How to overcome Erectile Dysfunction And Premature Ejaculation Last Longer and Perform Stronger Today! Sex is a basic human need central to a balanced and fulfilling life. Important Message: Erectile Dysfunction and Premature Ejaculation are medical conditions that require proper medical assessment and intervention. No single pill or herbal product can substitute for a medical consultation by an experienced physician. Treatment should be personalized to suit the individual’s needs and expectations. We hope you will find the following information useful and find an opportunity to once again re-discover sex in a safe and healthy manner. Human Sexuality With respect to a man’s psyche, sexuality is intimately related to his ability to perform which, when compromised may pose a fundamental threat to his well being. The effect can range from a feeling of inadequacy, frustration, denial, lack of motivation to low self-esteem, depression and even aggressiveness. Consequently, personal, family and business relationships may be adversely affected. Boston Medical Group specializes in the diagnosis and treatment of two common sexual ailments, namely Erectile Dysfunction (or ED) and Premature Ejaculation (or PE) Erectile Dysfunction is Sexuality reflects defined as the inability who we are and to achieve or maintain an erection sufficient how we relate to for satisfactory sexual the world and intercourse. This condition is therefore, an affects one in two adult integral part of males to various degrees. Even though effective our physical and treatments for ED had psychological well been available for at least a being. decade before Viagra® was released in March 1988, it had been difficult for the afflicted individual to know where to go to seek help. The massive advertising campaign and successful launch of this drug has changed that to a certain extent. Talking about sexual dysfunction and seeking help became less taboo. However, the topic remains a sensitive area for most men. The advent of Viagra® and later on, Levitra® and Cialis® has helped many men restore their sex life. For many others, the high hope in the “miracle pill” has quickly deflated in light of certain side-effects and lack of efficacy. For these men, to re-confront these problems becomes more challenging than the first time. These drugs are not for everybody and are not without risks. It is estimated that between 30-70 % of men do not respond to these drugs, depending on their age and underlying health problems and at least 15% suffer from undesirable side-effects. Additionally, a possible link between these pills and sudden blindness was made public in May 2005. Despite the drug maker’s position that there is no direct evidence to support causality, the FDA has enforced new labeling to warn men of possible blindness arising from the use of these drugs. According to the Associated Press, as printed in the Washington Post July 9, 2005: “Viagra® and two other popular impotence drugs may cause sudden blindness in rare cases, the Food and Drug Administration said in a formal alert Friday” Although the statement said it remained unclear whether the drugs are actually causing the sudden blindness, it warned that men most prone to the ocular condition to discuss the newly identified risk with their doctors. The condition, called non-ar- teritic anterior ischemic optic neuropathy, or NAION, is caused by a blockage of blood to the optic nerve. “Risk factors for developing NAION include diabetes and heart disease, two of the leading causes of impotence. In addition, the agency identified other risk factors including being older than 50, smoking, high blood pressure, and high cholesterol.” Note that these named risk factors are the same risk factors for ED! According to Medscape Medical News Oct 19, 2007: Sudden loss of hearing has been reported in patients taking phosphodiesterase-5 inhibitors (Viagra®, Levitra® and Cialis®), the US FDA warned healthcare professionals. In some cases, the sudden loss or decrease in hearing was accompanied by vestibular symptoms such as tinnitus, vertigo, and dizziness, according to an alert sent from MedWatch, the FDA’s safety information and adverse event reporting program. Hearing loss was temporary in about 33% of patients; for the remainder, hearing loss was either ongoing at the time of report or the final outcome not described. In almost all cases, the condition was one-sided. According to WebMD Medical News Oct 19, 2007: Viagra, Levitra, and Cialis haven’t been proven to cause hearing loss, but the alert was warranted due to “the strong relationship between the use of these drugs and sudden hearing loss in these cases,” states the FDA. If you have tried Viagra®, Levitra® or Cialis® unsuccessfully or, if you cannot take these pills due to health problems or side-effects, or if you want to improve your sex life safely and effectively, Boston Medical Group has the answer. Our highly experienced doctors can offer you a personalized treatment that works in an overwhelming majority of cases even when other treatments have failed. Premature Ejaculation (PE) or “coming too quick” is yet another sensitive and embarrassing condition affecting at least one in three sexually active men. Effective treatment is readily available. So, if you are not satisfied with your current performance or if your partner wishes you to last longer, Boston Medical Group can also help. Erectile Dysfunction Signs of Erectile Dysfunction: • Difficulty achieving or maintaining an erection occurs at least once in every four times of attempting sexual intercourse, or the problem persists for more than one month. • Achieving an erection takes longer than usual or becomes more difficult in certain positions. • Sexual erection becomes weaker or less rigid. • Maintaining an erection becomes a conscious effort or becomes more difficult. • Morning erections becomes less frequent or less rigid. • Climaxing becomes more rapid or occurs with an incomplete erection. How Common Is Erectile Dysfunction? Erectile Dysfunction is very common. And it happens to the best of us! Although it tends to be more common in men over 40 years of age, it can affect men of all ages. In mid 1992, the results of the world’s largest Erectile Dysfunction study called The Massachusetts Male Aging Study (MMAS) became available. These results showed that: • 52% of all men between the ages of 40 and 70 have some degree of erectile dysfunction. (Classified as minimal, moderate or severe.) • At least 1 in 10 men cannot get an erection at all (complete ED). • The majority of causes of erectile dysfunction are physical in nature. • There is a strong association between age and ED such that the prevalence of ED increases with age – 39% at 40 and 67% at 70 are affected. 100 90 80 70 60 50 LENCE OF VA 40 IMPOTENCE PRE 30 20 10 0 40 45 50 55 60 65 70 AGE (years) MINIMAL IMPOTENCE MODERATE IMPOTENCE COMPLETE IMPOTENCE OVERALL IMPOTENCE “Erectile Dysfunction is more common than diabetes, hypertension and heart conditions combined. With safe and effective treatment available, we can help men quickly restore their erectile function and sexual relationship” Barry Buffman, M.D. Urology What Causes Erectile Dysfunction? Psychological Erectile Dysfunction Contrary to popular belief, psychological factors account for only about 10% of all cases of Erectile Dysfunction (ED). The psychological factors are mostly the result of nervousness, lack of confidence or performance anxiety. These conditions cause an increased sympathetic tone and raised circulating catecholamine concentration. Which in turn, causes the blood vessels to constrict (vaso- constriction) resulting in a temporary reduction of blood flow to the penis, hence erectile difficulties. Psychological ED can be self-perpetuating: each failure increases the associated anxiety levels and can frequently lead to a continual failure. Other psychological causes include stress, guilt, sexual boredom, depression etc. Physical or Organic Erectile Dysfunction It is now known that 90 % of cases of ED are caused or contributed by physical factors, most of which are related to poor circulation, a condition referred to as “vascular insufficiency”. The penis requires a very healthy blood flow to be completely erect. Even a marginally impaired blood flow can cause significant problems. Risk factors include: • Diabetes • Hypertension • High blood cholesterol • Cardiac diseases • Smoking • Arterial sclerosis (age-related thickening and hardening of the arteries) • Poor overall circulation • Certain types of medication “The risk factors for most cases of Erectile Dysfunction, namely being older than 50 years of age, diabetes, hypertension, high blood cholesterol, cardiac disease and smoking are also the same risk factors for developing sudden blindness in association with (though not conclusively proven) the use of Viagra®, Levitra® and Cialis®, according to the FDA’s alert”. William Livingston, M.D. Urology The effect of aging: With age, the artery becomes hardened and thickened and loses some of its elasticity. Other vascular risk factors, such as diabetes, cholesterol, hypertension, smoking etc. can aggravate the effect on aging on the artery, making it even more difficult to dilate in response to sexual stimulation. Other physical causes are not common but can be readily diagnosed. These include: • Hormonal deficiencies caused by testicular disease, liver disease or thyroid problems. • Neurological problems such as Multiple Sclerosis, stroke, Parkinson’s Disease etc. • Trauma to pelvic area as experienced in certain types of surgery, radiation therapy or automobile accidents that results in damage to the pelvic nerves or arteries. ED can affect completely healthy individuals as well. “We aim to provide both an immediate resolution to the problem and the possibility of long term improvement. The best treatment is a balanced decision between risks and benefits taking into account the short term gain and future prognosis”. Alan Sperber, M.D. Urology Should Erectile Dysfunction Be Treated? Yes! Like any medical problem, erectile dysfunction should be treated promptly.