When, What, and How to Treat Erectile Dysfunction?
    - How to Optimally Treat Erectile Dysfunction?

    A strong eagerness to pursue best effective treatments for any "illnesses" is absolutely understandable. In today's medical
    practice, the commonest things come to mind for such endeavor will be taking some drugs or undergoing certain procedures or
    both.

    However, my lifelong personal and professional experience fails to prove this contemporary approach to be effective enough; but
    together, we can do and drive more beyond the power of medication and procedure/ surgeries. Instead, I let the following
    concepts and disciplines guide me on how to take care of the patients coming to my practice; they are:

    1. Life is a one-way street of accumulation, modification, and continuation from inception to eternity.

    2. Life is a constantly changing, adjusting dynamic process of struggles to cope with reality, certainty, and uncertainty of daily
       living for survival, growth, and continuation.

    3. There has been no magic in life and medicine; if any, that is to exercise and apply currently available knowledge, skill,
       technology, medication, commonsense, and a tad of wisdom at reasonable time in reasonable way to reasonable patients.

    4. Medical professionals have never cured anyone yet, but just follow the above to modify patients' inside and outside
       environments so to undergo their best possible self-healing process for optimal functional recovery with their own residual
       strength.

    5. The core foundation of all healthcare is quality healthy lifestyle without overindulgence and obsession, which consists of
       the following five components:
        a. Eat, enjoy, and control foods, and don’t let foods control you;
        b. Keep up quality daily mental and physical exercises, but avoid any form of overindulgence and obsession;
        c. Sleep well and sound for at least 6-8 hours every day;
        d. Meditate regularly to reinforce spiritual and physical connection, and pray if religious;
        e. Follow currently available reasonable, realistic medical advice as needed.

    The above understanding is my professional open secrets, which have guided me how to help patients, who are willing to listen
    to me, move on their life. The outcome under such line of care has been tremendous and best possible as one could have
    expected.

    To achieve the best possible result from what we do solely relies on if we have enough energy and ability to handle well for the
    following two steps in every thing we do:

    1. Decision-making: At this step we consider if what we are going to do is most reasonable at the time and location under
        the circumstance.  
    2. Action-taking: After making right decision, we ought to make sure if the actions we will take are most reasonable for me
       and you.   

    If we can handle both steps correctly, we can expect to rake in the best possible result to meet what we like, love, want, and need
    at a time in a location under a circumstance

    At the moment making decision, we also have to balance the equation between medical necessity and professional possibility.

    What is medical necessity?
    Medical necessity is what you are going to realistically accomplish to face off current medical calamity confronting you in your
    favor. It comes from two prongs-perspectives:  

    1. Perspective from patients and their family: It tends to be emotionally subjective and even irrational, and
    2. Perspective from professionals: It should be kept as professionally objective as possible.

    What is medical necessity for handling the dismay from erectile dysfunction (ED)?
    Combining both perspectives, you can arrive at a balancing point of equation so to make a good right decision.

    To help arrive at this decision, I would like to remind each other of the following:  Necessity may evolve and change over the
    course of lifetime, and is always relative ranging from being absolutely essential at young age to being more and more optional
    during twilight years of life.

    How do these hold true for managing ED? At young age, erection for sexual intercourse is absolutely essential so we may and
    can produce natural baby - offspring.

    But as we age, erection for sexual intercourse gradually becomes more and more optional, especially toward the twilight years of
    life, during which keeping life going should come first and erection for sexual intercourse is secondary, because we have worked
    hard so we can live on but we don't have  to do sex hard for survival. In short, survival comes first and erection for sex follows if
    possible and necessary.

    What is professional possibility?
    Professional possibility is what are the options of treatment that we may and can take so to achieve the goals of medical care at
    what expense that we are willing to cope with. Known to us, nothing is free and everything comes with a price. Likewise, all
    events of life including all medical care come with same scenario.   

    Before delving into treatment options for ED, I would like to remind each other of how and what are the real nature of medical care
    is supposed to be. In reality, it is a process of rehabilitation by applying current available knowledge, skill, technology, medication,
    common sense, and wisdom to help improve the impaired function of certain parts of the body to the level being reasonably
    acceptable to the patient and current professional standard, but never being "normal" like that when we are young.

    An example
    I would like to take the care for hip joint as an example to illustrate the same course of medical care for all illnesses. The
    expected scenario of caring for disabling hip resulting from age-related degenerative arthritis would be as follows:

    1. First, collect and analyze the detailed history about the disabling hip joint stressing the quality, quantity, and sequence
       of events of all symptoms as well as their potentially related discomforts over time,

    2. Then, conduct proper physical examinations to define the range of motion and the level of disability;

    3. Now, begin the options of care initially with least invasive options including:
       a. behavioral modification;
       b. use of pain killers with or without narcotics;
       c. physical therapy so to keep up the range of motion and learn how to walk safely and effectively with or without walking
           cane;
       d. may try steroid injection to hip so to ease the pain for better walking, or rolling walker;
       e. get on wheelchair if not a surgical candidate; and finally,
       f. undergo hip replacement as the last resort of care for degenerative hip joint disease.

    Specifically, what are the professional possibilities - options - for managing ED?
    A similar scenario holds true and applies to caring for erectile dysfunction (ED). The steps are as follows:

    1. First, collect and analyze the detailed history about general health and the progress of ED, and understand what is the
       goal the patient and partner wish to reach but at what expense and price that they wish and are willing to cope with;

    2. Then, conduct proper physical examinations to check if there is physical concerns in his nerve, circulation, testes, and
       penis, which may be associated with ED;

    3. Next, order blood tests such as complete blood count, functional tests for kidneys and liver, blood lipids, etc.

    3. Now, decide the reasonable options of care for individuals according to the above, but always starting out with least
       invasive options including:
       a. behavioral modification;
       b. use available erection-enhancing drugs;
       c. try using alprostadil suppository to the urethra or through self-injection to the corporeal bodies of the penis as
           instructed;
       d. or try using penile pump device; finally,
       e. undergo implanting penile prosthesis as the last resort of care for erectile dysfunction - ED.

    What is behavioral modification for ED?  
    The core of behavioral modification is: Quality Healthy Lifestyle with no Overindulgence and Obsession. Click this link to peruse,
    digest, absorb, and translate those ideas into actions of daily living. Before then, all talk and wish are still useless.

    So, clearly, without taking idea-loaded actions, a favorable change to energize your ability will never come. I do realize that making
    a change from the overlooked past to the new active vibrant present is not easy and requires calling upon a determining and
    willing soul to start actions. That is the only way to make a change possible.  

    Once you  gain more energy and ability from quality healthy lifestyle, and feel better and ready to do something fun, but still
    remember to let commonsense help you perform better in life and daily living - of course, the matter of sexual intercourse
    included.  

    So, think about what you have done best to perform daily chores and tasks in daily living so to rake in what you like, love, want,
    and need at a time and location under a circumstance. Regardless of age, the time to perform best has been always when you
    are well prepared after a good mental and physical rest and recovery. Therefore, do the same for sex life.

    How does the fear for failure play a role in causing erectile dysfunction?
    It is not infrequent to see few men falling victim to fear for failure, resulting from occasionally and unexpectedly experiencing
    inability to sustain an erection due to being physically too tired or under unwanted influence of too much alcohol consumption or
    taking too much stimulant for sexual excitement. Some men after such an embarrassing occasion may become mentally
    captivated by fear of failure at next attempts leading to inability to sustain erection to complete coitus, which may unfortunately
    recycle incessantly, although most of them should be able to recover after a good rest and relaxation. At times, temporary ande
    timely use of one of PDE-5 inhibitors like sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis), or avanafil (Stendra).

    Then, when and how to use erection-enhancing drugs? (click this to read more)
    As just stated to take advantage of common sense, take such drugs as prescribed while your stomach is at least half-way empty
    and you have gained your best possible mental and physical rest and recovery. Besides, never forget an ample subtle power of
    foreplay while sexual partner is physically ready and in right mood.

    What can be done after failing to respond to drugs by mouth?
    Now is the time to upgrade the care to the one more "invasive and cumbersome".

    What are they?
    These kinds of drugs is alprostadil - prostaglandin E-1, which comes with two formulations:

    1. Urethral suppository - Its brand name is MUSE at the doses of 125 and 250 mcg, But you may use it as
       instructed with dose-adjusting up to 500, 750, or up to 1,000 mcg.

    2. Penile self-injection - Make sure to follow the instructions of its use with its dose range from 10-40 mcg.

    However, known to all, nothing is free but always comes with a price; likewise, it is true for drug use.

    Specifically for using these drugs by mouth or urethra, seek emergent attention if erection lasts longer than 3-4 hours.

    If the above drug use fails to achieve satisfactory erection for intercourse, the next available step is trying penile pump or vacuum
    constriction device.  As always, exercise all advised precaution for all drug use and medical care, follow the instructions for better
    safety. For this device, do not keep the constriction ring on more than 30 minutes.  

    Just caution! It's nice to know and accept that a good use of any device takes time to practice and master its use; likewise, this
    discipline holds true for penile pump device. If you are not able to use it as what you wish and expect, bring the device to doctor or
    its specialist for refining the techniques on how to apply it correctly before giving up its use.  

    After implementing the trying of behavioral modification to seriously practice quality healthy lifestyle without overindulgence and
    obsession, use of erection-enhancing drugs, and pump device, finally, we come to view the power of surgery can do for us in
    today's medicine.

    Last Resort! - Penile Implant
    As always, view and take invasive surgery as the last resort of medical care. Take open coronary artery
    bypass for coronary arterial obstruction, hip or knee replacement for dysfunctional joint diseases as examples; so is penile
    implants or prosthesis for erectile dysfunction.

    Medically, all penile prosthesis is designed, tested, and accepted to support and help the penis to achieve artificial erection for
    sexual intercourse as their common goal. But the pros and cons in their operability, functionality, and cost forge the industry to
    make three types of penile prosthesis available so to serve individual realistic need: malleable, self-contained, and inflatable.

    The difference is just like that in automobiles; take the auto from Ford Auto Company as examples, from which roughly three
    levels of cars may be categorized as Escort (like malleable), Taurus (like self-contained), and Lincoln (like the inflatable).

    Inflatable penile prosthesis is most expensive and closest to simulating a natural penis, but requires more surgical skills to
    implant, and malleable penile prosthesis is least expensive and easiest to implant and operate; the self-contained one is in
    between. For more details for individual type of penile prosthesis, ask the surgeon.

    In my practice, more than 98% of times, the patient and I choose the inflatable one as long as patient's mental and manual
    physical dexterity are fit. Occasionally, I select the malleable one so the patient may have intercourse and fit draining condom
    device to collect urine for urinary continence.

    As you can see and imagine, no one kind of prosthesis fits all but should be individualized through joint effort among the patient,
    sexual partner, and the implant surgeon.

    Summary
    When and how to treat the concerns resulting from erectile dysfunction should follow the logical process from comprehensive
    evaluation to identify possible modifiable factors to meaningful application of treatment options in a reasonable sequence for
    rehabilitating erectile dysfunction.

    Such approach will give the patients with ED and their partner a best possible outcome of caring for ED with realistic
    understanding and expectation.

    Here I wish you well in pursuing a best possible care for ED.



    (James) Chin-Ti Lin, M.D,
    Certified urologist, award-winning author, and public speaker

All Willing Souls Can Do It                  
And We Can Help
                 
Email: realinct2002@yahoo.com                  
Dr. Lin's Quest beyond Medication and Surgery               
Sex Life, ED (Erectile
Dysfunction)...
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