced body fat mass, regional fat distribution and waist circumference in hypogonadal men with and without obesity 48,53-61. Used for fatigue and aging, And vasodilatation effect; thus, most frequently used in treatment of sexual dysfunction in Traditional Chinese Medicine (12). In studies on Mice, Tongkat Ali increases the number of times and duration of sexual performance of the animals under study (8) with testosterone levels increasing up to 440% in some animals. In conclusion, female sexual dysfunction is a common complaint in clinical practice, especially in postmenopausal women, and may have a negative impact on quality of life. In women going through the natural menopausal transition, a comprehensive, longitudinal study has found that prior function and relationship factors have a stronger impact on female sexual function than hormone concentrations (A) (39). While testosterone has been frequently prescribed to women with low sexual desire, there is no evidence of a consistent association between low testosterone levels and low libido, nor of consistent improvement in sexual problems when testosterone therapy is administered. “If your mind is focused on other concerns, it’s easy for sexual desire to wane.” Vaginal dryness can sometimes cause pain during intercourse, which can affect your sexual desire. “Low sexual desire is often multifactorial, and medications may not fix it all,” Dr. Zanotti acknowledges. Depending on the reasons for your decreased sexual interest, there are medications and other options available that may help you get your groove back. And in other cases, you can experience reduced sexual desire for no obvious reason — a condition sometimes called hypoactive sexual desire disorder. The role of dorsal-penile-vein ligation and spongiosolysis for impotence. Experience with distensible and nondistensible cylinders in 325 patients. First data analysis. Comparison with Inhibizone-impregnated AMS penile implants. Results from a hemodynamic prospective study. This health issue can have a significant impact on the quality of life and psychological health of affected individuals. SHK collected the data, performed the statistical analyses, and wrote the manuscript. BMI and hypertension were correlation with erection, the transitional zone volume of the prostate showed correlation with ejaculation and satisfaction, the total prostate volume was significantly correlated with satisfaction, and the total removed prostatic volume was related to erection and ejaculation. To remove greater volumes of the BPH nodules, much greater total energy levels are required during the operation. The total energy used was less than that used for KTP, which resulted in decreased infiltration of energy into the adjacent tissues, including the erectile nerves. Nevertheless, it should be highlighted that studies evaluating the optimal combination strategies are scarce. However, it should be noted that no exact definitions of non-responders to PDE5 inhibitors and of patients with difficult-to-treat ED exist. Nevertheless, due to the paucity of available evidence, future relevant studies are expected with great interest. Animal models have demonstrated that chronic daily PDE5 inhibitor intake may improve cavernosal endothelial function (Behr-Roussel et al., 2005; Kovanecz et al., 2008). Herbal supplements can have side effects or change how other medicines work. And being more comfortable during sex may boost your desire. Some hormone medicines that aim to relieve GSM symptoms could help make sex more comfortable. Learn more about ED, its causes, and treatment options. Depending on their ingredients, they may have dangerous side effects. In 2023, as the National Library of Medicine reported, Italian researchers studied the effectiveness of some popular over-the-counter ED products. Numerous treatments are available under a doctor’s direction. Sexual function and male cancer Overall, in the available studies, the strength of evidence for most pairwise comparisons between different dosages and formulations of PDE5 inhibitors was considered low or very low due to the lack of high-quality RCTs comparing different types of PDE5 inhibitors. In an attempt to harmonize clinical outcomes and heterogeneity, Madeira et al. (2020) recently performed a network meta-analysis including studies that assessed ED only with the IIEF-5 or IIEF–Erectile Function Domain. The diagonal grey-colored cells indicate the total number of primary studies included in each review. Scientists treated erectile dysfunction patients aged 25 to 45 with L-arginine aspartate. First, many people don’t bother to see a doctor about sexual dysfunction.15 That’s why erectile dysfunction should trigger an investigation for early indications of cardiovascular disease, such as comprehensive blood tests. Similar results are obtained with other α1-adrenergic receptor antagonists, such as phenoxybenzamine and moxisylite , but phentolamine is the only α1-adrenergic receptor antagonist used in the intracavernous therapy of ED, usually in combination with other drugs (i.e., prostaglandin E1, alprostadil and/or papaverine) (see below). The main problem with the known inhibitors of the RhoA-Rho kinase system is that this system is present in all vascular beds, and all these drugs given systemically have also potent vasorelaxing properties, which lead to a marked decrease in systemic blood pressure 102,103. This justifies, in part, the absence of arginases inhibitors in clinical practice and reveals that more studies, at least with the most active compounds, are required to determine how they inhibit the activity of the two arginases in order to identify the doses and routes of administration to be tested in vascular pathologies, including ED, as has been done with other polyphenols (resveratrol and quercetin) in cardiovascular diabetology 88,89,90. Together with the presence of arginases in the human penis , this makes arginases a realistic target for the therapy of vascular ED, as it occurs in diabetes and atherosclerosis 76,80,81. Gazzaruso C. Current opinions on the relationships between athero-thrombosis, type 2 diabetes mellitus and erectile dysfunction. Our approach with this patient differed from standard management of erectile dysfunction. The patient noted during his last follow-up visit that his erectile dysfunction “nightmare” was gone, adding, “I am so much better than I was when I came here that I hate to complain about anything.” The following case report details a patient with chronic, severe erectile dysfunction and an integrative approach that effectively corrected this pathology. Although the prevalence of erectile dysfunction increases with advancing age, it is not an inevitable consequence of aging. Sexual dysfunction In contrast, in other more recent trials no significant adverse effects on sexual function were found with metoprolol , propranolol , acebutulol and atenolol . With this review we aimed to provide a practical overview of the available literature regarding the effects of eight widely used classes of cardiovascular agents on sexual function. Sufficient knowledge about the effects of these widely used antihypertensive drugs will make it possible for cardiologists and general practitioners to spare and even improve patients’ sexual health by switching to different classes of cardiac medication. Other drug classes, however, such as angiotensin II receptor blockers (ARBs) are able to improve patients’ sexual function. Currently, oral PDE5I is the first-line treatment of ED which has the advantages of high safety and good effect. ED is a common disease in men and seriously affects the life quality of patients and their partners. In an open-label phase 1 clinical trial, 17 male patients with ED after radical prostatectomy were insensitive to PDE5I and ICI. Although many animal experiments have confirmed the effectiveness of stem cell therapy in treating ED, there are only a few clinical trials on stem cell therapy. In the current scheme of stem cell therapy, it mainly includes mesenchymal stem cell (MSC), adipose tissue-derived stem cell (ADSC), urine-derived stem cell (UDSC), and muscle-derived stem cell (MDSC) (58, 59). Plus, working out can help you feel good overall, which is great for sexual function. This can lead to better sexual function and a higher quality of life. Alcohol use can impact how well sildenafil works for erectile dysfunction. Influence of baseline diabetes mellitus prevalence on erectile function of combined therapy (testosterone and phosphodiesterase type 5 inhibitors, PDE5i) versus PDE5i alone. In a more recent meta-analysis, including 8 placebo-controlled RCT—encompassing 913 patients with a mean follow-up of 10.8 weeks—Zhu et al. concluded that the combined therapy was superior when compared to PDE5i alone in improving erectile function. Considering the relatively modest effect of TRT on erectile function, several studies have attempted to evaluate whether the combined therapy of TRT and PDE5i can result in better outcomes 38, 50, 84, 85. Hence, in our opinion, there is no doubt that T deficiency should be adequately investigated in all men presenting with sexual dysfunction. When VSS commenced 2 h after dosing, the median total duration of grade 3 or 4 erections for patients receiving sildenafil was 19.5 min (range 0–55 min), and the mean duration (±s.e. mean) was 19.4±4.1 min. The median and mean durations of grade 3 or 4 erections for the treatment groups as a whole and for the responder subsets are shown in Figure 2. One patient in Study I discontinued the study after completing treatment and was lost to follow-up. For men who need more than a single ED medication can offer, the combination of 50mg sildenafil and 22mg tadalafil in Ro Sparks presents a strong option that may provide better results for some patients who did not see enough benefit with monotherapy. Erectile dysfunction (ED) is incredibly prevalent, affecting around a third of all men in the U.S. Vacuum erection devices work by forming a vacuum around the penis, drawing in blood, and quickly forming an erection after just a few minutes. These PDE5 inhibitors (pills) work by enhancing the effects of nitric oxide, a naturally-occurring substance that relaxes blood vessels and allows for better blood flow to the penis. One study used in-situ hybridization to localize MC4R mRNA to stretch activated mechanoreceptors and sensory afferent nerves of the penis .We will discuss the various treatments and answer any questions you may have about the benefits of each option, as well as side effects.The participants in the present included studies were varied, across different forms of ED including psychogenic or organic, as well as comorbidities such as obesity, hypertension, dyslipidaemia and diabetes, which limits any comparison between studies.Couples who go through the process of infertility treatment are never evaluated for sexual dysfunctions (11), but they should be, and they should also be offered help in case of diagnosis of sexual dysfunction (35-37).Men should be counseled that ED is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment.Therefore, these novel results open a new window on a potential direct action of TZDs in the resolution of ED; however, it remains to be clarified whether these effects could improve erectile function under diabetic conditions.A retrospective study. The data on fenugreek’s utility in improving sexual function are sparse and sometimes conflicting, and no studies have been conducted specifically on its application in ED treatment. Until the body of literature on saw palmetto expands, physicians should counsel patients that further work is required to assess its mechanism of action as well as the ingredient’s influence on sexual health and erectile function. Tribulus has also been reported to increase libido and serum testosterone in rat models of sexual dysfunction. A placebo-controlled RCT conducted by Chen et al. in 50 men with ED demonstrated that 31% of men taking a daily 5 gram (g) dose of L-arginine for a 2 week period reported improved erectile function on O’Leary’s sexual function questionnaire. Medical concerns pertaining to sexual health and erectile dysfunction (ED) are often uncomfortable for men to discuss due to the personal nature of these conditions. BlueChew Free Trial Guide and How to Get $25 OFF Your First Month with Our BlueChew Coupon Code In vitro experiments (14, 17, 44, 45) reported that taurine was necessary to maintain normal physiological functions of sperm, including sperm motility, capacitation and acrosome reaction, and the mechanism was related to its antioxidant ability. For testis, previous studies have reported that the expression of CSD has been detected in the testis (30) and accessory gonads (31) such as epididymis, ductus deferens and anterior prostate of male animals. Taurine content in human semen was reported to be from 319 to 1590 μmol/L and was maintained at a 10 times higher level than in the blood (27). Additionally, further studies have found that taurine has protective effects on reproductive toxicity induced by heavy metals or some drugs (13, 18). In addition, dietary taurine deficiency in species with low taurine biosynthesis rate (such as cats and foxes) can lead to many diseases, such as retinal degeneration (5), dilated cardiomyopathy (6), immune dysfunction (7) and reproductive defects (8). Chronic alcohol abuse and cigarette smoking also adversely affect sexual potency. For increasing sexual pleasure, cantharidin (“Spanish fly”) from blister beetles, which have been used for millennia as a sexual stimulant. Enhanced sexual behavior may provide increased relationship satisfaction and self-esteem in humans. An aphrodisiac is defined as any food or drug that arouses the sexual instinct, induces veneral desire and increases pleasure and performance. Hence, the erectogenic properties of Melanotan II are not limited to cases of psychogenic erectile dysfunction; men with a variety of organic risk factors developed penile erections. Melanotan-II is a potent initiator of erections in men with psychogenic erectile dysfunction and has manageable side effects at a dose of 0.025 mg./kg.” “PT-141, a cyclic heptapeptide melanocortin analog, was evaluated following subcutaneous administration to healthy male subjects and to patients with erectile dysfunction (ED) who report an inadequate response to Viagra®. Well-designed randomized controlled trials are indicated to study further the mechanism and effects of 5ARIs on sexual function. For women with antidepressant-induced sexual dysfunction the addition of bupropion at higher doses appears to be the most promising approach studied so far. 2.4. Efficacy Given the limited body of literature evaluating this ingredient, further work is required to assess its impact on overall sexual function. Althoughzinc can improve sexual desire in rats in a dose-dependent fashion, no studies have evaluated its efficacy in the treatment of ED. Zinc, however, is commonly included in dietary supplements targeted at improving overall sexual function. Few studies have evaluated the impact of zinc supplementation on improving erectile function. PDE5 inhibitor–pretreated patients might expect avanafil to provide a similar or better benefit than other PDE5 inhibitors. Therefore, patients should be informed that an adequate trial involves ≥6 attempts with avanafil.3 The proportion of patients without any follow-up visit among the purchasers of 1 box of avanafil at visit 1 (66.7%) was higher than those among the purchasers of 2 boxes of avanafil (52.5%) and the purchasers of 3 to 6 boxes of avanafil (33.3%). McCullough et al18 reported that the cumulative probability of achieving intercourse success with sildenafil increased with the number of attempts, and reached a plateau after approximately 8 attempts. Among them, sildenafil is the first approved, safe, and effective oral drug for the treatment of ED.In a RCT comparing PUL to TURP, it was demonstrated that PUL led to a higher grade of recovery and better preservation of ejaculatory function.If you notice a dip in your interest in sex, it can feel isolating.Erectile dysfunction (ED) is a common medical disorder which decreases quality of life in men.1,2 It has been estimated that the worldwide prevalence of ED will be 322 million cases by the year 2025.When we look at bipolar TURPs or PVPs, then the durability data is more extensive, because the procedures are more well-established.Rabijewski M, Papierska L, Kozakowski J, Zgliczyński W. The high prevalence of testosterone deficiency in population of polish men over 65 years with erectile dysfunctions.PAE is a minimally invasive, radiology-based, endovascular treatment performed for LUTS secondary to BPH.Penile fibrosis or plaque and penile deformities have been reported with use of ICI.Androgens, particularly testosterone and dihydrotestosterone (DHT), are essential for normal prostate function 19,20.A meta-analysis of endogenous DHEA on cardiovascular disease risk indicates the variations in metabolic effects of DHEA and suggests inconsistency in the positive effects of DHEA on cardiovascular disease . The clinical, research and regulatory implications of this syndrome are considerable and researchers using epidemiological methods are well placed to map out the contours of the problem and perhaps pinpoint possible treatments. In particular, MM and GC conceived and/or designed the work; AF, NB, and CS acquired data, GR, GC, LV, and MM played an important role in interpreting the results; GC and MM drafted or revised the manuscript. Two different sources of data were analyzed. Augmented improvement of ED symptoms in association with PDE5i treatment Sexual health, a crucial and pivotal part of overall health, is a complex interplay of cultural, social, relational, intrapsychic, and biomedical aspects 115, 116. Assessment of Methodologic Quality Your doctor will put you on a program designed to restore normal blood flow to the penis.These studies enrolled small sample, making the conclusion less convincing.Eight of 17 men with DO who were treated with Adderall reported improved sexual experience and 6 men experienced reduced orgasmic latency time (OLT).TESD is one of the most long-lasting side effects in users of antidepressants (ADs), despite its occurrence being underestimated in technical data sheets for ADs, where the incidence is stated as 2%–16% .The NOS component applied to cohort, cross-sectional, and case-control studies aimed for evaluation.Pelvic floor exercises, also known as Kegel exercises, can have a positive impact on erectile function.However, Viasil’s components may address other factors contributing to poor erectile function. The above study documented erectogenic effects of MT-II in men with presumed normal underlying physiology. A double blind placebo-controlled crossover study by Wessells et al. demonstrated the safety and pro-erectile activity of subcutaneous MT-II in humans . The pro-erectile activity of MT-II was reported as a significant unexpected reaction during a phase-I human trial of human tanning . Its efficacy is likely driven by the increased bioavailability of NO, which may enhance erectile function. L-arginine is the only ingredient in ED-oriented nutraceuticals to reproducibly demonstrate significant improvements in erectile function across multiple human trials. Although PDE5 inhibitors are FDA approved, several factors drive men to seek alternative therapies to improve erectile function3,5. Benelli et al. reported that turnera increases copulatory behavior in sexually impotent rats, indicating the potential for its use in ED. However, without studies analyzing the efficacy of yohimbine compared with conventional PDE5 inhibitor therapy, yohimbine is not recommended as a first-line ED treatment. We used the generic inverse variance method to enable individually optimised strategy for each study. 4.3 Cluster trials Studies increasingly employ 'cluster randomisation' (such as randomisation by clinician or practice) but analysis and pooling of clustered data poses problems. Change data are more problematic and for it the rule described above does not hold. However, as it was expected that therapists would frequently also be the rater, such data were commented on with 'prone to bias'. The panel consensus is that a large study of penile arterial reconstructive surgery must be performed to determine its effectiveness. Magnetic resonance imaging (MRI) can be used to evaluate the status of a penile implant, but MRI is contraindicated in patients with ferromagnetic implants. Vacuum constriction devices are a low-cost treatment appropriate for some patients with ED. It is important to watch for priapism in patients taking intracavernous injection therapy. Nevertheless, the use of herbal medicines continues to expand rapidly across world and many people perceive usage of herbal medication as a safe and reliable way to improve health outcome. Hyperglycemia can cause numerous complications in penile tissue, and controlling diabetes is vital to prevent severe symptoms. Several medications are generally well-tolerated by diabetic patients, including Viagra (sildenafil) and Cialis (tadalafil). Metformin is generally a safe medication for diabetic patients. Rare but Serious Side Effects Hypnotherapy aims to address the underlying psychological causes of ED, such as anxiety, stress, and depression. Hypnotherapy is an approach to healing that involves deep relaxation, suggestion, and visualization. Further research with randomized controlled studies on the effect of VD supplementation seems warranted. Recently, Andrukhova et al. reported that VD receptor mutant mice are characterized by lower bioavailability of the vasodilator NO due to reduced expression of the key NO synthesizing enzyme i.e. eNOS. Interestingly, the latter study showed that VD response occurs within seconds and, for this reason, it appears that VD has a non-genomic direct effect on endothelial cells. Though success of PDE5 inhibitors in males with sexual dysfunction did stimulate interest in treating FSD, the same effectiveness of this drug class has not been found across genders. Several PDE5 inhibitors (sildenafil, vardenafil and tadalafil) are available for the treatment of erectile dysfunction. A compromised state of relaxation in this artery may play a role in female sexual dysfunction. Animal models have been used to investigate female sexual function and dysfunction over the past 20 years and several experimental approaches have been developed. However, female sexual dysfunction (FSD) is more complicated and significantly less is understood in comparison to male sexual dysfunction. One study found that 72% of men with secondary delayed orgasm were able to restore orgasm with PVS (84).When that happens it may affect your sex life.Additionally, the World Health Organization’s VigiBase database of adverse reactions to dutasteride paints an epidemiological profile similar to that of finasteride.Χ2-test (two-sided Pearson χ2-test with two degrees of freedom) was used between sexual function scores and patient parameters (age at SNM, functional diagnosis, PVR).The erectile function domain of the IIEF (IIEF-EF) contains 6 questions which the patient answers on a scale from 1 (never or almost never) to 5 (almost always or always), providing a total score of 6 to 30 points.Initially, we planned to recruit a total of 50 men in this study.If conducive conditions are not actualized, then treatment addressing the problem or difficulties may be indicated, though the criteria for a sexual dysfunction diagnosis may not be met.The mean EDITS index score was 77.22 ± 15.91, and the satisfaction rate of avanafil treatment (the proportion of patients with an EDITS index score ≥60) was as high as 87.5%. Efficacy data are derived from clinical trials, effectiveness and satisfaction data are derived from real-life scenarios, and safety data are derived from all the studies reviewed. Like other PDE-5 inhibitors, vardenafil is contraindicated in patients taking organic nitrates (eg, nitroglycerin, isosorbide mono- or dinitrate), nitrate preparations used to treat angina, amyl nitrate or amyl nitrite.21,77 This is thought to be due to a stimulation of soluble guanylate cyclase by nitric oxide, resulting in a large cGMP accumulation which in turn and through a cascade of events leads to smooth muscle relaxation, and thus to a decrease in blood pressure. The number and type of the most frequent treatment-emergent adverse events were comparable with those of other studies of PDE-5 inhibitors in these patient groups. 74,75 Most men with concomitant cardiovascular disease, including heart failure and stable arrhythmias, can be safely treated for ED with vardenafil or other PDE-5 inhibitors.76 Eardley et al’s previously described analysis,66 conducted upon data from a large pool of patients with ED and underlying conditions, showed that the use of concomitant medications did not affect the safety or tolerability of vardenafil in patients with diabetes, hypertension or dyslipidemia. Commonly reported adverse events in patients receiving vardenafil include headache, rhinitis, flushing and dyspepsia. Investigators identified three completed studies of l-arginine for erectile dysfunction male participants . There are currently no clinical trials in progress assessing the effect of l-arginine alone in male or female participants related to sexual dysfunction. Black women more often reported low sexual desire, and white women reported higher levels of sexual pain . In conclusion, the study advocates for an integrated, interdisciplinary approach to BPH treatment, emphasizing the importance of considering sexual health in therapeutic decision-making. However, emerging techniques demonstrate potential in preserving sexual function, underscoring the need for patient-centric treatment approaches. This narrative review aims to explore the impact of these surgical treatments on sexual function, a critical aspect of patient quality of life often overlooked in BPH management. Silicone lubricants are also not recommended for men struggling with erectile dysfunction, as clinical experience suggests that the slipperiness of the lubricant may inhibit the friction needed for maintenance of an erection. Before initiation of treatment, patients should be evaluated for organic causes. Psychiatric history should delve into any stressors at home or work, history of infertility, sexual abuse or trauma, repressive sexual education or religious beliefs, and history of being widowed or divorced 22, 43. Critical components of the history intake include medical, surgical, psychiatric, sexual, social, and religious history. One specific scenario that has been studied in patients with situational DO is timed intercourse for fertility treatment . Common triggers include childhood sexual abuse, sexual trauma, repressive sexual education or religious beliefs, general anxiety, and history of being widowed or divorced . It is important for clinicians to acknowledge that many patients with BPH commonly experience preoperative sexual dysfunction, including both ED and EjD . Following surgical treatment for BPH, some patients experience an unexpected yet welcome improvement in their sexual function. Addressing these psychological aspects is essential when evaluating and managing sexual dysfunction in BPH patients. Elevated estrogen levels, for instance, may interfere with the nitric oxide/cyclic guanosine monophosphate (NO/cGMP) pathway, which is essential for penile erection and can thus affect erectile function . For those ready to get started with FOLX for erectile medication, the process begins here.Average net change in serum testosterone levels of men supplemented with Eurycoma longifolia.It should be kept in mind that more than two-thirds of hypertensive patients require combination therapy of at least two drugs to reach their blood pressure goals.Early reference to its medicinal use was in 2900 BC Chinese Materia medica which believed it increased sexual energy.A recent double-blind randomised study among 1549 patients in which 400 participants received ramipril, 395 telmisartan and 381 a combination of the two, no benefits of ARBs on erectile dysfunction were proven .Penile erection predominantly depends on vascular event and according to several studies there is a strong association between ED and ASCV diseases .The following section delves into detailed findings from these studies, highlighting the long-term efficacy and safety of PUL in managing LUTS while preserving sexual health 125,126,127.Another study used adjunct bupropion on an as needed basis, with starting doses of immediate-release bupropion 75 mg taken 1 to 2 hours before sex.26 Doses were titrated based on the resolution of sexual dysfunction symptoms with the maximum dose being bupropion immediate-release 75 mg 3 times a day. Precision medicine offers a new approach to treating erectile dysfunction in 2024. This approach highlights the potential for emerging therapies for erectile dysfunction in 2024. Combination therapies offer new hope for men facing erectile dysfunction (ED). Researchers are making significant strides in treating erectile dysfunction. This advancement in medical therapies for erectile dysfunction could transform how we manage impotence. The clinical efficacy and safety profile of PDE5i has been reported by numerous high-quality, well-designed, blinded, randomized controlled trials comparing PDE5i both to placebo and to other PDE5i drugs 3,4,5,6. The following article evaluates the current standard treatment strategies as well as emerging novel and innovative therapeutic options in ED. Gene and cellular-based therapies are designed to act on the molecular level to improve specific cellular and enzymatic functions to mitigate and/or reverse underlying ED. Regenerative therapeutic strategies such as low-intensity shock wave, gene and cellular-based therapies, and penile transplants are designed to improve penile hemodynamics and revitalize the cavernosal smooth muscle to mitigate and/or reverse underlying ED. We also planned to undertake a sensitivity analysis to assess the effects of including data from trials where we used imputed values for ICC in calculating the design effect in cluster randomised trials. For the primary outcomes we would have included these studies and if there was no substantive difference when the implied randomised studies were added to those with better description of randomisation, then we would have entered all data from these studies. This often seems to be true to us and the random‐effects model takes into account differences between studies even if there is no statistically significant heterogeneity. The random‐effects method incorporates an assumption that the different studies are estimating different, yet related, intervention effects. We are aware that funnel plots may be useful in investigating reporting biases but are of limited power to detect small‐study effects. A recent issue of Sexual Medicine Reviews includes an extensive field review on post-SSRI sexual dysfunction (PSSD), a medical condition tied to stopping SSRI and SNRI antidepressants that was formally recognized in Europe in 2019. Similarly, PDE-5 inhibitors (such as sildenafil) and testosterone used for erectile dysfunction symptoms in PSSD have had limited success. If the sexual dysfunction did not start after the initiation of the antidepressant, it is unlikely to be PSSD. It is generally recommended that patient's blood pressure is to be evaluated prior to starting of dapoxetine. There is preliminary data for use of sildenafil and some of the Chinese herbs. Pharmacological treatment of premature ejaculation includes use of topical anesthetic agent, tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) (Table-22). Genital anaesthesia, loss of libido and sexual dysfunction are features of this syndrome.Results of the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) in 112 patients with follow-up visits.One highly significant finding was highlighted by a study comparing secondary and primary infertility women (19), which showed that sexual function was most seriously impaired in women with secondary infertility.However, the vast majority of health care providers did not receive sexual health training in their graduate programs (Malhotra, Khurshid, Hendricks, & Mann, 2008).In the East, many herbal tonics and preparations are used to assist the aging male improve his ability to have sexual drive or perform penetrative sex by increasing sexual stimulation, erectile, ejaculatory, orgasmic and other responses for sexual function and satisfaction.It is unclear if the sexual dysfunction that appears on treatment is continuous with PFS or distinct from it.Most men can be sexually active during treatment, but you’ll want to confirm this with your doctor.Abundant taurine existing in testis not only comes from endogenous synthesis in testis stated above, but also can be transported into testis across blood-testis barrier through its special transporters such as SLC6A6, also named as TauT (39).On the one hand, taurine can directly promote the secretion of T via acting on the Leydig cells of testis (30). Sexual health cannot be defined, understood or made operational without a broad consideration of sexuality, which underlies important behaviours and outcomes related to sexual health. In general use in many languages, the term sex is often used to mean “sexual activity”, but for technical purposes in the context of sexuality and sexual health discussions, the above definition is preferred. Sexual health-related issues are wide-ranging, and encompass sexual orientation and gender identity, sexual expression, relationships, and pleasure. The growth factors and other biologically active components of platelet-rich plasma are known to improve erectile functions through the endothelial nitric oxide synthase (eNOS) pathway.