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B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals sale viagra viagra online prescription Erectile dysfunction takes more than a physical toll. The emotional impact the condition can have on a man and his partner can be just as difficult. It is common for men with ED to feel anger, frustration, sadness, or lack confidence. However, the condition can be treated. The first step in addressing your concerns about ED is to be honest with yourself, your partner, and your doctor. Once ED has been brought out into the open, coping with it as you go through treatment will be easier and less stressful. Communication is essential to a successful diagnosis and treatment, as well as, helping your partner understand your feelings. When you hear concerning erectile dysfunction you frequently associate this with somebody who is a lot of older and unable to perform sexually while undergoing an erectile dysfunction treatment. But, this is often definitely not the case. Many men, as young as 30, can be diagnosed with erectile dysfunction or ED for short. Low levels of testosterone rarely lead to erection problems, but may reduce a man's sex drive. Make an appointment to see a health professional within 1 to 2 weeks if an erection problem occurs more than 25% of the time and the problem: Health Tip: Why You May Have Erectile Dysfunction The researchers concluded that under the supervision of a physician, sildenafil can be safely used in conjunction with heart medications. There are insufficient studies on the newer medications vardenafil (Levitra) and tadalafil (Cialis) to draw conclusions, however. A comparison of satisfaction rates and ED in subjects treated with sildenafil, intracavernous PGE1 (alprostadil), and penile implant surgery was performed by Rajpurkar and Dhabuwala in 138 men with ED. This was a nonrandomized study in which all subjects were initially offered sildenafil. The mean follow-up was 19.54 months, and questionnaires were used to obtain the data. Their conclusions were that men with a penile implant had significantly better erectile function and satisfaction. "Smoking, because it causes blood vessel constriction, is a very big cause of erectile dysfunction," said Dr. Larry Lipshultz, chief of male reproductive medicine at Baylor College of Medicine in Houston. Psychogenic impotence is relatively uncommon. It is characterized objectively by the presence of good nocturnal and morning erections and negative findings from all other tests. During the interview, a history of highly variable erections that can be totally absent one day but virtually normal the next suggests a psychogenic cause. Virtually 100% of men with severe depression have erectile dysfunction (ED). Sildenafil (Viagra) works well for psychogenic ED; other treatment modalities are also effective because the tissues, nerves, hormone levels, and vasculature are normal. The authors usually recommend a full psychological evaluation in these patients so that the underlying etiology can be identified and treated appropriately rather than just treating the symptom of ED. Therefore, the authors defer treatment of the patient's ED until he has begun psychological testing and therapy for the underlying problem. The doctor may also wish to interview your sexual partner since your partner may be able to offer in sight about the underlying causes. Treatments (with the exception of testosterone supplementation, where effective) work on a temporary basis: they enable an erection to be attained and maintained long enough for intercourse, but do not permanently improve the underlying condition. In addition, always follow the directions on your prescription label carefully and ask your doctor or pharmacist to explain any part that you do not understand. Take these drugs exactly as directed. Do not take more or less or take it more often than prescribed by your doctor. Do not take these drugs more than once a day. High blood pressure High cholesterol Prostate cancer Transurethral alprostadil provides the same significant improvement in erectile function as injectable alprostadil with a better tolerated method of delivery. In one large study,15 65 percent of patients reported successful and satisfactory intercourse. This form of alprostadil is thought to diffuse into the corpus spongiosum and then into the corpus cavernosum. Once the drug enters the cavernosum, the arteriolar smooth muscle relaxes, resulting in erection. In a large double-blind, placebo-controlled study, the most common reported side effect was penile pain (10.8 percent), which was not judged by patients to prevent its use.15