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Erectile Dysfunction ManagementAka: Impotence Management

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  1. See Also
    1. Erectile Dysfunction (Impotence)
    2. Erectile Dysfunction Causes
  2. General Measures
    1. Psychological Support: Sex Therapy Indications
      1. Relationship Problems
      2. Performance Anxiety
      3. Situational Stress
    2. Alternative Sexual Techniques
      1. Closeness, fondling or foreplay
      2. Mutual masturbation
    3. Modifications
      1. Tobacco Cessation
      2. Reduce Alcohol intake
      3. Eliminate Medication Causes of Impotence
    4. Devices
      1. Constriction rings (for early detumescence)
      2. Vacuum Suction Device
  3. Systemic Pharmacologic Management
    1. Phosphodiesterase-5 Inhibitor
      1. Viagra (Sildenafil) 50 mg PO 1/2 hour before
      2. Levitra (vardenafil)
      3. Cialis (Tadalafil) 20 mg PO 1/2 hour before
        1. Sustained effect for 36 hours
    2. Testosterone Supplementation
    3. Apomorphine (Uprima) - new agent
    4. Yohimbine 5.4 mg PO qid
    5. Vitamin E
    6. Trazodone (Desyrel) 50 to 100 mg PO qhs
      1. May be combined with Yohimbine
      2. Priapism may occur (See Priapism Management)
    7. Apomorphine hydrochloride (Zydis) SL
      1. Experimental Central Dopamine Stimulant
      2. Nausea and Vomiting may occur
    8. Phentolamine PO
      1. Experimental Alpha Adrenergic Antagonist
  4. Local Pharmacologic Therapy: Alprostadil
    1. Intracorporal Injection (Caverject)
    2. Intraurethral Alprostadil (MUSE)
  5. Surgery
    1. Penile Prosthesis
      1. Malleable device ($10,000)
      2. Inflatable prosthesis ($25,000)
    2. Penile Revascularization

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