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Monitoring erections that occur during sleep (nocturnal penile tumescence) can help distinguish between erectile dysfunction of psychological and physical causes. 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.
Several other, more invasive options exist for patients who do not respond to PDE-5 inhibitor therapy or in whom it is contraindicated. Alprostadil (prostaglandin E1) causes smooth-muscle relaxation and subsequent vasodilation by acting on adenylate cyclase to increase the intracellular cyclic adenosine monophosphate (cAMP) concentration. Prostaglandin E1 may be administered intraurethrally, where it is absorbed and transported throughout the erectile bodies. The reported efficacy of intraurethral alprostadil therapy is variable. Padma-Nathan and colleagues59 reported a response rate of 65.9%. Fulgham and associates60 noted improvement in 30% of patients; however, this study has been criticized for inadequate dose titration.61 The most common side effect of intraurethral alprostadil therapy is local penile pain caused by drug-mediated sensitization of nerve fibres.60
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Diagnosis Non-ischemic priapism due to a ruptured left helicine artery, intermittent penile turgidity and erectile dysfunction.
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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.
"Duchenne muscular dystrophy is a crippling disease that affects both skeletal muscle and cardiac muscle," said lead researcher Christine Des Rosiers, a professor of cardiology in the department of nutrition at the University of Montreal. "Currently, there is a need for the development of more effective treatment strategies for patients affected with this disease."
"There is an association between these two conditions, but we still don't know the exact mechanism," Gao said. His team said further research is warranted.
Most commonly reported adverse effect is headache, which occurred in 15% of men taking the 20-mg dose, 11% of those taking 10 mg, and 11% of those taking 5 mg; this compares with 5% of those who took placebo; dyspepsia is second most common adverse effect and is observed in 10% of men taking 20 mg, 8% taking 10 mg, and 4% taking 5 mg; dyspepsia occurred in only 1% of controls
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