In a prospective study from the Prostate Cancer Prevention Trial database, Thompson et al reported that men presenting with ED had a significantly higher chance of developing a cardiovascular event over a 7-year follow-up period.  The hazard ratio was 1.45, which is in the range of risk associated with current smoking or a family history of MI.
Aging, liver and kidney problems, and concurrent use of certain medications (such as erythromycin [an antibiotic] and protease inhibitors for HIV) slows the metabolism (breakdown) of sildenafil. Slowed breakdown allows sildenafil to accumulate in the body and potentially may increase the risk of side effects. Therefore, in men over 65 years of age, in men with significant kidney and liver disease, and in men who also are taking medications called protease inhibitors, the doctor will initiate sildenafil at a lower dose (25 mg) to avoid accumulation of sildenafil in the body. A protease inhibitor ritonavir (Norvir) is especially potent in increasing the accumulation of sildenafil, thus men who are taking Norvir should not take sildenafil doses higher than 25 mg and at a frequency of no greater than once in 48 hours. Other medications that may affect the level of sildenafil include erythromycin and ketoconazole.
Psychotherapy, marital counseling, or sex therapy may be helpful in treating cases of impotence that have psychological or emotional causes. A range of other treatments exists for cases of impotence that arise from purely physiological causes. These treatments include vacuum devices, penile injections, and penile implants. These mechanical or physically invasive approaches have largely been superseded, however, by the drug sildenafil citrate (trade name Viagra), which is taken in pill form. This drug works by enhancing the effects of nitric oxide, a chemical that, upon sexual stimulation, is normally released to widen the blood vessels supplying the penis. The increased flow of blood through those vessels into certain tissues in the penis causes an erection. See also sexual dysfunction.
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."
If you want to score points, this is the go-to line. I understand that when you can’t get hard, other sexy acts may be the last thing you want to do, but reciprocate the kindness your woman shows (unless you’re dating an asshole: If someone’s mean about an infrequent loss of boner, dump them.) Forget about your dick for a minute, and eat some pussy. Have you ever gotten head from a woman without getting her off? I thought so. You're taking the pressure off yourself, and giving her a grand gift. Bonus: A well-documented side effect of eating pussy is getting a boner, so this one is a win-win... win! Win!! WIN!!!!
Erections are neurovascular events, meaning that nerves and blood vessels (arteries and veins) are involved in the process of an erection and all must work properly to develop a hard erection that lasts long enough. Erection begins with sexual stimulation. Sexual stimulation can be tactile (for example, by a partner touching the penis or by masturbation) or mental (for example, by having sexual fantasies, viewing porn). Sexual stimulation or sexual arousal causes the nerves going to the penis to release a chemical, nitric oxide. Nitric oxide increases the production of another chemical, cyclic GMP (cGMP), in the muscle of the corpora cavernosa. The cGMP causes the muscles of the corpora cavernosa to relax, and this allows more blood to flow into the penis. The incoming blood fills the corpora cavernosa, making the penis expand.
For the past few months I’ve been dating a lovely man but our relationship is at risk because he can’t get it up. He says he fancies me and always seems turned on. Sometimes he gets hard - but when we try for sex he loses his erection. On the few occasions he has got hard, he doesn’t orgasm. I’ve always been a very sexual person and would like a lot of sex. We’re hardly having any. I find it difficult to orgasm even if he tries other things because I keep thinking. Why can’t he have proper sex with me?
"Data shows the longer you ride, the higher your chance of developing ED in terms of distance per week," Gittens says. If you cycle for exercise or socialization, you don't have to necessarily give it up, just make some modifications. Gittens suggests riding for shorter distances, giving yourself a rest every once in a while, finding a comfortable seat, and getting a bike that’s sized appropriately.
The availability of phosphodiesterase-5 (PDE5) inhibitors—sildenafil, vardenafil, tadalafil, and avanafil—has fundamentally altered the medical management of ED. In addition, direct-to-consumer marketing of these agents over the last 15 years has increased the general public’s awareness of ED as a medical condition with underlying causes and effective treatments.
The FDA does not recommend alternative therapies to treat sexual dysfunction. Many products are advertised as "herbal viagra" or "natural" sexual enhancement products, but no clinical trials or scientific studies support the effectiveness of these products for the treatment of erectile dysfunction, and synthetic chemical compounds similar to sildenafil have been found as adulterants in many of these products. The United States Food and Drug Administration has warned consumers that any sexual enhancement product that claims to work as well as prescription products is likely to contain such a contaminant.
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.
This penile tumescence monitor is placed at the base and near the corona of the penis. It is connected to a monitor that records a continuous graph depicting the force and duration of erections that occur during sleep. The monitor is strapped to the leg. The nocturnal penile tumescence test is conducted on several nights to obtain an accurate indication of erections that normally occur during the alpha phase of sleep.
There are many effective treatments for impotence. The most popular is a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors. These include sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis) and avanafil (STENDRA). These drugs are taken in pill form. They work in most men. But they are less effective in men with neurological causes of impotence.
But the main challenge to finding the best ED drug for you may turn out to be health insurance rules—not biochemistry. It's a common practice among insurers to limit the number of pills you can obtain per month. After you hit your limit, the out-of-pocket cost for a single pill can be as high as $20. "The main obstacle in my practice is the cost," Dr. Liou says. You'll need to work with your doctor to get the pill you need at a price you can afford.
Sexual dysfunction and ED become more common as men age. The percentage of complete ED increases from 5% to 15% as age increases from 40 to 70 years. But this does not mean growing older is the end of your sex life. ED can be treated at any age. Also, ED may be more common in Hispanic men and in those with a history of diabetes, obesity, smoking, and hypertension. Research shows that African-American men sought medical care for ED twice the rate of other racial groups.