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There are contraindications for each drug (i.e., reasons why a person should not try to use it). Men with certain liver, kidney, or cardiovascular conditions may not be able to take ED medications safely. Men taking nitrates and alpha-blockers to treat hypertension may need to find other ways to treat their ED. Other health conditions could make PDE-5 medications unsafe for men.

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If the medicines aren’t right for you, you could try using a penile implant, vacuum pump devices, or have surgery. Your doctor may send you to a urologist to talk about these options. How long will I have to take medicine for erectile dysfunction? What is the difference between tadalafil (Cialis), vardenafil (Levitra), and sildenafil (Viagra)? Are there any lifestyle changes I should make? How can I talk with my partner about my problem? Is there something I can do other than take medicine to help? What other medicines cause this problem?
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If tadalafil does not work, a doctor might recommend sildenafil, which works in a similar way.
Where surgical sperm retrieval may be considered while elevated levels are suggestive of failure of spermatogenesis (Table 45.13). In rare cases undetectable levels of FSH can be suggestive of hypogonadotrophic hypogonadism where treatment with exogenous FSH may be effective. Testosterone and LH measurements are helpful in the assessment of men where androgen deficiency is suspected or where there is a need to exclude sex steroid abuse or steroid secreting tumours of the testes or adrenals. As men with hyperprolactinaemia have sexual dysfunction, it is necessary to exclude elevated prolactin levels in men with loss of libido and impotence. Persistently elevated prolactin levels warrant further investigations such as imaging of the pituitary gland. Cauda Equina and Lumbosacral Plexus Disorders Wed, 18 Dec 2019 | Fecal Incontinence Neuroanatomical Basics of Radical Prostatectomy

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Sildenafil is our most popular erectile dysfunction treatment due to its clinically proven effects and affordable price. It works by establishing reliable blood flow to the penis, ensuring a strong erection when you need one.
In general, more than 6 in 10 men say they have harder erections after taking it.

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DiabetesDiabetes is a known risk factor for ED, and its prevalence in patients with diabetes is estimated to be greater than 50%. When compared to a healthy control group, men with diabetes were found to be 3.5 times more likely to have ED than those without diabetes.21 While PDE5Is have proven to be highly efficacious in the treatment of ED, men with diabetes tend to have a poorer response with this drug class compared with those without, although some of the evidence is mixed. Because the release of NO is mediated by neuronal and endothelial NO synthase, it is postulated that neuropathy and endothelial disease (commonly diagnosed in patients with diabetes) diminish the effects of PDE5Is.22

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Many men are unhappy with their ability to get or maintain an erection, but only 5% of these men seek help. This is because most men, in general, are unwilling to discuss their sex life, even when it is going well.

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    The major breakthrough occurred in 1998 when sildenafil became the first oral drug to be approved to treat ED.4 This was followed by the use of tadalafil and vardenafil as similar phosphodiesterase-5 inhibitor oral medications for treating ED in 2003.4

    Another brand name of sildenafil, called Revatio, is used to treat pulmonary arterial hypertension (high blood pressure in the lungs) and improve exercise ability in men and women with this condition.
    13. Yuan J, Zhang R, Yang Z, et al. Comparative effectiveness and safety of oral phosphodiesterase type 5 inhibitors for erectile dysfunction: A systematic review and network meta-analysis. European Urology. 2013;63(5):902-912.

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    Ginseng. Korean red ginseng has long been used to stimulate male sexual function, but few studies have tried systematically to confirm its benefits. In one 2002 study involving 45 men with significant ED, the herb helped alleviate symptoms of erectile dysfunction and brought "enhanced penile tip rigidity." Experts aren't sure how red ginseng might work, though it's thought to promote nitric oxide synthesis. "I would recommend ginseng [for men with ED]," says Espinosa. Discuss with your doctor before taking it since ginseng can interact with drugs you may already be taking and cause allergic reactions.

    If you’re ready to start seeing improvements, consider trying some of the natural remedies for impotence explained below. These remedies include eating an anti-inflammatory diet, getting more exercise, using essential oils and other supplements, and of course, getting a handle on stress.
    Sildenafil is sometimes used “off-label” to treat other medical conditions, including:

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    25. Heaton JPW, Lording D, Liu SN, et al. Intracavernosal alprostadil is effective for the treatment of erectile dysfunction in diabetic men. Int J Impot Res. 2001;13(6):317-321.

    Can’t or don’t want to take ED drugs? The vacuum pump method is the next most common choice among men with erectile dysfunction who pass on pills, says Dr. Bennett. To create an erection, you place a plastic cylinder over the penis and pump the air out of the cylinder to force blood to flow into the penis. An elastic ring that you slide onto the base of your penis holds the erection. This ED treatment device is effective for about 75 percent of men. Side effects include numbness, bruising, and weak ejaculation — and the ring must be removed after 30 minutes.
    In cases of underlying conditions resulting in erectile dysfunction, treating the underlying condition can help reverse the dysfunction.

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    During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect of avanafil.

    If a medication is causing your ED, your doctor may lower your dose or try a different drug.
    There are many unproven herbals, dietary supplements, and natural remedies for ED. These include panax, propionyl-L-carnitine, L-citrulline, pomegranate, rhodiola rosea, golden root, Indian ginseng, zinc supplements, and ashwagandha.

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A healthy diet also helps to maintain a healthy body weight, which is important because men who have a 42-inch waist are 50 percent more likely to have ED than men with a 32-inch waist. Also, obesity increases the risk for vascular disease and diabetes, two factors that contribute to ED.

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Some estimates indicate that about 40% of men over the age of 40 will have erection problems at times. being unable to get an erection experiencing a partial erection having an erection of a shorter than usual duration. What causes an erection to fail?

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Impotence, also called erectile dysfunction (ED), can be a very frustrating problem. Some men are able to achieve an erection but are not able to maintain one. Others are not able to achieve one at all. Causes of impotence can be both physiological (affecting mostly the body and organs) or psychological (affecting the mind). Luckily, there are natural remedies for impotence you can try.

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