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Men with diabetes, radical prostatectomy, and other complicating factors may still benefit from treatment with a phosphodiesterase type-5 inhibitor such as Viagra. Patients who fail a trial of PDE5 inhibitor should be informed of the benefits and risks of other therapies. This of a different PDE5 inhibitor is unlikely to have a profound effect on sexual function and someone who fails a first drug trial, but should be considered in selected cases. Second-line therapies include intra-urethral suppositories, intra-cavernous drug injection, vacuum-constriction devices, and penile prosthesis. Medicated Urethral System for Erection (MUSE). MUSE is an intra-urethral suppository of alprostadil, of vaso-active drug that relaxes smooth muscle in the penis and induces penile erection. Although not as effective as intra-cavernosal penile injection, MUSE is a less invasive treatment option. An initial trial dose of intra-urethral alprostadil should be administered under healthcare provider supervision due to the risk of fainting. The cost of intra-urethral suppositories is high with respect to the overall success and therefore should be used judiciously.

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Several FDA-approved phosphodiesterase-5 (PDE5) inhibitor medications exist to treat ED in men. These medications work by enhancing the effects of nitric oxide to relax the penile muscles, expand blood vessels that go into the penis, and improve penile blood flow. This helps improve the ability to get and maintain erections.
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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.
This procedure is performed in an exam room and does not require anesthesia. You do not need to prepare anything in advance for your appointment.

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Even if you take the medicine, you still need physical and mental stimulation and desire to have an erection. If your first dose doesn’t help, call your doctor. Your doctor may want to change your tablet strength.
Viagra is the brand name of the prescription medicine sildenafil. It’s used to treat erectile dysfunction (trouble getting or keeping an erection) in men.

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For men with lower levels of DHEA, one study suggests that oral DHEA treatment may help reduce the symptoms of ED. However, experts agree that we need more research on the effectiveness of DHEA for treating ED. eVitaminsNatrolNature’s LabSuperior LabsTheralogixZhou Nutrition L-arginine

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https://www.sciencedirect.com/science/article/abs/pii/S0302283802001756?via%3Dihub Preliminary observations on the use of propionyl-L-carnitine in combination with sildenafil in patients with erectile dysfunction and diabetes. (2004).

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    Coronavirus vs. seasonal flu: Symptoms that can differentiate between the two infections

    You could also try a medicine called alprostadil (only available with a prescription). This is a man-made hormone that helps to stimulate blood flow to the penis.
    Prescription ED medications can potentially lower blood pressure. If you already have low blood pressure or are being treated for high blood pressure, there is a possibility that ED treatments could lead to hypotension, which is a serious risk. The doctor will be able to advise you on safe treatment options. You may need blood pressure results to acquire a prescription for certain ED medications.

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    Certain oral medications can be used to relax the penis and allow for proper blood flow when sexually aroused.

    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.
    A small percentage of erectile dysfunction cases are related to surgery for prostate cancer. After the operation to remove the prostate, 15 percent to 60 percent of men can have erectile dysfunction, even when newer “nerve sparing” surgery is performed. Often, this side effect is temporary, and improvement can be seen up to one year after surgery.

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    Inflatable implants are a pair of tubes placed in the penis and connected to a squeezable pump inside the scrotum. You squeeze the pump to get an erection. Inflatable implants can also help slightly increase length and width.

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    Arginine: It's found naturally in food, and it relaxes blood vessels and is used to treat heart problems. Doctors think it boosts circulation to the penis, but Espinosa says he doesn’t recommend it much because the body metabolizes it so quickly. “You need a lot and you need to take it frequently for it to work,” he says.

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    The clinical term for this treatment used by urologists is low-intensity shockwave therapy (LiSWT). During the treatment, a small wand-like device uses targeted sound waves to stimulate penile tissue and encourage blood flow, which can also speed up the healing process. Low-intensity shockwaves have also been shown to grow new blood vessels and improve blood flow in the penis, which is essential for erections.

    Your doctor may recommend pursuing some mental health support to alleviate the impact of stress, depression, or anxiety on your ED. Seeking help from a mental health professional can help treat erectile dysfunction.
    Getting an erection is a complicated process. During an erection, the blood vessels that let blood into your penis relax and widen (dilate). This lets more blood in, which causes the sponge-like tissues of your penis to swell and harden. Your thoughts and senses (touch, hearing, smell and sight) influence a part of your brain that can trigger an erection.

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Taking one of these medications should not result in an instant erection, thankfully — stimulation is still required. But when stimulation occurs, the medicine gives a helping hand to boost nitric oxide and its effects.

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When you get aroused, your body produces a molecule called cGMP which helps to stimulate an erection by increasing blood flow to the penis.

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