Back pain treatment could solve erection problems

Men who experience back pain and lower spine problems could also experience problems with erections. Irwin Goldstein, M.D., medical director of Alvarado Hospital’s Sexual Medicine Program—the first hospital-based sexual medicine program in the U.S.—and editor-in-chief of The Journal of Sexual Medicine, recently discovered that treating one patient’s back pain also cured his erection problems.

The patient had experienced a car accident, and complained of leg numbness, back pain and erectile dysfunction. “After completing the initial workup, we determined the problem was the patient’s pelvic floor muscles,” Dr. Goldstein said. “We referred him to one of the hospital’s physical therapist who had advanced training in pelvic floor rehabilitation.” Treating the back pain resulted in improvement in erectile dysfunction.

Erectile dysfunction drugs may not always be needed. Back pain treatment could improve erectile dysfunction long-term. Back injuries can cause trapping of blood. Men with back pain may be experiencing blood flow difficulties in the pelvis as the cause of erection problems. According to Dr. Goldstein, pelvic muscles can become weak and spasm from back injuries, resulting in decreased sexual function from limited blood flow to the penis when muscles spasm.

Muscle energy, core and lumbar strengthening exercises to align the pelvis and relax the pelvic floor muscles, performed by Physical therapist and pelvic floor specialist Kerri Krebs, facilitated recovery. Following treatment, erectile function and leg numbness improved for the patient, who had seen several other physicians and also had been prescribed erectile dysfunction medication.

Orthopedic spine specialist Ramin Raiszadeh, M.D warns however that men with back or pelvic pain, or who experience urinary incontinence need to see a specialist as soon as possible. Erection problems can be caused by …”other medical conditions, including cardiovascular disease, diabetes, infection, inflammation and tumors can cause these symptoms as well.”

Other approaches to treat erectile dysfunction linked to back pain and injury include Yoga, acupuncture, steroid injections, or massage. Disc herniation, muscle spasm from inactivity and weakness, spinal stenosis, and traumatic back injuries can also cause erection difficulties. Keeping your back in shape, and getting treatment for back pain could lead to improved sexual function and less difficulty with erections, and should be explored after more serious causes of erectile dysfunction are ruled out. “If the sexual problem persists, the patient should see a sexual medicine specialist,” says Dr. Goldstein.

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Post-Prostatectomy Rehabilitation Improves Men’s Natural Sexual Function

Men’s Natural Sexual Function

This year doctors will diagnose nearly 219,000 men with prostate cancer. Many will undergo radical prostatectomy surgery. While radical prostatectomy provides an excellent cure, impotence (erectile dysfunction) is a common side effect. However early, postoperative penile rehabilitation can speed prostatectomy patients’ healing, achieve natural erectile function and improve their quality of life.

Studies show that even 24 months after prostate cancer treatment sexual dysfunction was the most important quality of life issue. “Increasingly doctors are finding quality of life issues important in the overall treatment of any disease, including erectile dysfunction,” said Dr. Skip Freedman, executive medical director for AllMed Healthcare Management.

Treating erectile dysfunction has changed over the last several years, and can offer men a confusing number of treatment choices. Today treatments can range from vacuum erectile devices, oral drugs and injection therapies to penile prostheses.

Working with postoperative patients, a doctor may choose either single or combined therapies based on a patient’s rehabilitation need and lifestyle. “Starting penile rehabilitation early after a prostatectomy prevents tissue damage, or fibrosis, by oxygenating the cavernosa or erectile tissue,” said Dr. Freedman.

Doctors commonly prescribe single oral therapies such as 5PDEI, or sildenafil (trade name Viagra). Studies of these drugs show early treatment with 50 to 100 milligrams a day (or every other day) improves sexual function and that higher doses produce better results. There’s also a health benefit. Using sildenafil early preserves the smooth muscles in the penis. At 100 milligrams a day, 5PDEI increases the smooth muscle content of the cavernosa. With oral therapies, patients often will accept a lower degree of sexual satisfaction.

After post-radical prostatectomy, vacuum erectile devices (VEDs) or vacuum constriction devices (VCDs) aid earlier recurring erections while preserving the penile length and girth that heightens sexual satisfaction for men and their spouses.

Injecting vaso-active substances, such as alprostadil (Prostaglandin E1, or PGE1), increases blood flow and expands blood tissue vessels. Studies on intracavernous injections of PGE1 show it can prevent long-term postoperative damage by periodically increasing oxygenation of the spongy cavernosa tissue. Intraurethral PGE1 (MUSE, or Medicated Urethral Suppository for Erections) can promote the earlier return of spontaneous erections and sexual activity.

Intracavernous PGE1 or VCDs are best used during the first postoperative months, because they allow sexual activity to begin earlier and facilitate long-term healing. However, because of the postoperative nerve damage (neuropraxia), 5PDE1 medications are rarely successful in producing erections. In time, their efficacy improves, however.

Tri-mix, or Triple P, is a combined injection therapy using varying concentrations of PGE1, phentolamine and papaverine. It allows patients to inject lower doses of each and with less pain. Early low-dose Triple P can produce more effective erections than early low-dose PGE1.

Combining oral and injection therapies, such as using oral 5PDEI and intracavernous PGE1 can increase early sexual activity and improve natural erections. The oral addition of sildenafil with the injections allows a lower dose of PGE1 and decreases the patient’s pain.

Today there are many treatment choices for men with postsurgical impotence. “Health insurers and re-insurers should consider their plan language, as well as the individual’s need to decide on the medical necessity of penile rehabilitation therapy,” said Dr. Freedman. “Insurers covering treatment for erectile dysfunction should also cover early penile rehabilitation, because after radical prostatectomy, all patients exhibit impotence.”

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Prevalence of Erectile Dysfunction and Use of ED Medications Among Teens, Young Men

Erectile dysfunction medications and youth

A new study indicates a high prevalence of erectile dysfunction (ED) and evidence of recreational use of erectile dysfunction medications (EDM) among adolescents and young men.

Researchers at Children’s Memorial Hospital and Northwestern University’s Feinberg School of Medicine conducted an anonymous survey of 234 sexually active males between the ages of 18-25 on the campuses of three national universities in Chicago. This survey � � � � � � � �” the first of its kind � � � � � � � �” found that a significant number of surveyed young men had used erectile dysfunction medications (EDM) such as Viagra� � � � � � � � � – many in conjunction with other recreational drugs, and most without consulting their physician.

Often associated with sexual dissatisfaction, decreased quality of life, depression and anxiety,� � erectile dysfunction has rarely been studied in adolescent males. This first study to gauge ED occurring with condom use (EDwC) indicates that men who have experienced ED while putting on a condom are four times more likely to use condoms inconsistently.

13%� � of the respondents reported erectile dysfunction, defined as “ever had difficulty getting or keeping an erection,” but rarely discussed this with their medical providers.� � 25% reported� � erectile dysfunction occurring with condom use. “Our exploratory study examines the prevalence and correlates of ED, EDwC and EDM use in a community-based sample of college-age males,” said Najah Musacchio, MD, fellow in General Academic Pediatrics and lead investigator. “Participants with EDwC were 4 times more likely to use condoms inconsistently, and 5 times more likely to have multiple sex partners in the last year, suggesting that EDwC may represent a barrier to safer sex and play a role in STI transmission,” said Robert Garofalo, Director of Adolescent HIV Services.

A total of 302 college-age males completed a self-administered survey. Oral consent was obtained before survey administration. Sixty-eight participants (23%) reported no anal/vaginal sex in the past year and were excluded from analysis. Participants were predominantly white (66%), ages 18-20 (64%) and heterosexual (95%). Most (83%) had one to five sexual partners in the past year and 47% reported 100% condom use for anal/vaginal sex. Six participants (3%) had a prior STI, five of whom were men who have sex with men (MSM).

6%� � of surveyed men used erectile dysfunction medications.� � 57% of participants who took EDM used them to treat erectile dysfunction; 29% used them to enhance sexual performance.� � 64% percent of� � erectile dysfunction medications users mixed EDM with alcohol or illicit drugs; 36% with multiple other drugs. “Particularly concerning is mixing Viagra� � � � � � � and other EDM with alcohol and drugs, such as ecstasy or methamphetamine,” said Musacchio. “Such drugs boost sex drive and reduce inhibitions, yet impair sexual performance.� � erectile dysfunction medication use may permit men in altered mental and physical states to engage in unsafe sexual behaviors, creating concern for unwanted pregnancy and sexually transmitted infections (STI).”

Survey participants rarely obtained their� � erectile dysfunction medication from a medical provider: most (54%) got EDM from their friends or other non-medical sources (39%) such as the Internet.

In studies with adult men who have sex with men (MSM), Viagra� � � � � � � use has similarly been associated with risky sex (increased number of sex partners, higher rates of STIs, and unprotected sex with HIV-positive partners). “Although small in number, the young MSM in our sample reported disproportionate� � erectile dysfunction medication use and STIs, possibly warranting exploration of these issues in this adolescent subpopulation,” said Musacchio.

Survey findings suggest that� � erectile dysfunction and EDwC occur with some frequency in adolescents, and that these issues are rarely discussed with medical providers. Given the association between ED and negative health outcomes such as depression and sexual dissatisfaction, medical providers should ask adolescent males about ED and counsel them on potential health risks of� � erectile dysfunction medication and substance use, they advised. Providers should specifically inquire about EDwC, stressing the importance of using condoms with all sexual encounters.

“The topic must be addressed,” Musacchio said. “Data indicates that ED and� � erectile dysfunction medications use is not uncommon in young males. It should be openly discussed in the medical community and between provider and patient � � � � � � � �” especially since it can lead to unsafe sex and other health risks.”

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Possible Link between Erectile Dysfunction Drugs and Optic Neuropathy

Erectile Dysfunction and Impotence Drug Alert

FDA is alerting healthcare practitioners about a possible association between PDE-5 inhibitors used to treat erectile dysfunction, such as Viagra, Levitra and Cialis, and a serious vision disorder. This condition, known as NAION, or non-arteritic ischemic optic neuropathy, can cause a sudden loss of eyesight by blocking blood flow to the optic nerve. This possible association is reflected in newly approved labeling for these drugs. Thus far, over 40 cases of NAION have been reported in patients using the drugs, and 26 of these patients experienced continuing or permanent vision loss.

Though the proportion of patients affected is probably very small, since NAION can produce permanent vision loss, it’s important for physicians and patients to be aware of the possible risk. Moreover, we do not know for sure that these drugs were responsible for the vision problems. It could be the drugs or it could be certain other known risk factors like diabetes, smoking, hyperlipidemia, hypertension – but in about half of the reported cases, there was a temporal relationship between taking the drug and the onset of visual symptoms, and that does raise some concern about the role of the drugs.

Practitioners should caution patients who are taking these drugs that if they experience a sudden loss of vision in one or both eyes, to immediately stop the medication and seek medical attention. Practitioners should also ask patients whether they’ve ever experienced severe loss of vision, which might indicate that they’ve had a prior episode of NAION. These patients are at increased risk of developing the condition again.

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New Drug Udenafil for Erectile Dysfunction in US Trials

A potential addition to the treatment options for erectile dysfunction (ED) is entering Phase III trials in the United States. Udenafil, a new long-acting drug under development for ED, will be evaluated in 80 sites throughout the country.

Erectile dysfunction, an inability to achieve or sustain an erection suitable for sexual intercourse, affects approximately 18 million men in the United States. Current drug treatment options for this condition now include a category of drugs called phosphodiesterase type 5 (PDE-5) inhibitors. These drugs are Cialis® (tadalafil), Levitra® (vardenafil), and Viagra® (sildenafil). Udenafil is also a PDE-5 inhibitor.

Dong-A PharmTech Co. Ltd, announced that its US partner, Warner Chilcott plc, has started two Phase III trials for the new PDE-5 drug. The randomized, double-blind, placebo-controlled trials will enroll approximately 1,120 subjects who have erectile dysfunction. Dong-A PharmTech hopes to complete these Phase III trials as well as other trials in the European Union and other major markets within two years. The pharmaceutical company also plans to initiate Phase 2b clinical trials that will evaluate the safety and efficacy of udenafil for treatment of benign prostatic hyperplasia and pulmonary arterial hypertension.

According to a clinical practice guideline issued by the American College of Physicians in an October 19, 2009 news release regarding treatment of ED, clinicians are urged to use PDE-5 drugs for men with erectile dysfunction unless they are taking nitrates.

A comparison among the different PDE-5 drugs, according to the ACP news release, indicates that “the evidence is insufficient to compare the effectiveness or adverse effects of different PDE-5 inhibitors for the treatment of ED because there were only a few head-to-head trials,” noted guideline lead author Dr. Amir Qaseem, who is also senior medical associate with the ACP.

Udenafil was approved for treatment of erectile dysfunction in Korea in November 2005 under the trade name Zydena®. The drug was also approved for marketing in Russia in July 2008. If udenafil is approved in the United States, it will compete with Cialis, Levitra, and Viagra for treatment of erectile dysfunction. According to an analysis by the American College of Physicians of 130 studies that evaluated PDE-5 inhibitors alone or in combination, treatment with the currently available drugs resulted in statistically significant and clinically relevant improvements in sexual and erectile function in men with ED, regardless of the cause (e.g., depression, diabetes, prostate cancer).

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