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Counselling also may be used with medicine treatment or vacuum devices for erection problems that have psychological and physical causes. Medicines are usually the main treatment viagra samples cheap for erection problems.

If you don't want to use medicine, or if medicine doesn't work for you, you may want to talk with your doctor about some of the following options.

Most of these

treatments

But because it is sold as a dietary supplement, it is hard to know if you are getting the right amount.

Some men take this dietary supplement to try to treat erection problems. The amino acid increases the amount of nitric oxide in the blood, which relaxes blood vessels. Some men who have low zinc levels in their body have had success using zinc supplements to treat erection problems. Male Genital Problems and Injuries Reducing Medication Costs Healthy Aging Dealing With Medicine Side Effects and Interactions Premature Ejaculation Tests for Erection Problems Low Testosterone. Psychosocial interventions for erectile dysfunction. In AJ Wein et al., eds., Campbell-Walsh Urology , 10th ed., vol. American Urological Association (2005, reviewed and confirmed 2011). Also available online: http://www.auanet.org/content/clinical-practice-guidelines/clinical-guidelines.cfm?sub=ed. Use of sildenafil (Viagra) in patients with cardiovascular disease. Effect of lifestyle changes on erectile dysfunction in obese men.

In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. Gregory Thompson, MD - Internal Medicine Brian O'Brien, MD, FRCPC - Internal Medicine Adam Husney, MD - Family Medicine Christopher G. Erectile dysfunction can have organic or psychological causes.

Often, an organic problem can be complicated by psychological factors.

The cause can usually be found by history and examination, but testosterone, luteinising hormone and prolactin should be measured. Non-drug treatments are suitable for some patients, while prostaglandin E1 is the most appropriate drug for intracavernosal injection. Introduction Erectile dysfunction (impotence) is the inability to obtain and sustain an erection adequate for sexual intercourse. This is a common problem and the prevalence increases with age.

It is important to distinguish erectile dysfunction from ejaculatory disorders including premature ejaculation and ejaculatory failure. Many men are reluctant to seek help from their doctors as evidenced by the proliferation of franchised, entrepreneurial clinics advertising in the popular press.

Basic clinical assessments should be undertaken for all men presenting with erectile dysfunction to identify. – men who have significant underlying medical disease. – those for whom specific medical therapy may be beneficial.

– those with a psychogenic cause where psychotherapy as part of the medical management may be important.

Extensive investigations are not usually justified. History A careful history, including a drug history, will usually differentiate organic from psychogenic impotence. Drugs that are commonly associated with sexual dysfunction include antihypertensives (including diuretics), cimetidine, major tranquillisers and most antidepressants.

Organic impotence generally has a gradual, insidious onset with progressive worsening until no erection is obtained. At first, there may be loss of rigidity and/or difficulty sustaining an erection. Organic impotence is evident consistently in all situations, whether during attempted intercourse with his regular or another partner, masturbation or in response to erotic stimuli.

Nocturnal erections are markedly diminished and this manifests as a loss of erections on waking. Psychogenic impotence is more likely to have an abrupt onset.

This is often related to a distinct precipitating event (e.g.

a psychologically traumatic episode of sexual failure).

The impotence is often inconsistent, occurring only in certain situations.

Nevertheless, organic impotence usually invokes a secondary psychological overlay which may complicate evaluation of the aetiology.

This underlines the need for a careful, unhurried approach and empathy during history taking.

Androgen deficiency causes more loss of libido than erectile dysfunction. It is unusual for men complaining of impotence to have androgen deficiency as a cause of their sexual dysfunction. This is in contrast to the low sexual activity of androgen-deficient men which often causes them little concern.

Physical examination Evidence of possible causative factors (e.g. diabetes, pituitary disease, lipid disorders, vascular or neuropathic disease, androgen deficiency) should be sought systematically.

Gonadal status (secondary sexual characteristics, testis size) and visual field defects suggesting pituitary tumour should be assessed. Altered peripheral pulses and neurological reflexes in the legs can be evidence of vascular or neurological disorders.

Investigation Few investigations of erectile dysfunction lead to specific interventions, so extensive testing cannot be justified in routine practice. Specific correctable underlying causes such as androgen deficiency or pituitary tumour should be sought, even though they are rare.

Their treatment may be gratifying and has implications for general health (e.g. general energy and well-being, risk of osteoporosis).

Serum prolactin, testosterone and luteinising hormone (LH) should be measured and repeated if any is abnormal.