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What Should I Do If I am Having Problems Achieving/Maintaining an Erection? How is premature ejaculation treated? GORDON F. GREEN, CDR, MC, USNR To help diagnose the cause of the problem, your doctor will ask medical history questions such as: However, because people with diabetes also tend to have problems with their heart, these medications may not be appropriate and cause dangerous interactions with your heart medicine. Talk to your doctor to determine what treatment is best. Victim of abuse (in any form) Patients who express a loss of libido, depression, or any signs of diminished secondary sexual characteristics should have an endocrine evaluation that consists of at least measuring morning serum testosterone levels. The relative merits of measuring total, free, and bioavailable testosterone levels and serum hormone–binding globulin are controversial. At this time, measuring total and free testosterone levels is recommended and should be performed when screening for hypogonadism. These hormone levels are generally higher in the morning than later in the day; therefore, a morning level should be checked whenever possible. Free or bioavailable testosterone is an important component because this is the testosterone that is usable. That portion attached to other proteins, the serum hormone–binding globulins, store testosterone. Learn to use stress management techniques and coping mechanisms, such as deep breathing or guided imagery. Thompson and his colleagues provided the first substantial evidence linking erectile dysfunction and subsequent risk for heart disease in a December 2005 report in the Journal of the American Medical Association. Yet the connection is not as well recognized among doctors and patients as cardiologists and urologists think it should be. With the introduction of effective pharmacologic therapies for erectile dysfunction, more men are seeking treatment. The underlying cause of erectile dysfunction is usually a chronic medical illness or a side effect of certain drugs. Less commonly, the problem is psychogenic. Even after optimal treatment of common medical disorders such as diabetes mellitus and hypertension, erectile dysfunction may persist. Pharmacologic treatments, such as the intracavernosal or transurethral administration of alprostadil or the use of the new oral medication sildenafil, may offer patients substantial benefit. Before any of these drugs are prescribed, consideration should be given to existing medical illnesses and medications, partner satisfaction, comfort with the method of administration and the side effect profile. (Am Fam Physician 1999;60:1159-72.) Make time to be alone together: Try taking a bath together, sharing a candlelight dinner, taking a walk, or just holding each other in bed. Erectile Dysfunction and High Blood Pressure Permanently alters or may injure erection bodies Patches now available No reports on long-term use During a period of four years, 123 men had a heart attack, died from heart disease, experienced chest pain due to clogged arteries, or were in need of a heart bypass or cardiac catheterisation. The men with erectile dysfunction were twice as likely to end up in the group who had heart problems than those who did not have sexual problems. viagra sale

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