What is the “normal” frequency of sex?

What is the “normal” frequency of sex?

It’s human nature to wonder whether you are having more or less sex than others. But it’s a difficult question to answer.

Many factors can influence how often people have sex. Relationship status, health, and age can all play a role. Couples who are in the early “honeymoon” stage of their relationship may have sex frequently. As the relationship progresses, the rate might slow down. If they are busy with work or childcare, they might not have as much time for sex as they used to. If they have an illness or chronic pain, they might have less sex – but that might change if they’re feeling better.

The Kinsey Institute’s 2010 National Survey of Sexual Health and Behavior provides us with some statistics on the sexual frequency of men and women. Much depended on whether the respondents were single, partnered, or married.

Men

  • Only 2% of single men between the ages of 18 and 24 had sex 4 or more times per week, but 21% of married men did.

  • Just under half of married men between the ages of 25 and 49 had sex a few times per month to weekly. This was the highest rate in this age category.

  • Age was not necessarily a deterrent to sexual frequency. Thirteen percent of single men age 70 and older had sex a few times per month to weekly. For partnered and married men in this age group, the rates were 63% and 15% respectively.

Women

  • About 5% of single women between the ages of 18 and 24 had sex 4 or more times per week, but 24% of married women did.

  • Like the men, just under half of the women between the ages of 25 and 59 had sex a few times per month to weekly, more than their single and partnered peers.

  • Sexual frequency did decrease with age for women, although almost a quarter of partnered women over age 70 had sex more than 4 times a week, according to the survey.

Even if men and women do have sex more frequently, it doesn’t mean they are happier. Researchers from Carnegie Mellon University conducted a study of 64 couples between the ages of 35 and 65. Half the couples were instructed to double their weekly frequency; the other half were given no such instructions.

The couples answered questions about their sexual activity and their happiness. Those who had sex more frequently were not any happier. In fact, their levels of happiness decreased a bit. It appeared that being told to have more sex made it lose some of its spontaneity and excitement.

Remember that every couple is different. The “right” frequency is one that satisfies both partners. It may take time to figure this out, but putting the focus on intimacy, communication, and bonding with a partner is more important than worrying about numbers, targets, or the sexual frequency of other couples.

It’s also possible that one partner wants to have sex more or less frequently than the other. Communication is critical here, as couples need to make compromises. A qualified sex therapist can help partners with that negotiation.

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Erectile Dysfunction

Erectile Dysfunction

What is erectile dysfunction (ED)? What causes ED? How is ED treated?

Erectile dysfunction (ED) is a man’s inability to achieve or maintain an erection suitable for satisfactory sex.
To understand ED, it’s important to understand how erections occur. When a man is sexually aroused, nerves and chemicals work together to relax smooth muscle tissue and widen arteries so that the penis can fill with blood. Veins constrict to keep the blood inside the penis, forming the erection. Once the man ejaculates, the blood is released back into the body.
ED becomes more common as men get older. It’s also associated with some medical conditions, like heart disease and diabetes. In fact, an estimated 50% of diabetic men have some degree of ED.

ED can happen for many reasons, both physical and psychological:

  • Poor blood flow to the penis.

This is one of the most common causes of ED and can be the result of diabetes, heart disease, high cholesterol, and high blood pressure.
  • Nerve damage.

When a man is sexually aroused, his brain sends messages to his penis to start the erection process. But if there is nerve damage, these messages cannot be transmitted properly. Thus, conditions that affect the nervous system - like diabetes, spinal cord injury, multiple sclerosis, and stroke – can lead to ED. Erectile nerves can also be damaged during cancer treatments, like radiation therapy or radical prostatectomy (removal of the prostate gland).
  • Hormonal issues.

Men with low testosterone or thyroid disorders may have trouble with erections.
  • Medication side effects.

ED is a side effect of some medications, such as those prescribed for high blood pressure, heart disease, peptic ulcers, insomnia, and depression. Not all medications in these categories have sexual side effects, however. For example, some antidepressants do, but other antidepressants do not.
  • Peyronie’s disease.

Peyronie’s disease is a wound healing disorder marked by a distinct curvature of the penis. Many men with Peyronie’s disease develop ED, although experts aren’t sure exactly why.
  • Psychological and emotional issues.

Fighting with a partner, anxiety, depression, stress, past sexual abuse, and concerns about sexual performance can all affect one’s sexual well-being. In these cases, sessions with a sex therapist or counselor may help.
        A man’s lifestyle can also interfere with his erectile function. Smoking, obesity, drug and alcohol abuse, an unhealthy diet, and poor exercise habits can contribute to other health conditions associated with ED.

Men with ED have several treatment options:

  • Psycho-sexual treatments.

These approaches may reduce both the man’s and his partner’s anxiety, enhance arousal, and offer pleasurable options, which may reduce the man’s stress. These interventions can be performed separately or parallel to medical treatments.
  • Oral medications.

Phosphodiesterase type 5 (PDE5) inhibitors like avanafil (Stendra), sildenafil (Viagra), generic sildenafil, tadalafil (Cialis), and vardenafil (Levitra) help increase blood flow to the penis. These drugs are usually the first method patients try, but they should not be used by men who take nitrates. Patients with slow drug absorption (e.g., Parkinsonian patients) may need to wait 2-3 hours for an erection to develop after taking PDE5 inhibitors.
  • Penile injections.

Men can learn to inject medication into the penis. This medication helps blood vessels dilate, allowing more blood for erection.

 

  • Urethral suppositories.

These medications are inserted into the urethra at the tip of the penis.

  • Vacuum erection devices.

The man places his penis into a vacuum cylinder and pumps air out. He then places a constriction ring at the base of the penis, which keeps the erection.
  • Penile implants.

Implants (sometimes called penile prostheses) are surgically placed inside the penis and allow a man to get an erection when he wishes. Nowadays, most penile implants are inflatable devices controlled with a pump.
Men who are having trouble with erections are encouraged to see a doctor. It’s not unusual for ED to have a combination of causes. It can also be a sign of a more serious medical condition like diabetes or heart disease, so it’s important to have a complete checkup.

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Can gout affect sexual health and performance?

Can gout affect sexual health and performance?

Yes, it can – especially for men.

Gout is a particularly painful type of arthritis, caused by sharp, crystallized deposits of uric acid in the joints. Uric acid is produced when the body processes purines – substances found in some foods and beverages like liver, seafood, peas, and beer. Uric acid is usually absorbed in the blood, processed by the kidneys, and eliminated with urine. But sometimes, the kidneys don’t process uric acid properly, causing it to build up. Uric acid can also accumulate when a person eats too many foods that contain purines.
Eventually, the buildup forms sharp crystals, leading to gout. Gout often starts in the feet, especially in the big toe. But it can also form in the knees, wrists, fingers, and elbows. In addition to pain, patients with gout may experience swelling, stiffness, and redness in the affected area.
Gout is far more common in men than in younger women. Estrogen, a female sex hormone, helps the kidneys process uric acid. However, once women reach menopause, their risk for gout increases, as their estrogen levels drop substantially.
In women, gout tends to occur more in the fingers and ankles. It is also more common in women with high blood pressure and poor kidney function.
Studies have shown that men with gout are at higher risk for developing erectile dysfunction (ED). They are also more likely to have severe cases of ED.
This might be explained by a possible connection between high levels of uric acid and endothelial dysfunction. The endothelium is tissue that lines all blood vessels, including those in the penis. Problems with the endothelium can restrict blood flow to the penis, which weakens erections. As men with gout have higher levels of uric acid, this link might account for their ED.
In 2017, the journal Arthritis Research & Therapy published a large study on gout and ED in men who lived in England. They identified 9,653 men between the ages of 18 and 64 who were diagnosed with gout between 1998 and 2004 and followed them until 2015. For comparison, they also identified 38,218 men without gout who were around the same age.
The scientists found that the men with gout were at higher risk for ED. During the study period, 18% of the men with gout developed ED, compared to 11% of the men without gout.
The men with gout were also more likely to drink more alcohol, be overweight, or have medical conditions like diabetes, high blood pressure, heart disease, chronic kidney disease, and depression.
In addition, the researchers discovered that ED risk might be increased within the year before a gout diagnosis, possibly because of higher levels of uric acid in the blood.
Pain from gout can make sex uncomfortable for both men and women. Some couples try new sexual positions or have sex when medications for gout are most effective. It’s important for patients to tell their partners if a particular activity is painful and feel open to discussing other options for intimacy.
Patients with gout may take non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation. Other medications may be prescribed to stop production of uric acid or improve the body’s ability to process it. Eating a healthy diet that is low in purines might help relieve the severity and frequency of gout attacks.
Those who think they may have gout, particularly men with ED, are encouraged to see their doctor.

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What are prostatic calculi (prostate stones)? Do they affect sexual function?

What are prostatic calculi (prostate stones)? Do they affect sexual function?

Prostatic calculi (also called prostate stones) are small brownish-gray stones that form in the prostate. Each stone, or calculus, is roughly the size of a poppy seed. A man may have one calculus, or he could have hundreds of calculi.
Most of the time, prostatic calculi themselves don’t cause any symptoms, and they often aren’t found during routine medical exams.
However, prostatic calculi can become infected and, in turn, lead to urinary tract infections and prostatitis (inflammation of the prostate gland).
Some men with prostate stones experience pain in the lower back, penis, or perineum (the area between the anus and the scrotum). They might also have trouble urinating.
Prostate stones are more common in men who are middle-aged or older, and especially in men with an enlarged prostate, prostate cancer, chronic prostatitis/chronic pelvic pain syndrome.
Prostatic calculi that don’t cause symptoms usually don’t require treatment. Sometimes, they pass on their own in a man’s urine.
If stones are causing symptoms or contributing to other prostate conditions, they might be treated with antibiotics. In more severe cases, they can be removed surgically.
The direct effects of prostatic calculi on a man’s sexual function have not been widely researched. Some studies have suggested that ejaculatory pain and erectile dysfunction (ED) might be associated with prostatic calculi, but more information is needed.
Men who have questions about prostatic calculi are encouraged to see their andrologist.

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Why might intensity of orgasm decline?

Why might intensity of orgasm decline?

Like many aspects of sex, intensity of orgasm can depend on the individual as well as the situation. Here are some of the more common reasons orgasms might become less powerful:
Aging
Levels of sex hormones decline for both men and women as they get older. Men’s testosterone levels drop gradually over time, which can dampen both desire and orgasm intensity.
For women, estrogen decreases at menopause are more abrupt. Some experts believe that the clitoris becomes less sensitive due to estrogen decline. Many women climax through clitoral stimulation; less sensitivity may diminish the intensity of orgasms.
Also, estrogen is important for keeping vaginal tissues flexible and lubricated. When levels fall, the vagina can become dry and narrow. Intercourse may become uncomfortable. (Read more about vulvar and vaginal atrophy
Routine/Boredom
If a couple has been together for several years, they may fall into a sexual routine that does not excite one partner (or both) as much as it used to. Changing the pattern may help. Couples are encouraged to talk to one another to make sure each partner is getting his or her sexual needs met.
In addition, men who use pornography and/or masturbate daily may find that their orgasms become less intense or less satisfying.
Stress and Anxiety
Stress can affect sexual health in many ways, including orgasm. If a person is under pressure at work, feeling overwhelmed by family responsibilities, or anxious about the state of a romantic relationship, he or she may become distracted during sex, which could take away some of the pleasure.
Low Desire and Poor Arousal
Problems with sex drive (libido) or arousal (the body’s physical preparation for sex) may also lower orgasm intensity. These issues can have both physical and psychological causes, such as hormonal declines or relationship conflict. Patients are encouraged to see a doctor or therapist.
Weak pelvic floor
The pelvic floor is a muscle group that supports the pelvic organs, such as the bowel, bladder, and uterus. These muscles tend to weaken as people get older. Surgery, obesity, and childbirth may weaken them as well.
Kegel exercises are designed to strengthen the pelvic floor muscles. People who keep their pelvic floor toned often find that the intensity of their orgasms improves.
Birth Control Methods
Some men claim that they have orgasm difficulties when using condoms. Oral contraceptives can be similarly problematic for women, too.
It’s important to note that diminished orgasms are not a reason to stop using birth control or engage in unsafe sex. Couples should make sure they are using condoms correctly. Women may consider switching from oral contraceptives to another form of birth control, such as an IUD.
Communication is an essential component of any sexual relationship. If a partner’s orgasms become diminished, the couple can work together to solve the issue. The answer may be as simple as making more time for the relationship, asking for help with responsibilities, or changing birth control methods. It may also help to consult a doctor, sex therapist, or counselor.

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Is flibanserin (Addyi) safe for women who take antidepressants?

Female Sexual Health

Dr. Ahmad Motawi

What is Addyi?

Addyi is the brand name of flibanserin, a drug designed to treat acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women.
HSDD refers to a lack of sexual desire that causes distress and/or trouble with personal relationships. It’s normal for women to lose interest in sex from time to time, but for women with HSDD, the problem is persistent. Acquired HSDD occurs after a woman has had a healthy sex drive for some period of time, often many years. Generalized HSDD happens with any sexual partner and any sexual situation.
Addyi works by balancing chemicals the brain that influence sexual desire.
The drug was approved by the U.S. Food and Drug Administration (FDA) in August 2015. It is available in the United States since October 17, 2015.
Will Addyi be available outside the United States?
As of August 2015, it is unclear if and when women outside the U.S. will have access to Addyi. On August 21, 2015, The Pharmaceutical Journal reported that Sprout Pharmaceuticals, the drug’s developer, had not yet applied to the European Medicines Agency for permission to market Addyi in Europe.
Sprout plans to seek approval in Canada later this year, according to an August 20, 2015 report from CTV News.
What are some side effects of Addyi?
Some women who take Addyi experience dizziness or sleepiness. This is why Addyi is meant to be taken at bedtime. Women may also have nausea, fatigue, insomnia, and dry mouth.
What are some of the health risks of Addyi?
Addyi does have some safety concerns.
The drug is not safe for women with poor liver function. Also, women who take medications called CYP3A4 inhibitors should not take Addyi.
Two of the most serious concerns are loss of consciousness (syncope) and extremely low blood pressure (hypotension). If either of these situations occur, women should seek medical care immediately.
It is very important that women avoid drinking alcohol while they are taking Addyi. Risks of syncope and hypotension are higher when the drug is mixed with alcohol. Further research on this interaction is planned.
Women should always see their doctor before taking Addyi. A thorough medical exam may reveal other health conditions or medication that could be contributing to low sexual desire. Relationship problems may also be a factor to consider.
Patients who have no improvement in their desire or personal distress after 8 weeks should stop taking Addyi and seek further professional help.

Dr. Ahmad Motawi

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What is the refractory period?

What is the refractory period?

After orgasm, both men and women experience a resolution stage. At this time, their bodies “recover” from sexual excitement and return to their normal states. For men, the penis becomes flaccid again and he goes through a refractory period.

During the refractory period, a man doesn’t think about sex or get aroused. His body does not respond to sexual stimulation and he is unable to reach orgasm again until the period is over. The length of the refractory period is different for every man. It may take a half hour or more for his body to perform sexually again.

Younger men may need only a few minutes of recovery time, but older men usually have a longer refractory period, sometimes between 12 to 24 hours. For some men, the refractory period can last a few days.

Experts aren’t sure why the length of refractory periods varies so much among men. But they do know that the length of time needed is not related to potency or testosterone levels.

Some men wonder how they can shorten their refractory period. No drugs have been approved for this purpose, but research has shown that some two drugs used to treat erectile dysfunction - may reduce recovery time.

Women do not have refractory periods the way men do. But fatigue after orgasm can make them lose interest in sex temporarily. This can happen after one orgasm or multiple orgasms.

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What lifestyle changes can men make to improve their erectile function?

What lifestyle changes can men make
to improve their erectile function?

There are many things men can do to improve erectile function. Many of them provide other health benefits as well, so it makes sense to give them a try.
Before considering these lifestyle changes, it’s helpful to remember the role of penile blood flow in forming and maintaining an erection.
When a man is sexually stimulated, penile arteries widen and smooth muscle tissue relaxes. As a result, the penis fills with blood, which gives the erection its firmness.
Often, erectile dysfunction occurs when there are problems with blood flow. Many of these suggestions improve blood flow, but there are other factors, like nerve damage, that can be involved.

Exercise

Many men find that their erectile function improves when they exercise regularly. Exercise helps to keep blood flowing smoothly, including blood to the penis. Research has shown that men who are more physically active are at a lower risk of developing erectile dysfunction.
Men should consult their doctors before beginning a regular exercise program to ensure that the type of exercise they choose is appropriate for them.

Maintain a healthy weight

Obesity can damage blood vessels that allow blood into the penis for an erection. Studies have shown that heavier men tend to have more erectile problems, which may improve after the men lose weight.
Weight loss may also help erectile function by decreasing inflammation, increasing testosterone, alleviating depression, and boosting confidence.

Don’t smoke (or quit if you do smoke)

Scientific studies have found that men who smoke are more likely to develop erectile dysfunction than nonsmoking men. This likelihood appears to increase with the amount of cigarettes smoked over time. Men who stop smoking often see an improvement in their erectile function.

Eat a healthy diet

Research has shown that eating a Mediterranean diet may improve erectile function for some men. This diet includes fruits, vegetables, grains, and olive oil. Research has also shown that men without erectile dysfunction were more likely to eat lots of fruits, vegetables, nuts, and fish, and whole grains.

Control blood sugar and manage diabetes

Many men with diabetes have erectile problems. High blood sugar can damage blood vessels, nerves, and erectile tissue.
Blood vessels may be more susceptible to atherosclerosis – hardening of the arteries – in diabetic men. This means that plaques build up in the arteries, making it more difficult for blood to flow freely into the penis and form an erection.
Nerve damage, or neuropathy, can cause signaling problems between the brain and the penis. A man’s brain may register sexual stimulation, but if the “message” doesn’t reach the penis, there will be erectile problems.
High blood sugar can also interfere with the production of chemicals needed for an erection, like the neurotransmitter nitric oxide.
Other chemicals associated with diabetes can stiffen erectile tissue, leading to valve problems and “venous leak.” When this happens, the erection cannot be maintained because blood leaks out of the penis and back into the body.

Manage blood pressure

High blood pressure, or hypertension, is a common cause of erectile dysfunction, as it can interfere with penile blood flow.
While it’s important to manage high blood pressure, medications for this condition may also affect erectile function. It appears that older drugs, such as diuretics and beta-blockers, are more likely to have sexual side effects than newer ones. A man’s physician can help him decide on the best treatment options.

Manage depression

Depression is associated with erectile dysfunction, although it is unclear whether one directly causes the other. A man’s depression may lead to erectile difficulties. However, erectile dysfunction may also make him depressed.
Nevertheless, managing depression may help alleviate erectile dysfunction. It is important to note, however, that some commonly prescribed medications for depression, such as selective serotonin-reuptake inhibitors (SSRIs), have sexual side effects. A man may need to try different medications, with a physician’s guidance, to determine which one works best for him.

Remain sexually active

In a Finnish study of men between the ages of 55 and 75, men who had intercourse less than once a week were twice as likely to have erectile dysfunction than those who had intercourse once a week. The researchers concluded that regular intercourse protects against erectile dysfunction.

Be careful when bike riding

Men put a lot of pressure on their genitals when riding a bike. Compressing the perineum (the area between the scrotum and anus) on a bicycle seat can stop blood flow to this area, causing sexual difficulties. Men are advised to use a noseless bicycle seat, adjust their position on the bicycle so that there is less pressure on the perineum, and limit the time they spent bike riding.

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What is chronic prostatitischronic pelvic pain syndrome (CPCPPS)?

What is chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)?

Prostatitis is inflammation of the prostate gland, the walnut-sized gland located below a man’s bladder. The prostate gland secretes fluid that, along with sperm, forms semen.

There are different types of prostatitis, one of which is chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). This is the most common type. Young and middle-aged men are more likely to develop CP/CPPS, but it can happen at any age.

CP/CPPS may be classified as inflammatory or non-inflammatory.

In inflammatory cases, urine, semen, and fluid secreted by the prostate contain infection-fighting cells. But these fluids don’t contain bacteria.

When CP/CPPS is non-inflammatory, no infection-fighting cells and no bacteria are found in the fluid.

Men with CP/CPPS can experience chronic discomfort or pain in the groin, genitals, perineum (the area between the anus and the genitals), or bladder. They may have pain with urination and ejaculation as well. Many feel anxious about the situation.

But symptoms don’t happen to every man with CP/CPPS. Also, symptoms may come and go on their own.

CP/CPPS can be hard to diagnose because its symptoms are similar to other medical conditions, like kidney and bladder problems. Also, some researchers believe that CP/CPPS is not related to the prostate gland but may be caused by pelvic floor muscle strain instead.

Men usually undergo a digital rectal exam, during which their doctor inserts a lubricated, gloved finger into the rectum. By doing this, the doctor can feel any abnormalities in the prostate gland.

Doctors may also analyze urine and prostatic fluid. In some cases, blood tests, ultrasounds, MRIs, or biopsies are ordered to rule out other conditions.

CP/CPPS can also be difficult to treat and, unfortunately, it cannot always be cured. It can also take some time to find what best relieves a man’s symptoms. Some strategies for treating CP/CPPS symptoms include the following:

Medications.

Anti-inflammatory, pain medications, and muscle relaxants may be recommended. Alpha-blockers, which help relax muscles around the prostate, may also help. Some doctors prescribe antibiotics for CP/CPPS, but this treatment option is controversial.

Heat.

Some men find relief by taking a hot bath or by applying a heating pad or hot water bottle to the affected area.

Changes in diet.

Spicy foods and caffeinated or acidic drinks can aggravate symptoms for some men.

Lifestyle changes.

Activities that make symptoms worse, like bicycle riding, may need to be avoided.

Pillows.

Experimenting with different pillows or cushions may help a man who is uncomfortable while seated.

 Prostatic massages.

These massages can help release some pressure around the prostate.

Counseling.

Psychological issues among men with CP/CPPS are common. Men with the condition have considerably higher levels of anxiety than those without it. Some experts believe that psychological problems are part of the cause of CP/CPPS. Such problems could also develop as a result. In either case, talking to a counselor may help men cope with this aspect of CP/CPPS.

Men with severe CP/CPPS may require surgery.

Sometimes, CP/CPPS gets better on its own.

Most men with CP/CPPS can have sex as they did before. However, it may be uncomfortable at times, especially during a pain flare-up. Couples may need to take a break from sex until the discomfort passes.

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What is venous leakage and how does it cause erectile dysfunction (ED)?

What is venous leakage and how does it cause erectile dysfunction (ED)?

Problems with blood vessels are a common cause of erectile dysfunction (ED). The term venous leakage refers to veins in the penis.

Blood vessels are important for erections. When a man becomes sexually aroused, the arteries in his penis expand to allow blow to flow in, making the erection firm.

However, to keep the erection rigid, blood needs to stay in the penis until the man ejaculates. To accomplish this, veins constrict to trap the blood inside. (This process is called veno-occlusion.) Once the man climaxes, or if sexual stimulation ends, the veins widen and blood flows back into the body.

If the veins do not constrict enough, blood will “leak” back into the body, softening the erection. Many men with this type of ED find that they can get a firm erection at first, but gradually lose the firmness.

Venous leak is often a cause of ED in younger men.

Several factors can contribute venous leak and ED:

  • Vascular disease (which affects blood vessels)

  • Radiation therapy for cancer treatment

  • Diabetes

  • Peyronie’s disease

  • Nerve disorders

  • Anxiety

To diagnose venous leakage, a doctor might conduct the following tests:

  • Doppler ultrasound. This procedure uses sound waves to show how blood is flowing in and out of the penis.

  • Dynamic infusion cavernosometry. With this test, a doctor can measure the pressure in the penis during an erection to determine the degree of venous leakage. Cavernosometry is used less frequently, usually in men who have already undergone Doppler ultrasound.

A doctor will also assess a man’s overall health and check for conditions related to ED, like vascular disease, diabetes, Peyronie’s disease, and nerve disorders.

Treatments for ED due to venous leakage can vary. Some men have success with oral ED medications, but there are other options, including vacuum devices, self-injections, urethral suppositories, psycho-sexual treatments, and penile implants.

Lifestyle modifications, like getting more exercise and eating a healthier diet, may also help control underlying factors like diabetes and vascular disease.

In some cases, venous ligation surgery, which repairs the leaking veins, might be considered. However, this approach is not typically recommended because it has limited long-term success. More research is warranted in this area.

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