Although not indicated for routine use, nocturnal penile tumescence (NPT) testing may be useful in the patient who reports a complete absence of erections (exclusive of nocturnal "sleep" erections) or when a primary psychogenic etiology is suspected. Such testing should be performed by those with expertise and knowledge of its interpretation, pitfalls, and usefulness. Various methods and devices are available for the evaluation of nocturnal penile tumescence, but their clinical usefulness is restricted by limitations of diagnostic accuracy and availability of normative data. Further study regarding standardization of NPT testing and its general applicability is indicated.

On the horizon is gene therapy that would deliver genes that produce products or proteins that may not be functioning properly in the penile tissue of men with ED. Replacement of these proteins may result in improvement in erectile function. Experimental animal models have demonstrated improvement in erectile function with gene therapy. Human studies may also demonstrate success with this therapy. Gene therapy may take a long time for regulatory approval and public acceptance.


In this study, ED proceeded CVD in almost 70% of cases. Similarly, many men with ED have been found to have pre-existing CVD. A study by Vlachopoulos et al evaluated the incidence of asymptomatic CVD in 50 men with ED.22 These authors found that 19% of men with ED had asymptomatic CVD. Similarly, Mulhall and colleagues found that 20% of men presenting with ED and vascular insufficiency on penile duplex had asymptomatic CVD.23
Erectile dysfunction (ED) affects 50% of men older than 40 years, [4] exerting substantial effects on quality of life. [5] This common problem is complex and involves multiple pathways. Penile erections are produced by an integration of physiologic processes involving the central nervous, peripheral nervous, hormonal, and vascular systems. Any abnormality in these systems, whether from medication or disease, has a significant impact on the ability to develop and sustain an erection, ejaculate, and experience orgasm.
Drugs for treating impotence can be taken orally or injected directly into the penis or inserted into the urethra at the tip of the penis. Oral testosterone can reduce impotence in some men with low levels of natural testosterone. Patients also have claimed effectiveness of other oral drugs--including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone--but no scientific studies have proved the effectiveness of these drugs in relieving impotence. Some observed improvements following their use may be examples of the placebo effect, that is, a change that results simply from the patient's believing that an improvement will occur.
The health care provider will ask about the firmness and duration of erections at different times (e.g., sex with partners, erections after sleep). Discussing sexual dysfunction with a health care provider is very important because many conditions causing it can be successfully treated. If a man has no diseases that cause ED and can have an erection with masturbation or early morning awakening, he likely has ED due to psychological causes.

There have been rare reports of priapism (prolonged and painful erections lasting more than six hours) with the use of PDE5 inhibitors such as sildenafil, vardenafil, and tadalafil. Patients with blood cell diseases such as sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks of developing priapism. Untreated priapism can cause injury to the penis and lead to permanent impotence. Therefore, if your erection lasts four hours, you should seek emergency medical care.

You're not hard. You're about to have sex for the first time with your date, who's truly beautiful. All you want to do is present your glorious, super strong erection and let it do the talking. And yet when you look down, you're limp instead of hard. This doesn't make any sense! you think. Every element you could possibly need for an erection is here. Nudity, beauty, passion, the tantalizing thrill of boning someone for the first time, and a little bit of booze to take the edge off. What on earth is wrong and why are you so unlucky? You turn to your date. "I swear, this never happens..."
Martha K Terris, MD, FACS is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Institute of Ultrasound in Medicine, American Society of Clinical Oncology, American Urological Association, Association of Women Surgeons, New York Academy of Sciences, Society of Government Service Urologists, Society of University Urologists, Society of Urology Chairpersons and Program Directors, and Society of Women in Urology

All these treatments listed above do not provide immediate effect on your body. If you need an instant erection, you should take a look at the topical erection treatment. Targeted delivery has been recently identified as an emerging alternative to orally administered products mainly due to the current concerns of the side effects that may occur from taking prescription drugs. Topical erection treatment presents a preferable delivery method to get an erection that enhances the desired effect directly to the intended site of action while limiting the exposure of the rest of the body to the ingredients.
Physical examination should include the assessment of male secondary sex characteristics, femoral and lower extremity pulses, and a focused neurologic examination including perianal sensation, anal sphincter tone, and bulbocavernosus reflex. More extensive neurologic tests, including dorsal nerve conduction latencies, evoked potential measurements, and corpora cavernosal electromyography lack normative (control) data and appear at this time to be of limited clinical value. Examination of the genitalia includes evaluation of testis size and consistency, palpation of the shaft of the penis to determine the presence of Peyronie's plaques, and a digital rectal examination of the prostate with assessment of anal sphincter tone.
In prescribing sildenafil, a doctor considers the age, general health status, and other medication(s) the patient is taking. The usual starting dose for most men is 50 mg, however, the doctor may increase or decrease the dose depending on side effects and effectiveness. The maximum recommended dose is 100 mg every 24 hours. However, many men will need 100 mg of sildenafil for optimal effectiveness, and some doctors are recommending 100 mg as the starting dose.
medicines called alpha-blockers such as Hytrin (terazosin
HCl), Flomax (tamsulosin HCl), Cardura (doxazosin
mesylate), Minipress (prazosin HCl), Uroxatral (alfuzosin HCl),
 Jalyn (dutasteride and tamsulosin HCl), or Rapaflo (silodosin).
Alpha-blockers are sometimes prescribed for prostate
problems or high blood pressure. In some patients, the use
of Sildenafil with alpha-blockers can lead to a drop in blood pressure or to fainting
Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject Impulse, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include papaverine, alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).
There have been rare reports of priapism (prolonged and painful erections lasting more than six hours) with the use of PDE5 inhibitors such as sildenafil, vardenafil, and tadalafil. Patients with blood cell diseases such as sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks of developing priapism. Untreated priapism can cause injury to the penis and lead to permanent impotence. Therefore, if your erection lasts four hours, you should seek emergency medical care.
I'd recommend the second option. In any long-term relationship, there will come a time when you flirt a little too much. Technology makes those little transgressions seem much more major because there's digital proof. (I'm guessing that you would never have flashed him in the real world. Would you?) Maybe you should just learn from your experience and save your boyfriend the drama. Understand that you made a mistake, and keep your breasts to yourself.

Q. I started to suffer from erectile dysfunction? Why is this happening and what can I do to treat it? I am a healthy 52 year old. I have hypertension but i take pills to treat it and my levels are around 130/80. except that I am at great shape. In the last few months I feel that a problem in my sex life. I want to have sex but i can't due to erectile dysfunction. What can be the reason for this? and more important what can I do?
The general medical history is important in identifying specific risk factors that may account for or contribute to the patient's erectile dysfunction. These include vascular risk factors such as hypertension, diabetes, smoking, coronary artery disease, peripheral vascular disorders, pelvic trauma or surgery, and blood lipid abnormalities. Decreased sexual desire or history suggesting a hypogonadal state could indicate a primary endocrine disorder. Neurologic causes may include a history of diabetes mellitus or alcoholism with associated peripheral neuropathy. Neurologic disorders such as multiple sclerosis, spinal injury, or cerebrovascular accidents are often obvious or well defined prior to presentation. It is essential to obtain a detailed medication and illicit drug history since an estimated 25 percent of cases of erectile dysfunction may be attributable to medications for other conditions. Past medical history can reveal important causes of erectile dysfunction, including radical pelvic surgery, radiation therapy, Peyronie's disease, penile or pelvic trauma, prostatitis, priapism, or voiding dysfunction. Information regarding prior evaluation or treatment for "impotence" should be obtained. A detailed sexual history, including current sexual techniques, is important in the general history obtained. It is also important to determine if there have been previous psychiatric illnesses such as depression or neuroses.
To examine what is known about the demographics, etiology, risk factors, pathophysiology, diagnostic assessment, treatments (both generic and cause-specific), and the understanding of their consequences by the public and the medical community, the National Institute of Diabetes and Digestive and Kidney Diseases and the Office of Medical Applications of Research of the National Institutes of Health, in conjunction with the National Institute of Neurological Disorders and Stroke and the National Institute on Aging, convened a consensus development conference on male impotence on December 7-9, 1992. After 1 1/2 days of presentations by experts in the relevant fields involved with male sexual dysfunction and erectile impotence or dysfunction, a consensus panel comprised of representatives from urology, geriatrics, medicine, endocrinology, psychiatry, psychology, nursing, epidemiology, biostatistics, basic sciences, and the public considered the evidence and developed answers to the questions that follow.

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
So here’s something that’s really fascinating. Healthy eating is a way to reduce anxiety and stress. Now how, you may be asking, right? Well, think about it. We live in a world where there are so many variables and where we don’t have control over our lives. But now, with healthy eating, we have control over what goes into our body. And now having that control empowers us to be even healthier, to be more directive in what we do. And certainly, that begins then to reduce the anxiety and the stress. So all in one, you have a healthier body, but certainly a healthier mind.
All studies demonstrate a strong association with age, even when data are adjusted for the confounding effects of other risk factors. The independent association with aging suggests that vascular changes in the arteries and sinusoids of the corpora cavernosa, similar to those found elsewhere in the body, are contributing factors. Other risk factors associated with aging include depression, sleep apnea, and low HDL levels.
To start with, ED is NOT in your head. You can’t simply will yourself to get an erection, no matter how much you try. Studies show over 80% of ED cases are caused by a treatable physical disorder. Diseases such as diabetes, high blood pressure, and high cholesterol are common causes. Even a perfectly healthy man can develop ED after a brain or spinal cord injury. ED can be a side effect of certain medications, too.  Read more on our Causes of ED page.

Another common problem for men who have trouble in the bedroom is substance use or abuse. In some cases, a man suffering from erectile dysfunction may be diagnosed with depression and be prescribed selective serotonin reuptake inhibitors, or SSRIs. These medications may be able to assist in alleviating the symptoms of depression, but they can also lead to erectile dysfunction.
Chlamydia and erectile dysfunction: What's the link? Some people who have chlamydia also experience erectile dysfunction (ED), which involves problems getting or maintaining an erection. Chlamydia can infect the prostate gland, leading to prostatitis, pain, and ED. In this article, learn more about the link between this common infection and ED, and treatments for both. Read now
Men with a rare heart condition known as long QT syndrome should not take vardenafil since this may lead to abnormal heart rhythms. The QT interval is the time it takes for the heart's muscle to recover after it has contracted. An electrocardiogram (EKG) measures the QT interval. Some people have longer than normal QT intervals, and they may develop potentially life-threatening abnormal heart rhythms, especially when given certain medications. Men with a family history of long QT syndrome should not take vardenafil, as it is possible to inherit long QT syndrome. Furthermore, vardenafil is not recommended for men who are taking medications that can affect the QT interval such as quinidine (Quinaglute, Quinidex), procainamide (Pronestyl, Procan-SR, Procanbid), amiodarone (Cordarone), and sotalol (Betapace).
In comparison, 37% of men who had received external radiotherapy as their primary therapy reported the ability to attain functional erections suitable for intercourse, along with 43% of men who had received brachytherapy as primary treatment. Pretreatment sexual health-related quality of life score, age, serum prostate-specific antigen (PSA) level, race or ethnicity, body mass index, and intended treatment details were associated with functional erections 2 years after treatment. [45]
So what do you do? If the guilt is too much, you can tell your boyfriend. It might be the only way to clear your conscience — and hopefully, if you explain the reasons why you did such a boneheaded thing, he'll understand. It will be hard and it may create drama for months to come, but my guess is that you can recover, if he's not a horribly jealous guy.
You may already know that lots of hard drugs — like cocaine, heroin, or Oxycontin — can cause sexual problems (though, quite frankly, if you're on cocaine, heroin, or Oxycontin, you have many more pressing concerns to deal with than getting dirrrty). But did you know that sometimes, even pot can inhibit erections? And you thought weed was just a harmless way to enjoy the musical stylings of Pink Floyd. Who knew it could actually mess with one's own pink floyd?
All these treatments listed above do not provide immediate effect on your body. If you need an instant erection, you should take a look at the topical erection treatment. Targeted delivery has been recently identified as an emerging alternative to orally administered products mainly due to the current concerns of the side effects that may occur from taking prescription drugs. Topical erection treatment presents a preferable delivery method to get an erection that enhances the desired effect directly to the intended site of action while limiting the exposure of the rest of the body to the ingredients.
#2 Physically exhausted. If you’ve been cranking it at the gym, haven’t been sleeping well, or you’ve been working your ass off at your job, getting tangled up with your lover for even more physically demanding activities may not sound ideal. Physical exhaustion has a direct effect on your ability to get aroused. The only fix for this one is to get some rest.
The trouble is, most people don't know that sexual dysfunction can be a warning sign of something more serious. Dr Graham Jackson, a cardiologist and the chairman of the Sexual Advice Association, would like to change that. "People aren't aware of the underlying causes of their problems because they feel well otherwise," he says. "They'll say, 'It's my age' or 'I'm nervous because I'm in a new relationship.' But every man with erectile dysfunction should have their heart and blood pressure checked."
Watts and coworkers, in their review article, make several points about this ED/CAD nexus. Endothelial dysfunction is present in both CVD and ED, and is linked through the NO mechanism. The authors note that PDE5 inhibitors improve endothelial function and have a salutary effect on both CVD and ED. Both ED and cardiac disease respond to modifications in lifestyle as well as pharmacologic manipulation. These authors also report that the presence of ED gives the clinician an opportunity to assess CVD and prevention as well.20
It is essential to discuss erectile dysfunction with your doctor, so any serious underlying causes can be excluded and treatment options can be discussed. Many men are embarrassed discussing this issue with their doctor, or even their partner. Open communication with your doctor, and in your relationship, is important for effectively managing this common problem.
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.
How men can improve their sexual performance Many men want to know how to enhance their own and their partners’ sexual satisfaction. However, placing too much emphasis on performance can lead to anxiety. Certain lifestyle changes can help to reduce sexual anxiety, improve erectile dysfunction, and increase stamina. In this article, we describe 13 methods to try. Read now

Cavallini, G., Modenini, F., Vitali, G., & Koverech, A. (2005, November). Acetyl-L-carnitine plus propionyl-L-carnitine improve efficacy of sildenafil in treatment of erectile dysfunction after bilateral nerve-sparing radical retropubic prostatectomy. Urology, 66(5), 1080-5. Retrieved from http://www.sciencedirect.com/science/article/pii/S0090429505006515

Anxiety is particularly pernicious. It triggers the fight-or-flight reflex that sends blood away from the central body, including the penis, and out to the limbs for self-defense or escape. Less blood in the central body means less blood available for erection. Erection dissatisfaction is upsetting, but try to accept it. It’s normal. And when men become anxious about it, erections become less likely.
Name of DrugWhen to TakeDoseDietary RestrictionsViagraTake between 30 and 60 minutes (and up to 4 hours) before sex; works for about 4 hoursRecommended dose for most men is 50mgs; after that, dosage may go to as high as 100mg, or as low as 25mg, which may be prescribed for men over 65.Quickly absorbed by the body, less effective after a high-fat meal, and best taken on an empty stomach.Name of DrugWhen to TakeDoseDietary RestrictionsLevitraTake 1 hour before sex; works for 4 to 5 hours, and may be slightly more effective than ViagraStarting dose for most men is 10mgs a day, but men over 65 often start on the 5mg pill.Can be taken with or without food, although slightly less effective after a high-fat meal.  Avoid anything containing grapefruit juice; it may make side effects worse.Name of DrugWhen to TakeDoseDietary RestrictionsCialisComes in two forms. The daily pill stays effective in between doses, but may take 4 to 5 days before it begins working. The “weekender” version of Cialis can start working in as little as 30 minutes for men who take the highest dose of the drug (20mgs); it stays effective in the body for up for 36 hours.Daily pill comes in both a 2.5mg and 5mg tablet; most men start with the lower dose. The use-as-needed, “weekender” pill comes in 5, 10 and 20mg strengths; recommended starting dose is 10mg,Can be taken with or without food.   Avoid heavy drinking (5 glasses of wine or 5 shots of whiskey); when combined with Cialis, it can lead to headaches, dizziness, an increase in heart rate, and a drop in blood pressure.Name of DrugWhen to TakeDoseDietary RestrictionsStaxyn Take 1 hour before sex, although many men report erections in 20 to 30 minutes.  Because Staxyn comes in a sleek black package and is taken as a rapidly dissolving tablet (without water), some men think of it as a more discrete way to treat ED.Comes in 10mg tablets; do not take more than 1 a day.Avoid taking it with any kind of liquid. Should be placed directly on the tongue and allowed to dissolve without chewing.Name of DrugWhen to TakeDoseDietary RestrictionsStendraPrescribing information now recommends taking it 30 minutes before sex. Some men, however, report results in as little as 10 to 12 minutes, depending on the dose. Because of these findings, Auxilium Pharmaceuticals, the Chesterbrook, Pa., company that has U.S. marketing rights to the drug, has asked the FDA to revise the prescribing information.Starting dose is 100mgs for most men, but the 50mg tablet is recommended for men taking alpha-blocker drugs, like those used for high blood pressure and prostate problems.May be taken with or without food, and with a moderate amount of alcohol (3 drinks).   Drinking more than that can increase the chances of side effects like rapid heart rate, low blood pressure, dizziness and headaches.Name of DrugWhen to TakeDoseDietary RestrictionsPenile injections & the MUSE suppositoryTake 5 to 10 minutes before planning to have sex; erections last for 30 to 60 minutes.MUSE comes in 4 dosage strengths; most men start at 125mgs. Avoid taking more than twice within a 24-hour period.N/A
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]
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.
Total testosterone levels: Health care professionals should obtain a patient's blood samples for total testosterone levels in the early morning (before 8 a.m.) because the testosterone levels go up and down throughout the day. If you have a low testosterone level, a health care professional should check it again to confirm that it is truly low. In some men, a specialized test measuring the active form of testosterone (free or bioavailable testosterone) may be recommended.
Erections are more complicated than you think. Your brain, nerves, heart, blood vessels, and a whole lot of hormones have to work together perfectly or nothing happens. It’s a lot to ask, and sometimes things break down. And while ED happens to most guys at some point in their lives, erectile dysfunction isn’t something you can just ignore and hope it goes away.
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