Maybe your performance issues stem from feelings of discomfort relating to something you've done. Are you having trouble performing because you're feeling uncertain about whether you really love your partner? Or because you feel like you crossed a line in terms of infidelity and now the guilt is tearing you up inside? Maybe your conscience is what's wreaking havoc with your sex.
Vascular: Anything that affects the flow of blood to the penis can result in erectile dysfunction. The main culprit tends to be atherosclerosis, the condition that narrows arteries and which can result in poor blood circulation, high blood pressure, heart disease and stroke. Atherosclerosis causes about half the cases of erectile dysfunction in men over 50. Also, the veins through which the blood leaves the penis may not be working properly, allowing the blood to leave too soon.
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.
It is necessary to identify the causes of worry and try to remove these. They could include concern about personal relationships, work, family problems, health or even sexual “performance” with a new or old partner. It is often said that the brain is the biggest sex organ of them all – if it is too busy with other things, it will not be involved in arousal and the erection that follows.
Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor's OK. Medications for erectile dysfunction do not work in all men and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:

PDE5 inhibitors, the primary second-line therapy, have been the mainstay of ED treatment since the release of sildenafil (Viagra) in 1998, with the subsequent development of many others, and still more in the development stage. These medications do improve erectile quality for the majority of men, and they work by enhancing blood flow in the corpora cavernosa. These medications are generally used on demand and need to be taken about an hour before sexual intimacy. Tadalafil (Cialis) is longer acting and does come in a daily preparation potentially eliminating the ‘on-demand’ need. The daily dosing of tadalafil, 2.5–5 mg\day, has also been approved by the FDA for treatment of symptoms of BPH.41 PDE5 inhibitors are contraindicated in men taking nitrates, but otherwise PDE5 inhibitors are very safe and effective. When PDE5 inhibitors are coadministered with nitrates, pronounced systemic vasodilation and severe hypotension are possible. Many patients with ED are elderly and have the same risk factors as patients with CAD, so these drug combinations are commonly considered or encountered in clinical practice.42
Maybe your performance issues stem from feelings of discomfort relating to something you've done. Are you having trouble performing because you're feeling uncertain about whether you really love your partner? Or because you feel like you crossed a line in terms of infidelity and now the guilt is tearing you up inside? Maybe your conscience is what's wreaking havoc with your sex.
The cost to you for ED drug therapy varies considerably, depending on the pharmacy price, prescription co-pays, and your level of health plan coverage. Nationally, the out-of-pocket cost per pill ranges from approximately $15 to $20. Even if private insurance covers it, you may be limited to four doses per month. Here are a few things you can do to contain costs:
Thanks to over a decade of primetime television commercials, most of us can name at least one drug that treats erectile problems. However, far fewer of us can name drugs that may actually cause the problem. In reality, MedlinePlus reported that there are far more of these, and even common drugs such those to treat depression and heartburn can make it difficult to get an erection.
Goodmoring I want to make sure I keep my promise with dr.abulumen and also to help people who are in need I was in weak ejaculation and erection I come to hear of doctor abulumen through a friend of mine I decide to give a try and am very happy to say this that am now free from this problem, dr abulumen cured me I don’t know how he did it but thank god for his help if you need his help you can contact him now on his email DR.ABULUMENSPELLHOME@GMAIL.COM
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.
An analysis of 14 studies involving more than 90,000 patients with ED confirmed the relation between ED and an increased risk of cardiovascular events and mortality. [56] Compared with patients without ED, those with ED had a 44% increased risk of cardiovascular events, a 25% increased risk of all-cause mortality, a 62% increased risk of MI, and a 39% increased risk of cerebrovascular events. Treatment of ED, either through lifestyle interventions or by pharmacologic means, may improve prognosis and reduce risk.
A semi-firm penis if correctly handled can give a somewhat pleasant orgasm. I really don't think there is such a thing as an unpleasant orgasm though. I have have ED for two years. It has been than long since I had sex with my wife in her vagina. There has been plenty of oral sex for her. The ED drugs do not work with me. I take injectable Testosterone, and that does not make a big difference. About twice a month I am able to masturbate. Hey I am glad to know it still works. Next week I am going to see urologist number 2. The first one was a jerk and basically wrote me off because of my age. Now I have read about the Viberect device and the NEW pudendal artery (to the penis). There is hope, but in the mean time I will masturbate as often as I can.
Fact is, almost all men experience erection problems from time to time. Sometimes it's a temporary condition that will go away with just power of mind or little treatment. But unfortunately in many cases it may be an ongoing problem. Whatever it is, if you don't want to eventually destroy your self esteem and harm relationship with your lover, immediate treatment is required.
The risk of impotence increases with age. It is four-fold higher in men in their 60s compared with those in their 40s according to a study published in the Journal of Urology (2000;163:460-463). Men with less education are also more likely to experience impotence, perhaps because they tend to have less healthy lifestyles, eat a less healthy diet, drink more and exercise less. Physical exercise tends to lessen the risk of impotence.
Currently, placement of a penile prosthesis is the most common surgical procedure performed for erectile dysfunction. Penile prosthesis placement is typically reserved for men who have tried and failed (either from efficacy or tolerability) or have contraindications to other forms of therapy including PDE5 inhibitors, intraurethral alprostadil, and injection therapy.
Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. Erectile dysfunction is a common complication of treatments for prostate cancer, including prostatectomy and destruction of the prostate by external beam radiation, although the prostate gland itself is not necessary to achieve an erection. As far as inguinal hernia surgery is concerned, in most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life of patients with preoperative sexual dysfunction, while, in most cases, it does not affect patients with a preoperative normal sexual life.[11]

Stiffy Solution: The good news is, almost all of these conditions can be successfully treated if you catch them early on. And since erectile problems may be the first side effect your dude has experienced, seeking medical treatment for his erectile problems may be the thing to get him into a doctor's office. So if your dude is a well-rested, non-drinking, non-smoking, paragon of relaxation who suddenly can't get wood, urge him to talk to his doctor — his misbehaving penis may actually be communicating something way more important than "Not tonight, honey."
Impotence, also called erectile dysfunction, in general, the inability of a man to achieve or maintain penile erection and hence the inability to participate fully in sexual intercourse. In its broadest sense the term impotence refers to the inability to become sexually aroused; in this sense it can apply to women as well as to men. In common practice, however, the term has traditionally been used to describe only male sexual dysfunctions. Professional sex therapists, while they identify two distinct dysfunctions as forms of impotence, prefer not to use the term impotence per se. Thus, because of its pejorative connotation in lay usage and because of confusion about its definition, the word impotence has been eliminated from the technical vocabulary in favour of the term “erectile dysfunction.”

Lifestyle choices that impair blood circulation can contribute to ED. Smoking, excessive drinking, and drug abuse may damage the blood vessels and reduce blood flow to the penis. Smoking makes men with atherosclerosis particularly vulnerable to ED. Being overweight and getting too little exercise also contribute to ED.  Studies indicate that men who exercise regularly have a lower risk of ED.

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