Editing Erectile dysfunction (section)

==Treatment==
[[File:18971230 Male sexual dysfunction ads - The Helena Weekly Independent.jpg|thumb|upright=1.5| One ad from 1897 claims to restore "perfect manhood. Failure is impossible with our method".<ref name=1897ads/> Another "will quickly cure you of all nervous or diseases of the generative organs, such as Lost Manhood, Insomnia, Pains in the Back, Seminal Emissions, Nervous Debility, Pimples, Unfitness to Marry, Exhausting Drains, Varicocele and Constipation".<ref name=1897ads>{{cite news |title=Wonderful Medicine Free / Manhood Restored / The Great Hudyan |url=https://newspaperarchive.com/helena-weekly-independent-dec-30-1897-p-7/ |work=The Helena Weekly Independent |date=December 30, 1897 |location=Helena, Montana, U.S. |pages=7–8}} (and [https://newspaperarchive.com/helena-weekly-independent-dec-30-1897-p-8/ page 8])</ref> The U.S. Federal Trade Commission warns that "phony cures" exist even today.<ref name=FTC_PhonyCures>{{cite web |title=Phony Cures for Erectile Dysfunction |url=https://www.consumer.ftc.gov/articles/0202-phony-cures-erectile-dysfunction |website=ftc.gov |publisher=U.S. Federal Trade Commission |archive-url=https://web.archive.org/web/20200430095049/https://www.consumer.ftc.gov/articles/0202-phony-cures-erectile-dysfunction |archive-date=April 30, 2020 |url-status=live}}</ref> ]]
Treatment depends on the underlying cause. In general, [[exercise]], particularly of the [[aerobic exercise|aerobic]] type, is effective for preventing ED during midlife.<ref name="EuroGuideline">Wespes E (chair), et al.
Guidelines on Male Sexual Dysfunction: Erectile dysfunction and  premature ejaculation. European Association of Urology 2013{{rp|6, 18–19}}<!--Not sure how to fix the rp template or how it is supposed to be placed--></ref> Counseling can be used if the underlying cause is psychological, including how to lower stress or anxiety related to sex.<ref name=":0" /> Medications by mouth and vacuum erection devices are first-line treatments,<ref name=EuroGuideline/>{{rp|20, 24}} followed by injections of drugs into the penis, as well as penile implants.<ref name=EuroGuideline/>{{rp|25–26}} Vascular reconstructive surgeries are beneficial in certain groups.<ref name="elsevier.com">{{Cite book|url=https://www.elsevier.com/books/encyclopedia-of-reproduction/skinner/978-0-12-811899-3|title=Encyclopedia of Reproduction - 2nd Edition|website=www.elsevier.com|date=29 June 2018 |publisher=Elsevier Science |isbn=978-0-12-811899-3 |access-date=2019-01-17|archive-date=2021-02-22|archive-url=https://web.archive.org/web/20210222234452/https://www.elsevier.com/books/encyclopedia-of-reproduction/skinner/978-0-12-811899-3|url-status=live}}</ref> Treatments, other than surgery, do not fix the underlying physiological problem, but are used as needed before sex.<ref>{{Cite web|url=https://www.urologyhealth.org/urologic-conditions/erectile-dysfunction|title=What is Erectile Dysfunction? - Urology Care Foundation|website=www.urologyhealth.org|access-date=2019-08-05|archive-date=2019-08-05|archive-url=https://web.archive.org/web/20190805050205/https://www.urologyhealth.org/urologic-conditions/erectile-dysfunction|url-status=live}}</ref>

===Medications===
The [[PDE5 inhibitor]]s [[sildenafil]] (Viagra), [[vardenafil]] (Levitra) and [[tadalafil]] (Cialis) are prescription drugs which are taken by mouth.<ref name=EuroGuideline/>{{rp|20–21}} As of 2018, sildenafil is available in the UK without a prescription.<ref>{{cite news |url=https://www.bbc.com/news/health-42155489 |title=Viagra can be sold over the counter |date=28 November 2017 |work=BBC News |access-date=5 April 2018 |archive-date=22 February 2021 |archive-url=https://web.archive.org/web/20210222234502/https://www.bbc.com/news/health-42155489 |url-status=live }}</ref> Additionally, a cream combining [[alprostadil]] with the permeation enhancer [[DDAIP]] has been approved in Canada as a [[First-line treatment|first line treatment]] for ED.<ref>{{cite web|vauthors=Bujdos B|title=New Topical Erectile Dysfunction Drug Vitaros Approved in Canada; Approved Topical Drug Testim Proves Helpful for Erectile Dysfunction|date=16 November 2010|url=http://www.accessrx.com/blog/current-health-news/vitaros-testim-topical-drugs-treat-erectile-dysfunction-a1115|access-date=15 April 2011|archive-date=13 May 2011|archive-url=https://web.archive.org/web/20110513011529/http://www.accessrx.com/blog/current-health-news/vitaros-testim-topical-drugs-treat-erectile-dysfunction-a1115|url-status=live}}</ref> Penile injections, on the other hand, can involve one of the following medications: [[papaverine]], [[phentolamine]], and [[prostaglandin E1]], also known as [[alprostadil]].<ref name=EuroGuideline/> In addition to injections, there is an alprostadil [[suppository]] that can be inserted into the urethra. Once inserted, an erection can begin within 10 minutes and last up to an hour.<ref name=":0">{{Cite web|url=https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment|title=Treatment for erectile dysfunction {{!}}|website=US National Institute of Diabetes and Digestive and Kidney Diseases|language=en-US|access-date=2019-08-04|archive-date=2021-02-22|archive-url=https://web.archive.org/web/20210222234446/https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment|url-status=live}}</ref> Medications to treat ED may cause a side effect called [[priapism]].<ref name=":0" />

====Prevalence of medical diagnosis====
In a study published in 2016, based on US health insurance claims data, out of 19,833,939 US males aged ≥18 years, only 1,108,842 (5.6%), were medically diagnosed with erectile dysfunction or on a PDE5I prescription (''μ'' age 55.2 years, ''σ'' 11.2 years). Prevalence of diagnosis or prescription was the highest for age group 60–69 at 11.5%, lowest for age group 18–29 at 0.4%, and 2.1% for 30–39, 5.7% for 40–49, 10% for 50–59, 11% for 70–79, 4.6% for 80–89, 0.9% for ≥90, respectively.<ref name="US study">{{cite journal | vauthors = Mulhall JP, Luo X, Zou KH, Stecher V, Galaznik A | title = Relationship between age and erectile dysfunction diagnosis or treatment using real-world observational data in the USA | journal = International Journal of Clinical Practice | volume = 70 | issue = 12 | pages = 1012–1018 | date = December 2016 | pmid = 28032424 | pmc = 5540144 | doi = 10.1111/ijcp.12908 }}</ref>

===Focused shockwave therapy===
[[Extracorporeal shockwave therapy|Focused shockwave therapy]] involves passing short, high frequency acoustic pulses through the skin and into the penis. These waves break down any plaques within the blood vessels, encourage the formation of new vessels, and stimulate repair and tissue regeneration.<ref>{{cite journal | vauthors = Vardi Y, Appel B, Jacob G, Massarwi O, Gruenwald I | title = Can low-intensity extracorporeal shockwave therapy improve erectile function? A 6-month follow-up pilot study in patients with organic erectile dysfunction | journal = European Urology | volume = 58 | issue = 2 | pages = 243–8 | date = August 2010 | pmid = 20451317 | doi = 10.1016/j.eururo.2010.04.004 }}</ref><ref>{{Cite web|url=https://edclinics.co.uk/shockwave-therapy/|title=Shockwave Therapy for Erectile Dysfunction &#124; ED Clinics|date=27 July 2020|access-date=22 September 2021|archive-date=23 September 2021|archive-url=https://web.archive.org/web/20210923151918/https://edclinics.co.uk/shockwave-therapy/|url-status=live}}</ref>

Focused shockwave therapy appears to work best for males with vasculogenic ED, which is a blood vessel disorder that affects blood flow to tissue in the penis. The treatment is painless and has no known side effects. Treatment with shockwave therapy can lead to a significant improvement of the IIEF (International Index of Erectile Function).<ref>{{cite web | title = International Index of Erectile Function (IIEF): Guidelines on Clinical Application of IIEF patient Questionnaire | work = Department of Urology | publisher = Addenbrooke's Hospital | location = Hills Road, Cambridge, CB2 0QQ | url = https://www.camurology.org.uk/wp-content/uploads/interpretation-of-the-iief.pdf | access-date = 2021-09-22 | archive-date = 2021-10-26 | archive-url = https://web.archive.org/web/20211026022523/https://www.camurology.org.uk/wp-content/uploads/interpretation-of-the-iief.pdf | url-status = dead }}</ref><ref>{{cite journal | vauthors = Man L, Li G | title = Low-intensity Extracorporeal Shock Wave Therapy for Erectile Dysfunction: A Systematic Review and Meta-analysis | journal = Urology | volume = 119 | pages = 97–103 | date = September 2018 | pmid = 28962876 | doi = 10.1016/j.urology.2017.09.011 | s2cid = 7048621 }}</ref><ref>{{cite journal | vauthors = Clavijo RI, Kohn TP, Kohn JR, Ramasamy R | title = Effects of Low-Intensity Extracorporeal Shockwave Therapy on Erectile Dysfunction: A Systematic Review and Meta-Analysis | journal = The Journal of Sexual Medicine | volume = 14 | issue = 1 | pages = 27–35 | date = January 2017 | pmid = 27986492 | doi = 10.1016/j.jsxm.2016.11.001 }}</ref>

=== Testosterone ===
Men with low levels of testosterone can experience ED. Taking testosterone may help maintain an erection.<ref name="cdc">{{Cite web|url=https://www.cdc.gov/diabetes/library/features/diabetes-and-men.html|title=Men and diabetes|date=2019-04-01|publisher=US Centers for Disease Control and Prevention|language=en-us|access-date=2019-08-04|archive-date=2021-02-22|archive-url=https://web.archive.org/web/20210222234533/https://www.cdc.gov/diabetes/library/features/diabetes-and-men.html|url-status=live}}</ref> Males with [[type 2 diabetes]] are twice as likely to have lower levels of testosterone, and are three times more likely to experience ED than non-diabetic men.<ref name=cdc/>

===Pumps===
{{Main|penis pump}}

A vacuum erection device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as [[penis pump]] and may be used just prior to [[sexual intercourse]]. Several types of FDA approved vacuum therapy devices are available under prescription. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the base of the penis to maintain it. These pumps should be distinguished from other [[penis pump]]s (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to [[masturbation]]. More drastically, inflatable or rigid penile implants may be fitted surgically.<ref name="lecturioerect">{{cite web|url=https://www.lecturio.com/concepts/erectile-dysfunction/|title=Erectile Dysfunction|website=The Lecturio Medical Concept Library|access-date=21 July 2021|archive-date=21 July 2021|archive-url=https://web.archive.org/web/20210721163306/https://www.lecturio.com/concepts/erectile-dysfunction/|url-status=live}}</ref>

=== Vibrators ===
{{Main|Vibrator (sex toy)}}

The vibrator was invented in the late 19th century as a medical instrument for pain relief and the treatment of various ailments. Sometimes described as a massager, the vibrator is used on the body to produce [[sexual stimulation]]. Several clinical studies have found vibrators to be an effective solution for Erectile Dysfunction.<ref>{{Cite journal |last1=Ismail |first1=Ezzat A. |last2=El-Sakka |first2=Ahmed I. |date=2016-06-01 |title=Innovative trends and perspectives for erectile dysfunction treatment: A systematic review |journal=Arab Journal of Urology |language=en |volume=14 |issue=2 |pages=84–93 |doi=10.1016/j.aju.2016.04.002 |pmid=27493808 |issn=2090-598X|pmc=4963167 }}</ref><ref>{{Cite journal |last1=Miranda |first1=Eduardo P. |last2=Taniguchi |first2=Hisanori |last3=Cao |first3=David L. |last4=Hald |first4=Gert M. |last5=Jannini |first5=Emmanuele A. |last6=Mulhall |first6=John P. |date=2019-06-01 |title=Application of Sex Aids in Men With Sexual Dysfunction: A Review |journal=The Journal of Sexual Medicine |language=en |volume=16 |issue=6 |pages=767–780 |doi=10.1016/j.jsxm.2019.03.265 |pmid=31029536 |issn=1743-6095|pmc=8519170 }}</ref> Examples of FDA registered vibrators for erectile dysfunction include [[MysteryVibe]]'s Tenuto<ref>{{Cite journal |last1=Rodríguez Martínez |first1=Jesús E. |last2=Alcaina |first2=Leandro R. |last3=Agullo |first3=Guillermo H. |date=2022-11-01 |title=Improved erectile function after focal muscle vibrations therapy in a patient with neurogenic erectile dysfunction: a case report |url=https://www.sciencedirect.com/science/article/pii/S1743609522015867 |journal=The Journal of Sexual Medicine |language=en |volume=19 |issue=11, Supplement 4 |pages=S69 |doi=10.1016/j.jsxm.2022.08.012 |s2cid=253821604 |issn=1743-6095|url-access=subscription }}</ref> and Reflexonic's Viberect.<ref>{{Cite journal |last1=Clavell Hernandez |first1=J. |last2=Wu |first2=Q. |last3=Zhou |first3=X. |last4=Nguyen |first4=J. N. |last5=Davis |first5=J. W. |last6=Wang |first6=R. |date=2018-07-01 |title=319 Penile vibratory stimulation in penile rehabilitation after radical prostatectomy: a randomized, controlled trial |url=https://www.sciencedirect.com/science/article/pii/S1743609518305551 |journal=The Journal of Sexual Medicine |series=Proceedings of the 21st World Meeting on Sexual Medicine |language=en |volume=15 |issue=7, Supplement 3 |pages=S253–S254 |doi=10.1016/j.jsxm.2018.04.282 |s2cid=58240260 |issn=1743-6095|url-access=subscription }}</ref>

=== Surgery ===
{{Main|Penile implant}}
Often, as a last resort, if other treatments have failed, the most common procedure is [[Penile implant|prosthetic implants]] which involves the insertion of artificial rods into the penis.<ref name=EuroGuideline/>{{rp|26}} Some sources show that vascular reconstructive surgeries are viable options for some people.<ref name="elsevier.com"/>

===Alternative medicine===
The [[United States Food and Drug Administration|Food and Drug Administration]] (FDA) does not recommend alternative therapies to treat sexual dysfunction.<ref>{{Cite web|url=http://www.medscape.com/viewarticle/562177|title=Dangers of Sexual Enhancement Supplements|website=Medscape|access-date=2009-02-10|archive-date=2021-02-22|archive-url=https://web.archive.org/web/20210222234545/https://www.medscape.com/viewarticle/562177|url-status=live}}</ref> Many products are advertised as "[[herbal viagra]]" or "natural" sexual enhancement products, but no clinical trials or scientific studies support the effectiveness of these products for the treatment of ED, and synthetic chemical compounds similar to sildenafil have been found as [[adulterant]]s in many of these products.<ref>{{cite journal |vauthors=Gryniewicz CM, Reepmeyer JC, Kauffman JF, Buhse LF | title = Detection of undeclared erectile dysfunction drugs and analogues in dietary supplements by ion mobility spectrometry | journal = Journal of Pharmaceutical and Biomedical Analysis | volume = 49 | issue = 3 | pages = 601–06 | year = 2009 | pmid = 19150190 | doi = 10.1016/j.jpba.2008.12.002 }}</ref><ref>{{cite journal |vauthors=Choi DM, Park S, Yoon TH, Jeong HK, Pyo JS, Park J, Kim D, Kwon SW | title = Determination of analogs of sildenafil and vardenafil in foods by column liquid chromatography with a photodiode array detector, mass spectrometry, and nuclear magnetic resonance spectrometry | journal = Journal of AOAC International | volume = 91 | issue = 3 | pages = 580–88 | year = 2008 | pmid = 18567304 | doi = 10.1093/jaoac/91.3.580 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Reepmeyer JC, Woodruff JT | title = Use of liquid chromatography-mass spectrometry and a chemical cleavage reaction for the structure elucidation of a new sildenafil analogue detected as an adulterant in an herbal dietary supplement | journal = Journal of Pharmaceutical and Biomedical Analysis | volume = 44 | issue = 4 | pages = 887–93 | year = 2007 | pmid = 17532168 | doi = 10.1016/j.jpba.2007.04.011 | url = https://zenodo.org/record/1259165 | access-date = 2019-07-02 | archive-date = 2020-01-28 | archive-url = https://web.archive.org/web/20200128091836/https://zenodo.org/record/1259165 | url-status = live }}</ref><ref>{{cite journal | vauthors = Reepmeyer JC, Woodruff JT, d'Avignon DA | title = Structure elucidation of a novel analogue of sildenafil detected as an adulterant in an herbal dietary supplement | journal = Journal of Pharmaceutical and Biomedical Analysis | volume = 43 | issue = 5 | pages = 1615–21 | year = 2007 | pmid = 17207601 | doi = 10.1016/j.jpba.2006.11.037 | url = https://zenodo.org/record/1259163 | access-date = 2019-07-02 | archive-date = 2021-10-09 | archive-url = https://web.archive.org/web/20211009125925/https://zenodo.org/record/1259163 | url-status = live }}</ref><ref>[https://www.fda.gov/Safety/Recalls/EnforcementReports/ucm217780.htm Enforcement Report for June 30, 2010] {{Webarchive|url=https://web.archive.org/web/20160625154458/http://www.fda.gov/Safety/Recalls/EnforcementReports/ucm217780.htm |date=June 25, 2016 }}, [[United States Food and Drug Administration]]</ref> The FDA has warned consumers that any sexual enhancement product that claims to work as well as prescription products is likely to contain such a contaminant.<ref>[https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048386.htm Hidden Risks of Erectile Dysfunction "Treatments" Sold Online] {{Webarchive|url=https://web.archive.org/web/20190423031555/https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048386.htm |date=2019-04-23 }}, [[United States Food and Drug Administration]], February 21, 2009</ref> A 2021 review indicated that ginseng had "only trivial effects on erectile function or satisfaction with intercourse compared to placebo".<ref>{{cite journal | vauthors = Lee HW, Lee MS, Kim TH, Alraek T, Zaslawski C, Kim JW, Moon DG | title = Ginseng for erectile dysfunction | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | pages = CD012654 | date = April 2021 | issue = 4 | pmid = 33871063 | pmc = 8094213 | doi = 10.1002/14651858.cd012654.pub2 }}</ref>