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ED FAQ

What causes Erectile Dysfunction (ED)?

The etiology of ED is classified into 5 main categories. When a physician is treating a patient for ED it is important to understand and ascertain the etiology, so the correct therapy can be recommended and effective. The etiologies of ED include:

1) Vascular (Arthritogenic Vs. Venous Leak)

2) Neurogenic

3) Psychogenic – depression, performance anxiety, stress

4) Endocrine – thyroid disorder, low testosterone, hyperprolactinemia

5) Medication

What medications can cause Erectile Dysfuntion (ED)?

There are a variety of medications that can interfere with a man’s ability to get an erection. An erection is a vascular phenomenon. Any medication that impedes the ability of blood vessels to expand can cause ED. Medication examples include:
1) Anti hypertensives – beta blockers, thiazide diuretics, clonidine and methyldopa
2) Anti depressants – lithium, tricyclics, phenothiazines
3) Medication that can lower testosterone levels- cimetidine, spironolactone
4) Others – Alcohol, any sedatives or sleeping agents, smoking and cannabis use

What medical conditions cause Erectile Dysfunction (ED)?

The most common medical conditions that can cause ED include: Low testosterone, renal failure, hypertension, obesity, high cholesterol, any cardiovascular condition, atherosclerosis, coronary artery disease, diabetes, liver failure, alcoholism, neurological disease and thyroid disease.

How does a physician asses for Erectile Dysfunction (ED)?

A complete work up for ED includes a complete medical evaluation. Its important for a physician to asses a patient’s (i) sexual history, (ii) frequency of sexual activity and (iii) expectations of therapy. With regard to sexual history it is important to tell your Specialists about:

1) When did the ED start? Does it happened every time or occasionally?
2) How hard (rigid) are your erections? Are they strong enough for sex?
3) Do you have difficulty sustaining erection or getting an erection?
4) Do you lose an erection when you are on your back only?
5) Are you still able to have an orgasm and ejaculation?
6) Any pain with erection?
7) What medications, interventions or therapies have you tried thus far and their success?
8) When was the last time you had sexual intercourse?
9) Do you get erections in the morning, upon waking up ?
10) Are you able to get an erection without your partner present?
11) Do you have any curvature to the penis when erect, this could be related to a condition called Peyronie’s Diease?
12) Any history of trauma or injury to the penis?
13) How strong is your sex drive, libido, and desire for sexual activity?
14) What is your relationship status?
15) Do you use protection, condoms for instance?
16) Do you lose an erection when putting on a condom?

Is it safe to take ED medication if I have a heart condition?

It is a common misconception that ED medication such as Viagra or Cialis are not safe if an underlying heart condition exists. This is not true, in fact Viagra was initially investigated to be a cardioprotective medication. Patients who have a known history of coronary artery disease (CAD) or heart failure who take an ED medication do not exhibit any worsening of their cardiac function, condition or are at increased risk of worsening hemodynamics.
Men who have a history of angina ( chest pain ) or myocardial infarction may be on a nitrate medication for chest pain. Nitrates work by causing vasodilation in the coronary (heart) vessels. If taken with an ED medication this could cause a man’s blood pressure to drop. Therefore men who take nitrates for chest pain should be advised to avoid taking such nitrates when using ED medication.
Vardenafil, brand name Staxyn or Levitra, is contraindicated in men with QT-prolongation. QT prolongation is a heart condition in which the heart takes longer than normal to recharge for the next contraction. Vardenafil may interfere with anti-arrhythmic medication patients with QT-prolongation usually take.

What is the difference between Viagra & Cialis?

There are several important differences between Viagra and Cialis.
Cialis (Tadalafil)
Can be taken with or without food
Duration of action 36 hours (last longer than Viagra)
Can be taken daily to improve spontaneity
Side effect: stuff nose, congestion
Viagra (Sildenafil)
Must be taken on an empty stomach
Duration of action 6 hours
Can only be taken for on – demand activity
Side effect: blurry vision, blue hue to vision

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