Vacuum Erection Devices (VED): Basic Principles

VEDs are a useful noninvasive treatment for ED. They involve a cylindrical device that is placed over the penis. Many types of VEDs are now available, and it is recommended that only those available by prescription should be used.¹ ² A VED, which mechanically creates penile blood engorgement, consists of a vacuum chamber or cylinder, a pump to produce negative pressure, and constriction rings.

VEDs can be used to treat organic or psychogenic ED. Current reviews report successful results in men with a variety of organic etiologies, including spinal cord injuries, postprostatectomy, diabetes, and arterial insufficiency.

After the penis and constriction rings are coated with water-soluble lubricant and the rings are loaded onto the cylinder base, the cylinder is placed over the penis with the base held firmly against the pubis to maintain a seal. The pump is then activated to slowly create negative pressure, or a vacuum, inside the cylinder, which draws blood into the corpora cavernosa, producing an erection.

Once the penis is engorged, the constriction band is pulled from the cylinder onto the base of the penis. The negative pressure is released through a valve, and the cylinder is removed. It takes an average of 2 to 2½ minutes to create an erection through this procedure, according to recent reviews.

The erectile state produced by VEDs differs from a normal erection: penile skin temperature is lower, the veins of the penis appear distended, and penile circumference is increased. In addition, the penis may pivot at the base, requiring the patient to stabilize the penis during intercourse.

How it Works

This mechanical device consisting of a plastic cylinder is placed externally over the penis. Activation of an attached pump creates a vacuum that encourages blood to flow in to the penis. A rubber ring is then snapped over the base of the penis, keeping the blood in the penis and maintaining the erection.

Long-Term Experience

Long-term follow-up of men who chose the vacuum constriction devices as primary treatment for their erectile dysfunction reveals that this treatment option is inappropriate for men with mild Erectile Dysfunction and ineffective for men with severe Erectile Dysfunction. It seems that men with moderate Erectile Dysfunction are the best candidates for this treatment option. Our study, which was recently published in Urology (May 1999), showed that even when properly trained, 65% of patients who purchased the device stopped using it. Of the patients who discontinued, most stopped treatment early (1-4 months).

In addition, now that effective oral medication is available for men with moderate Erectile Dysfunction, the use of vacuum constriction devices in this patient population will most likely also decrease.


Advantages & Limitations

External Vacuum Pump: Advantages

    Least invasive method of all

    Requires no medication or surgery

    Insurance will cover expense

External Vacuum Pump: Limitations

    High rate of discontinued use (65%)

    Cumbersome

    Painful erection

    Ineffective

Erectile Dysfunction Tests

Doctors once believed that most erectile dysfunction (ED) was caused by psychological problems. That is no longer thought to be the case.

Some erection problems are psychological. However, doctors now recognize that many cases of ED are caused by underlying medical problems.

A physician’s initial evaluation for ED will typically involve taking a simple medical history and performing a physical examination. If this initial evaluation suggests a physical cause for your ED, diagnostic tests may be necessary to determine the underlying cause.

Tests for Erectile Dysfunction
A variety of different tests can be used to identify the cause of your ED.

Physical Exam
A detailed physical exam can help your doctor assess your overall health. Your doctor will likely check your blood pressure and ask about any recent injuries or illnesses. They will ask about your current medications or supplements. They will examine the penis and testicles for changes in sensitivity.

Psychological Testing
Your doctor may want to assess whether any psychological problems could be contributing to your ED. You will probably be checked for signs of stress, depression, and anxiety. Your doctor may ask about your relationship with your romantic partner. Detailed questions about your sex life may also be asked.

Nocturnal Erection Test
Men usually have erections at night as they sleep. Because there are so many different highly coordinated physiologic systems that are required to achieve an erection, the presence of nighttime erections can help determine whether your ED has a physical or mental cause.
A nocturnal erection test can determine if you have nighttime erections. This test involves placing a ring of special tape on the penis before sleep. If you have an erection, the tape will separate overnight. If there is genuine dysfunction of the muscles, blood vessels, hormones, or nerves required to produce an erection, then nocturnal erections will be absent.
This could be due to underlying medical conditions such as stroke, high blood pressure, diabetes, or multiple sclerosis. On the other hand, if all of the biologic systems needed for an erection are functional and the cause of ED is psychological, then nighttime erections will still be present during the deep slumber typical of the REM phase of sleep.

Blood and Urine Tests
Blood and urine tests can detect signs of diseases associated with erectile dysfunction. Such diseases include:
· diabetes
· heart disease
· kidney disease
These tests can also indicate if hormone levels might be playing a role in your ED.

Ultrasound
An ultrasound uses sound waves to see inside the body. It is a very effective way of examining blood flow. When a man has ED, an ultrasound can check blood flow in the penis. An ultrasound wand is simply moved over the blood vessels that supply the penis..
Sometimes, an injection may be used to stimulate an erection before this test. Then an ultrasound can check whether blood flow increases appropriately. Pain from the injection is rare. If you do have discomfort, it will likely be mild and go away quickly. However, if you are afraid of injections, talk to your doctor. It may be possible to use an erectile dysfunction drug, such as sildenafil, before the test instead.

Social Aspects Of Penis Enlargement

Health is a condition of full physical, mental and social well-being and nut just absence of diseases and physical defects.

Men's wish to change external look of penis is main indication to esthetic corrections.

The problem of penis enlargement traces its roots from ancient phallic cults. In trade and sculptural pictures of ancient Hindu prevailed males with very big penises. On Corsica Island were found phallic monuments of Bronze Age having length of 15-25cm.

Extremely big penis is the main theme of numerous Japanese “night books” used over ages as an visual stimulant. In Europe in Renaissance period in vogue were male left flypiece. D. Richards explains this phenomenon: “Penis size is very important for a man. In penis is concentrated all male great pride. In penis lives the greatest part of male “ego”.

Therefore, exists a particular cultural and social tendency for big penis worship. Research workers claim that exists huge documented information proving that feeling of disappointment caused by distress of soul, their anxieties, matrimonial problems, along with mental disorders result from ignorance and lack of exact information about sex and genital organs.

Recent years was increased popularity of penis enlargement operations and it requires statistic researches. Wessels H., et al. (1998) tried to establish mathematical relationship between penis length in rest state and penis length in erected state. According to the results, relationship between penis length in rest state and in erected state is not so great to use it for prognosis.

The increase of penile length compared with the initial size is more frank for small penises, but anyway the difference can not be considered statistically significant. The most accurate length of penis during erection can be predicted by the maximum tension.

The popularity of this kind of researches once again proves that big penis is firmly associated in public mind with domination and this certainly is an important argument in favor of a more delicate attitude to genital surgery.

Do Male Enhancement Products Really Work?

There are several different types of male enhancement products you can find on the market today. Some of the most popular include:

·  Pills: These dietary supplements contain a mixture of vitamins, minerals, hormones or herbs that are intended to enlarge the penis.

·  Lotions: Like male enhancement pills, these lotions contain a mixture of ingredients for penis enlargement.

·  Pumps: These pumps use a vacuum mechanism to draw blood into the penis and cause it to swell. This creates a temporarily larger-looking penis.

·  Stretching: This method involves a stretcher or extender that is attached to the penis in order to exert traction and lengthen the penis.

·  Penile rings: These rings are placed around the shaft of the penis to increase size and, in some cases, to also help a man maintain an erection.

In addition to these products, there are also certain procedures and exercises used for male enhancement. These have not been proven to be effective and the long-term effects of such methods are unknown.

Scientific Evidence

If you are considered using a male enhancement product, it’s important to look closely at the scientific evidence backing the product. In most cases, the endorsements for these products come solely from testimonials from customers or the sexual partners’ of customers. In addition, there may be questionable before-and-after photos as well a skewed data accompanying the advertisement. These are unreliable sources of information regarding the effectiveness of the product.

In addition, it’s important to consider the safety of the product and its potential effects on your health. Many of these have safety and health claims which have not yet been proved. In the case of dietary supplements, no Food and Drug Administration (FDA) evaluation is required before putting the product on the market. Just about all the packaging for male enhancement pills or lotions contains a sentence that reads like “These statements have not been evaluated by the Food and Drug Administration (FDA).” This indicates that the products have not been proven to work and could potentially be harmful to your health. With vacuum pumps, stretching devices, exercises and surgery, it’s important to consider that these methods may cause damage to the elastic tissues in the penis and may compromise a man’s ability to maintain an erection in the future.

The Truth About Penis Size

One of the main reasons that men become interested in or try male enhancement products is the fear that their penis size is smaller than average or unsatisfactory for their partner. However, studies have found that many men who believe their penis is too small actually have a normal-sized penis. The following information is essential for men who are considered using male enhancement products:

·  The average penis size is between 3 to 5 inches when not erect and 5 to 7 inches when erect.

·  Penis is only considered to be abnormally small (a condition called micropenis) when it is less than 3 inches long when erect.

·  Studies suggest that penis size is not a top priority for most women when choosing a mate. There is insufficient data at this point about how gay men perceive their partners’ penis size.

·  Understanding a sexual partner’s desires is more likely to improve your sexual relationship than simply increasing the size of the penis.

Healthy And Safe Alternatives

As indicated by the information above, there are no proven methods for male enhancement, and many of these products are considered to be risky or unsafe. Therefore, it is safer to consider some healthy alternatives to improve your perception of your penis size. Some examples of safe and healthy alternatives to male enhancement products include:

·  Get in shape. Being overweight or having a large belly can make your penis appear smaller. Lose extra fat and get in shape to help your penis appear larger.

·  Trim your pubic hair. Having a lot of pubic hair at the base of the penis can obscure part of it and make it appear smaller. Keep your pubic hair trimmed for a larger appearance.

·  Look in the mirror. Many men don’t spend much time in front of a mirror, particularly when they are naked. Consequently, their perception of their penis size may be skewed since a penis tends to appear smaller and shorter when viewed from above. Look in a mirror and you may find that your penis is larger than you think.

·  Educate yourself. Learn about the average penis size and how it relates to satisfaction in the bedroom. Many men find out that they have a completely normal penis and that their sex life can be just as exciting without increasing its size.

·  Talk to your partner. Many men are able to improve their sex life just by talking with their partner about needs, desires and preferences. You may find that penis enlargement isn’t necessary to improve your sexual relationships or to increase your self-confidence and satisfaction.

·  See a therapist. If you find that you are significantly focused on feelings of inadequacy about your penis size, you may benefit from seeing a therapist to work through those issues.

Male enhancement products are enticing to many men, but the fact is that these products tend to be unsafe and may pose certain health risks. Try the alternatives listed above to improve your perception about your penis size instead of turning to male enhancement products.

What Are Premature Ejaculation Causes?

Premature ejaculation is characterized with sperm release from penis before penetration or right away after it. There is no another scientific description of this disorder in medicine.

Many sexologists tried to find a connection between premature ejaculation and intercourse duration, number of frictions during intercourse, time that it takes a woman to reach orgasm, but no one has found this connection. 

Who suffers from premature ejaculation?
In most cases premature ejaculation is found in young men who started early their sexual life. Premature release of sperm occurs because of excessive excitement or hypersensitive glans – these are two major factors causing premature ejaculation right away after beginning of sexual intercourse or before penetration.

It is considered that premature ejaculation occurs in younger age and with experience disappears. However, when the situation not changes, man starts seeking medical advice. 

Premature ejaculation occurs rarely among adult males. However, the disorder may be kept from teenage but may appear in mature years. Causes of premature ejaculation in experienced men differ from premature ejaculation in young men. 

Premature ejaculation causes
All factors causing premature ejaculation may be divided into next groups:
 - physiologic, i.e. connected with diseases and peculiarities of male genitalia constitution
 - psychological, i.e. connected with environmental effect over male psyche

There are two physiologic causes of premature ejaculation:
1) chronic inflammation of seminal vesicles  (vesiculitis);
2) hypersensitive glans.

Age and Male Sex Drive

Charlie Chaplin became father when he was over 60 years old. In harems of Oriental sovereigns there were not less than hundred wives and concubines, and certainly their duties included not only feeding camels and keeping the house clean...

Heracles overnight could make love to fifty daughters of Thespius and it is considered his Thirteenth Labour. Andrologists say each male has such sexual reserves.

Everyone knows that male age has its effects on potency. At twenty years old men are able to make sex day and night. By thirty they get cooler and their sex life becomes regular. Males at forty have enough power and experience to make many things. After fifty, naturally occur age-specific changes in male body: cells do regenerate slowly and production of sex hormones get reduced. Sex drive remains high but male needs more power to perform.

However, age is not just the number of living years but it is a rate showing deterioration of human body. Some males aged 70 give a head start to males aged 30. Therefore, to estimate health condition doctors use notion of “biological age” - true rate of aging which is identified with special tests. It includes examinations of cardiovascular, respiratory and nervous systems, cholesterol rate in blood, elasticity of chorda.

When all body systems are in good condition in a man, then his biological age corresponds his passport one. In some cases tests show that there are some problems with health. For example, blood vessels are not keeping up, lumen is narrow and there is much cholesterol in blood. So in this case male age may be over age indicated in passport. These tests help doctors to find out if patient belongs to risk group for heart attack – this information is very useful for those who care about their health and do not want to die during an orgasm.

Each male is interested in personal rate of sexual activity. What is his rate – high, low or normal? Has he any reserves or not? To find the answer to these questions there is no need to make sex marathons or  compare with friends.  It would be enough to consult specialists in this field – andrologists (andrology is a medicine section which studies causes, mechanisms and treatment of male sexual diseases).

After examination of biological age of a male, including ultrasound investigation of penile vessels, the male would be given to fill a questionnaire about his sexual activity. It is recommended to answer on those questions fairly.

When male body is OK but sexual satisfaction is low, more likely that peak of sexual activity is not occurred yet. In such men those things would come. Instead, if health is not OK and sexual satisfaction is high, possibly male has overrated his resources and his body stretches to the limit its capabilities. In this case it is necessary to take actions, otherwise male sex drive would go down.

How To Prevent Erection Failures

If you observe that erection failures occur more frequently, probably, you are waiting too much from yourself or you are trying to make sex in an inappropriate place. Check below ways to reduce to minimum these failures. Most important thing is that these tips would help to avoid anxiety which leads to a serious long-term problems.

 - Make sex only when you are disposed to it.

 - Admit that you are a human and not a machine. Your feelings and sexual performance not necessarily should be equal. Sometimes you are in condition of greater readiness and sometimes you need an additional stimulation. You should say this to your partner.

 - Avoid accidental partners, at least until you acquire self-confidence. You will trouble less and work better if you would create steady relationships with a partner whose reactions you know and whom you may trust.

 - Do not judge your quality observing condition of your penis. Mutual satisfaction may be achieved without sexual intercourse, though during physical contact erection may occur without your conscious participation.

- If you cannot achieve erection or it disappeared before sexual intercourse or during it, you should not get upset. Explain to your partner what has happened. “Probably, I am very tired today. Let us try tomorrow in the morning.” Do not feel yourself guilty and assure your partner that there is no his guilt in that. Most important is not to withdraw physically and mentally from each other only because this time you cannot achieve erection for performing sexual intercourse. Stay close with your partner by any means except sex. If you like to be together, no matter if you have erection or not, you will be less anxious the next time when experiencing erection failure.

Natural Ways to Increase Male Potency

Male impotence, also known as erectile dysfunction, is the inability to get or maintain an erection firm enough for sexual intercourse, according to the National Kidney and Urological Disease Information Clearinghouse (NKUDIC). Male potency is usually easily remedied through the use of medication. For people who are uncomfortable with the side effects of pharmaceuticals and want to try to treat naturally before resorting to them, fortunately there are natural ways to increase male potency.

Lifestyle

Make healthy lifestyle changes to increase potency. NKUDIC suggests that the first and least invasive way to treat erectile dysfunction is to quit smoking, lose weight and adopt a healthy exercise routine. Sometimes these changes are enough to solve the problem.

Anxiety

Find ways to reduce your anxiety levels which can contribute to erectile dysfunction, according to the Ohio State University Medical Center. Try relaxation breathing, massage from your partner, yoga or meditation as natural ways to improve potency by relieving anxiety.

Psychotherapy

See a therapist to discuss any emotional or psychological issues that may be causing performance anxiety. This can help you feel more confident in your abilities and help you realize that you are normal. The therapist can help you determine if you are having relationship issues that are leading to impotence problems and help you find ways to solve them.

Constriction Rings

Consider a constriction ring if you can sufficiently obtain an erection but have trouble keeping it. The constriction ring is placed at the base of the penis and will keep blood from flowing out of the penis after an erection is achieved, helping it last longer.

Psychogenic Erectile Dysfunction

Erection refers to the most simple physiological male sexual response. This reaction involves only two mechanisms  vascular and neurogenic. Ironically, while the reactions of psychosexual disorders the most common is male erectile dysfunction .
The presence of an erection for men is more important fact than the sexual act itself . That is why any erectile dysfunction is not perceived as a single problem, but as a downfall to the male in principle.
If we turn to the terminology  erectile dysfunction means - impossible to achieve an erection at all, or inability to maintain it throughout the intercourse.
Erectile dysfunction can occur at any age. Most frequently observed inability to enter the penis into the vagina. Somewhat less evident disappearance of erection when attempting copulation, though before it can be quite strong. Also, there are cases when a man can achieve an erection only in certain conditions or any situations.
Research on European and American scientists have revealed the following facts: erectile dysfunction were recorded in more than 80 millions men younger than 40. Number of older men suffering from erectile dysfunction, twice that number.
Do not take as psychogenic erectile dysfunction single erectile dysfunction cases (or lack thereof extinction at the most inopportune moment). Individual episodes still is nothing, it may be caused by a variety of reasons: stress, tension, unsuitable conditions, especially relations with a new partner. If you experience a failure and think about the possibility of its recurrence, it can lead to a true psychogenic erectile dysfunction and a phenomenon known as psychogenic impotence .

Psychological causes of erectile dysfunction
Erectile dysfunction is quite often provoked by psychogenic disorders. The most common form of the syndrome is the expectation of failure. Random sexy failure - the reduction or disappearance of erection - leads to doubt in his masculine power. Fear intensifies in anticipation of sexual intercourse, resulting in a loss of erection. Triggered the principle of auto-suggestion: the more such concerns, the more likely their implementation. Over time, manifested genuine problems with achieving and maintaining an erection begins the so-called psychogenic impotence. Subsequently, this may cause loss of interest in sex as such, the loss of faith in yourself. Numerous attempts to overcome self intercourse converted into a set of  "saving " rituals, partners can not concentrate on anything other than monitoring and evaluation of response to their actions. This suppresses the possibility of even stronger erections and exacerbates psychogenic erectile dysfunction.
As a result, we are seeing a vicious circle:
• weakness of erection ;
• fear of further failures ;
• change his position on the role of the observer ;
• erectile dysfunction ;
• strengthening the fear of failure ;
• psychogenic erectile dysfunction .
If at any time not to break this cycle, erectile dysfunction will constantly get reinforcements.

Treatment of psychogenic erectile dysfunction
Psychogenic erectile dysfunction treatment combines psychotherapy and pharmacotherapy . Therapist can help relieve anxiety and fear of sexual intercourse. Pharmacotherapy initially exhausted by symptomatic agents - tranquilizers, which helped to get rid of anxiety for a short time  Also used homeopathic remedies that are based primarily on the placebo effect.
In the last decade the situation has changed with the advent of PDE5 inhibitors type. They are used in all kinds of erectile dysfunction, regardless of what caused the breach. Especially these drugs are effective in the case of the vascular nature of violations. But psychogenic erectile dysfunction retreats before the action of the inhibitors.
PDE-5 inhibitors may be the type of drug treatment as psychological impotence and as a means of psychological protection: if there is attraction and provide a powerful means of stimulating the vascular effect, minimizing the possibility of failure. Therefore, the appointment of PDE- 5, it is desirable to continue to completion of psychogenic disorders: their effect is both symptomatic and pathogenetic. It is also desirable parallel with the reception held inhibitors in therapy because Fear of failure can reduce the effect of even such an effective means of, and psychological erectile dysfunction again prevail over medicines.
Increasingly inhibitors are used in situations where disorder is not yet evident, but there are prerequisites for sexual failures: increased workload, change of the partner, stress, fatigue. However, inhibitors use should certainly be after consultation with a specialist.

Medication Erectile Disfunction

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 It is believed that 25% of cases of ED in some way connected with the intake of medicines. For example, the Massachusetts study on issues of aging men found that the frequency of ED was 28% among patients receiving treatment for diabetes, 39% among cardiac patients, and 15% among men - hypertensives receiving drug therapy. At present we know a large number of drugs that adversely affect the various links in a sexual act. Some of them have an effect on the central mechanisms of erection (antidepressants, antihypertensive medications central action), while others interact with the peripheral components of the arc at the level of the corpora cavernosa (blockers). Clinical signs of drug ED is relatively rapid onset, temporal association with drug intake, negatively affects the various links in a sexual act, and a decrease in severity of illness or its complete disappearance after discontinuation of the drug.
A special place in the pathogenesis of erectile dysfunction occupy such diseases as hypertension and diabetes. The main factor for the development of ED in this case becomes microangiopathy, which leads to a breach of circulation in cavernous bodies. The influx of arterial blood to the penis is carried out on the dorsal and cavernous arteries, originating from the internal pudendal artery. Further relaxation of smooth muscle elements of the cavernous tissue leads to filling of arterial blood lacunae. This, in turn, leads to compression of subtunikalnyh and emissarnyh venules and blocking the outflow of blood from the penis. This phenomenon is known as venookklyuzivny mechanism. Hypoxia, hypercholesterolemia, hyperglycemia leads to phenotypic changes in cavernous tissue - namely, to increase the synthesis and accumulation of collagen with the outcome in the cavernous fibrosis. Cavernous fibrosis is the main link in the pathogenesis of ED. At 48 h after the erection of the cavernous tissue develops, the degree of hypoxia, at which the induction of collagen synthesis in the cavernous tissue. Oxygenation cavernous tissue occurs during erection of the penis. In men with normal sexual function, not even sexually active, 4-8 episodes of spontaneous erections during the night to ensure adequate oxygenation cavernous tissue to prevent the changes leading to fibrosis. In diabetes the existing microcirculatory disorders aggravated by progressive autonomic neuropathy. There is a correlation between ED and coronary artery atherosclerosis. These diseases have common risk factors - hypertension, dyslipidemia, diabetes, smoking, sedentary lifestyle.