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What is ED?

Erectile dysfunction is the inability to get and keep an erection firm enough to enjoy sex.

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How common is ED?

ED is extremely common and affects an estimated 50 million men in the United States.  Anywhere from 10% to 30% of men between 40 to 49 years of age complain of ED while 25% to 76% of men over 70 years of age are affected. 

1) Laumann EO, West S, Glasser D, Carson C, Rosen R, Kang JH. Prevalence and correlates of erectile dysfunction by race and ethnicity among men aged 40 or older in the United States: from the Male Attitudes Regarding Sexual Health Survey. J Sex Med. 2007;4(1):57-65. 2) Rosen RC, Wing R, Schneider S, Gendrano N III. Epidemiology of erectile dysfunction: the role of medical comorbidities and lifestyle factors. Urol Clin North Am. 2005;32(4):403-417.

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What causes ED?

ED is primarily a disease of the blood vessels but can also be caused by damaged nerves.  Diseases that can cause or worsen symptoms of ED include coronary artery disease, cerebrovascular disease, peripheral artery disease, and diabetes mellitus type 1 and 2.  Hormone disorders, some neurologic disorders, smoking, illicit drug use, certain prescription drugs, and certain psychological disorders can also be the culprit. 

1) Saigal CS, Wessells H, Pace J, Schonlau M, Wilt TJ, for the Urologic Diseases in America Project. Predictors and prevalence of erectile dysfunction in a racially diverse population. Arch Intern Med. 2006;166(2):207-212. 2)Jackson G, Boon N, Eardley I, et al. Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus. Int J Clin Pract. 2010;64(7):848-857. 3) Vlachopoulos C, Terentes-Printzios D, Ioakeimidis N, et al. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circ Cardiovasc Qual Outcomes. 2013;6(1):99-109.

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How can ED be treated?

1) Heidelbaugh JJ. Management of erectile dysfunction. Am Fam Physician. 2010;81(3):305-312. 2) Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291(24):2978-2984.

Treatment of ED is best done through a combination approach that identifies the root problem and addresses it in as many scientifically validated means as are appropriate.  Some common treatments include lifestyle modification, prescription medications, platelet rich plasma (PRP) injections (sometimes referred to as P-Shot®), and low-intensity extracorporeal shockwave therapy (Li-ESWT).

If ED is caused by low libido, testosterone replacement can be an effective treatment as well.  However, testosterone does not directly affect the physiology of an erection. 

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What is the best treatment for ED?

The best treatment is the one that fixes the underlying problem.  Medication helps achieve an erection but is only as good as the existing blood vessels in the penis.  Exciting new therapies have been developed that seek to improve the health of existing blood vessels and stimulate growth of new blood vessels in the penis.  Two promising therapies include platelet rich plasma (PRP)  injections (sometimes referred to as P-Shot®), and low-intensity extracorporeal shockwave therapy (Li-ESWT). A combination of pharmacological treatment with one that improves blood vessels often provides the best results.

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Which is better? Viagra vs Cialis vs Levitra

Multiple clinical trials and systematic reviews have demonstrated that sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) have similar efficacy in promoting an erection.  The side effect profile is largely the same as well.  The difference lies in how quickly they work and how long they last, which can be used to your advantage depending on your lifestyle. 

1) Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200:633. 2) Montague DK, Jarow JP, Broderick GA, et al. The Management of Erectile Dysfunction: An Update (Reviewed and Validity Confirmed 2011). Linthicum, MD: American Urological Association; 2005.

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Why should I treat ED?

Erectile dysfunction is a sensitive and important area of men’s health to address as it often results in patient demoralization, loss of confidence, relationship problems, or sex avoidance.  Treating these issues can greatly improve self-confidence and decrease sexual anxiety or avoidance.

1) Jannini EA, Isidori AM, Aversa A, Lenzi A. Althof SE. Which is first? The controversial issue of precedence in the treatment of male sexual dysfunctions. J Sex Med. 2013;10(10):2359-2369.

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Low-intensity Extracorporeal Shockwave Therapy

Treatment of erectile dysfunction with focused shockwave therapy (Storz Duolith SD1) in st george utah
Shockwave Therapy
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PRP injections

Treatment of erectile dysfunction with focused shockwave therapy (Storz Duolith SD1) in st george utah
PRP Injections
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