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People with certain illnesses, such as leukaemia and sickle cell anaemia, or who have a penile implant or Peyronie’s disease, where the penis may be scarred and produces erections that are not straight, should not use alprostadil.

Men for whom sexual activity is not advised should not use alprostadil.

The most common side effects of alprostadil include pain in the penis or bruising in the penis at the site of injection.

Fibrosis (the development of fibrous tissue) can also develop following injections into the penis.

The most serious side effect is priapism (a persistent erection), which is a medical emergency.

Your doctor will inform you of what to do if you have an erection that persists for 2 hours or more. It is very important that you follow your doctor’s instructions and inform them that you have experienced this side effect. Vacuum erection devices work by creating a vacuum, which increases blood flow to the penis, producing an erection. The penis is lubricated and placed inside a hollow plastic chamber.

Air is pumped out of the chamber, either manually or by a battery powered pump.

This creates a vacuum which pulls blood into the penis to cause an erection.

Once the penis is erect, the man fits a rubber ring around the base of his penis to keep the blood trapped inside the penis when the cylinder is removed. After intercourse, the ring can be removed to return the penis to a limp state.

Vacuum erection devices avoid surgery and can be used as often as required. However, they may be difficult to use, and many men and their partners feel they take much of the pleasure and spontaneity away from sexual activities.

Vacuum pumps are not suitable for men who have problems with blood clotting, or blood disorders such as leukaemia.

Penile implant surgery is not a common procedure but in some cases it may be the most appropriate treatment for erectile dysfunction. The procedure involves placing an implant inside the penis, along its length, so that it can become erect.

The implant may be a pair of semi-rigid rods or a pair of inflatable cylinders. The inflatable implants allow the penis to look and feel limp (flaccid) or erect, depending on how much the cylinders are inflated. The cylinders in an inflatable implant are hollow, and the man gets an erection by squeezing a pump located in his scrotum to fill the cylinders with salt water (saline) stored in a reservoir implanted in his lower abdomen. A release valve drains the saline out of the cylinders and back into the reservoir.

With the semi-rigid, malleable rod type of implant, the rods run along the length of the penis and can be bent upwards to produce an erect penis, or downwards when an erect penis is not required.

Like all surgery, there are some risks, such as infection or bleeding.

If you have had surgery and have severe pain, fever, swelling or excessive bleeding, you should contact your doctor as soon as possible. In cases where a man’s anatomy prevents blood flow into or out of the penis, vascular surgery may be an option.

This treatment option is

rarely

If there is a blockage that prevents blood from flowing into the penis, a doctor may recommend an operation that bypasses the blocked blood vessels, using a length of vein or manufactured tubing, to allow more blood to flow into the penis and help produce an erection. If the problem is that blood leaks back out of the penis, this can be corrected by tying off the major veins that drain the penis, a procedure known as venous ligation. In a small number of men, blood tests may show abnormally low levels of testosterone, the male sex hormone. In such cases your doctor might prescribe a course of testosterone injections or a testosterone implant. The supplements can help boost sex drive as well as increasing the ability to have erections. Testosterone gel or patches, applied daily to the skin, are another option.

There is a lack of scientific evidence supporting the effectiveness of complementary therapies for the treatment of impotence.

Always check with your doctor before taking any herbal medicines or supplements for impotence.

These formulations may contain ingredients that can interact with other medicines or cause dangerous side effects. Erectile dysfunction often has physical causes, but sometimes there is a psychological basis for erection problems.

A man may have had an episode of erectile dysfunction due to some passing cause like fatigue, stress, relationship difficulty or intoxication. This may have led to embarrassment or a feeling of failure. Even if the physical cause does not remain, future attempts to have sex may trigger memories of this embarrassment and acute anxiety that it will happen again. This anxiety itself price of sildenafil 100mg is capable of causing erectile dysfunction, and so a man may get trapped in a self-reinforcing cycle of anxiety and erectile dysfunction.

In these instances, seeing a GP, counsellor or psychologist can be very helpful.

Stress, anxiety, depression and low self-esteem, in fact, almost all significant emotional problems, can have a major effect on sexuality. So do many chronic physical illnesses, even if they don't directly affect genital function.

Counsellors and psychologists can assist with these and a wide range of other sexual and relationship problems and can also help female partners suffering from sexual problems.

They are particularly skilled in helping patients to overcome guilt or anxiety relating to sexual abuse, and in helping couples to sort out relationship difficulties.