Did you know that erectile dysfunction precedes coronary artery disease in almost 70 percent of cases.2 The arteries in the penis are smaller than those that cause heart disease symptoms, which means they are likely to be affected by blockages sooner. When the arteries in the penis are blocked, keeping an erection will be difficult regardless of your level of arousal.
A good indicator that "everything is in working order" and that it is probably a psychological cause is if a “morning erection” is still experienced. Feelings like fear, anger, distress and anxiety cause part of the nervous system to come into play which directly blocks the action of another part of the system involved in creating an erection. This is a natural reaction – our ancestors would find it more difficult to run from a predator with an erection in the way!
Besides PDE5 inhibitors and among second-line therapies are VCDs which are clear plastic chambers placed over the penis, tightened against the lower abdomen with a mechanism to create a vacuum inside the chamber. This directs blood into the penis. If an adequate erection occurs inside the chamber, the patient slips a small constriction band off the end of the VCD and onto the base of the penis. An erection beyond 30 min is not recommended. These devices can be a bit cumbersome, but are very safe.40
Cosgrove et al reported a higher rate of sexual dysfunction in veterans with posttraumatic stress disorder (PTSD) than in veterans who did not develop this problem. [42] The domains on the International Index of Erectile Function (IIEF) questionnaire that demonstrated the most change included overall sexual satisfaction and erectile function. [43, 44] Men with PTSD should be evaluated and treated if they have sexual dysfunction.
When pills don’t work, an ED implant offers hope. Penile implants are custom-fitted devices that are surgically implanted to allow you to obtain an erection when desired. They are undetectable to the naked eye, so no one will know you have one unless you tell them. The Titan® penile implant from Coloplast produces a totally natural, controlled and spontaneous erection that will restore your confidence, relationships and pleasure.
One report from a recent community survey concluded that erectile failure was the leading complaint of males attending sex therapy clinics. Other studies have shown that erectile disorders are the primary concern of sex therapy patients in treatment. This is consistent with the view that erectile dysfunction may be associated with depression, loss of self-esteem, poor self-image, increased anxiety or tension with one's sexual partner, and/or fear and anxiety associated with contracting sexually transmitted diseases, including AIDS.
Experts often treat psychologically based impotence using techniques that decrease anxiety associated with intercourse. The patient's partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety during treatment of physical impotence. If these simple behavioral methods at home are ineffective, a doctor may refer an individual to a sex counselor.
Lemonaid Health services are provided by one of our three medical groups. All three medical groups do business as 'Lemonaid Health'. In all states other than Texas and Kansas, Lemonaid services are provided by LMND Medical Group, Inc., A Professional Corporation, doing business as Lemonaid Health. In Texas, Lemonaid services are provided by LMND Medical Group, A Professional Association, with registered office 1999 Bryan Street, Suite 900, Dallas, TX 75201. In Kansas, Lemonaid services are provided by LMND Medical Group, A Professional Association, with registered office 112 SW 7TH Street, Suite 3C, Topeka, KS 66603. Our team is based at 150 Spear Street, Suite 350, San Francisco, California 94105, USA. You can call us on +1 415 926 5818.
For more information please refer to the erectile dysfunction article. There are also other causes of problems in bed like enlarged prostate, or you may be interested in general male enhancement. This is not the subject we are talking about. The main purpose of this review is to let you know how to get an erection when you need it. We will take a look at the products and techniques that will help you get an instant erection on demand. Face it, if you want to take total control of a woman, you just can't let concerns about your performance disrupt the thrill and momentum of spontaneous, passionate sex. You want to know without a doubt that you'll be as hard and as hot and as enduring as you ever dreamed. And you want it now. Now means instant erection when you need it.

There are hundreds of medications that have the side effect of ED and/or decreased libido. Examples of drugs implicated as a cause of ED include hydrochlorothiazides and beta-blocking agents. Medications used to treat depression, particularly the SSRIs such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly, Sarafem), fluvoxamine (Luvox, Luvox CR), paroxetine (Paxil, Paxil CR, Pexeva) and sertraline (Zoloft), may also contribute to ED.9 Bupropion (Wellbutrin) which has a predominant effect on blocking the reuptake of dopamine is an antidepressant with lower incidence of ED.10 The side effects of 5ARIs occurring in fewer than 5% of patients can include gynaecomastia, ED, loss of libido and ejaculatory dysfunction.11


A rigid or nearly rigid erectile response to intracavernous injection of pharmacologic test doses of a vasodilating agent (see below) indicates adequate arterial and veno-occlusive function. This suggests that the patient may be a suitable candidate for a trial of penile injection therapy. Genital stimulation may be of use in increasing the erectile response in this setting. This diagnostic technique also may be used to differentiate a vascular from a primarily neuropathic or psychogenic etiology. Patients who have an inadequate response to intracavernous pharmacologic injection may be candidates for further vascular testing. It should be recognized, however, that failure to respond adequately may not indicate vascular insufficiency but can be caused by patient anxiety or discomfort. The number of patients who may benefit from more extensive vascular testing is small, but includes young men with a history of significant perineal or pelvic trauma, who may have anatomic arterial blockage (either alone or with neurologic deficit) to account for erectile dysfunction.
If you have been having ED for more than two months, you should see a doctor to find the cause. To detect the cause of ED, your doctor will take a history of when you started to have problems with erections and sex drive, illnesses or injuries that could cause ED, and any recent physical or emotional changes in your life. You also will need to review all the medications you take. The evaluation most often includes a physical exam.
By contrast, psychogenic impotence typically is abrupt in onset, often in relation to psychological trauma, and may wax and wane. Patients with psychogenic impotence may have total erectile failure with one partner but not another, or be impotent during sexual intercourse but not during self-stimulation. Normally occurring spontaneous erections in the morning suggest psychogenic rather than organic causes for impotence.

Jump up ^ Reepmeyer JC, Woodruff JT (2007). "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 of Pharmaceutical and Biomedical Analysis. 44 (4): 887–93. doi:10.1016/j.jpba.2007.04.011. PMID 17532168.
However, men are affected psychologically when it comes to achieving erections. For instance, if a man is with a woman for the first time, or even before he feels comfortable with her, he may suffer from performance anxiety. In such a situation, his mind and body are both saying yes, but then they become out of sync. The body is then saying yes, but the mind is filled with question. “Will I be able to perform?” “How long will I last?” “Am I big enough to satisfy her?” “Is she looking at that mole on my stomach?” All kinds of questions may be going through a man’s mind upon getting in bed, and these can be distracting, they can lead to self-doubt, and therefore, failure to achieve or maintain an erection.

Conditions associated with reduced nerve and endothelium function (eg, aging, hypertension, smoking, hypercholesterolemia, and diabetes) alter the balance between contraction and relaxation factors (see Pathophysiology). These conditions cause circulatory and structural changes in penile tissues, resulting in arterial insufficiency and defective smooth muscle relaxation. In some patients, sexual dysfunction may be the presenting symptom of these disorders.
The physical side effects of chemotherapy are usually temporary and resolve within one to two weeks after stopping the chemotherapy. However, chemotherapy agents, such as Ciplatin or Vincristine, may interfere with the nerves that control erection leading to possible impotence. Make sure you discuss potential side effects of cancer chemotherapy with your doctor or healthcare provider.
You're right that this should be a last resort, but Paduch also agrees that sometimes a little confidence can help you get back on track. The thing is, you should only take an ED medicine if it's prescribed by your doctor (otherwise you'll miss out on the important medical info you should know before you take it). Another option is an l-arginine supplement, which can increase nitric oxide and blood flow.
In the meantime, make sure he gets some rest and takes it easy. The more you two stress about it — and the more pressure he feels you are putting on him — the harder it will get for him to get hard, in all likelihood. So take a few days off. Relax, be patient, and help him find him some help if he needs it. In the meantime, here's a Cosmopolitan.com guide about exactly this topic from sex therapist Dr. Jane Greer.
The medications are extremely effective, which is very good. And the medications are, for the most part, extremely well-tolerated. But there are, like with any medications, a potential downside. The one absolute downside to the use of any of these erection what we call PDE5 medications is if a patient is using a nitroglycerin medication. And nitroglycerins are used for heart disease and for angina, for the most part, although there are some recreational uses of nitrites. And that’s important because your blood vessels will dilate and your blood pressure will drop. And that is an absolute contraindication.
Several pathways have been described to explain how information travels from the hypothalamus to the sacral autonomic centers. One pathway travels from the dorsomedial hypothalamus through the dorsal and central gray matter, descends to the locus ceruleus, and projects ventrally in the mesencephalic reticular formation. Input from the brain is conveyed through the dorsal spinal columns to the thoracolumbar and sacral autonomic nuclei.
How’s this for a win-win: The more sex you have, the less likely you are to suffer from erectile dysfunction, according to a 2008 study published in The American Journal of Medicine. Men aged 55-75 who reported having sex less than once per week had twice the incidence of erectile dysfunction (there were 79 cases of ED per 1,000) as men who have sex once a week (32 cases of ED per 1,000). But if you really want to up your odds, shoot for three times per week (only 16 cases of ED per 1,000). Can you really argue with science, or a perscription to have more sex?
This is a completely legitimate and rational fear that disrupts a man’s ability to become aroused. If a man is not ready for a child and you are not on birth control, there is always a chance you could conceive. If you are new to one another, he doesn’t know for certain if you are a carrier of a disease. This is where the physiological and the psychological partner up and shut it down, to protect their dude.
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I know it’s awkward to talk about money like you’re business partners but partners is just what you are: You’re fiancés who share finances. So you need to be very clear about what this merger means. Right now, it doesn’t sound like you’re being very transparent with each other. Why were you surprised to find he was making more and contributing less than you feel he should? Do you not know how much he makes? Does he not know how much you expect him to pay back?
Psychological factors — Psychological issues such as depression, anxiety, guilt or fear can sometimes cause sexual problems. At one time, these factors were thought to be the major cause of impotence. Doctors now know that physical factors cause impotence in most men with the problem. However, embarrassment or "performance anxiety" can make a physical problem worse.
How soon the drugs start working ranges from 15 to 60 minutes. Neither Viagra nor Levitra will work if you take them after a meal, which blocks their absorption. However, neither Cialis nor Stendra interact with food this way. The onset time determines how soon you can engage in intercourse. Stendra and daily-use Cialis are closest to being an "on demand" erectile drug; using the others requires more planning.
3. An intact, anatomically correct penis; 25% of impotence may be psychologic or 'partner-specific', 25% has an organic component and 50% of impotence is organic in nature; in organic impotence, nocturnal penile tumescence is absent Management-surgical Microvascular surgery to bypass occluded vessels–most effective in younger ♂, penile prosthesis Management-medical Combined therapy with phentolamine and papaverine–self-injected by the Pt, wielding an erection of 1 hr's duration is useful for arterial, neurologic, psychogenic impotence; other therapies–zinc, bromocriptine–Parlodel, isoxsuprine-Vasodilan, Voxsuprine, nitroglycerine, yohimbine–Yocon, Yohimex Etiology Smoking, CAD, HTN, DM, medications–hypoglycemic agents, vasodilators, cardiac drugs, antihypertensives, anger and depression; it is inversely correlated to dehydroepiandrosterone, HDL-C, and an index of dominant personality Primary impotence Complete absence of successful sexual coupling Secondary impotence Priapism, penile plaques, Peyronie's disease; drugs linked to impotence: antihypertensives–eg, methyldopa, guanethidine, reserpine, clonidine, due to ↓ BP, antidepressants–eg, phenelzine, isocarboxazide, amitriptyline–causing altered moods and decreased libido, tranquilizers–eg, chlordiazepoxide and lorazepam, and the muscle-relaxing diazepam, cimetidine, which ↑ prolactin, and is associated with impotence and loss of libido. Cf Infertility, Orgasmic dysfunction.

The mechanisms by which testosterone plays a role in erectile function are not completely understood. A study evaluating the effect of testosterone on erections in surgically castrated rabbits and control animals, in which the rabbits’ intracavernosal pressures were compared after cavernosal nerve stimulation, determined that castrated rabbits had much lower pressures after stimulation than control rabbits did. [21] Notably, the pressures increased when castrated rabbits received exogenous testosterone replacement.
So not only are erectile problems common, they're nothing for you or your special friend to be freaked out about. Check out the nine most common reasons that dudes sometimes can't get it up, and get ready to become the soothing voice of reason the next time the guy you're with has a hard time pitching his tent in your happy valley. Everything (and every penis) is gonna be fine!
In addition to Viagra, other ED drugs available in the United States include avanafil (Stendra), tadalafil (Cialis) and vardenafil (Levitra). These all improve blood supply to the penis. In combination with sexual stimulation, the drugs can produce an erection sufficient to initiate and complete intercourse. There is also a fast-dissolving form of Levitra, called Staxyn, that you put under your tongue.
First realize that this is normal, and just because it happened once does not mean it will happen again (but freaking out about it could make it happen again). Then Skyler tells people to completely ditch the idea that sex is a goal-oriented act with orgasm being the big finish. Instead, take a pleasure-oriented mentality where various sex acts are done because they feel good — not because it's part of series of steps to get you to climax. This helps take away some of the anxiety, because when you're not so focused on the performance, it's not that big of a deal if there's a little bit of stage fright, she says. There's plenty of other things you can do while hanging out with a non-erect penis!

“Cardiovascular exercise and weight resistance exercises increase a man’s testosterone, which helps ward off ED,” Gittens says. The problem is, your testosterone levels drop as you age. Your levels now as a 25-year-old will drop about 50 percent by the time you're 75, according to data from the Reviews of Urology. To keep your levels high, check out this testosterone-boosting workout.
However, in contrast, a recent systematic review of published studies, the authors concluded that overall, the addition of testosterone to PDE-5 inhibitors might benefit patients with ED associated with testosterone levels of less than 300 ng/dL (10.4 nmol/L) who failed monotherapy. [20] A limitation of existing studies are their heterogeneous nature and methodological drawbacks.
Six herbs for treating erectile dysfunction Erectile dysfunction can be an embarrassing condition that can leave men unable to achieve an erection or a full orgasm. This MNT Knowledge Center article talks about six different herbal supplements that could help people with erectile dysfunction, including ginkgo biloba, horny goat weed, and red ginseng. Read now
Erectile dysfunction can occur as a side effect of medication taken for another health condition. Common culprits are high blood pressure meds, antidepressants, some diuretics, beta-blockers, heart medication, cholesterol meds, antipsychotic drugs, hormone drugs, corticosteroids, chemotherapy, and medication for male pattern baldness, among others.
In the meantime, make sure he gets some rest and takes it easy. The more you two stress about it — and the more pressure he feels you are putting on him — the harder it will get for him to get hard, in all likelihood. So take a few days off. Relax, be patient, and help him find him some help if he needs it. In the meantime, here's a Cosmopolitan.com guide about exactly this topic from sex therapist Dr. Jane Greer.
Having learned a great deal more about erectile dysfunction including its risk factors and causes, you should be equipped to assess your own erectile function. If you have experienced erectile issues or you have some of the risk factors mentioned above, it may be worth making a trip to your doctor’s office. If you choose to seek help, give your doctor as much information as you can about your symptoms including their frequency and severity as well as the onset. With your doctor’s help, you can determine the best course of treatment to restore sexual function.
Before delving into the causes and solutions to erectile dysfunction, it’s first important to understand how erections work. The penis is mostly comprised or fibrous tissue that fills with blood upon arousal. This is what causes an erection, and after arousal is finished, blood drains back out into the body and the penis becomes flaccid. Men can have erections for no discernible reason throughout the day, but when sexual stimulation occurs, rather through contact, visual, audible, or mental stimulation, the potential for achieving an erection increases.

The history can be useful in distinguishing organic from psychogenic impotence (Table 187.1). The patient with organic impotence describes problems with erection that progress over months to years. At first, the patient will have partial erections or seemingly firm erections that become flaccid during intercourse. With time, total erectile failure ensues. Organic impotence is constant and nonselective, meaning it is not better or worse with any specific partner or any type of stimulation.
There are treatments available to help you to get and maintain an erection. In addition, making healthy changes to your lifestyle could help with impotence. Switching to a healthier balanced diet, taking more exercise and cutting down on or giving up alcohol and cigarettes could help you to see an improvement in sexual function. If you think that the problem may be related to stress or anxiety, counselling can also help.

Fortunately, impotence is usually treatable. A thorough evaluation starting with a history and physical exam is needed to help diagnose the underlying cause. Once the cause of impotence is determined, treatment can be tailored to target that cause and any other contributing factors. Treatments used for impotence may include medications, vacuum devices, surgery, and psychotherapy.


Circulatory problems: An erection occurs when the penis fills with blood and a valve at the base of the penis traps it. Diabetes, high blood pressure, cholesterol, clots, and atherosclerosis (hardening of the arteries) can all interfere with this process. Such circulatory problems are the number one cause of erectile dysfunction. Frequently, erectile dysfunction is the first noticeable symptom of cardiovascular disease.

The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) study, designed to determine whether an individual man’s sexual outcomes after most common treatments for early-stage prostate cancer could be accurately predicted on the basis of baseline characteristics and treatment plans, found that 2 years after treatment, 177 (35%) of 511 men who underwent prostatectomy reported the ability to attain functional erections suitable for intercourse. [45]
Don’t give up or blame yourself - you shouldn’t assume that your situation is impossible to improve or that your partner is disappointed in you. Studies show as long as you don’t stop trying to engage your partner sexually, they will still respond positively. If you communicate and stay positive you can work with your partner to get the result you’re looking for.
Impotence can have emotional causes but most often it is due to a physical problem. The physical causes of impotence include diseases (such as diabetes and hypertension), injuries (such as from prostate surgery), side-effects of drugs (such as the protease inhibitors used in HIV therapy), and disorders (such as atherosclerosis) that impair blood flow in the penis. Impotence is treatable in all age groups. Treatments include psychotherapy, vacuum devices, surgery and, most often today, drug therapy.
Constriction of the trabecular smooth muscle and helicine arteries induced by sympathetic innervation makes the penis flaccid, with blood pressure in the cavernosal sinuses of the penis near venous pressure. Acetylcholine is thought to decrease sympathetic tone. This may be important in a permissive sense for adequate trabecular smooth muscle relaxation and consequent effective action of other mediators in achieving sufficient inflow of blood into the lacunar spaces. When the trabecular smooth muscle relaxes and helicine arteries dilate in response to parasympathetic stimulation and decreased sympathetic tone, increased blood flow fills the cavernous spaces, increasing the pressure within these spaces so that the penis becomes erect. As the venules are compressed against the tunica albuginea, penile pressure approaches arterial pressure, causing rigidity. Once this state is achieved, arterial inflow is reduced to a level that matches venous outflow.

Appallingly little is known about the prevalence of erectile dysfunction in the United States and how this prevalence varies according to individual characteristics (age, race, ethnicity, socioeconomic status, and concomitant diseases and conditions). Data on erectile dysfunction available from the 1940's applied to the present U.S. male population produce an estimate of erectile dysfunction prevalence of 7 million.
Depression and anxiety: Psychological factors may be responsible for erectile dysfunction. These factors include stress, anxiety, guilt, depression, widower syndrome, low self-esteem, posttraumatic stress disorder, and fear of sexual failure (performance anxiety). It is also worth noting that many medications used for treatment of depression and other psychiatric disorders may cause erectile dysfunction or ejaculatory problems.

Yes, the vacuum device is effective. In fact, with use of the vacuum device, 88% of men will have an erection that is satisfactory for completion of sexual activity. The vacuum device may be the only therapy that is effective after the removal of a penile prosthesis. Patients also use vacuum devices as part of penile rehabilitation after radical prostatectomy to help preserve the tissue of the penis and prevent scarring within the penis and loss of penile length. Its use, however, is limited by the mechanical nature of it and the time taken to pump the device and apply the band. Sex partners may complain of the penis being cool to touch.
Me and my boyfriend have been together almost two years, and he has only said "I love you" about a dozen times. I know he loves me by his actions but I would still like to hear the words. I have tried talking to him about it but he also isn't one for talking about anything that could possibly be uncomfortable. Sometimes this really makes me insecure, especially since I tell him daily I love him. Other times I feel like I am just being silly and that actions speak louder than words. What should I do?
Three days after Michael was found to have a dangerously blocked coronary artery, surgeons inserted a stent to prop the artery open. Now he is keen to get more men going to their doctor to be checked up. "When it comes to sex, people keep things to themselves. But this is an easy way to catch heart problems at an early stage and treat them before the worst happens."
Then you have to be able to make the right diagnosis. What is the basis for their erectile dysfunction? Is it psychogenic? Is it some sort of neurological or blood vessel or hormonal issue? So you have to make a diagnosis. You have to be able to make an assessment. And then only after those things are done, then you start to think about medications.
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