Sexual Health for Men (cont.)

The reason priapism is serious is any erection lasting more than two hours can create permanent scarring of the erectile tissue, making future potency difficult or impossible. And as the drug companies suggest, if an erection should last more than four hours, emergency contact to an urologist or emergency room should be initiated for prompt treatment. When treatment is offered quickly, potency can be restored with minimal loss.

Treatment begins with taking vasoconstrictors, such as pseudoephedrine, found in the over-the- counter medication Sudafed, also application of ice to the penis to help the blood vessels constrict. If these maneuvers are unsuccessful, then a doctor will inject a very small amount of a vasoconstrictor into the penis, such as epinephrine. Rarely, if these maneuvers are ineffective, the physician will withdraw a small amount of blood from the penis to initiate detumescence.

"The reason priapism is serious is any erection lasting more than two hours can create permanent scarring of the erectile tissue, making future potency difficult or impossible."

MODERATOR:
Who is a good candidate for these medications? And who should avoid them?

BURROWS:
The list to avoid is easier than who is a good candidate. Men who should avoid these medications are:

  • Men who are on nitrates, such as nitroglycerine, Indur or Nitropaste. The interaction of the PDV family with nitroglycerine can trigger a drop in blood pressure which can be life threatening.
  • Men with severe coronary artery disease who cannot tolerate exercise should be counseled by a cardiologist if they can tolerate exercise stress.
  • Men with a rare condition called Retinitis Pigmentosa should never take this class of medications.

This leaves the vast majority of men, who may have diabetes, hypertension or surgeries, who would be excellent candidates for this class of medications.

MEMBER QUESTION:
My question regards Uprima, an ED drug available in Europe. Is there any chance it will soon be approved here?

BURROWS:
Uprima, also known as apomorphine, was tested recently in this country and was felt to cause a high incidence of blood pressure drop. It doesn't appear to have a release date any time soon in this country due to this side effect. This medication works very differently than the PDV medications in that it stimulates central receptors, that is, the man's brain, to improve potency.

MEMBER QUESTION:
Are there alternatives to these drugs which are just as or almost as effective?

BURROWS:
The most important change a man can do to improve loss of sexual function is to quit smoking and to increase exercise. In addition, management of other medical problems, such as hypertension, diabetes, elevated cholesterol, can all improve a man's potency without requiring more medication. Supplements do not appear to help or hurt.

"Libido and erectile dysfunction are often confused. Some men have no trouble obtaining erection but have no desire to engage in sexual activity."

MEMBER QUESTION:
What is the best remedy for premature ejaculation?

BURROWS:
Premature ejaculation is currently where ED was ten years ago, and that is, it is not talked about commonly, but there are an enormous amount of men who suffer from this. There are no FDA-approved medications to treat this, but several physicians are trying medications off label in combination with Viagra, Levitra or Cialis with good results. Some of the drug companies are working on combination medicines that will hopefully have FDA approval shortly.

MEMBER QUESTION:
Are there any medications or treatments to increase libido?

BURROWS:
Libido and erectile dysfunction are often confused. Some men have no trouble obtaining erection but have no desire to engage in sexual activity. These men should have their blood levels tested for testosterone and if this is found to be low, have the option of receiving testosterone replacement therapy. The most common reasons for a man's testosterone to decrease are medications and age greater than 60. Supplements such as DEHA do not appear to improve libido significantly.

MEMBER QUESTION:
I have been married for 4 years and had a baby about 5 months ago. Since then, and while I was pregnant, my husband refuses to have intercourse or anything sexual for that matter. It's been 10 months and he will not talk about it. What he does say is that having the baby "messed with him", and he thinks it will get better. I have tried talking to him a million times in non-accusatory ways. Everything else in our relationship is great and he adores our baby. I don't know what else to do. I've tried everything. I wish I knew what he was thinking.



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