Prostatitis — chronic

Chronic prostatitis is swelling and irritation (inflammation) of the prostate gland that develops slowly and continues for a long period of time.
Chronic prostatitis is usually not caused by a bacterial infection. When it is caused by bacteria, chronic prostatitis may occur with or follow:
Acute prostatitis
Urinary tract infection
Risks include:
Age over 30
Certain sexual practices (such as anal sex without a condom)
Excessive alcohol intake
Injury to the perineum (the area between the scrotum and anus)
These factors may cause congestion of the prostate gland, which produces a breeding ground for bacteria.
Other possible causes are related to stress and tightness of the pelvic muscles.
Blood in the urine
Decreased urine stream
Frequent urination
Low-grade fever
Pain with urination
Urinary hesitancy (delayed start of urination)
Low-grade or subtle symptoms may include:
Low back pain
Pain and burning with urination
Pain in the perineum or pelvic floor
Pain with bowel movement
Pain with ejaculation
Testicular pain
Note: There may be no symptoms.
Exams and Tests
A physical examination may show:
Discharge from the urethra
Enlarged, mildly tender prostate
Enlarged or tender lymph nodes in the groin area
Swelling and tenderness of the scrotum
Triple-void urine specimens may be collected for urinalysis and urine culture. Urine may be collected:
Initial stream
After a prostate massage by examiner
Other tests may include:
Culture of prostate secretions
Semen analysis
Treatment options for chronic prostatitis include a combination of medication, surgery, and lifestyle changes.
Chronic prostatitis is treated with a long course (6 — 12 weeks or longer) of antibiotics. Trimethoprim-sulfamethoxazole (Bactrim) and ciprofloxacin (Cipro) are commonly used. Other antibiotics that may be used include:
Most antibiotics do not get into the prostate tissue well. Often, the infection continues even after long periods of treatment. After antibiotic treatment has ended, it is common for symptoms to return.
Stool softeners may be recommended to reduce discomfort with bowel movements.
Nonsteroidal anti-inflammatory medications (NSAIDs such as Aleve and Motrin) and alpha blockers (such as Hytrin, Flomax, and Cardura) may also be used.
Transurethral resection of the prostate may be necessary if antibiotic therapy is unsuccessful or the condition keeps returning. This surgery is usually not performed on younger men because it carries a risk of retrograde ejaculation, which can lead to sterility, impotence, and incontinence.
Prostate massage and myofascial release are other treatments that may help this condition.
Frequent and complete urination is recommended to decrease the symptoms of urinary urgency. If the swollen prostate restricts the urethra, the bladder may not empty. Inserting a suprapubic catheter, which allows the bladder to drain through the abdomen, may be necessary.
See your health care provider for an exam after you finish taking antibiotics to make sure that the infection is gone.

Prostate cancer

Prostate cancer is cancer that starts in the prostate gland. The prostate is a small, walnut-sized structure that makes up part of a man’s reproductive system. It wraps around the urethra, the tube that carries urine out of the body.

The cause of prostate cancer is unknown. Some studies have shown a relationship between high dietary fat intake and increased testosterone levels.
There is no known association with an enlarged prostate or benign prostatic hyperplasia (BPH).
Prostate cancer is the third most common cause of death from cancer in men of all ages and is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40.

The appropriate treatment for prostate cancer is not clear. Treatment options vary based on the stage of the tumor. In the early stages, talk to your doctor about several options including surgery, radiation therapy, or, in older patients, monitoring the cancer without active treatment.
Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to remove the testes, or chemotherapy.
Surgery, radiation therapy, and hormonal therapy can interfere with sexual desire or performance on either a temporary or permanent basis. Discuss your concerns with your health care provider.

Pneumocystis carinii pneumonia

Pneumocystis carinii pneumonia (PCP) is a fungal infection of the lungs.

PCP is a pneumonia caused by the fungal organism Pneumocystis carinii (now renamed Pneumocystis jiroveci). This organism is common in the environment and does not cause illness in healthy people.
However, Pneumocystis carinii can cause a lung infection in in people with a weakened immune system due to any of the following conditions:
Bladder Cancer
Chronic use of corticosteroids or other medications that affect the immune system
Solid organ or bone marrow transplant
PCP was a relatively rare infection before the AIDS epidemic. Before the use of preventive antibiotics for PCP, up to 70% of people in the U.S. with advanced AIDS would develop PCP.

PCP in those with AIDS usually develops slowly and is less severe. People with PCP who do not have AIDS usually get sick faster and are more acutely ill.
Symptoms include:
Cough — often mild and dry
Rapid breathing
Shortness of breath — especially with activity (exertion)


Leukoplakia is a precancerous lesion that develops on the tongue or the inside of the cheek as a response to chronic irritation. Occasionally, leukoplakia patches develop on the female external genitalia.
Leukoplakia is primarily a disorder of the mucous membranes of the mouth. It is caused by irritation. Lesions usually develop on the tongue, but they may also appear on the insides of the cheek.
Irritation may result from rough teeth or rough places on dentures, fillings, and crowns. It may also result from smoking or other tobacco use (smoker’s keratosis). Persons who smoke pipes are at high risk for developing this condition, as are those who hold chewing tobacco or snuff in the mouth for a long period of time.
Leukoplakia patches may develop on the female external genital area, but the cause is unknown.
Like other mouth ulcers, leukoplakia may become cancerous.
The disorder is most common in the elderly.
«Hairy» leukoplakia of the mouth is an unusual form of leukoplakia that is seen mostly in HIV-positive people. It may be one of the first signs of HIV infection. It can also appear in others when their immune systems are not working well, such as after a bone marrow transplant. It may be caused by the Epstein-Barr virus.
White patches usually appear on the tongue and sometimes on other places in the mouth. The condition may look like thrush, a type of candida infection that is also associated with HIV and AIDS in adults.
The primary symptom of leukoplakia is a skin lesion with the following characteristics:
Usually on the tongue
May be on the inside of the cheeks
In females, occasionally on the genitals
Usually white or gray
May be red (called erythroplakia)
Slightly raised
Hardened surface
The symptoms of hairy leukoplakia are painless, fuzzy, white patches on the tongue.
The typical white patch of leukoplakia develops slowly, over weeks to months. The lesion may eventually become rough in texture, and may become sensitive to touch, heat, spicy foods, or other irritation.
A biopsy of the lesion confirms the diagnosis. An examination of the biopsy specimen may find changes that indicate oral cancer.

Cervical cancer

Alternative Names   
Cancer — cervix
 Cervical cancer is cancer that starts in the cervix, the lower part of the uterus (womb) that opens at the top of the vagina.
 Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of routine use of Pap smears.
Cervical cancers start in the cells on the surface of the cervix. There are two types of cells on the cervix’s surface: squamous and columnar. The majority of cervical cancers are from squamous cells.
The development of cervical cancer is usually very slow. It starts as a pre-cancerous condition called dysplasia. This pre-cancerous condition can be detected by a Pap smear and is 100% treatable. That is why it is so important for women to get regular Pap smears. Most women that are diagnosed with cervical cancer today have not had regular Pap smears or they have not followed up on abnormal results.
Undetected, pre-cancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. It can take years for pre-cancerous changes to turn into cervical cancer. Patients with cervical cancer do not usually have problems until the cancer is advanced and has spread.
Almost all cervical cancers are caused by HPV (human papilloma virus). HPV is a common virus that is spread through sexual intercourse. There are many different types of HPV, and many do not cause problems. However, only certain strains of HPV actually lead to cervical cancer. (Other strains may cause genital warts.)
Other risk factors for cervical cancer include:
Having sex at an early age
Multiple sexual partners
Sexual partners who have multiple partners or who participate in high-risk sexual activities
Women whose mothers took the drug DES (diethylstilbestrol) during pregnancy in the early 1960s to prevent miscarriage
Weakened immune system
Poor economic status (may not be able to afford regular Pap smears)
Most ot the time, early cervical cancer has no symptoms. Symptoms that may occur can include:
Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody, or foul-smelling
Abnormal vaginal bleeding between periods, after intercourse, or after menopause
Periods become heavier and last longer than usual
Any bleeding after menopause
Symptoms of advanced cervical cancer may include:
Loss of appetite
Weight loss
Pelvic pain
Back pain
Leg pain
Single swollen leg
Heavy bleeding from the vagina
Leaking of urine or feces from the vagina
Bone fractures
Exams and Tests   
Pre-cancerous changes of the cervix and cervical cancer can not be seen with the naked eye. Special tests and tools are needed to spot such conditions.
Pap smears screen for pre-cancers and cancer, but do not offer the final diagnosis. If abnormal changes are found, the cervix is usually examined under magnification. This is called colposcopy. Pieces of tissue are surgically removed (biopsied) during this procedure and sent to a laboratory for examination. 
Other tests may include:
Endocervical curettage (ECC) to examine the opening of the cervix
Cone biopsy
If the woman is diagnosed with cervical cancer, the health care provider will order more tests to determine how far the cancer has spread. This is called staging. Tests may include:
CT scan
Chest x-ray
Intravenous pyelogram (IVP)
Treatment of cervical cancer depends on the stage of the cancer, the size and shape of the tumor, the age and general health of the woman, and her desire to have children in the future.
Early cervical cancer can be cured by removing or destroying the pre-cancerous or cancerous tissue. There are various surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future.
Types of surgery for early cervical cancer include:
LEEP (Loop Electrosurgical Excision Procedure) — uses electricity to remove abnormal tissue
Cryotherapy — freezes abnormal cells
Laser therapy — uses light to burn abnormal tissue
A hysterectomy (removal of the uterus but not the ovaries) is not often performed for cervical cancer that has not spread. It may be done in women who have repeated LEEP procedures. However, in more advanced disease, a radical hysterectomy may be performed. This type of hysterectomy removes the uterus and much of the surrounding tissues, including internal lymph nodes and upper part of the vagina. In the most extreme surgery, called a pelvic exenteration, all of the organs of the pelvis, including the bladder and rectum, are removed.
Radiation may be used to treat cancer that has spread beyond the pelvis, or cancer that has returned. Radiation therapy is either external or internal. Internal radiation therapy uses a device filled with radioactive material, which is placed inside the woman’s vagina next to the cervical cancer. The device is removed when she goes home. External radiation therapy beams radiation from a large machine onto the body where the cancer is located. It is similar to an x-ray.
Chemotherapy uses drugs to kill cancer. Some of the drugs used for chemotherapy for cervical cancer include 5-FU, Cisplatin, Carboplatin, Ifosfamide, Paclitaxel, and Cyclophosphamide. Sometimes radiation and chemotherapy are used before or after surgery.
The type of cancer
The stage of the disease
The age and general physical condition of the woman
Pre-cancer conditions are completely curable when followed up and treated properly. The chance of being alive in 5 years (5-year survival rate) for cancer that has spread to the inside of the cervix walls but not outside the cervix area is 92%.
However, the 5-year survival rate falls steadily as the cancer spreads into other areas.
Possible Complications   
Some types of cervical cancer do not respond well to treatment.
The cancer may come back (recur) after treatment.
Women who have treatment to save the uterus have a high risk of the cancer coming back (recurrence). 
Surgery and radiation can cause problems with sexual, bowel, and bladder function.
When to Contact a Medical Professional   
Call your health care provider if you:
Are a sexually active woman who has not had a Pap smear in the past year
Are at least 20 years old and have never had a pelvic examination and Pap smear
Think your mother may have taken DES when she was pregnant with you
Have not had regular Pap smears (ask your health care provider how often you should have one performed)
If you smoke, quit. Cigarette smoking is associated with an increased risk of cervical cancer.

Laser surgery

Alternative Names   — Surgery using a laser
Laser surgery is a medical procedure that uses laser light to remove diseased tissues or treat bleeding blood vessels. Laser surgery may also be used for cosmetic purposes, such as removing wrinkles, tattoos, or birthmarks.
A laser is a light beam that can be precisely focused. It is used to treat tissues by heating the targeted cells until they «burst.»
There are several types of lasers, including the carbon dioxide (CO2) laser, the YAG (yttrium aluminum garnet) laser, and the pulsed dye laser. Each laser has specific uses. The color of the light beam used is directly related to the type of surgery being performed and the color of the tissue being treated.
Why the Procedure is Performed    
Laser surgery can be used to:
Close small blood vessels to reduce blood loss
Close lymph vessels to reduce swelling and decrease the spread of tumor cells
Close nerve endings to reduce pain that occurs after surgery
Remove tumors (such as those in the brain or liver)
Remove warts, moles, and tattoos
Reduce the appearance of skin wrinkles, scars, and other skin blemishes
Remove hair
Possible risks of laser surgery include:
Incomplete treatment of the problem
Skin color changes
Some laser surgery is done when you under general anesthesia. Be sure to discuss the risks with your health care provider.
After the Procedure    
How well a patient does depends on the condition being treated. Always talk to your health care provider about your expected recovery before surgery.
The amount of time it takes to recover from surgery depends on the surgery and on the individual. Based on an evaluation of your health status prior to surgery, your health care provider can give you a good estimate of the recovery time.


Alternative Names — Phlebitis
Thrombophlebitis is swelling (inflammation) of a vein caused by a blood clot.
The following increase your chances for thrombophlebitis:
Being hospitalized for a major surgery or with a major illness
Disorders that make you more likely to develop blood clots
Sitting for a long period of time (such as on a long airplane trip)
There are two main types of thrombophlebitis:
Deep venous thrombosis (affects deeper, larger veins)
Superficial thrombophlebitis (affects veins near the skin surface)
The following symptoms are often associated with thrombophlebitis:
Inflammation (swelling) in the part of the body affected
Pain in the part of the body affected
Skin redness (not always present)
Warmth and tenderness over the vein
Exams and Tests    
The health care provider can usually diagnose the condition based on how the affected area looks. You may need to have your pulse, blood pressure, temperature, skin condition, and circulation frequently checked to make sure you don’t have complications.
If the cause cannot be easily identified, one or more of the following tests may be done:
Blood coagulation studies
Doppler ultrasound
In general, treatment may include support stockings and wraps to reduce discomfort as well as medications such as:
Analgesics (pain killers)
Antibiotics (if infection is present)
Anticoagulants (blood thinners) to prevent new clots from forming
Nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen to reduce pain and inflammation
Thrombolytics to dissolve an existing clot
You may be told to do the following:
Apply moist heat to reduce inflammation and pain
Keep pressure off of the area to reduce pain and decrease the risk of further damage
Raise the affected area to reduce swelling
Surgical removal, stripping, or bypass of the vein is rarely needed but may be recommended in some situations.
For more specific recommendations, see the particular condition (superficial thrombophlebitis or deep venous thrombosis).
Thrombophlebitis and other forms of phlebitis usually respond to prompt medical treatment.
Possible Complications    
Superficial thrombophlebitis rarely causes complications.
Complications of deep vein thrombosis include blood clots in the lungs (pulmonary embolism) or chronic pain and swelling in the leg.
When to Contact a Medical Professional    
Call your health care provider if you have symptoms of thrombophlebitis.
Call your health care provider promptly if thrombophlebitis symptoms do not improve with treatment, if symptoms get worse, or if new symptoms occur (such as an entire limb becoming pale, cold, or swollen).

Prostate resection — minimally invasive

Alternative Names   
Laser prostatectomy; Transurethral needle ablation; TUNA; Transurethral incision; TUIP; Holmium laser enucleation of the prostate; HoLep; Interstitial laser coagulation; ILC; Photoselective vaporization of the prostate; PVP; Transurethral electrovaporization; TUVP; Transurethral microwave thermotherapy; TUMT
Minimally invasive prostate resection is surgery to remove part of the prostate gland, to treat an enlarged prostate. The surgery will improve the flow of urine through the urethra, the tube that carries urine from the bladder outside of your body. It can be done in several different ways. There is no incision (cut) in your skin.
These procedures are usually done in your doctor’s office or at an outpatient surgery clinic.
The surgery can be done in many different ways, depending on the size of your prostate and what caused it to grow. Your doctor will consider the size of your prostate, how healthy you are, and what type of surgery you may want.
All of these procedures are done by passing an instrument through the opening in your penis. You will be given general anesthesia (asleep and pain-free), spinal or epidural anesthesia (awake but pain-free), or local anesthesia and sedation. Choices are:
Laser prostatectomy: Laser prostatectomy takes about 1 hour. The laser destroys prostate tissue that blocks the opening of the urethra. You will probably go home the same day. You may need a Foley catheter placed in your bladder to help drain urine for a few days after surgery.
Transurethral needle ablation (TUNA): The surgeon passes needles into the prostate. High-frequency sound waves (ultrasound) heat the needles and prostate tissue. You may need a Foley catheter placed in your bladder to help drain urine after surgery for 3 to 5 days.
Transurethral microwave thermotherapy (TUMT): TUMT delivers heat using microwave pulses to destroy prostate tissue. Your doctor will insert the microwave antenna through your urethra.
Transurethral electrovaporization (TUVP): A tool or instrument delivers high-voltage electrical current to destroy prostate tissue. You will have a catheter place in your bladder. It may be removed within hours after the procedure.
Transurethral incision (TUIP): Your surgeon makes small incisions (cuts) where the prostate meets your bladder. As a result, the urethra becomes wider or more open. This procedure takes 20 to 30 minutes. Many men can go home the same day. Full recovery can take 2 to 3 weeks.
Why the Procedure is Performed    
An enlarged prostate can make it hard for you to urinate. You may also get urinary tract infections. Removing all, or part, of the prostate can gland can make these symptoms better. Before you have surgery, your doctor will suggest you change how you eat or drink. You may also try some medicines.
Your doctor may recommend prostate removal if you:
Cannot completely empty your bladder (urinary retention)
Have repeat urinary tract infections
Have bleeding from your prostate
Have bladder stones with your enlarged prostate
Urinate very slowly
Took medicines, and they did not help your symptoms
Risks for any surgery are:
Blood clots in the legs that may travel to the lungs
Breathing problems
Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
Blood loss
Heart attack or stroke during surgery
Reactions to medications
Additional risks for this surgery are:
Problems with urine control (incontinence)
Passing semen back into your bladder instead of out through the urethra (retrograde ejaculation)
Erection problems — impotence
Urethral stricture (tightening of the urinary outlet from scar tissue)
Before the Procedure    
You will have many visits with your doctor and tests before surgery:
Complete physical exam
Visits with your doctor to make sure medical problems, such as diabetes, high blood pressure, and heart or lung problems, are being treated well
If you are a smoker, you should stop several weeks before the surgery. Your doctor or nurse can help.
Always tell your doctor or nurse what drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription.
During the weeks before your surgery:
You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and other drugs like these.
Ask your doctor which drugs you should still take on the day of your surgery.
On the day of your surgery:
Do not eat or drink anything after midnight the night before your surgery.
Take the drugs your doctor told you to take with a small sip of water.
Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure    
You will probably go home the day you have surgery, or the day after. You may still have a catheter in your bladder when you leave the hospital.


Alternative Names -Plaque psoriasis
Psoriasis is a common skin condition that causes skin redness and irritation. Most persons with psoriasis have thick, red skin with flaky, silver-white patches called scales.
   Psoriasis is a very common condition. The disorder may affect people of any age, but it most commonly begins between ages 15 and 35. It can appear suddenly or slowly. In many cases, psoriasis goes away and then flares up again repeatedly over time. The condition is not contagious.
 Psoriasis seems to be an inherited disorder. That means it is passed down through families. Doctors think it probably occurs when the body’s immune system mistakes healthy cells for dangerous substances.
 Skin cells grow deep in the skin and normally rise to the surface about once a month. In persons with psoriasis, this process is too fast and dead skin cells build up on the skin’s surface.
Psoriasis may affect any or all parts of the skin. There are five main types of psoriasis.
Erythrodermic — The skin redness is very intense and covers a large area.
Guttate — Small, pink-red spots appear on the skin.
Inverse — Skin redness and irritation occurs in the armpits, groin, and in between overlapping skin.
Plaque — Thick, red patches of skin are covered by flaky, silver-white scales. This is the most common type of psoriasis.
Pustular — White blisters are surrounded by red, irritated skin.
In general, psoriasis may be severe in persons who have a weakened immune system. This may include persons who have:
Autoimmune disorders (such as rheumatoid arthritis)
Cancer chemotherapy
Up to 30% of people with psoriasis may also have arthritis, a condition known as psoriatic arthritis. Psoriasis may also affect the nails. About 10% of people with psoriasis have visible changes only in the nails.
Persons with psoriasis have irritated patches of skin. The redness is most often seen on the elbows, knees, and trunk, but can appear anywhere on the body. For example, there may be flaky patches on the scalp.
 Sunlight may help your symptoms go away. Be careful not to get sunburned. Some people may choose to have phototherapy. Phototherapy is a medical procedure in which your skin is carefully exposed to ultraviolet light. Phototherapy may be given alone or after you take a drug that makes the skin sensitive to light.
 Persons with very severe psoriasis may receive medicines to suppress the body’s immune response. These medicines include methotrexate or cyclosporine. (Persons who have psoriatic arthritis may also receive these drugs.)
    Psoriasis is a life-long condition that can be controlled with treatment. It may go away for a long time and then return. With appropriate treatment, it usually does not affect your general physical health.

Erection problems

Alternative Names    
Erectile dysfunction; Impotence; Sexual dysfunction — male
An erection problem is the inability to get or maintain an erection that is firm enough for a man to have intercourse. You may be unable to get an erection at all, or you may lose the erection during intercourse before you are ready. If the condition persists, the medical term is erectile dysfunction.
Erection problems are common in adult men. In fact, almost all men experience occasional difficulty getting or maintaining an erection. In many cases, it is a temporary condition that will go away with little or no treatment. In other cases, it can be an ongoing problem that can damage a man’s self esteem and harm his relationship with his partner, and thus requires treatment.
If you have difficulty having or keeping an erection more than 25% of the time, it is considered a problem.
In the past, erection problems were thought to be «all in the man’s mind.» Men often were given unhelpful advice such as «don’t worry» or «just relax and it will take care of itself.» Today, doctors believe that when the problem is not temporary or does not go away on its own, physical factors are often the cause.
One way to know if the cause is physical or psychologic is to determine if you are having nighttime erections. Normally, men have 3 to 5 erections per night, each lasting up to 30 minutes. Your doctor can explain a test to find out if you are having the normal number of nighttime erections.
In most men, erection difficulties do not affect their sex drive.
Premature ejaculation (when orgasm comes on too quickly) is not the same as impotence. Together with your partner, you should seek counseling for this problem, which is usually due to psychological factors.
Male infertility is also quite different from impotence. A man who is unable to maintain an erection may be very capable of producing sperm that could fertilize an egg. An infertile man is usually able to maintain an erection, but he may be unable to father a child due to problems with sperm count or other factors.
An erection requires the interaction of your brain, nerves, hormones, and blood vessels. Anything that interferes with the normal process can lead to a problem.
Common causes of erection problems include:
Diseases and conditions such as diabetes, high blood pressure, heart or thyroid conditions, poor blood flow, depression, or neurologic disorders (such as multiple sclerosis or Parkinson’s disease)
Medications such as blood pressure medications (especially beta-blockers), heart medications (such as digoxin), some peptic ulcer medications, sleeping pills, and antidepressants
Nerve damage from prostate surgery
Nicotine, alcohol, or cocaine use
Poor communication with your partner
Repeated feelings of doubt and failure or negative communication that reinforce the erection problems
Spinal cord injury
Stress, fear, anxiety, or anger
Unrealistic sexual expectations, which make sex a task rather than a pleasure
Erection problems tend to become more common as you age, but it can affect men at any age and at any time in their lives. Physical causes are more common in older men, while psychological causes are more common in younger men.
Low levels of testosterone rarely lead to erection problems, but may reduce a man’s sex drive.
Home Care    
For many men, lifestyle changes can help:
Cut down on smoking, alcohol, and illegal drugs.
Get plenty of rest and take time to relax.
Exercise and eat a healthy diet to maintain good circulation.
Use safe sex practices, which reduces fear of HIV and STDs.
Talk openly to your partner about sex and your relationship. If you are unable to do this, counseling can help.
Couples who cannot talk to each other are likely to have problems with sexual intimacy. Men who have trouble communicating their feelings may find it difficult to share with their partner any anxieties about their sexual performance. In these circumstances, counseling can be very helpful for both you and your partner.
When to Contact a Medical Professional    
Call your doctor if:
The problem does not go away with self-care measures — effective treatments are available
The problem begins after an injury or prostate surgery
You have other symptoms like low back pain, abdominal pain, or change in urination
If erection problems seem to be caused by a medication you are taking for an unrelated condition, consult your doctor. You may benefit from reducing the dose of the drug or changing to another drug that has the same result but not the same side effects. DO NOT change or stop taking any medications without first talking to your doctor.
Talk to your health care provider if your erection problems are related to fear of recurring heart problems. Sexual intercourse is usually safe in these circumstances.
Call your doctor immediately or go to an emergency room if medication for erection problems give you an unwanted erection that lasts more than 4 hours. Permanent impotence or other lasting damage to your penis may result from this condition.
What to Expect at Your Office Visit    
Your doctor will perform a physical examination, which will likely include:
Checking your blood flow (circulation)
Exam of your penis
Neurological exam
Rectal exam
To help diagnose the cause of the problem, your doctor will ask medical history questions such as:
Have you been able to achieve and maintain erections in the past?
Is the difficulty in achieving erections or maintaining the erection?
Do you have erections during sleep?
How long have you had difficulty with erections?
What medications are you taking (including prescription medications, over-the-counter medications, and recreational drugs)?
Do you smoke? How much each day?
Do you use alcohol? How much?
Have you recently had surgery?
Have you ever had vascular surgery or other treatments for your blood vessels?
Are you depressed?
Are you afraid or worried about something?
Are you experiencing a lot of stress?
Has your energy level decreased?
Are you sleeping well each night?
Are you afraid of sexual activity because of physical problems?
Have there been any recent changes in your life?
What other symptoms do you have?
Have you noticed changes in sensations in your penis?
Do you have any problems with urination?
Tests that may be done include:
Blood tests, including complete blood count, metabolic panel, hormone profile, and PSA
Neurological (nerve) testing
Nocturnal penile tumescence (NPT) to check for normal nighttime erections
Penile ultrasound to check for blood vessel or blood flow problems
Psychometric testing
Rigidity monitoring
Urine analysis
The treatment depends on the cause. For example, if the problem is caused by a hormonal imbalance, medication to treat the underlying endocrine disorder will be prescribed. Consult your health care provider for appropriate evaluation and management.
There are many treatment options today. These include medicines taken by mouth, injections into the penis, vacuum devices, and surgery. In order to treat erectile dysfunction effectively, you must be aware of and comfortable with the possible side effects and complications that may occur with each therapy.
Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are medicines prescribed for mild-to-moderate erection difficulties caused by either physical or psychological problems. The drugs work only when the man is sexually aroused. The effect is usually seen within 15 — 45 minutes.
These drugs are called phosphodiesterase-5 (PDE5) inhibitors.
Although these drugs have become extremely popular, they do not enhance erections if you are not impotent. And they DO have side effects, which can be as serious as a heart attack or as minor as muscle pain or facial flushing.
These drugs should not be used with certain other medications, including nitroglycerin. When taken with nitroglycerin, a man’s blood pressure can become dangerously low. Some men have died after taking these drugs and nitroglycerin.
PDE5 inhibitors should be used with caution if you have any of the following conditions:
Recent stroke
Severe heart disease, such as unstable angina, a recent heart attack, or arrhythmia
Severe heart failure
Uncontrolled hypertension (high blood pressure)
Uncontrolled diabetes
Very low blood pressure (hypotension)
If pills do not work, other options are available. Testosterone skin patches or injectionjs may be prescribed, especially if the problem is related to age. A medicine called alprostadil, injected at the penis or inserted as pellets, improves blood flow to the penis. This usually works better than medications taken by mouth.
For some patients, a vacuum pump or penile implant (prosthesis) may also be recommended or needed.
Consult your health care provider to see if one of these treatments is right for you