Even if a teen’s ED turns out not to stem from physical causes, “the answer isn’t go home, relax, you’re fine,” Dr. John P. Mulhall told Reuters Health.

Taking the right approach to treatment in teens is important, according to Mulhall, who’s with Memorial Sloan Kettering Cancer Center in New York City. Young men with ED may experience psychological harm that interferes with their sexual function in adulthood, and the earlier treatment is started, he added, the more effective it will be.

In the medical journal BJU International, Mulhall and his team report on 40 males ranging in age from 14 to 19 who came to one of three different specialized ED treatment centers for help. On average, the young men had been having problems for nearly two years. Most were accompanied by one or both parents.

Half of the teens reported having a decreased or absent sex drive, 30 had difficulty achieving spontaneous erection during sexual encounters, and 35 had trouble maintaining erections.

Twenty-five had ultrasound to check penile blood flow, which identified blood vessel problems in 12. The remaining 13 were considered to have psychological causes of erectile dysfunction.

The young men in the study weren’t necessarily having sex, Mulhall noted; for example, they might have simply noticed that while their friends were talking about waking up with erections, this had never happened to them.

“The common theme for most of these teenagers is they are mature,” he added. “You can imagine what a young boy, what a young man has to go through to raise this with his parents and come in and see us.”

When a physical cause of ED is diagnosed, Mulhall said, treatment is often possible, with hormone therapy, for example, if endocrine problems are identified, or vascular surgery for the few with blood vessel problems.

For young men whose ED problems are related to a bad sexual experience or loss of confidence, Mulhall said, the first line of treatment is to give them medication that will allow them to achieve erections when they have sexual relations, along with psychotherapy. Typically, he added, these young men can stop using the medication within 12 months.

Mulhall admits that the idea of treating ED in teens might be controversial to some, but he argues that doing so is crucial to a young man’s sexual and overall well-being. “There’s a real value to nipping things early in the bud so you’re not building up this chronic sense of no sexual self confidence,” he said.

“No 35-year-olds like to think of their parents having sex, nor do they like to think about their kids having sex,” Mulhall added. Nevertheless, he said, “The more open we are with these teenagers the more likely they are to make better decisions.”

SOURCE: BJU International, March 2009.

“The highest risk for coronary heart disease was in younger men,” says researcher Jennifer St. Sauver, Ph.D. The study was published in the February 2009 issue of Mayo Clinic Proceedings. The results suggest that younger men and their doctors may need to consider erectile dysfunction a harbinger of future risk of coronary heart disease — and take appropriate steps to prevent it, says Dr. St. Sauver.

“The importance of the study cannot be overstated,” writes Martin Miner, M.D., in an editorial in the same issue of Mayo Clinic Proceedings. The results “raise the possibility of a ‘window of curability,’ in which progression of cardiac disease might be slowed or halted by medical intervention,” writes Dr. Miner, who practices at the Men’s Health Center, Miriam Hospital, Providence, R.I.

Erectile dysfunction is common, and prevalence increases with age. It affects 5 to 10 percent of men at age 40. By age 70, from 40 to 60 percent of men have the condition.

Dr. St. Sauver says researchers wanted to learn more about the connections between age, cardiovascular disease and erectile dysfunction. Two previous studies, both published in 2005, laid groundwork for the Mayo Clinic study. One found that erectile dysfunction predicted an increased risk of heart disease, but the erectile dysfunction of the study participants was not assessed with an externally validated questionnaire and cardiac events were not subjected to standardized review for diagnostic accuracy [Thompson et al, JAMA, 2005]. The second predicted that future cardiovascular disease would be higher in younger men with erectile dysfunction, but wasn’t able to follow the men to determine if heart disease developed [Ponholzer et al, Eur Urol, 2005].

For the Mayo Clinic study, the investigators identified 1,402 men who lived in Olmsted County, Minn., in 1996 and did not have heart disease. Every two years for 10 years, these men were assessed for urological and sexual health.

Answers to questions from the Brief Male Sexual Function Inventory, a statistically validated questionnaire, were used to determine erectile dysfunction. The baseline prevalence of erectile dysfunction in study participants was: 2.4 percent in men aged 40-49; 5.6 percent in men aged 50-59; 17 percent in men aged 60-69 and 38.8 percent in men 70 years and older. Those initial data and the increasing incidence of erectile dysfunction over time were linked to data from a long-term study of heart disease in Olmsted County residents, led by Veronique Roger, M.D., Mayo Clinic cardiologist.

Over 10 years of follow-up, researchers found that men with erectile dysfunction were 80 percent more likely to develop coronary heart disease compared to men without erectile dysfunction. The highest risk of new heart disease was seen in the youngest study participants who had erectile dysfunction. In men 40 to 49 years old when the study began, the number of new cases in men with erectile dysfunction was more than 50-fold higher than in men without erectile dysfunction. Statistically, that’s a cumulative incidence of 48.52 per 1,000 person years in those with erectile dysfunction compared to 0.94 per 1,000 person years in those without erectile dysfunction).

In men in their 50s, 60s and 70s, the total incidence of new cases of heart disease also was higher in those with erectile dysfunction. However, the differences were not as striking as those seen among the 40- to 49-year- olds.

“In older men, erectile dysfunction may be of less prognostic importance for development of future heart disease,” says Dr. St. Sauver.

This study did not determine reasons for the increased risk of heart disease among men with erectile dysfunction. Some have theorized that erectile dysfunction and coronary artery disease may be different manifestations of the same underlying disease process. A buildup of plaque that can block arteries around the heart may plug the smaller penile arteries first, causing erectile dysfunction. Alternatively, arteries may lose elasticity over time, contributing to heart disease. This arterial stiffening may affect the smaller penile arteries first.

Other Mayo Clinic researchers were: Brant Inman, M.D.; Debra Jacobson; Michaela Mc Gree; Ajay Nehra, M.D.; Michael Lieber, M.D.; Dr. Roger; and Steven Jacobsen, M.D., Ph.D.

Cycling police officers in five areas of the US were the subjects of the study, swapping their conventional seats for the noseless designs. The 90 participants spent six months riding on the seats, with those saying they had not experienced penile numbness rising from 27% to 82% as a result. It was also reported that 97% of the participants continued to use the new seats after the study.

The main author of the study, Dr. Steven Schrader of the National Institute for Occupational Safety and Health in Cincinnati, said, “For a long time there has been this thing ‘Oh it doesn’t happen, cyclists don’t have this problem. And many men are shy about talking about the numbness or impotence, even the officers in the study.’”

Lengthy periods spent on a bike seat have often been associated with penile numbness due to the pressure exerted on blood vessels and nerves within the perineum, but there are other schools of thought on effective solutions. Training manuals stress a number of techniques to stop problems arising in the first place such as periodically standing on the pedals to relieve pressure, sloping the saddle forward and wearing padded cycling shorts.

UK retailer Cyclesense of Tadcaster have recently introduced the crescent-shaped Moonsaddle into their range of products and have reported mixed reactions from customers. Owner Dave Stainthorpe, speaking exclusively to BikeRadar, said ‘We’ve only had a few Moonsaddles returned because people didn’t get on with them, but this is the same with just about every saddle on the market – saddles are very individual things. We’ve had both positive and negative feedback.”

Tests in rats showed two erectile dysfunction drugs — Schering-Plough’s Levitra and Pfizer’s Viagra — helped carry a chemotherapy drug past the blood-brain barrier, the team at Cedars-Sinai Medical Centre in Los Angeles said.

Rats with brain tumours lived 42 days when injected with the cancer drug adriamycin. But when they also got Levitra, known generically as vardenafil, the rats survived an average of 53 days. Levitra appeared to be more effective, the researchers reported in the journal Brain Research.

Levitra and Viagra, known generically as sildenafil, are in a class of drugs known as PDE5 inhibitors. They were originally tested as heart drugs because they increase blood flow in small vessels.

“We chose adriamycin for this study because it is one of the most effective drugs against brain tumour cell lines in the laboratory but it has very little effect in animals and humans because it is unable to cross the blood-brain tumour barrier,” neurosurgeon Dr. Keith Black, who led the study, said in a statement.

“The combination of vardenafil and adriamycin resulted in longer survival and smaller tumour size,” Black said.

The blood-brain barrier is a molecular mechanism that keeps harmful agents out of the brain. Brain tumours grow little blood vessels to supply themselves with nutrients and these also have a barrier, called the blood-brain tumour barrier.

Black said the impotence drugs appear to affect the tumour blood-brain barrier but not the larger blood-brain barrier, which may help doctors use chemotherapy drugs to kill off brain tumours without damaging healthy brain tissue, he said.

MS affects both the central and the peripheral nervous system. It therefore can produce a wide range of different symptoms. Treating them can make you feel more comfortable even though it will not stop the disease from developing. Some symptoms can be managed by changing your diet, and introducing more physical exercise and other changes of habit. Medications are available for each kind of symptom. Managing your condition involves deciding whether to treat any given symptom as needed or regularly, depending on how inconvenient or painful it is. The symptoms include:

• insomnia and fatigue;
• muscle spasms, stiffness and tremors;
• constipation and frequent urination;
• pain and abnormal sensations;
• depression; and
• erectile dysfunction.

There is an emerging consensus on how to treat MS. There is evidence that long-term treatment with interferon beta and glatiramer acetate can reduce or delay disability if started early enough. It seems that permanent damage to the nervous system is caused during the first phase of the disease. Early treatment can therefore improve the quality of life for those with relapsing-remitting MS. But some people whose initial symptoms are mild prefer not to begin interferon therapy, which causes flu-like side effects, until their condition worsens.

The treatment for the associated ED covers the full spectrum of remedies. The PDE-5 inhibitors, Viagra, Cialis and Levitra have good general effectiveness but, to date, only Viagra has been through clinical tests with MS sufferers. Nevertheless, since they all work in the same way, there is every reason to suppose that all three would help those with MS. But since none of these medications affects libido and depression with MS is quite common, counselling is almost certainly necessary to help couples resume intimacy. Since testosterone deficiency is not associated with MS, it is not helpful to prescribe a testosterone supplement. You should also note that the FDA has specifically warned against the use of Yohimbe for ED without prescription. Apomorphine hydrochloride sold under the brand name Uprima is used in the USA but, after a large scale study in the UK, its use there was discontinued in 2006.

Penile injections or suppositories that are inserted into the urethra are available. You can administer them yourself or your partner can do it for you. For those with MS, there can sometimes be a slight but transient ache from the injections. The resulting erection lasts for about one hour. There are three medications used for this purpose:

• prostaglandin E1 is sold under the names Alprostadil, Muse, Caverject and Edex – this has the best outcomes with the fewest side effects and is the only medication approved by the FDA for this purpose;
• Papaverine is an opium alkaloid used as a smooth muscle relaxant but it has a greater risk of causing priapism and so has not been approved by the FDA for this purpose;
• Phentolamine sold under the brand name Regitine is a vasodilator sometimes used in conjunction with either of the two other medications to improve blood flow.

As an alternative to drug therapy, you can also try the vacuum device which is placed over the penis. When air is pumped out, blood enters the penis and causes an erection. A small band is placed to prevent the blood from draining out and the erection is safe for about 20 minutes. If you have not responded to oral or injected medication, and have found counselling of little use, you may consider a surgically-implanted prosthesis whether semi-rigid or inflatable.

There can be associated problems with stiffness in the legs which make it difficult to maintain the necessary motion or to stay comfortable. Drugs, physiotherapy and experiment with different sexual positions may help. Similar management problems can occur if bladder control is not properly maintained. Again medications are available to keep the problem under control. Other problems of maintaining concentration and inhibition control can be addressed through counselling and behavioural therapy. Otherwise, different symptoms associated with depression and physical causes can be controlled but your physician must be involved at all times to ensure a proper and safe balance between the medications and your sexual needs.

A study published in the July issue of The American Journal of Medicine found erectile dysfunction incidence was 79 cases per 1,000 in men who had reported having sexual intercourse less than once per week — dropping to 32 cases per 1,000 in men reporting intercourse once per week and falling further to 16 per 1,000 in those reporting intercourse three or more times per week.

Dr. Juha Koskimaki of Tampere University Hospital analyzed a five-year study of 989 men ages 55 to 75 from Pirkanmaa, Finland. The investigators observed that men reporting intercourse less than once per week at baseline had twice the incidence of erectile dysfunction compared with those reporting intercourse once per week.

Further, the risk of erectile dysfunction was inversely related to the frequency of intercourse.

Other factors that may affect the incidence of erectile dysfunction, such as age, body mass index and smoking, chronic medical conditions — diabetes, heart disease, hypertension, cerebrovascular disease and depression — were included in the analysis of the data.

Erectile Dysfunction is a medical term, which defines: “The repeated inability of the male partner to attain or sustain an erection firm enough to carry-on and complete a sexual intercourse.

Ageing men who don’t take part in frequent sexual intercourse with their partner gradually lose their erection capacity and rather develop the ED. And, once reaching at the ED stage they gradually get distracted from the sexual activities and then despite heartiest desire could not satisfy their partner.

The study reveals the vital result in simple terms: “More sex, less ED risk.” In other words, the risk of erectile dysfunction was inversely proportional to the frequency of sex.

The researchers observed that men not indulging in sex even at least in a week were at the double risk of developing Erectile Dysfunction than those having sexual intercourse once in a week.

And, as the sex-in-a-week surpassed ‘thrice a week’ indulging men were able to cut their erectile dysfunction risk to almost one-fourth, compared to men who had less-than-weekly sex, researchers observed.

For the study, the team of researchers led by Juha Koskimaki, MD, PhD of Tampere University Hospital, Department of Urology, Tampere, Finland, analysed 989 men aged between 55 to 75 years for five years.

At the commencement of study no men had erectile dysfunction. During the period of study, 79 cases of erectile dysfunction per 1,000 men were reported among men who had sexual intercourse less than once a week. The number further dropped to 32 cases per 1,000 among men reported having sexual intercourse once a week. Not only that, the numbers further reduced to 16 per 1,000 men who had participated in sexual activities for thrice a week.

Koskimaki says about the result, “Regular intercourse has an important role in preserving erectile function among elderly men, whereas morning erection does not exert a similar effect. Continued sexual activity decreases the incidence of erectile dysfunction in direct proportion to coital frequency.”

The study is published in the July issue of The American Journal of Medicine.

In the study, led by Dr. Juha Koskimki, from Tampere University Hospital’s Department of Urology, researchers studied 989 Finnish men aged 55 to 75 years old. They found that men who said they had sexual intercourse less than once a week had twice the risk of developing erectile dysfunction, compared to the men having sexual intercourse once a week.

According to the statistics derived, there were 79 cases of erectile dysfunction per 1,000 men in case of men who had sexual intercourse less than once a week. This number dropped to 32 cases per 1,000 among men who said they had sexual intercourse once a week, and it dropped even further, to 16 per 1,000, among men who said they had sexual intercourse three or more times a week.

In addition it was found that the development of complete erectile dysfunction could be predicted from the frequency of morning erections. In case of men with less than one morning erection a week, the risk of developing erectile dysfunction was found to be 2.5-fold greater than in the case of men who had two to three morning erections per week.

“This is the same as any other part of the body. It’s what we in vascular surgery refer to as the ‘use it or lose it’ concept,” said Dr. Hossein Sadeghi-Nejad, an associate professor of urology at UMDNJ New Jersey Medical School Hackensack University Medical Center. “Sexual activity will promote maintenance of normal erectile function down the line.”

The report was published in the July issue of The American Journal of Medicine.

In the study, led by Dr. Juha Koskimki, from Tampere University Hospital’s Department of Urology, researchers collected data on 989 Finnish men aged 55 to 75 years old.

The researchers found that men who said they had sexual intercourse less than once a week had twice the risk of developing erectile dysfunction, compared with men reporting having sexual intercourse once a week.

Among men who had sexual intercourse less than once a week, there were 79 cases of erectile dysfunction per 1,000 men. That number dropped to 32 cases per 1,000 among men who said they had sexual intercourse once a week, and it dropped even further, to 16 per 1,000, among men who said they had sexual intercourse three or more times a week, the researchers reported.

The frequency of morning erections was not associated with the incidence of moderate erectile dysfunction, the researchers noted.

However, the development of complete erectile dysfunction could be predicted from the frequency of morning erections. Among men with less than one morning erection a week, the risk of developing erectile dysfunction was 2.5-fold greater than among men who had two to three morning erections per week.

“Regular intercourse has an important role in preserving erectile function among elderly men, whereas morning erection does not exert a similar effect,” Koskimki said in a statement. “Continued sexual activity decreases the incidence of erectile dysfunction in direct proportion to coital frequency.”

Sadeghi-Nejad said there is a scientific basis for this finding, and it also has implications for rehabilitation of patients after prostate cancer treatment.

“What is very hot these days is what we can do to rehabilitate people who develop erection problems after prostate cancer surgery or radiation therapy,” Sadeghi-Nejad said. “Anything you can do to increase oxygenation in the penis will help get patients back to normal.”

If one can naturally engage in behaviors that increase blood flow to the penis, it will have a positive effect in preventing erectile dysfunction, Sadeghi-Nejad said.

Sadeghi-Nejad noted that the study only addressed intercourse, and not masturbation. “This is essentially the same concept,” Sadeghi-Nejad said. “Anything you can do to bring blood to the penis is beneficial,” he added.

New research has shown that 1 in 10 men experience erectile dysfunction (ED) and as many as 1 in 5 men suffer a loss of libido, as a result of work-related stress.

These latest figures suggest that 90% of men have shown at least one clinical feature of stress due to work but only 54% of men know that stress from work may be the cause of their ED. Stress, either at work or home, is a known cause of ED and prolonged stress is associated with low testosterone levels.

Unfortunately 44% of men would not go to their GP if they experience erection problems, and those who do go to their GP about their ED wait on average 17 months before going for a consultation. But there’s no need to delay – oral treatments for ED (PDE5 inhibitors), such as Levitra, Viagra and Cialis, have revolutionised the treatment of men with ED and are now widely prescribed as a first option for treatment.

Dr David Edwards, an Oxfordshire GP comments: “Work-place stress clearly has a strong impact on the incidence of ED in men. Men should think about the underlying cause of their ED, including how to combat their stress levels; not staying too late at work, a balanced and healthy diet, and regular exercise. We know that oral treatments usually work well for men with ED, but 1 in 3 men with ED are not able to have satisfactory sex the first time they take a tablet and consequently a third of them do not return to their doctor. These men could still be successfully treated by simply switching to a different tablet or increasing the dose, and should be encouraged to return to their GP.”

Men have recently ranked ‘high success rate with first tablet’ as one of the most desirable attributes that a treatment can have. It is important for men with ED not to give up on their treatment too soon and return to their GP to ensure that they have tried the range of treatments available.

Low testosterone levels (which may be stress-related) can cause ED and also prevent PDE5 inhibitors working properly. All men with ED should ask their GP to test their testosterone levels. If low, this can be treated successfully alongside treatments for ED.

The SortED in 10 Campaign supported the research and highlighted that erection problems are very common, affecting half of all men between the age of 40 and 70[8]. Given the range of oral treatments now available men should waste no time in asking their GP or nurse about what help is available.