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Tobacco, alcohol or drug use: All three of these substances can damage a person's blood vessels and/or restrict blood flow to the penis, causing ED. Smoking in particular plays a large role in causing ED in people with arteriosclerosis. 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. No prescription pharmacy External vacuum therapy Safe ED can have a range of causes, both physical and psychological. Possible physical causes include: Guilty feelings Are there physical causes of erectile dysfunction? A prior history of cigarette smoking, heart attacks, strokes, and poor circulation in the extremities suggest atherosclerosis as the cause of the erectile dysfunction. Diminished sensation of the penis and the testicles, bladder dysfunction, and decreased sweating in the lower extremities suggest diabetic nerve damage. Loss of sexual desire and drive, lack of sexual fantasies, gynecomastia (enlargement of breasts), and diminished facial hair suggest low testosterone levels. The researchers at the Chinese University of Hong Kong believe that the root cause of both the erectile problems and the heart disease could be down to blood vessel damage caused by high blood sugar levels. They advise men who have impotency problems to see their doctor, as this appears to be a reliable warning sign of future health problems. Conclusions: Erectile dysfunction is a significant health concern affecting around one in 10 Australian men aged 1659 years. Current smoking is significantly associated with erectile dysfunction in Australian males. This association was strengthened as the number of cigarettes smoked increased. Health promotion programmes could use the link between smoking and erectile dysfunction to help reduce smoking levels among men. Without Prescription Other substances or drugs that can cause or lead to ED include recreational and frequently abused drugs, such as: The simplest erectile dysfunction treatment may be a mishmash of psychological and medical elements. to implant a device that can cause the penis to become erect "There are lots of different ways to be sexual, and if one way becomes difficult or even impossible, you have to explore, together, the things you can do with each other that are sexually exciting," says Downey. Erection involves the integration of neural and vascular functions. In essence, an erection occurs when blood flow to the penis exceeds flow out of the penis. The cavernosal arteries supply blood to the corpora cavernosa of the penis (through the pudendal artery); the emissary veins running through the tunica albuginea allow drainage. During erection, relaxation of trabecular smooth muscle results in increased blood flow to the corpora cavernosa and expansion of the sinusoids therein. This distension causes mechanical compression of the emissary veins, which impedes their ability to drain blood and thereby results in penile rigidity8 (Fig. 1). Oral sildenafil appears to be safe in the treatment of erectile dysfunction in the real world. It is accepted widely by our patients as first line treatment and is successful in 91% of our patients. At the end of the study period 80% of the patients were willing to continue with sildenafil therapy. In our part of the United Kingdom, there is a large expectation for ED to be treated in the NHS. Of those men eligible for treatment of their ED in the NHS, 30% qualify under the clinical categories and 18% under the 'distress' category. This has implications on the local prescribing policies and resources. Under the current guidelines, only 55% of men with one or more cardiovascular risk factors qualify for treatment in the NHS. The majority of men presenting with ED could be managed in primary care. In clinical studies, Levitra has been shown to work quickly, provide consistent results, and improve sexual function in most men the first time they take the drug. It also has shown to be effective in men of all ages, in patients with diabetes mellitus, and in men who have undergone radical prostatectomy. Women who use the vaginal ring should not smoke. Accepted 22 December 2005 Your doctor will perform a physical examination, which will likely include: Accept that there are events you cannot control.

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