Your doctor will do a physical exam and ask you questions about your symptoms. He or she may do a blood or urine test. Your doctor may consider other tests to rule out other conditions.
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Causes of ED are usually a side effect of physical disease, injury, or drugs. While there are many causes, the most common physical causes include: Diabetes High Blood Pressure Heart Disease Obesity Atherosclerosis Prescription Medications Smoking Alcoholism or Substance Abuse Relationship Issues Stress Depression or Anxiety Diagnosis
5. Lee M, Sharifi R. Chapter 99: Erectile Dysfunction. Pharmacotherapy: A Pathophysiologic Approach, 11e. McGraw Hill; 2020. Accessed March 31, 2022. https://accesspharmacy.mhmedical.com/content.aspx?bookid=2577§ionid=230460622
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The association of CVD and ED was noted in 1997 as one analysed the results of the MMAS. In this landmark study, 1709 men aged 40–70 years were enrolled between 1987 and 1989. A follow-up some 10 years later revealed a striking relationship between ED and CVD. In this study, it became clear that the risk factors for ED were very similar to those of CVD, such as diabetes mellitus, smoking and dyslipidaemia.18
Did you know that diabetes can contribute to erectile dysfunction and other men’s health conditions? Find out more about why treating your diabetes is important. Get more education on diabetes awareness.
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Researchers who took part in the Massachusetts Male Aging Study found that what you eat could reduce your chances of ED.
You should not take more than 1 dose in 24 hours. Tadalfil and vardenafil come in tablets of 2.5 mg, 5 mg, 10 mg and 20 mg. Sildenafil comes in tablets of 25 mg, 50 mg and 100 mg.
If you start with the recommended dose of 50mg sildenafil and find that it’s still not effective after several attempts then you can try 100mg the next time.
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ABSTRACT: Erectile dysfunction (ED) is a common urologic condition that causes distress in men. Risk factors and predictors for ED include age, cardiovascular disease (CVD), hypertension, diabetes, smoking, and certain medications. CVD and ED share several risk factors, and ED may be a predictor of future cardiovascular events. Lifestyle modifications and phosphodiesterase type 5 inhibitors (PDE5Is) are considered first-line therapies for ED. PDE5Is can be less effective in patients with diabetes and should be used cautiously in certain patients with CVD. This review explores treatment options for ED with a focus on those with a history of diabetes or CVD.
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The role of the endothelium in erectile function became clearer with the observation that the phosphodiesterase type 5 (PDE5) inhibitor, sildenafil, enhanced erectile function. Erection occurs with the release of nitric oxide (NO) from the vascular endothelial cells.17 The reduction in endothelial cell production of NO results in the negative impact on the smooth muscles in the corporal bodies and results in less relaxation of the smooth muscle cells with decrease in blood supply and resulting ED. A similar phenomenon is well known to impact the coronary arterial system resulting in CVD.
The recent shift in the management and evaluation of ED, with primary care physicians replacing urologists in the forefront of ED diagnosis and therapy, has been a welcome and timely change.
Don’t spend another day with the sexual disappointment and frustration that comes with ED. Contact one of our Oakdale Erectile Dysfunction Clinics to schedule a fast and friendly consultation with a trusted ED specialist. Related Procedures Platelet Rich Plasma (PRP) Treatment Peyronie's Disease Treatment Erectile Dysfunction Treatment About What is GAINSWave? What to expect? How it works? Comparing treatments Frequently asked questions Medical advisory board Clinical research Find a provider near you → Locations New York Texas Florida California Colorado Arizona Washington See all locations → Quick Links Men’s Health Guide GW Magazine As Seen On For Providers Provider Resources For Affiliates For Press Partnership
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Surgery is an option in some cases of erectile dysfunction. Most surgery cases are performed for one of three reasons: to implant a device to initiate erections; to reconstruct arteries and increase penis blood flow; to block off veins that allow blood to leak from the penile tissues.
U.S. Food and Drug Administration. FDA Drug Safety Communication: fda cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. www.fda.gov/Drugs/DrugSafety/ucm436259.htm. Bassil N , Alkaade S , Morley JE . The benefits and risks of testosterone replacement therapy: a review. Ther Clin Risk Manag 2009;5:427–48. Søe KL , Søe M , Gluud C . Liver pathology associated with the use of anabolic-androgenic steroids. Liver 1992;12:73–9. doi:10.1111/j.1600-0676.1992.tb00560.x Randrup E , Baum N , Feibus A . Erectile dysfunction and cardiovascular disease. Postgrad Med 2015;127:166–72. doi:10.1080/00325481.2015.992722 Wrishko R , Sorsaburu S , Wong D , et al . Safety, efficacy, and pharmacokinetic overview of low-dose daily administration of tadalafil. J Sex Med 2009;6:2039–48. doi:10.1111/j.1743-6109.2009.01301.x Seftel AD , Sun P , Swindle R . The prevalence of hypertension, Hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. J Urol 2004;171:2341–5. doi:10.1097/01.ju.0000125198.32936.38
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427191/ Effect of Lifestyle Changes on Erectile Dysfunction in Obese Men: A Randomized Controlled Trial. (2004).
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If you think you or someone else may have overdosed on: Avanafil (Stendra), call your doctor or the Poison Control center
It’s a very rare side effect, but if you have a prolonged erection for more than 4 hours then you need to contact your doctor immediately.
Over the past two decades, Innerbody Research has helped tens of millions of readers make more informed decisions to live healthier lifestyles. We evaluate the service based on adherence to quality, the latest medical evidence and health standards, and a simple question: would we buy the product or service ourselves if it weren’t part of our job, and would we recommend it to family and friends?
A German study found that 69% of men involved in a sleep apnea study also suffered from ED. Disruptions to breathing during sleep affect oxygen levels in the blood, which can cause problems generating an erection. Lack of sleep also disrupts hormone production.
The price of sildenafil offered by each pharmacy varies as each supplier decides on their own prices. Some pharmacies mark the product price up more than others.
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It is important for clinicians prescribing these drugs to make the patient aware of the action of the drugs especially the fact that they do not result in an immediate erection, and that they do not cause an erection without sexual stimulation. There is frequently a great expectation when men begin using these drugs and it is wise to temper their enthusiasm and explain they do not work immediately, and may not work every time, but also let the patient know that if these drugs do not work, there are other options.
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Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
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ED is usually easy to diagnose. If you are tempted to self-diagnose, talk to your doctor. He or she will want to make sure it isn’t related to another health condition.
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Currently, three pills (Viagra/sildenafil, Levitra/vardenafil, Cialis/tadalafil) are available and FDA-approved for erectile dysfunction. They are all called phosphodiesterase inhibitors, which means they act by blocking a chemical that stops erections.
Vacuum pumps are a physical, non-medical ED treatment which serve to improve the quality of erections by improving blood flow and providing a firmer erection.
Instead, Espinosa suggests taking L-citrulline, which helps your body make more arginine. But, he warns, high doses can lower your blood pressure.
Pharmalogic TreatmentPharmacologic options for treatment of ED include oral phosphodiesterase type 5 inhibitors (PDE5Is) or intraurethral or intracavernosal injection alprostadil.6 Intracavernosal nonprostaglandin agents such as papaverine, phentolamine, and atropine have also been used to successfully manage ED, but none are FDA-approved for this indication. Testosterone replacement may also be considered for men with hypogonadism.6
Bullet point: In men with ED, assessing androgen status is a simple evaluation, and therapy when indicated can be beneficial, and in most men, safe.
Among the most popular treatment options for erectile dysfunction are pharmaceuticals. Drugs such as Viagra (Sildenafil), Levitra (Vardenafil), and Cialis (Tadalafil) are popular and boast an 80% success rate. These drugs are classified as phosphodiesterase-5 inhibitors (PDE-5) – which enable an erection, temporarily, but are not the best for maintaining an erection over time.
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“Alcohol is a depressant and can cause both temporary and long-term erectile dysfunction,” Mucher cautions.
At Innerbody Research, we customize our evaluation criteria depending on the type and nature of the health-related service. For sexual health products and telehealth companies, we use the following for our evaluations:
Urethral suppositories (MUSE) have the same ingredient as ED injections (alprostadil) only they are in pellet form. You will insert the pellet into your urethra (urinary channel), where it will dissolve.
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A very rare side effect of sildenafil is an alteration in color perception due to the drug’s inhibition of PDE-6 in addition to PDE-5. Vardenafil is somewhat more selective in this regard, having no known effect on PDE-6, and thus no known effect on color perception. And while vardenafil is less thoroughly researched than sildenafil, there are still numerous studies looking at thousands of users over nearly two decades, so its safety and efficacy are without question.
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Urologists say this may be the cure for erectile dysfunctionMen with heart disease don’t know risks for erectile dysfunctionErectile dysfunction drugs vary in effectiveness, side effects Dr. Jennifer Landa is Chief Medical Officer of BodyLogicMD, the nation's largest franchise of physicians specializing in bioidentical hormone therapy. Dr. Jen spent 10 years as a traditional OB-GYN, and then became board-certified in regenerative medicine, with an emphasis on bio-identical hormones, preventative medicine and nutrition. She is the author of "The Sex Drive Solution for Women." Learn more about her programs at www.jenlandamd.com.
Working with erectile dysfunction doesn’t have to be a solo journey. Did you know you can get affordable primary care with the K Health app? Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data. Frequently Asked Questions What foods help you get hard? A diet rich in whole grains, fruits, and vegetables, and low in saturated fat, sugar, and red meat may help to support healthy and firm erections. What causes weak erections? The potential causes of erectile dysfunction include underlying health issues such as heart disease, diabetes, mental health problems, and issues affecting blood supply and blood flow. How can I get hard fast without pills? Several natural methods such as improving your diet with healthy foods and engaging in regular exercise may help improve blood flow to the penis. However, these methods are unlikely to provide fast-acting relief for erectile dysfunction. What foods work like Viagra? Viagra works by enhancing the effects of nitric oxide to relax the penile muscles, expand blood vessels that go into the penis, and improve penile blood flow. So far, no studies have found any foods that provide these same benefits for ED. K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. 14 SOURCES
Your prescription is issued by our GMC registered doctor and dispensed from our UK registered pharmacy. So, you can be sure of receiving genuine medication.
Tadalafil does not affect any type of contraception, including the contraceptive pill and emergency contraception.
Erectile dysfunction (ED) is a common medical condition that primarily affects men older than 40. Among other symptoms, ED can make it difficult to get and maintain erections during sexual activity, placing an unwanted burden on your intimate relationships as well as on your physical and emotional health. While you can’t get standard prescription ED pills over the counter, some supplementary treatments do not require a prescription.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027992/ Erectile Dysfunction Predicts Cardiovascular Events as an Independent Risk Factor: A Systemic Review and Meta-Analysis. (2019).
Therefore, anybody buying medicines from an online pharmacy can check if the pharmacy is legitimately registered by clicking on the logo or going directly to the GPhC website and searching their online register.
Other factors that “stress” the body can also increase your risk for ED. These include: substance abuse, using marijuana, smoking cigarettes, depression, anxiety and low self esteem. Cigarette smoking — or using nicotine — leads to constricted blood vessels, which has negative effects for sexual health. Other mental/emotional obstacles can cause less desire for sex and decrease testosterone. Several ways to help manage stress include: Research Examines Optimal Time of Day for Exercise for Women, Men The benefits of exercise are undeniable, no matter when you decide to ... Treatments Information My account Who are we Customer services
Certain over-the-counter (OTC) supplements may help with erectile dysfunction, such as: L-arginine in combination with pycnogenol Has been shown in studies to improve sexual function in men with ED Korean red ginseng (also called panax ginseng) Studies have shown improvements in erections Yohimbe Some studies have shown it to be slightly more effective than placebo for ED Carnitine (propionyl-L-carnitine) May improve erectile dysfunction Also used to enhance the effectiveness of sildenafil (Viagra) Dehydroepiandrosterone (DHEA) Declines in DHEA are associated with increased incidence of ED DHEA supplements are often promoted to improve sexual health, though more study is needed
Lifestyle causes of ED include; smoking, drinking too much and being obese or overweight.
Exercise is probably the most effective natural remedy for Erectile Dysfunction.
Believe it or not, all of these medications work by achieving the same effect. All of them are PDE-5 inhibitors, and they support or enhance the effects of nitric oxide in our bodies. Roman sildenafil 40 mg BlueChew sildenafil 30 mg BlueChew tadalafil 6 mg Hims Stendra 100 mg Hims Viagra 40 mg Lowest price $4/dose $2.65/dose $3.21/dose $29/dose $70/dose Free trial? How fast does it work? 40-60 minutes 20-60 minutes 30-60 minutes 15 minutes 40-60 minutes How long can it work? Up to 6 hours Up to 6 hours 18-36 hours Up to 6 hours Up to 6 hours Medication form Pill Chewable Chewable Pill Pill
Simply walking may be a good activity to try. According to one study, 30 minutes of walking a day was associated with a 41 percent decrease in risk for ED.
Sexual health clinics treat problems with sexual health. They can provide the same treatment you would get at your GP surgery.
All men receiving testosterone replacement need to have periodic measurement of haemoglobin and haematocrit to monitor for erythrocytosis. Feldman HA , Goldstein I , Hatzichristou DG , et al . Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994;151:54–61. Araujo AB , Esche GR , Kupelian V , et al . Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab 2007;92:4241–7. doi:10.1210/jc.2007-1245 Lindau ST , Schumm LP , Laumann EO , et al . A study of sexuality and health among older adults in the United States. N Engl J Med 2007;357:762–74. doi:10.1056/NEJMoa067423 Shah J . Erectile dysfunction through the ages. BJU Int 2002;90:433–41. doi:10.1046/j.1464-410X.2002.02911.x Mobley D . Early history of inflatable penile prosthesis surgery. Asian J Androl 2015;17:225–9. Roumeguère T , Wespes E , Carpentier Y , et al . Erectile Dysfunction is associated with a high prevalence of hyperlipidemia and coronary Heart Disease Risk European Urology.44:355–9. Klein R , Klein BE , Lee KE , et al . Prevalence of self-reported erectile dysfunction in people with long-term IDDM. Diabetes Care 1996;19:135–41. doi:10.2337/diacare.19.2.135 Larsen SH , Wagner G , Heitmann BL . Sexual function and obesity. Int J Obes 2007;31:1189–98. doi:10.1038/sj.ijo.0803604 McWaine DE , Procci WR . Drug-induced sexual dysfunction. Med Toxicol Adverse Drug Exp 1988;3:289–306. doi:10.1007/BF03259941 Croft H , Settle E , Houser T , et al . A placebo-controlled comparison of the antidepressant efficacy and effects on sexual functioning of sustained-release bupropion and sertraline. Clin Ther 1999;21(4):643–58. doi:10.1016/S0149-2918(00)88317-4 Janeway M , Baum N . Managing the enlarged prostate gland in elderly men. Clinical Geriatrics http://www.consultant360.com/articles/managing-enlarged-prostate-gland-elderly-men. Kumar RJ , Barqawi A , Crawford ED . Adverse events associated with hormonal therapy for prostate Cancer. Rev Urol 2005;7 Suppl 5:S37–S43. Aksam A , Yassin A , Saad F . Testosterone and erectile dysfunction. J Andrology 2008;29. Gades NM , Nehra A , Jacobson DJ , et al . Association between smoking and erectile dysfunction: a population-based study. Am J Epidemiol 2005;161:346–51. doi:10.1093/aje/kwi052 Mobley D , Baum N . Smoking: it’s impact on urologic conditions. Rev Urology 17 2015. Stein RA . Endothelial dysfunction, erectile dysfunction, and coronary heart disease: the pathophysiologic and clinical linkage. Rev Urol 2003;5(Suppl 7):S21–S27. Andersson K , Stief C . Penile erection and cardiac risk: pathophysiologic and pharmacologic mechanisms. Am J Cardiol 2000;86:23–6. doi:10.1016/S0002-9149(00)00887-0 Feldman HA , Johannes CB , Derby CA , et al . Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med 2000;30:328–38. doi:10.1006/pmed.2000.0643 Vlachopoulos C , Ioakeimidis N , Terentes-Printzios D , et al . The triad: erectile dysfunction-endothelial dysfunction-cardiovascular disease Curr Pharm Des. 2008;14:3700–14. Watts GF , Chew KK , Stuckey BG et al . The erectile-endothelial dysfunction nexus: new opportunities for cardiovascular risk prevention. Nat Clin Pract Cardiovasc Med 2007;4:263–73. doi:10.1038/ncpcardio0861 Montorsi F , Briganti A , Salonia A , et al . Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol 2003;44:360–5. doi:10.1016/S0302-2838(03)00305-1 Vlachopoulos C , Rokkas K , Ioakeimidis N , et al . Prevalence of asymptomatic coronary artery disease in men with vasculogenic erectile dysfunction: a prospective angiographic study. Eur Urol 2005;48:996–1003. doi:10.1016/j.eururo.2005.08.002 Mulhall J , Teloken P , Barnas J et al . Vasculogenic erectile dysfunction is a predictor of abnormal stress echocardiography. J Sex Med 2009;6:820–5. doi:10.1111/j.1743-6109.2008.01087.x Hodges LD , Kirby M , Solanki J , et al . The temporal relationship between erectile dysfunction and cardiovascular disease. Int J Clin Pract 2007;61:2019–25. doi:10.1111/j.1742-1241.2007.01629.x Inman BA , Sauver JL , Jacobson DJ , et al . A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc 2009;84:108–13. doi:10.4065/84.2.108 Ponholzer A , Temml C , Obermayr R , et al . Is erectile dysfunction an indicator for increased risk of coronary heart disease and stroke? Eur Urol 2005;48:512–8. doi:10.1016/j.eururo.2005.05.014 Thompson IM , Tangen CM , Goodman PJ , et al . Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005;294:2996–3002. doi:10.1001/jama.294.23.2996 Banks E , Joshy G , Abhayaratna WP , et al . Erectile dysfunction severity as a risk marker for cardiovascular disease hospitalisation and all-cause mortality: a prospective cohort study. PLoS Med 2013;10:e1001372. doi:10.1371/journal.pmed.1001372 Lewis RW , Fugl-Meyer KS , Corona G , et al . Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med 2010;7:1598–607. doi:10.1111/j.1743-6109.2010.01778.x Yaman O , Gulpinar O , Hasan T , et al . Erectile dysfunction may predict coronary artery disease: relationship between coronary artery calcium scoring and erectile dysfunction severity. Int Urol Nephrol 2008;40:117–23. doi:10.1007/s11255-007-9293-8 Montorsi P , Ravagnani PM , Galli S , et al . Association between erectile dysfunction and coronary artery disease. role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. Eur Heart J 2006;27:2632–9. doi:10.1093/eurheartj/ehl142 Montorsi P , Ravagnani PM , Galli S , et al . Association between erectile dysfunction and coronary artery disease:matching the right target with the right test in the right patient. Eur Urol 2006;50:721–31. doi:10.1016/j.eururo.2006.07.015 Yassin AA , Saad F . Testosterone and erectile dysfunction. J Androl 2008;29:593–604. doi:10.2164/jandrol.107.004630 Khera M . Androgens and erectile function: a case for early androgen use in postprostatectomy hypogonadal men. J Sex Med 2009;6:234–8. doi:10.1111/j.1743-6109.2008.01159.x Aversa A , Isidori AM , De Martino MU , et al . Androgens and penile erection: evidence for a direct relationship between free testosterone and cavernous vasodilation in men with erectile dysfunction. Clin Endocrinol 2000;53:517–22. doi:10.1046/j.1365-2265.2000.01118.x Wespes E , Amar E , Hatzichristou D , et al . EAU guidelines on erectile dysfunction: an update. Eur Urol 2006;49:806–15. doi:10.1016/j.eururo.2006.01.028
Diet, lifestyle, and home remedies may help prevent or treat erectile dysfunction (ED).
Every day, UW Medicine makes a difference in the lives of our patients and families. At our hospitals and clinics, we help them move from difficult diagnoses toward brighter, healthier futures. Looking for a Sub Internship?
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Every day, UW Medicine makes a difference in the lives of our patients and families. At our hospitals and clinics, we help them move from difficult diagnoses toward brighter, healthier futures. Looking for a Sub Internship?
Chelation therapy. Some say this chemical purge boosts circulation. There’s no proof it works.
Pregnancy & BreastfeedingCan I take Viagra (Sildenafil (Injection)) if I’m pregnant or breastfeeding?
Erectile dysfunction or ED (also known as impotence) is when a man cannot achieve or sustain an erection for sexual intercourse. This can be: a total inability, inconsistent ability, or a tendency to sustain only brief erections.
Natural Erectile Dysfunction Remedy, with no need for drugs regularly, that may have some very serious side effects, and headaches.
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Do you know about all the serious issues with Viagra, Cialis, and all their generic substitutes? Learn how men are able to regain full function without pills, shots, or surgery and go back to being intimate the natural way.
