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Sildenafil (Viagra) was the first oral phosphodiesterase type 5 (PDE5) inhibitor approved by the FDA in the United States for the treatment of erectile dysfunction (it is not approved for women). Sildenafil inhibits PDE5, which is an enzyme that destroys cGMP. By inhibiting the destruction of cGMP by PDE5, sildenafil allows cGMP to accumulate. The cGMP in turn prolongs relaxation of the smooth muscle of the corpora cavernosa. Relaxation of the corpora cavernosa smooth muscle allows blood to flow into the penis resulting in increased engorgement of the penis. In short, sildenafil increases blood flow into the penis and decreases blood flow out of the penis.

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A man’s psychological state is clearly an essential consideration when addressing issues of sexual function. While ED that is purely psychological is not common, many men who experience difficulty with erections may develop anxiety or fear about being able to get an erection the next time they try. This anxiety may lead to a stress response involving activation of the sympathetic nervous system and release of adrenaline, which will tend to make it even more difficult to get an erection. Conflict with a partner (or the absence of a partner) will also tend to increase stress and potentially interfere with erectile function.
Many medications can cause or contribute to erectile dysfunction, including certain blood pressure drugs, antidepressants, and tranquilizers. Men with erectile dysfunction should talk with their doctor if they suspect a prescription or over-the-counter drug may be causing erectile problems. Born This Way? Physiology and Erectile Dysfunction .

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Infection is a concern after placement of a penile prosthesis and is reported as a complication in up to 20% of men undergoing placement of a penile prosthesis. If the device becomes infected more commonly, it needs to be removed. Another prosthesis can be placed after the infection is treated and the penile tissues have healed, but it is a difficult surgery. Erosion of the prosthesis, whereby it compresses through the corporal tissue, into the urethra may occur. Symptoms include pain, blood in the urine, discharge, abnormal stream, and malfunction of the prosthesis. If the prosthesis erodes, it will need to be removed. A catheter is placed to allow the urethra to heal.

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Erectile dysfunction: A consistent inability to sustain an erection sufficient for sexual intercourse. Commonly known as impotence. Medically, the term erectile dysfunction is used to properly differentiate this form of impotence from other problems that interfere with sexual intercourse, such as disease, injury, drug side effects, or a disorder that impairs the nerve supply or the blood flow to the penis. Other forms of impotence include lack of sexual desire and problems with ejaculation and orgasm. Erectile dysfunction is treatable in all age groups, and treatment includes using medication (notably Viagra) and penile implants. Abbreviated ED. SLIDESHOW Erectile Dysfunction (ED) Causes and Treatment See Slideshow Health Solutions From Our Sponsors Drug Categories Drugs & Medications Slideshows Pill Identification Tool Vitamins, Herbs, & Dietary Supplements Images Diseases Symptom Checker Dictionary Quizzes RxList About Us Consumer Contact RxList Terms of Use Privacy Policy Sponsor Policy Pharmaceutical Companies A-Z Site Map WebMD Network WebMD Medscape Reference Medscape MedicineNet eMedicineHealth OnHealth WebMDRx
• Conditions such as diabetes, high blood pressure, heart or thyroid conditions, poor blood flow, depression, or neurologic disorders (such as multiple sclerosis or Parkinson's disease)

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Your doctor might consider a change in your treatment regimen. This might be appropriate if your impotence started soon after starting the drug. This can be discussed with your doctor.

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Exercise can help reverse some of the risk factors for E.D., such as being overweight or obese, having high blood pressure, being stressed, or having weak pelvic floor muscles.

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    Many people with ED are also prescribed oral medications to help them get and maintain an erection. Injectable or suppository use of alprostadil can also help some people. Testosterone therapy may be another option.

    What is low blood pressure (hypotension)? Explore low blood pressure causes, symptoms, and signs. Discover what is considered low...
    There’s nothing better than the buzz you get after an intense session in the gym.

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    If your doctor suspects that you may have an underlying condition, however, you might need further tests or a consultation with a specialist. Tests for underlying conditions can include: A physical exam: Your doctor will examine your penis and testicles for signs of abnormalities and will test sensation. Blood tests: Blood tests can show if you may have heart disease, diabetes, low testosterone levels, or other issues. Urine tests: Urinalysis is used to look for signs of diabetes and other health conditions. An ultrasound: A specially trained technician will use a wand-like device (transducer) over the blood vessels that supply the penis to analyze for blood flow issues. A psychological exam: Your doctor may want to evaluate you for depression or other mental illnesses that may cause erectile dysfunction. Want Respect at Work? Ditch the Emojis For Men, Vaping May Be a Downer in the Bedroom Change in the Kitchen Can Help Men in the Bedroom Acupuncture May Help Ease Prostate-Linked Pain Testosterone's Ties to Success May Be a Myth

    Do NOT take these medications if you are on nitroglycerin, taking medications with nitrates, or even have nitroglycerin at home. Ask your doctor if you have any questions about this.
    My current girlfriend, who I met three months after my implant operation, knows all about it. I explained it by joking that I’d gone from an automatic to a manual. She’s been so understanding, it makes me think that if I’d met her earlier I might not have had the issues I did as I wouldn’t have suffered so much anxiety about it.

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    Men with diabetes, radical prostatectomy, and other complicating factors may still benefit from treatment with a phosphodiesterase type-5 inhibitor such as Viagra. Patients who fail a trial of PDE5 inhibitor should be informed of the benefits and risks of other therapies. This of a different PDE5 inhibitor is unlikely to have a profound effect on sexual function and someone who fails a first drug trial, but should be considered in selected cases. Second-line therapies include intra-urethral suppositories, intra-cavernous drug injection, vacuum-constriction devices, and penile prosthesis. Medicated Urethral System for Erection (MUSE). MUSE is an intra-urethral suppository of alprostadil, of vaso-active drug that relaxes smooth muscle in the penis and induces penile erection. Although not as effective as intra-cavernosal penile injection, MUSE is a less invasive treatment option. An initial trial dose of intra-urethral alprostadil should be administered under healthcare provider supervision due to the risk of fainting. The cost of intra-urethral suppositories is high with respect to the overall success and therefore should be used judiciously.

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    Endocrinologic conditions include diseases or conditions that involve abnormalities of the glands and hormonal imbalance. Hypogonadism, known informally as "low T," is a medical condition that results from low levels of the male hormone testosterone (androgen deficiency). Symptoms of hypogonadism can include reduced sexual desire (low libido) and ED.

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    Lie on the floor and on your side.Place a pillow between your knees. Make sure the pillow is large enough to spread your legs apart.Squeeze your legs together and hold for five seconds, then release.Repeat step three, eight to 10 times, and do three to five sets.
    Erectile Dysfunction is the consistent inability to sustain an erection sufficient for sexual intercourse. A total inability to achieve an erection – You can never get an erection. An inconsistent ability to do so – You can only occasionally get an erection. A tendency to sustain only brief erections – You can get an erection, but can’t keep it long enough for satisfying sex.

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To summarize, there are many different factors that can cause or contribute to ED. Some of the strongest contributors, such as comorbid conditions, can be modified and controlled with lifestyle changes. Most common however, ED causes are multifactorial and complex. Our urology team is here to work with you to resolve your ED and improve your sexual function.

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Smoking, excessive use of alcohol and illicit drugs are also associated with ED.13 A study in 2005 suggests that ED is not only more likely among men who smoked compared with those who never did, but that in younger men with ED, cigarette smoking is very likely the cause of their impotence.14 15

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In any case, for most men, having natural erections should keep penis tissue well supplied -- although not every erection might fit the bill. For full effect, oxygenation probably needs to last a certain minimum time, Koskimäki says, though exactly how long is still unknown. That’s part of the reason his team asked only about sexual intercourse practices. “Masturbation often happens very quickly,” he notes.

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