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Investigate the hypothalamic-pituitary-gonadal axis by evaluating testosterone levels (a morning serum free and total testosterone level is suggested) in most patients, especially if the patient has a history of reduced libido. Tell friend How is ED diagnosed? Organic nitrates in any form are contraindicated when used regularly or intermittently because they potentiate hypotensive effects of nitrates; if nitrate administration is necessary, at least 48 h should elapse after the last dose of tadalafil Cream applied to the glans penis is most effective in men with mild-to-moderate ED. Effect is noticeable within 5 min. Same medication used for injection therapy and in MUSE system. Prostate resection - minimally invasive - discharge In one Hong Kong-based study involving 2,306 men with type-2 diabetes, slightly more than one fourth of the subjects had erectile dysfunction at the start of the study, and none of the participants had any signs or history of heart disease, stroke or vascular disease. After four years, 123 of these men either experienced a heart attack, died from heart disease, developed chest pain caused by clogged arteries, or needed bypass surgery or a catheter procedure to restore blood flow to the heart. Men who had erectile dysfunction at the beginning of the study were much more likely to experience one of these coronary heart disease (CHD) events. A statistical analysis revealed that out of every 1,000 diabetic men with erectile dysfunction, 19.7 could be expected to experience a CHD event each year, as compared to only 9.5 of 1,000 diabetic men without erectile dysfunction. After a complete analysis of many other factors, the study concluded that erectile dysfunction is an early warning sign for heart disease and that it indicated a 58% increase in the risk for CHD. Vacuum devices Patients who are refractory to sildenafil may benefit from vardenafil or tadalafil therapy. If none of these is successful, combine the agent with an injection of prostaglandin E-1. Gutierrez et al demonstrated that this combination was more effective than either one alone. Other successful combinations include using a PDE-5 inhibitor with MUSE.5 ViagraŽ is well known to be contraindicated with organic nitrates. These are drugs that are often used to treat heart conditions such low blood pressure. ViagraŽ appears to potentiate the effects of nitrates and therefore the two must not be taken concurrently. Furthermore, caution is advised for any patient using ViagraŽ who has a heart problem, even if they are not using nitrates. (2) If you have erectile dysfunction, Viagra or similar drugs like Cialis and Levitra may very well solve your problem. These drugs help the arousal signal from the brain do what it's supposed to do. They don't give you an erection, but they let you have one. You and your partner will have to adjust to using these medicines. Erectile problems aren't always vascular in nature. Sometimes the trouble is psychological or neurological and wouldn't necessarily be associated with a higher risk of heart disease, Ward cautioned. Still, research linking erectile dysfunction (ED) and heart disease suggests that a proactive approach is the best medicine. All PDE-5 inhibitors are contraindicated in men who use or may need to use nitrates. These drugs potentiate the vasodilatory effect of organic nitrates and nitric oxide donor drugs.45 The effect on systemic blood pressure, however, in both normotensive and hypertensive men tends to be clinically nonsignificant when sildenafil is used alone or in conjunction with other antihypertensive agents.46 Thadani and colleagues47 reported that use of vardenafil did not affect exercise tolerance among men with stable coronary artery disease.47 The study appears online Sept. 18 in the Journal of Sexual Medicine. The following health professionals can evaluate symptoms of erection problems: Natural treatment can support erectile function by improving overall health. Erectile dysfunction due to vascular disease may readily respond to nutritional changes and herbal support. For whatever reason they were taken, NSAIDs roughly doubled the risk of erectile dysfunction compared with non-use. The presence of arthritis without NSAID use increased the risk of erection difficulty by only 30 percent, the researchers explain, and they therefore conclude that NSAIDs were largely to blame for the link between arthritis and erectile dysfunction. Hypertension Diabetes Peripheral vascular disease -- This disease particularly affects blood vessels that supply blood to the lower extremities Touching exercises that are designed to take away the pressure to perform during sex. No reports on long-term use How severe is my ED? Urologists have tools that help determine whether ED is mild, moderate, or severe, and what can be done about it.