ED shares both unmodifiable and modifiable common risk factors with CVD (e.g., obesity, diabetes mellitus, dyslipidemia, metabolic syndrome, lack of exercise, and smoking). In this context, men with mild ED have similar risk factors to those of a general ED clinical trial population.

Thus, mild ED emerged as an important indicator of risk for associated underlying disease (CVDs). Several studies have shown some evidence that lifestyle modification and pharmacotherapy for cardiovascular risk factors may be of help in improving sexual function in men with ED.

However, it should be emphasized that more controlled prospective studies are necessary to determine the effects of exercise or other lifestyle changes in the prevention or treatment of ED.

Epidemiological studies have demonstrated consistent evidence for an association between lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) and sexual dysfunction regardless of age, and other comorbidities, and various lifestyle factors.

The Multinational Survey on the Aging Male (MSAM-7) study – performed in the US, France, Germany, Italy, Netherlands, Spain, and the UK - systematically investigated the relationship between LUTS and sexual dysfunction in > 12,000 men aged 50-80 years. Of 83% of men self-reported to be sexually-active, the overall prevalence of LUTS was 90%, with an overall prevalence of ED of 49%, and a reported complete absence of erection in 10% of patients. Moreover, the overall prevalence of ejaculation disorders was 46%.

The sexual history must include (when available) information about sexual orientation, previous and current sexual relationships, current emotional status, onset and duration of the erectile problem, and previous consultations and treatments.

The sexual health status of the partner(s) (when available) can also be useful. A detailed description should be made of the rigidity and duration of both sexually-stimulated and morning erections and problems with sexual desire, arousal, ejaculation, and orgasm.

Validated psychometric questionnaires, such as the International Index for Erectile Function or its short version Sexual Health Inventory for Men (SHIM), help to assess the different sexual function domains (i.e. sexual desire, EF, orgasmic function, intercourse, and overall satisfaction), as well as the impact of a specific treatment modality.

The psychometric analysis also supports the use of the erectile hardness score for the assessment of penile rigidity in practice and clinical trials research. In cases of clinical depression, the use of a 2-question scale for depression is recommended in everyday clinical practice: “During the past month have you often been bothered by feeling down, depressed or hopeless? During the past month have you often been bothered by little interest or pleasure, doing things?”.

Patients should always be screened for symptoms of possible hypogonadism (= testosterone deficiency), including decreased energy, libido, fatigue, and cognitive impairment, as well as for LUTS. For this specific purpose, screening questionnaires, such as the International Prostate Symptom Score may be utilized.

Physical examination Every patient must be given a physical examination focused on the genitourinary, endocrine, vascular, and neurological systems. A physical examination may reveal unsuspected diagnoses, such as Peyronie’s disease, premalignant or malignant genital lesions, prostatic enlargement or irregularity/nodularity, or signs and symptoms suggesting hypogonadism (small testes, alterations in secondary sexual characteristics, etc).

Blood pressure and heart rate should be measured if they have not been assessed in the previous 3-6 months. Laboratory testing must be tailored to the patient’s complaints and risk factors. Patients may need a fasting blood glucose or HbA1c and lipid profile if not recently assessed.

Hormonal tests include an early morning total testosterone. If indicated, bioavailable or calculated-free testosterone may be needed to corroborate total testosterone measurements. However, the threshold of testosterone to maintain ED is low and ED is usually a symptom of more severe cases of hypogonadism.

For levels > 8 nmol/l the relationship between circulating testosterone and sexual functioning is very low. Additional laboratory tests may be considered in selected patients (eg, prostate-specific antigen (PSA); prolactin, and luteinizing hormone. Although physical examination and laboratory evaluation of most men with ED may not reveal the exact diagnosis, these opportunities to identify critical comorbid conditions should not be missed.

Low-risk category The low-risk category includes patients who do not have any significant cardiac risk associated with sexual activity. Low-risk is typically implied by the ability to perform an exercise of modest intensity, which is defined as > 6 “metabolic equivalents of energy expenditure in the resting state” without symptoms.

According to current knowledge of the exercise demand or emotional stress associated with sexual activity, low-risk patients do not need cardiac testing or evaluation before the initiation or resumption of sexual activity or therapy for sexual dysfunction. Their problems can be solved by an ED pill.

What is Vidalista 60 mg?

A viagra containing the important Sildenafil Citrate is liable for assisting with ED and hypertension. Both these issues are associated with unpredictable bloodstream in the vessels.

How does Vidalista 60 mg work?

Vidalista 60 mg widens the veins, which brings about a better bloodstream, an interaction known as vasodilation. Legitimate progression of blood likewise implies a lower possibility of getting a coronary illness or a stroke. Vidalista 60 mg helps in keeping an erection for as long as 4 hours.

How to administer Vidalista 60 mg?

The patient should take the pill with a glass of water 1 hour earlier.
Try not to surpass the dose past one pill in 24 hours.
Stay away from high-fat dinners.
Stay away from liquor.

Intermediate- or indeterminate-risk category The intermediate- or indeterminate-risk category consists of patients with an uncertain cardiac condition or patients whose risk profile requires testing or evaluation before the resumption of sexual activity. Based upon the results of testing, these patients may be moved to either the high- or low-risk group. Cardiology consultation may be needed in some patients to help the primary physician determine the safety of the sexual activity.

High-risk category High-risk patients have a cardiac condition that is sufficiently severe and/or unstable for sexual activity to carry a significant risk. Most high-risk patients have moderate-to-severe symptomatic heart disease. High-risk individuals should be referred for cardiac assessment and treatment. Sexual activity should be stopped until the patient’s cardiac condition has been stabilized by treatment, or a decision made by the cardiologist and/or internist that it is safe to resume sexual activity.

Specialized diagnostic tests

Most patients with ED can be managed within the sexual care setting; conversely, some patients may need specific diagnostic tests. Nocturnal penile tumescence and rigidity test The nocturnal penile tumescence and rigidity assessment should be done on at least two nights. A functional erectile mechanism is indicated by an erectile event of at least 60% rigidity recorded on the tip of the penis that lasts for > 10 min.

Intracavernous injection test The intracavernous injection test gives limited information about the vascular status. A positive test is a rigid erectile response (unable to bend the penis) that appears within 10 min after the intracavernous injection and lasts for 30 min. Overall, the test is inconclusive as a diagnostic procedure and a duplex Doppler study of the penis should be requested if clinically warranted.

Duplex ultrasound of the penis A peak systolic blood flow > 30 cm/s, and end-diastolic velocity of < 3 cm/s and a resistance index > 0.8 are generally considered normal. A further vascular investigation is unnecessary when a Duplex examination is normal.

Arteriography and dynamic infusion should be performed only in patients who are being considered for vascular reconstructive surgery.

Psychiatric assessment Whenever clinically indicated, patients with psychiatric disorders should be referred to a psychiatrist who is particularly interested in sexual health. In younger patients (< 40 years) with long-term primary ED, a psychiatric assessment may be helpful before any organic assessment is carried out.

Penile abnormalities Surgical correction may be needed for patients with ED due to penile abnormalities (e.g. hypospadias, congenital curvature, or Peyronie’s disease with preserved rigidity).