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Proprietary Ayurvedic Medicine, Extreme Herbal Aphrodisiac formula for men and women
 
Indications - Erectile & Ejaculatory Dysfunction
 
What is erectile dysfunction?

Erectile dysfunction (ED), also known as impotence, is the inability to achieve or sustain an erection for satisfactory sexual activity. Erectile dysfunction is different from other conditions that interfere with male sexual intercourse, such as lack of sexual desire (decreased libido) and problems with ejaculation and orgasm (ejaculatory dysfunction). This article focuses on the evaluation and treatment of erectile dysfunction.

How common is erectile dysfunction?

Erectile dysfunction (ED, impotence) varies in severity; some men have a total inability to achieve an erection, others have an inconsistent ability to achieve an erection, and still others can sustain only brief erections. The variations in severity of erectile dysfunction make estimating its frequency difficult. Many men also are reluctant to discuss erectile dysfunction with their doctors due to embarrassment, and thus the condition is underdiagnosed. Nevertheless, experts have estimated that erectile dysfunction affects 30 million men in the United States.

While erectile dysfunction can occur at any age, it is uncommon among young men and more common in the elderly. By age 45, most men have experienced erectile dysfunction at least some of the time. According to the Massachusetts Male Aging Study, complete impotence increases from 5% among men 40 years of age to 15% among men 70 years and older. Population studies conducted in the Netherlands found that some degree of erectile dysfunction occurred in 20% of men between ages 50-54, and in 50% of men between ages 70-78. In 1999, the National Ambulatory Medical Care Survey counted 1,520,000 doctor-office visits for erectile dysfunction. Other studies have noted that approximately 35% of men 40-70 years of age suffer from moderate to severe ED, and an additional 15% may have milder forms.

What are some of the risk factors for erectile dysfunction?

The common risk factors for ED include the following:

  • Advanced age
  • Cardiovascular disease
  • Diabetes mellitus
  • High cholesterol
  • Cigarette smoking
  • Recreational drug use
  • Depression or other psychiatric diseases

How is erectile dysfunction diagnosed?

Patient history
A diagnosis of erectile dysfunction is made in men who have repeated inability to achieve and/or maintain an erection for satisfactory sexual performance for at least three months. Candid communication between the patient and the doctor is important in establishing the diagnosis of erectile dysfunction, assessing its severity, and determining the cause. During patient interviews, doctors try to answer the following questions:

  • Is the patient suffering from erectile dysfunction or from loss of libido or a disorder of ejaculation (for example, premature ejaculation)?
  • Is erectile dysfunction due to psychological or physical factors? Healthy men have involuntary erections in the early morning and during REM sleep (a stage in the sleep cycle with rapid eye movements). Men with psychogenic erectile dysfunction (erectile dysfunction due to psychological factors such as stress and anxiety rather than physical factors) usually maintain these involuntary erections. Men with physical causes of erectile dysfunction (for example, atherosclerosis, smoking, and diabetes) usually do not have these involuntary erections.
  • Are there physical causes of erectile dysfunction? A prior history of cigarette smoking, heart attacks, strokes, and poor circulation in the extremities suggest atherosclerosis as the cause of the erectile dysfunction.
  • Diminished sensation of the penis and the testicles, bladder dysfunction, and decreased sweating in the lower extremities may suggest diabetic nerve damage. Loss of sexual desire and drive, lack of sexual fantasies, gynecomastia (enlargement of breasts), and diminished facial hair suggest low testosterone levels.
  • Is the patient taking medications that can contribute to erectile dysfunction?

Physical examination
The physical examination can reveal clues for physical causes of erectile dysfunction. For example, if the penis does not respond as expected to touching, a problem in the nervous system may be the cause. Small testicles, lack of facial hair, and enlarged breasts (gynecomastia) can point to hormonal problems such as hypogonadism with low testosterone levels. A reduced flow of blood as a result of atherosclerosis can sometimes be diagnosed by finding diminished arterial pulses in the legs or listening with a stethoscope for bruits (the sound of blood flowing through narrowed arteries). Unusual characteristics of the penis itself could suggest the root of the erectile dysfunction, for example, bending of the penis with painful erection could be the result of Peyronie's disease. Particular attention is paid to any underlying risk factors for erectile dysfunction.

Laboratory tests
The following are common laboratory tests to evaluate erectile dysfunction:

  • Complete blood counts
  • Urinalysis: An abnormal urinalysis may be a sign of diabetes mellitus and kidney damage.
  • Lipid profile: High levels of LDL cholesterol (bad cholesterol) in the blood promotes atherosclerosis.
  • Blood glucose levels: Abnormally high blood glucose levels may be a sign of diabetes mellitus.
  • Blood hemoglobin A 1c: Abnormally high levels of blood hemoglobin A 1c in patients with diabetes mellitus establish that there is poor control of blood glucose levels.
  • Serum creatinine: An abnormal serum creatinine may be the result of kidney damage due to diabetes.
  • Liver enzymes and liver function tests: Advanced liver disease (cirrhosis) can result in hormonal imbalance and gonad dysfunction leading to low testosterone levels. Thus, evaluation for liver disease may be necessary in cases of erectile dysfunction.
  • Total testosterone levels: Blood samples for total testosterone levels should be obtained in the early morning (before 8 a.m.) because of wide fluctuations in the testosterone levels throughout the day. A low total testosterone level suggests hypogonadism. Measurement of bio-available testosterone may be a better measurement than total testosterone, especially in obese men and men with liver disease, but measurement of bio-available testosterone is not widely available.
  • Other hormone levels: Measurement of other hormones beside testosterone (luteinizing hormone (LH), prolactin level, and cortisol level) may provide clues to other underlying causes of testosterone deficiency and erectile problems, such as pituitary disease or adrenal gland abnormalities. Thyroid levels may be routinely checked as both hypothyroidism and hyperthyroidism can contribute to erectile dysfunction.
    PSA levels: PSA (prostate specific antigen) blood levels and prostate examination to exclude prostate cancer is important before starting testosterone treatment since testosterone can aggravate prostate cancer.
    Other blood tests: Evaluation for hemochromatosis, lupus, scleroderma, zinc deficiency, sickle cell anemia, cancers (leukemia, colon cancer) are some of the other potential tests that may be performed based on each individual's history and symptoms.

Imaging tests
In a setting of a previous pelvic trauma, X-rays may be performed to assess various bony abnormalities. Ultrasound of the penis and testicles is done occasionally to check for testicular size and structural abnormalities. Ultrasound with Doppler imaging can provide additional information about blood flow of the penis. Rarely, an angiogram may be performed in cases in which possible vascular surgery could be beneficial.

Other tests
Prostaglandin E1 injection test is sometimes performed to determine the penile blood flow. Prostaglandin is directly injected into the corpora cavernosa in order to cause dilation of blood vessels and promote blood flow into the penis. If erection ensues, it confirms normal or adequate blood flow to the penis. This can also provide information about possible therapeutic options.

Monitoring erections that occur during sleep (nocturnal penile tumescence) can help distinguish between erectile dysfunction of psychological and physical causes. A band is worn around the penis for two to three successive nights and it can signal intensity and duration of erections if they occur. If nocturnal erections do not occur, then the cause of erectile dysfunction is likely to be physical rather than psychological, however, tests of nocturnal erections are not completely reliable. Scientists have not standardized the tests and have not determined in whom they should be done.

Direct vibrational stimulation (biothesiometry) is occasionally done to evaluate penile nerve function. Small electromagnetic electrodes are placed on the shaft of the penis and vibration amplitude is slightly adjusted until sensation is noted by the patient. Although this test does not measure the exact nerve function, it serves as a screening method to detect any sensory nerve deficit as the cause of ED.

Psychosocial examination
A psychosocial examination using an interview and questionnaire may reveal psychological factors contributing to erectile dysfunction. The sexual partner also may be interviewed to determine expectations and perceptions encountered during sexual intercourse.

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  Indications

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Benefits of Vigor Musli Power

Solves erectile problems
Increases the volume of ejaculate
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Improves the semen quality
Increases sperm count
Controls premature ejaculation
Promotes general well being and vitality
Prolong performance
Increases frequency of orgasm
Increases libido
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Increases sexual confidence.

 
 
 
Indications
Low Male & Female Libido
Loss of Desire
Erectile & Ejaculatory Dysfunction
Lack of Libido
Vigor & Vitality
Stamina
Masturbation
Premature Ejaculation
Loss of Sexual Desire
Erectile Problems
Spermacrasia
Spermatorrhea
Vaginismus
Vaginal Dryness
Lack of Lubrication
Hypoactive Sexual Disorder
Loss of Sensation
Low Blood Flow to Genitals
Low Sex Drive Due to Depression
 

Low Male and Female Libido, Loss of Desire, Erectile and Ejaculatory Dysfunction, Masturbation, Premature Ejaculation, Sexual Desire

  Erectile Problems, Low Sex Drive, Vaginal Dryness, Lack of Lubrication, Sexual Disorder, Loss of Sensation, Spermacrasia, Spermatorrhea
         
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