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Acknowledgments We thank Sergio Martinez for constructing Fig. 3. OBJECTIVE: Depressed men commonly have erectile dysfunction, and men with erectile dysfunction are frequently depressed. Since the etiologic and modulatory relationships between depression and erectile dysfunction have been poorly characterized, a 12-week, randomized, double-blind, placebo-controlled trial was conducted at 20 urologic clinics to evaluate the effects of sildenafil treatment in men with erectile dysfunction and mild-to-moderate comorbid depressive illness. METHOD: Men (N=152, mean age=56 years) with erectile dysfunction for =" src="/math/ge.gif"6 months (mean=5.7 years), a DSM-IV diagnosis of depressive disorder not otherwise specified, and a Hamilton Depression Rating Scale score =" src="/math/ge.gif"12 (mean at baseline=16.9) were randomly assigned to flexible-dose treatment with sildenafil citrate or matching placebo. Interviewer-rated and self-report instruments were used to assess changes in sexual function, depressive symptoms, and quality of life. Conservative criteria were used to classify erectile dysfunction treatment response and nonresponse. RESULTS: Sildenafil was strongly associated with erectile dysfunction treatment response. Fifty-eight men met the conservative criteria for response (48 given sildenafil, 10 given placebo), and 78 men did not respond (18 given sildenafil, 60 given placebo). Mean decreases of 10.6 and 2.3 in Hamilton depression scale scores were seen in treatment responders and nonresponders, respectively; 76% of treatment responders showed a =" src="/math/ge.gif"50% decline in Hamilton depression scale score versus 14% of nonresponders. Quality of life was similarly improved in treatment responders. CONCLUSIONS: Sildenafil is efficacious for erectile dysfunction in men with mild-to-moderate depressive illness. Improvement of erectile dysfunction is associated with marked improvement in depressive symptoms and quality of life. The most common side effects of sildenafil are headache, flushing and dyspepsia (Table 4).17 A small percentage of patients report an alteration in color perception. Postmarketing reports released by the manufacturer indicate infrequent occurrences of priapism. Because of the presence of phosphodiesterase in the retina, patients with retinitis pigmentosa should not be given sildenafil. Erectile dysfunction, commonly referred to as ED, is the inability to achieve and sustain an erection suitable for sexual intercourse. This condition is not considered normal at any age and is different from other problems that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. Proteinuria Glycosuria Hypertriglyceridemia Hypogonadism Decreased libido; fatigue Bilateral testicular atrophy; scant body hair; gynecomastia Decreased morning free testosterone "Fourteen had complete relief, nine had almost complete relief of their symptoms, one had partial relief, and one indicated no change," says Kessler. Kessler presented his findings at the 1999 annual meeting of the American Urological Association. After all the information regarding the patient's status has been gathered, the various options in management can be discussed. This is best completed in the presence of the patient and his partner. Enough options are available that every man who wants to be sexually active can do so. These include sexual counseling if no organic causes can be found for the dysfunction, oral medications, external vacuum devices, or some type of invasive therapy, including the use of intracavernosal injection therapy or the Medicated Urethral System for Erections (MUSE), which is an intraurethral suppository. One of the most difficult aspects is teaching men that sex entails more than simply achieving an erection. 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 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 during erection could be the result of Peyronie's disease. One expert agreed that erectile dysfunction is a widespread problem. How should sildenafil (Viagra) be administered? Medications for erectile dysfunction include: * It will significantly charge up your sexual desire and stamina. "Furthermore, PDE5 inhibitors can exert direct effects on the retina, and such effects probably account for many of the visual side effects such as blue-tinged vision and light sensitivity that have been reported," they concluded. canadian viagra online VED Therapy Backgrounder - Vacuum erection therapy was created in 1961 by a long-time sufferer of ED. This plastic device (actually an external vacuum) can induce an erection. The better-made VEDs cost between $200 and $500 and are available with a physician's prescription. Results of recent surveys indicate that, on average, 15% of the male population has suffered from erectile dysfunction. As a strong indicator of its age-related increase, more than 50% of men over the age of 60 have varying degrees of erectile dysfunction (ED). So it may not be surprising that it is estimated that ED affects approximately 31 million men in the United States, and as a whole, there may be as many as 300 million men around the world suffering with ED. (1) How Erectile Dysfunction Works Dealing with erectile dysfunction can be difficult on a relationship. But, sexual intercourse is not the only way to be intimate with your partner. There are sexual and non-sexual ways to remain close. Here are some tips. Depression Psychological illnesses Increases width of penis when activated