Let's talk about the impact of Erectile Dysfunction on men's physical health
A broad array range of specialized diagnostic tests and procedures are available, particularly for assessing erectile dysfunction. These tests may be used to separate organically-based from purely psychogenic cases (e. g., nocturnal penile tumescence and rigidity testing) or to tailor specific treatment options (e.g., surgery).
In the majority of cases, however, the diagnostic evaluation has little impact on the selection of therapeutic options. However, before the commencement of such detailed investigations, patients with clear evidence of chronic organic disease should be evaluated and treated for their primary illness.
Those on drug therapy that is likely to be responsible for their erectile problem should have their medications changed or discontinued for a trial period while assessing for the return of potency.
Discontinuation of substance abuse before a full diagnostic workup is also required.
Estimation of hormonal levels: Patients with a history of decreased libido, diminished secondary sexual characteristics, developmental disorder, anosmia, headache, visual disturbance, and drug ingestion, or patients with physical signs consistent with hypogonadism or androgen resistance, such as abnormal secondary sexual characteristics, decreased testicular size, or abnormal testicular consistency, should have bioavailable serum testosterone and LH measured.
What is Vidalista 60 mg?
A viagra containing the important Sildenafil Citrate is liable for assisting with ED and hypertension. Both these issues are associated with unpredictable bloodstream in the vessels.
How does Vidalista 60 mg work?
Vidalista 60 mg widens the veins, which brings about a better bloodstream, an interaction known as vasodilation. Legitimate progression of blood likewise implies a lower possibility of getting a coronary illness or a stroke. Vidalista 60 mg helps in keeping an erection for as long as 4 hours.
How to administer Vidalista 60 mg?
The patient should take the pill with a glass of water 1 hour earlier.
Try not to surpass the dose past one pill in 24 hours.
Stay away from high-fat dinners.
Stay away from liquor.
Investigation of structural abnormalities of the penis;
Several techniques are available for the evaluation of the structural and functional integrity of the penile tissue. These include penile imaging, penile biopsy, and cavernosal electrical activity.
Penile imaging may help delineate Peyronie's disease and its effect on penile vascular competence, arteriovenous malformations, and lymph hemangiomas, penile ruptures, and tears of the tunica albuginea. A biopsy may be helpful in cases where corporeal fibrosis is suspected.
Single potential analysis of cavernous electrical (SPACE) activity can be measured in patients who had pelvic surgery (including prostatectomy), spinal cord injury, and long-standing insulin-dependent diabetes with presumed autonomic neuropathy, as well as smooth muscle dysfunction.
Penile tumescence monitoring: A variety of procedures are available to assess the involuntary, unconscious penile tumescence that occurs during the REM stage of sleep or the cognitively induced erection that occurs during the exposure to sensual (audio, audiovisual, or fantasy) and/or local tactile (penile vibration) sexual stimuli, which can be used to differentiate between organic and psychogenic erectile dysfunction.
Nocturnal penile tumescence (NPT) monitoring evaluates the presence or absence of the involuntary unconscious erections, which normally occur during the REM stages of sleep, during 1-3 nights. Normal nocturnal tumescence has been defined as a total night erection time greater than 90 min and an increase in penis circumference over 2 cm.
A change in circumference of 16 mm or 80% of a full erection is thought to reflect a sufficient degree of penile rigidity for vaginal intromission. A penile buckling pressure of lOOmmHg using the manual tonometer can provide a more accurate assessment of the degree of penile rigidity required for vaginal penetration than the percentage change in circumference. A buckling pressure less than 60 mm Hg is thought to be inadequate for vaginal penetration.
Formal NPT testing is performed in a sleep laboratory and includes monitoring the penile circumference and axial rigidity at or near the time of maximum tumescence, and should be reserved to investigate difficult cases, e.g., males in whom psychological factors are strongly suspected but in whom organic factors are questionable or the intake of pharmacological agents are not identified.
An electronic home device has been developed to provide continuous recording of NPT and rigidity.
Several pitfalls are associated with NPT monitoring, which limits the value of using this investigation as an initial screening test. These include
1) the paucity of NPT norms for men older than 65 yr;
2) the lack of validation by an independent method other than NPT monitoring itself for the basic assumption underlying this investigation;
3) the lack of clear objective measures to relate the quality of sleep-associated penile erections to those occurring during usual sexual activity;
4) the presence of psychological factors (e.g., anxiety, depression, or loss of sexual desire) or dreams with anxiety content may influence the occurrence of NPT;
5) the first-night effect that may occur on the first night of sleep laboratory monitoring;
6) sleep abnormalities such as apnea, periodic leg movement, and nocturnal myoclonus can adversely influence the quality of NPT recording;
7) the identification of NPT events is dependent on the arbitrary criterion of the minimum erection time required for an erection episode; and
8) the formal sleep laboratory testing is very costly and involves waking the patient when he has 80% of a full erection to measure the buckling pressure of the penis.
Vascular investigations: Patients suspected of having vascular lesions, based on history, physical signs, and those with abnormal tumescence monitoring, may undergo a more detailed vascular evaluation of the penile vasculature to determine whether a surgically correctable factor underlies the dysfunction.
Tests, which can directly evaluate the penile inflow and outflow vasculatures, include pharmaco-penile duplex ultrasound (PPDU), penile angiography, radionuclide scintigraphy, and measurement of cavernous oxygen tension.
Neurological investigations: As we know that sexual functioning is controlled by autonomic nervous systems several neurological assessments have been developed to assess the role of autonomic disorders in the development of sexual dysfunction.
These include biothesiometry (assesses vibration perception threshold), dorsal nerve conduction velocity, bulbocavernosus reflex (sacral reflex arc) latency, Pudendal nerve somatosensory-evoked potential, and Perineal electromyography.
Pudendal nerve somatosensory (genitocerebral)-evoked potential test allows the evaluation of the peripheral and suprasacral afferent pathways by stimulating the pudendal nerve at the penis. The evoked waveforms are recorded at various sites within the CNS, but most typically over the conus medullaris and parietal cortex.
Patients with sacral lesions (distal to the sacral recording electrodes) caused by multiple sclerosis, spinal cord trauma, or tumor may demonstrate prolonged peripheral and total conduction times. However, patients with lesions (cephalic to recording electrodes) caused by transverse myelitis, cervical disc disease, tumor, or trauma may have prolonged total conduction time and central conduction time, but normal peripheral conduction time.