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.
Impotence is a common problem among men and is characterized by the consistent inability to sustain an erection sufficient for sexual intercourse or the inability to achieve ejaculation, or both. Erectile dysfunction can vary. It can involve a total inability to achieve an erection or ejaculation, an inconsistent ability to do so, or a tendency to sustain only very brief erections.
Vardenafil and tadalafil belong to the same group of chemical compounds as sildenafil, namely phos-phodiesterase type 5 (PDE-5) inhibitors. Some men cannot benefit from sildenafil or the two newer PDE-5 inhibitors because they have low levels of nitric oxide. British investigators reported in late 2002 that three different types of compounds are being studied as possible medications for men with low levels of nitric oxide. They are Rho-kinase inhibitors, soluble guanylate cyclase activators, and nitric oxide-releasing PDE-5 inhibitors.
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]
An alprostadil cream that patients apply into the tip of the penis (the urethral meatus, the opening that urine passes through) is currently available in the UK and Europe. It is currently under review by the U.S. Food and Drug Administration (FDA). After application of the cream, an erection occurs within five to 30 minutes, and the erection lasts one to two hours in men who respond to the cream. Doctors recommend that one use the cream for a maximum frequency of two to three times per week and no more frequent than once every 24 hours. It has essentially the same contraindications and side effects as the other formulations of alprostadil. The cream may cause vaginal burning in roughly 4% of partners. Men should not use alprostadil cream for sexual intercourse with women of childbearing potential unless a condom is used. Researchers have performed controlled trial studies to evaluate the safety and effectiveness of this drug. Overall, 52% of men reported improvement in their erections compared to 20% of men receiving placebo. A later analysis demonstrated that 36% of men using the alprostadil cream had a clinically relevant improvement in vaginal penetration ability and 31% clinically relevant improvement in ability to have successful intercourse to ejaculation.

Trauma to the pelvic blood vessels or nerves can also lead result in ED. Bicycle riding for long periods has been implicated as an etiologic factor; direct compression of the perineum by the bicycle seat may cause vascular and nerve injury. [37] On the other hand, bicycling for less than 3 hours per week may be somewhat protective against ED. [37] Some of the newer bicycle seats have been designed to diminish pressure on the perineum. [37, 38]


Vijay Bhat, MD is a board certified internal medicine physician who is passionate about providing quality medical care that’s affordable for patients. He believes that integrating technology and medicine can make healthcare efficient and more accessible. Throughout his training Dr. Bhat was involved with global health initiatives, providing care to underprivileged communities locally and overseas. He’s also been a strong proponent of quality improvement in the medical field. Dr. Bhat graduated with a BS from the University of California Berkeley, and received his medical degree from Stony Brook University in New York. He completed his residency in Internal Medicine at Rutgers Robert Wood Johnson.
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.
Many common medications for treating hypertension, depression, and high blood lipids (high cholesterol) can contribute to erectile dysfunction (see above). Treatment of hypertension is an example. There are many different types (classes) of medications for high blood pressure; these include beta-blockers, calcium channel blockers, diuretics (medications that increase urine volume), angiotensin converting enzyme inhibitors (ACE inhibitors), and angiotensin receptor blockers (ARBs). Patients may use these medications alone or in combination to control blood pressure. Some of these medications can cause troubles with erections. For example, Inderal (a beta-blocker) and hydrochlorothiazide (a diuretic) cause erectile dysfunction, while calcium channel blockers and ACE inhibitors do not seem to affect erectile function. On the other hand, other medications (such as angiotensin receptor blockers [ARB] including losartan [Cozaar] and valsartan [Diovan]) may actually help with erections. Therefore, if possible, you may benefit from changing your medications, but this requires approval by your prescribing health care provider.
Patients with both ED and cardiovascular disease who receive treatment with an oral PDE5 inhibitor require education regarding what to do if anginal episodes develop while the drug is in their system. Such education includes stressing the importance of alerting emergency care providers to the presence of the drug so that nitrate treatment is avoided.
In addition, a man affected by lower testosterone may feel less sexually inclined, less interested in viewing sexual material, and less interested in physical activities. To add to this, a man dealing with less testosterone may also become less assertive, more inclined to stay in, and more likely to seek out medical help for his erectile dysfunction.
Half of all men between the ages of 40 and 70 will experience erectile dysfunction. While the problem doesn't cause heart disease, the two often occur together – study after study has shown that men with ED are dramatically more likely to develop heart disease and have a heart attack or stroke. One German study from 2010 found men with erectile dysfunction are twice as likely to die within the next two years as those without, prompting some experts to call the phenomenon "the canary in the trousers".
This consensus development conference on male erectile dysfunction has provided an overview of current knowledge on the prevalence, etiology, pathophysiology, diagnosis, and management of this condition. The growing individual and societal awareness and open acknowledgment of the problem have led to increased interest and resultant explosion of knowledge in each of these areas. Research on this condition has produced many controversies, which also were expressed at this conference. Numerous questions were identified that may serve as foci for future research directions. These will depend on the development of precise agreement among investigators and clinicians in this field on the definition of what constitutes erectile dysfunction, and what factors in its multifaceted nature contribute to its expression. In addition, further investigation of these issues will require collaborative efforts of basic science investigators and clinicians from the spectrum of relevant disciplines and the rigorous application of appropriate research principles in designing studies to obtain further knowledge and to promote understanding of the various aspects of this condition.
Lindsay Mitchell, ARNP is a Board Certified Family Nurse Practitioner and graduated with high honors from South University in Savannah, GA. She has a background in primary care, women’s health and focusing on evidence based practices. She has a strong passion for providing efficient and accessible patient care, along with caring for underserved patient populations. Prior to becoming an ARNP, she worked as a registered nurse in the emergency department in Jacksonville, Fl.

There are no formal tests to diagnose erectile dysfunction. Some blood tests are generally done to exclude underlying disease, such as hypogonadism and prolactinoma. Impotence is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease such as coronary artery disease and peripheral vascular disease. Therefore, a thorough physical examination is helpful, in particular the simple search for a previously undetected groin hernia since it can affect sexual functions in men and is easily curable.[11]

You should talk to your doctor about possible treatments. You may want to talk to other patients who have had the treatment planned for you. You also may want to seek a second doctor's opinion about surgery before making your decision. You may find it difficult to talk to your doctor about impotence. You will want to find a doctor who treats this condition and will help you feel comfortable talking about the problem and choosing the best treatment. You can also get more information by contacting your local National Kidney Foundation affiliate.


PDE 5 inhibitors are broken down primarily by enzyme, cytochrome P450enzyme CYP3A4. Medications that decrease or increase the activity of CYP3A4 may affect levels and effectiveness of PDE 5 inhibitors. Such drugs include medications for the treatment of HIV (protease inhibitors) and the antifungal medications ketoconazole and itraconazole. Thus caution is recommended.
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

I am 60 & have erection problems for 20 plus years. Factors for me include heavy smoking for 30 years, overweight, bad eating habits,many medications that claim " may cause sexual side effects ", extreme anxiety, circumcision, & stressful relationships. E.D. has been a big part of relationships ending. Masturbation is now my only recourse & that is many times unsuccessful Also have tried all of the E.D. medications with no success.Stress has been the biggest factor for inability to achieve an erection for me. An inventory of male erogenous zones is key. Many males are shy about trying what works for me with is extreme nipple play. That allows orgasm for me 90 percent of the time. Even at my age daily orgasms are welcome in me life. As far as knowing how to care for the older ladies, it is a learning process as to which I have been a good student. Pleasing a lady even without intercourse is very much possible.


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.

The most common inflatable prosthesis is the three-piece penile prosthesis. It is composed of paired cylinders, which doctors surgically insert inside the penis. Patients can expand the cylinders using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and pump, which doctors also surgically implant. The reservoir is usually in the pelvis. A doctor places the pump in the scrotum. By pressing on the pump, sterile fluid transfers from the reservoir into the cylinders in the penis. An erection is produced primarily by expansion of the width of the penis, however, one model can increase in length a small amount also. Lock-out valves in the tubing prevent the fluid from leaving the cylinder until a release valve is pressed. By pressing the relief valve and gently squeezing the penis, the fluid within the cylinders transfers back into the reservoir.
It is important that all erectile dysfunction is reported to your doctor, as sometimes it can be an indicator of something physically wrong with you that has to be treated. Also, your doctor is in the best position to find the reason for your erectile dysfunction. Routine questions and tests will provide a guide to the cause and allow your doctor to decide what kind of treatment you might need to deal with it. This may involve referral to a specialist. Detailed information can be found at the website of the Impotence Association – www.sda.uk.net
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?
Look, ED can have many causes. Most of the time, it’s physiological. But there are also lots of psychological reasons why someone may experience ED. Treating ED isn’t all about medication. Dealing with some of these psychological issues can help you battle ED, too. I’m talking about depression, anxiety, loss of desire, sense of inadequacy, guilt, fatigue, anger, relationship dysfunction. Working through these types of psychological challenges can help you achieve the happy, healthy manhood you deserve.
Three forms of penile prostheses are available for patients who fail with or refuse other forms of therapy: semirigid, malleable, and inflatable. The effectiveness, complications, and acceptability vary among the three types of prostheses, with the main problems being mechanical failure, infection, and erosions. Silicone particle shedding has been reported, including migration to regional lymph nodes; however, no clinically identifiable problems have been reported as a result of the silicone particles. There is a risk of the need for reoperation with all devices. Although the inflatable prostheses may yield a more physiologically natural appearance, they have had a higher rate of failure requiring reoperation. Men with diabetes mellitus, spinal cord injuries, or urinary tract infections have an increased risk of prosthesis-associated infection. This form of treatment may not be appropriate in patients with severe penile corporal fibrosis, or severe medical illness. Circumcision may be required for patients with phimosis and balanitis.
Traditionally, erectile impotence (the classical definition of impotence) is the failure to achieve penile erection during intercourse. It may have either physical or psychological causes. Alcoholism, endocrine disease, and neurological disorders are typical physical causes. Psychological causes include anxiety over performance, hostility or other negative feelings toward the sexual partner, and stress, anxiety, depression, or other emotional conflicts outside of the relationship. Erectile impotence occasionally occurs with age and, although attributed by the individual to the aging process itself, it is usually secondary to disorders of aging, such as faulty blood circulation or prostate disease. In cases of impotence caused by blood vessel dysfunction, an insufficient supply of blood flows into the penis, or the blood diffuses out into adjacent tissues.

The U.S. FDA (Food and Drug Administration) has a list of 29 OTC products that claim to treat erectile dysfunction. Patients should avoid these because many contain harmful ingredients. Other natural or herbal remedies such as DHEA, L-arginine, ginseng, and yohimbe are supplements that have been used but have not been proven safe and effective according to some researchers. Before using such compounds, individuals should consult their doctor. According to some experts, acupuncture does not effectively treat erectile dysfunction. Other home remedies for reducing ED symptoms include diet changes such as eating blueberries and citrus fruits and drinking red wine.


A lot of guys don’t want to admit it, but not being able to get or keep an erection happens more often than you’d think. Guys usually have trouble getting or keeping an erection when they’re nervous, scared or worried about something. They might be worried about how they’ll “perform,” or they could be feeling guilty about having sex. They might be afraid of getting a sexually transmitted disease (STD), or, if they are with a girl, getting their partner pregnant. Drugs (including some anti-depressants) and alcohol can also prevent you from getting and/or maintaining an erection.
In some cases, nocturnal penile tumescence testing is performed to find out whether the man has erections while asleep. Healthy men usually have about four or five erections throughout the night. The man applies a device to the penis called a Rigiscan before going to bed at night, and the device can determine whether he has had erections. (If a man is able to have normal erections at night, this suggests a psychological cause for his impotence.)
Uncooperative boners might be related to low testosterone, which could be caused by anything from being overweight or stressed to having a chronic health condition, says Paduch. And in men who have taken anabolic steroids, it's not uncommon for them to end up suppressing their natural testosterone production. If you abuse it over a long period of time, you can really mess with your natural testosterone levels, as well as your fertility and erectile function, he says.
In some cases, ED can be a warning sign of more serious disease. One study suggests ED is a strong predictor of heart attack, stroke, and death from cardiovascular disease. The researchers say all men diagnosed with ED should be evaluated for cardiovascular disease. This does not mean every man with ED will develop heart disease, or that every man with heart disease has ED, but patients should be aware of the link.
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