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Sexual stimulation can be tactile (for example, by a partner touching the penis cheapest place to buy sildenafil or by masturbation) or mental (for example, by having sexual fantasies, viewing porn). Sexual stimulation or sexual arousal causes the nerves going to the penis to release a chemical, nitric oxide. Nitric oxide increases the production of another chemical, cyclic GMP (cGMP), in the muscle of the corpora cavernosa. The cGMP causes the muscles of the corpora cavernosa to relax, and this allows more blood to flow into the penis.

The incoming blood fills the corpora cavernosa, making the penis expand. As blood flows into the penis, the corpora cavernosa swell, and this swelling compresses the veins (blood vessels that drain the blood out of the penis) against the tunica albuginea.

Compression of the veins prevents blood from leaving the penis.

When the amount of cGMP decreases by the action of a chemical called phosphodiesterase type 5 (PDE5), the muscles in the penis tighten, and the blood flow into the penis decreases. With less blood coming into the penis, the veins are not compressed, allowing blood to drain out of the penis, and the erection goes down.

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The ability to achieve and sustain erections requires the following: A healthy nervous system that conducts nerve impulses in the brain, spinal column, sildenafil without prescription and penis Healthy arteries in and near the corpora cavernosa that when stimulated can bring increased blood flow into the penis Healthy muscles and fibrous tissues within the corpora cavernosa, which can distend to allow the penis to fill with blood Adequate levels of nitric oxide in the penis Normal-functioning tunica albuginea that allows for compression of the veins Appropriate psychosocial interactions.

Erectile dysfunction can occur if a man doesn't meet one or more of these requirements. The following are causes of erectile dysfunction, and many men have more than one potential cause: Aging : There are two reasons why older men are more likely to experience erectile dysfunction than younger men. First, older men are more likely to develop diseases (such as heart attacks, angina, cardiovascular disease, strokes, diabetes mellitus, and high blood pressure) that are associated with erectile dysfunction. Second, the aging process alone can cause erectile dysfunction in some men by causing changes in the muscle and tissue within the penis.

Diabetes mellitus : Erectile dysfunction tends to develop 10 to 15 years earlier in diabetic men than among nondiabetic men.

The increased risk of erectile dysfunction among men with diabetes mellitus may be due to the earlier onset and greater severity of atherosclerosis (hardening of the arteries) that narrows the arteries and thereby reduces the delivery of blood to the penis.

Atherosclerosis can affect the arteries in the penis, as well as the arteries in the pelvis that supply the penile arteries.

Diabetes mellitus also causes erectile dysfunction by damaging nerves that go to the penis, much like the effect of diabetes on nerves in other areas of the body (diabetic neuropathy). Diabetes can also affect the muscles in the penis, leading to troubles with erections. Smoking cigarettes, obesity, poor control of blood glucose levels, and having diabetes mellitus for a long time further increase the risk of erectile dysfunction in people with diabetes.

Hypertension (high blood pressure) : Men with high blood pressure have an increased risk of developing erectile dysfunction. Hypertension can cause troubles buy sildenafil without prescription with erections related to atherosclerosis or from low levels of nitric oxide production from the arteries in the penis.

Medications to treat hypertension may cause erectile dysfunction.

Cardiovascular diseases : The most common cause of cardiovascular diseases in the United States is atherosclerosis, the narrowing and hardening of arteries that reduces blood flow.

Atherosclerosis (a type of vascular disease) typically affects arteries throughout the body; hypertension, high blood cholesterol levels, cigarette smoking, and diabetes mellitus aggravate atherosclerosis. Hardening of the arteries to the penis and pelvic organs, atherosclerosis, causes insufficient blood flow into the penis.

There is a close correlation between the severity of atherosclerosis in the coronary arteries and erectile dysfunction. For example, men with more severe coronary artery atherosclerosis (hardening of the arteries in the heart) also tend to have more erectile dysfunction than men with mild or no coronary artery atherosclerosis. Some doctors suggest that men with new onset erectile dysfunction undergo evaluation for silent coronary artery diseases (advanced coronary artery atherosclerosis that has not yet caused angina or heart attacks).

Metabolic syndrome is associated with multiple risk factors for erectile dysfunction including diabetes, abnormal lipid profile, hypertension, and obesity. Cigarette smoking : sildenafil without prescription Cigarettesmoking aggravates atherosclerosis and can cause vasospasm (spasms of the arteries) and thereby increases the risk for erectile dysfunction. Nerve or spinal cord damage : Damage to the spinal cord and nerves in the pelvis can cause erectile dysfunction. Nerve damage can be due to disease, trauma, or surgical procedures. Examples include injury to the spinal cord from automobile accidents, injury to the pelvic nerves from prostate surgery for cancer (prostatectomy), and some surgeries for colorectal cancer, radiation to the prostate, surgery for benign prostatic enlargement, multiple sclerosis (a neurological disease with the potential to cause widespread damage to nerves), and long-term diabetes mellitus.

BPH : Benign enlargement of the prostate is associated with erectile dysfunction. Trauma : Trauma to the pelvis, including pelvic fracture, may cause erectile dysfunction, and an untreated penile fracture may result in erectile dysfunction.

Substance abuse : Marijuana, heroin, cocaine, methamphetamines, crystal meth, and narcotic and alcohol abuse contribute to erectile dysfunction.

Alcoholism, in addition to causing nerve damage, can lead to atrophy (shrinking) of the testicles and lower testosterone levels. Low testosterone levels : Testosterone (the primary sex hormone in men) is not only necessary for sex drive (libido) but also is necessary to maintain nitric oxide levels in the penis. Therefore, men with hypogonadism (low testosterone with symptoms) can have low sex drive and erectile dysfunction.

Medications : Many common medicines produce erectile dysfunction as a side effect.

Medicines that can cause erectile dysfunction include many used to treat high blood pressure, antihistamines, antidepressants, tranquilizers, and appetite suppressants.

Examples of common sildenafil without prescription medicines that can cause erectile dysfunction include propranolol (Inderal) or other beta-blockers, hydrochlorothiazide, digoxin (Lanoxin), amitriptyline (Elavil), ed meds online no prescription famotidine (Pepcid), cimetidine (Tagamet), metoclopramide (Reglan), naproxen, indomethacin (Indocin), lithium (Eskalith, Lithobid), verapamil (Calan, Verelan, Isoptin), phenytoin (Dilantin), gemfibrozil (Lopid), amphetamine/dextroamphetamine (Adderall), and phentermine.

Prostate sildenafil without prescription cancer medications that lower testosterone levels such as leuprolide (Lupron) may affect erectile function. Some chemotherapies such as cyclophosphamide (Cytoxan) may affect erectile function. Recreational drugs : Recreational drugs, including alcohol, amphetamines, barbiturates, marijuana, nicotine, heroin and cocaine, are associated with erectile dysfunction. Depression and anxiety : Psychological factors may be responsible for erectile dysfunction. These factors include stress, anxiety, guilt, depression, widower syndrome, low self-esteem, posttraumatic stress disorder, and fear of sexual failure (performance anxiety).

It is also worth noting that many medications used for treatment of depression and other psychiatric disorders may cause erectile dysfunction or ejaculatory problems.

The common risk factors for ED include the following: Advanced age Cardiovascular disease Hypertension Diabetes mellitus High cholesterol Cigarette smoking Recreational drug use Depression or other psychiatric disorders Pelvic surgery, including radical prostatectomy and colorectal surgery Pelvic radiation, such as for prostate cancer and some colorectal cancers sildenafil overnight Trauma to the pelvis (pelvic fracture), penis (penile fracture), sildenafil without prescription and perineum.

Signs and symptoms of erectile dysfunction may include the following: Penile erection occurs, but the penis does not remain hard enough for completion of sex. Penile erections are not hard enough for penetration.

One can still achieve an orgasm and ejaculate with erectile dysfunction.

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How do health care professionals diagnose erectile dysfunction? Physicians make a diagnosis of erectile dysfunction in men who complain of troubles having a hard enough erection or a hard erection that does not last long enough.