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  • Erectile Dysfunction: Canadian Health and Care Mall

    Erectile Dysfunction fears dispelled. Alan Reynolds MD on the line

    dr Alan Reynolds

    Erectile dysfunction is a nightmare millions of men have a dread of. Losing the natural sexual power is something no man can painlessly accept regardless of his age. But it seems that modern medicine offers an impressive arsenal of tools for overcoming the unwanted problems, which means the terrifying halo should have been eliminated… But it is still there. So we’ve asked Alan Reynolds MD, Toronto General Hospital andrologist with 15 years of experience under the belt, to share his point of view and shed light on ED misconceptions and myths.

    With all the delicacy of ED problems, the statistics say the treatment success is exceeding 82%. So why is there so much fear and panic around ED?

    For many men erectile dysfunction, first and foremost, is a psychological problem, because they can not pull the trigger and seek professional medical attention. The initial signs of ED are neglected or, conversely, cause strong emotional excitement even further aggravating the condition. For some reason even the most cost-efficient capabilities of modern medicine are ignored by the wider audience. At the same time our methods are truly numerous, and the chances to restore sexual function even in seemingly hopeless cases are quite good.

    Are things that bad with understanding basic things?

    Of course, erectile dysfunction is a complicated phenomenon. And definitely, neither Viagra nor high concentration Cialis can be a silver bullet for all the cases. This way or the other, what is really tough to comprehend is the tendency to ignore the proven facts and largely available basic information. A large number of ED cases could have even been avoided. But in reality we have millions of males convinced that the prevalence of erectile dysfunction is directly related to the aging process. A huge number of people still believes ED problems are inevitable…

    So the attitude is the main stumbling block?

    Well, of course, a psychological factor is there, but again, it sounds like a poor excuse. You know how your body reacts to flu, you can even recollect the events preceding the illness, like walking in the heavy rain without umbrella, find reasonable explanations and make smart decisions. Why are things around erectile dysfunction should be different? In either event, the problem will remain and the only reasonable way to get rid of it is starting dealing with it. The quickest way towards a healthy body is to educate yourself – the opportunities are numerous: from webmd to online pharmacy live assistance; the web offers anonymity and quick access to HQ info whenever you need it.

    Perhaps, the problem is not that widely spread and the scope is not that striking against the background of the global statistics?

    The scope is huge indeed. The WHO claims 10% of the global male population suffer from ED. According to the latest researches conducted by pharmaceutical and research organizations like NIMH or International Journal of Impotence, the average prevalence of impotence in men over 40 years is estimated at 52%; 17.2% of which have mild, 25.2% – moderate and 9.6% – severe erectile dysfunction. Yes, the researchers do underline a more rapid development of ED with age, so while males in their 40 years suffer from ED problems in 40% of cases, those in their 70’s are way more subjected to ED risks and the mark of 67%. However, considering aging separately is a road to nowhere as there are numerous aspects that influence male’s health throughout life.

    For example, Big Pharma companies (Pfizer, Eli Lilly, etc.) have concluded that ED affects about 15 million men in the United States, in Europe this number is exceeding 31 million, in Germany – up to 6 million. However, in 70% of cases, as a rule, violation of potency in men remains undiagnosed, and only as little as 12% are assigned to the treatment. As for the scope… well, in 2014, given the data above, the scope of the problem in the US alone is comparable with cancer – 14.5 million registered cases.

    But how do we know these numbers are even close to the actual state of affairs?

    Big pharma guys know this market and invest huge resources in studies, information and statistics defines the demand/supply. But definitely, there can be no confidence in the laser precision of statistics. However, the problem hasn’t emerged the other day – throughout years we’ve accumulated huge volumes of data and we can be sure about the tendencies and at least approximate numbers.

    Thus, the first data on the global prevalence of ED was obtained almost twenty years ago – in 1994 with the studies by Massachusetts urologists performed in North and South America, Europe and Asia. At that time, the prevalence of erectile dysfunction in males, regardless of age ranged from 15 to 50% or more, and a repeated investigation in 2000 showed index value equal to 44%, now it equals 42%.

    So the problem is big and the level of understanding is very poor. How do we change the game?

    Doubtlessly, education on the problem is the key. And the first step is obvious.

    Finding the root of the problem?

    Exactly. Understanding the true reasons standing behind premature ejaculation or sexual fatigue is absolutely crucial, as these manifestations don’t pop out on their own. Erectile dysfunction can be caused by psychogenic and organic factors. Looking ahead, should say organic factors do not necessarily stand for irreversible violations. Selfsame, psychogenic erectile dysfunction is not that widely spread as organic ED. It is caused by various psychological disorders that, frankly speaking, can result into severe forms.

    So does it mean organic causes are the main driver of ED problems?

    I don’t say psychological nature of the problem is something that can be ignore. Indeed, the risks of ED problems emergence associated with depression are very high. However, statistically, if a person is suffering from ED issues, the odds these issues are caused by psychological factors are not very good. It’s a complex phenomenon with dozens of interdependencies.

    So what do we mean by organic factors:

    - Endocrine disorders (disturbance of the level of sex hormones (hypogonadism), diabetes, thyroid disorders, etc.).
    – Cardiovascular system problems. The basis of vascular erectile dysfunction may lie in such factors as arterial insufficiency and disorders of the penis venous drainage of the penis (IF).

    - Birth defects of the arteries of the penis.
    – Atherosclerotic aorta.
    – Elevated cholesterol levels (hypercholesterolemia).
    – Obesity.
    – Smoking.
    – Hypertonic disease.
    – Perineal trauma, post-traumatic impaired patency of the pelvic arteries.

    And here’s another group of organic factors that mostly includes organic changes of the penis (‘cavernous’ erectile dysfunction).

    - Peyronie’s disease.
    – Injuries.
    – Priapism.
    – Intracavernous injection – the introduction of drugs in the cavernous body of the drive.
    – Neurological disorders (caused by neurological diseases sphere, such as diabetes, as well as the effects of surgeries on the rectum, prostate, bladder).
    – Long-term medical treatment courses. By common drugs negatively affect sexual function include antidepressants, tranquilizers, psychotropic, antihypertensive drugs and etc..

    So can we say mentioned above is a comprehensive list of diseases?

    Well, not exactly, as again, erectile dysfunction problems can be caused by a complex of problems. Moreover, in most cases, ED has a mixed nature, since organic nature of the problems may provoke psychogenic disorders, and vice versa, psychological pathologies tend to cause various changes in physiological aspects (e.g. depression provoke the development of androgen deficiency) and so on.

    Do we have any numbers that estimate the risks associated with this or that aspect?

    Yes, according to National Center for Biotechnology Information data the main risk factors for ED development are the following: diabetes – 55%, ischemic diseases – 39%, cardiovascular system diseases – 60%, smoking – 56%, hypertension – 15%, abnormal levels of cholesterol – 25%. Depression is heading the list – 90%.

    90% for depression is a truly unexpected result. What stands behind it?

    In most cases, psychogenic erectile dysfunction is caused by the suppression of the central mechanism of erection. The main conditions leading to the development of erectile dysfunction include: neuroses, situational characteristics and dependence on psychotropic substances. The main predisposing factor of ED is considered to be neurosis, which can cause not only functional, but also organic dysfunction.

    Fear of sexual contact with a woman creates a nonexistent disease, suppresses psychological state, closing the vicious circle in the development of neurosis, which no longer represents the cause, but becomes the result of invented phobia. Once failing, men tend to fix their attention, losing confidence and mistakenly believing that these failures will haunt him constantly. That’s the reason for particularly severe violations observed in young men – the result of the first unsuccessful sexual intercourses.

    Mental disorders in the young age can lead to further inability to maintain erection until the end of sexual intercourse and to the emergence of premature ejaculation. And of course, it does not occur because of a defect in the sexual function of men, but the result of elemental obsession with individual case. As a rule, it is all about evolving nervousness and irritability, leading to persistent potency disorders.

    That seems to be easier than many imagine…

    Yes. It’s a matter of a very basic self-analysis. Psychological ED problems characterize characterizes the spiritual status of man; they are associated with emotions such as jealousy, shame, indecisiveness, hatred, shyness, anxiety, anger, fear and panic fear of being insolvent sexually. This latter provision is the leading cause of erectile function disorders.

    Psychological ED issues develop in men also impose excessive demands to themselves, comparing their sexual activity with a quantitative indicator (the number of sexual acts per week, day). This attitude raises uncertainty and nervousness, which, undoubtedly, will leads to a failure some day, the repetition of which consolidates confidence in the presence of an imaginary problem.

    A frequent impediment to the accomplishment of normal sexual intercourse is the emotional stress caused by the complexes and low self-esteem of men. Thus, psychic impotence serves a consequence of dissatisfaction with their appearance: weight, body type, individual features of the structure of the genital organs (length and thickness of the penis during erection) scars on the body and genital area. The cause of emotional stress can become pathological idealization of the partner: some people doubt they are worthy of very attractive women… the problems are numerous, but their nature is quite the same.

    Now when we know the sources of the problems, what are the best ways to treat them?

    Until we are not talking about severe violations of male genitalia (inherent ones or caused by traumas) and not considering the invasive treatment methods (practiced in up to 10% of ED cases) the first therapeutic choice is PDE-5 inhibitors. By the first choice we mean that 8 out of 10 specialists in the US will prescribe Viagra and Cialis within the treatment course in some 8 cases out of 10. Initially, pharmacotherapy mainly included tranquilizers and homeopathic medicines, the effect of which was based mainly on placebo effect.

    Since the beginning of 2000’s the state of affairs has changed with the mass production of PDE5 inhibitors. These medications demonstrate considerable efficiency regardless of the nature of the disease; although their effect in case of vascular nature of the violations is the most prominent.

    Talking about treatment of psychogenic erectile dysfunction, yes, ideally it combines psychotherapy and pharmacotherapy. Psychotherapy is required as fear of failure can reduce the effect of even such effective means or another dependence may emerge, basing on the fear that having full sexual intercourse is impossible without PDE-5 pills. But in many cases psychogenic erectile dysfunction receding before the power of inhibitors.

    How do these preparations managed to gain such impressive popularity?

    The popularity is the merit of their efficiency. This is how they work. The impulses along the nerves in the excitation of the men sent from the brain to the penis. The bearer of nerve signals are chemical substances that are excreted and straightening the penis. In the normal state tightened muscles do not allow blood flow to the penis. And naturally, relaxing these contributes to more blood flowing to the genitals, which leads to its swelling – erection.

    The process of relaxation of muscles is the prerogative of enzyme called phosphodiesterase type 5. It blocks the development of chemicals that tighten the muscles. When this enzyme is blocked the main share of the chemicals involved in the erection is not destroyed and doesn’t allow muscles tightening; as a result, the required volume of blood flows into the penis, ensuring longer, firm erection.

    What about their efficacy?

    Well, let’s consider the pioneer, sildenafil citrate, the first PDE-5 inhibitor better known as Viagra (the core active ingredient). During the clinical trials initiated by Pfizer to get the approval, 20 million of males in the US and Europe were treated with it during long 6 years. The efficacy (by efficacy a firm erection sufficient to conduct a full sexual intercourse is meant) after taking the drug has exceeded 82% of cases in general.

    In studies conducted during 24 weeks by NIH, the improvements were observed in 56%, 77% and 84% of males taking 25, 50 and 100 mg of sildenafil citrate. Viagra statistically enhanced sexual function in most patients against the background of placebo (demonstrated as low as 23% success efficiency); and the bigger the dosage, the more prominent the effect is. 66.6% of males with diabetes, admitted the erection enhanced and 63% of them were able to have successful intercourse, against the background of 25.6% and 31% of men on placebo.

    Tadalafil is even more powerful…

    Do you mean Cialis?

    Yes, it’s active ingredient. Tadalafil onset of action is observed within approximately 30 minutes after intake, and its peak is developed after 2 hours. The effect lasts for up to 36 hours; unlike Viagra it doesn’t depend on food intakes. The recommended starting dosages should not exceed 10mg.

    The 12-week clinical trial revealed that 68% and 80% of men on Cialis have managed to improve their sexual function with 10 and 20mg of preparation accordingly; and the impressive results were later confirmed in post-marketing researches. In diabetes control group 64% of patients reported significant enhancements in erection quality; while 54% of post radical prostatectomy patients reported noteworthy positive impact of the drug.

    For how long can one take PDE-5 inhibitors?

    According to the comprehensive research of Multicenter study group, the long-term treatment trial (4+ years) didn’t reveal the obvious reasons why you shouldn’t take the preparations on a constant basis. But this is where the risk of psychological dependence may emerge. This way or the other, the long-term researches are not many, so I recommend discussing any treatment course exceeding 3 months with the doctor.

    Let’s consider the dark side of pharmaceuticals – shortcomings side effects…

    All three drugs have a relatively short list of side effects. The most commonly side effects are: redness of the skin on the face, dizziness, headache and runny nose; observed in less than 10% of cases.

    Taking into account individual characteristics of human body is also essential: thus, the action of Viagra is not guaranteed in all the cases, the timeframe for onset of action may vary. The list of contraindications includes plenty of items, especially for those having problems with cardiovascular system. Therefore, self-treatment is not the desirable case – you should consult a doctor before initiating a treatment course.

    But what about prices? It is believed Viagra-like solutions are hardly accessible.

    Indeed, the original preparations will cost you $100-$120 per pack. But you can always drop in at some online pharmacy and shop for generic Cialis or Viagra online – the non-branded medications that utilise the identical formula and mostly produced in India and South-Eastern countries.

    Don’t you think that with the risks associated with fraud and scam people are not likely to buy drugs online?

    The choice is always there. If you do have money – you can buy original medications at a drugstore around the corner. If you are looking to cut off your expenses you can make a choice in favour of generics. An average Canadian Pharmacy Viagra drugstore will hardly sell you a counterfeit product. It’s just a matter of making the right choice: you will have to invest some time into figuring out whether you are buying from a decent seller.

    What aspects should one pay close attention to? Will you recommend some options?

    If you publish it’s for non-advertising reasons – no problem (smiling). I recommend buying ED pills like Canadian Viagra and Cialis from Canadian Health and Care Mall (www.canadianhealthcaremalll.com), as these options meet the most essential criteria of an online drugstore. A refund program, rich selection, quality guarantee and fast shipping. I’m not going to advertise advantages not related to drugs themselves. When considering this or that drugstore, you should definitely check the payment methods availability, get in touch with customer care team to see whether it is a working company. Reading reviews and, perhaps, even placing a small test order will be extremely helpful.