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Some find it too mechanical, and it has a “hassle factor,” he says, and the device also can be uncomfortable and/or impede ejaculation. Other men opt for a penile injection, using a diabetic’s syringe and needle.

The injected medication dilates the arteries and increases blood flow every time they want to have sex. The needle is small, so the injection is not terribly painful, but the treatment can be expensive, Dr.

“If the erection starts to become curved, we need order sildenafil online to know,” he adds. “If the erection doesn’t go down after two hours, you need to come in for a reversal. Those who would prefer not to use either of these first two options can turn to a surgical procedure. The surgeon inserts two cigar-shaped cylinders filled with saline attached to a small pump between the testicles and places a saline-filled reservoir inside the abdominal muscles.

None of this is visible from the outside, although you can feel the pump from the outside of the scrotum.

Squeezing that pump causes the saline to fill the cylinders, which simulates blood flow into the penis and causes “something close to a normal erection,” says Dr. “The head of the penis doesn’t fill up, but otherwise it’s the same,” he says.

“Each time the man pumps it up, it gets fully firm.

But it gets firm, stays firm, and he doesn’t have to worry about losing the erection. It doesn’t go down until he withdraws and presses a relief valve.” The downside of implants is a 2 percent chance of infection, which requires removal of the device, and a 6 percent chance of the device failing within five years (and 19 percent within 10 years), Dr.

“The attractive thing about an implant is that it’s part of your body,” he says.

“If you go on vacation, you don’t have to remember to take syringes or medications. It’s MRI safe, and it doesn’t set off any detectors at the airport.

You can have sex whenever you want, at no cost per use, with the same response every time.” Surgical implants are typically not a man’s first choice, he adds, but men rate them most highly of all options in satisfaction surveys. A man’s wife or significant other typically is supportive of a patient with erectile best online sildenafil dysfunction, in the sense that partners typically say, “Honey, it’s OK.

But he encourages partners to mention that it’s a common problem and that order sildenafil online there are straightforward solutions that a man can discuss with his urologist.

“She should encourage him to mention this to the doctor as part of his annual checkup,” he says. If a man has a problem in this area, he will invariably get referred to a urologist. If they fail, then they go to a urologist who specializes in erectile dysfunction.” Cleveland Clinic is a non-profit academic medical center. We do not endorse non-Cleveland Clinic products or services. Can Viagra, testosterone, or other drugs really restore your love life?

But the reverse is true, too: Good sex may help keep you healthy. "A satisfying sex life can foster good emotional health, which in turn can promote good physical health," says Julia Heiman, Ph.D., director of The Kinsey Institute for Research in Sex, Gender, and Reproduction at Indiana University. Moreover, sex itself may have direct health benefits.

For example, orgasm or any loving touch may cause the body to release substances that ease pain, bolster immunity, or elevate mood long after the immediate pleasure passes.

Indeed, people who have strong, intimate relationships tend to have fewer chronic diseases and to live longer, some research suggests.

So there can be good reasons beyond just pleasure to address any significant loss of sexual appetite or activity, regardless of your age.

The introduction of sildenafil ( Viagra ) a decade ago has graphically demonstrated that some sexual problems can be eased. But it has also fed the misconception that every sexual difficulty can—and should—be cured by popping a pill. More and more doctors, with little supporting evidence, are now prescribing sildenafil and related drugs not only to men but women too, as well as the hormone testosterone, in an effort to boost libido. And many consumers are buying DHEA (see caution) a potent hormone sold as a dietary supplement that the body converts to both testosterone and estrogen, with hopes of improving their sex drive and performance.

However, psychological issues, not physical ones, are usually the major culprits in the two most common sexual problems—lack of desire in women and premature ejaculation in men.

Even with largely physical problems, such as vaginal dryness or erectile difficulties, certain nondrug steps may be worth trying. Furthermore, not everyone who experiences changes in sexual desire and function as they age is bothered by those changes, and shouldn't be made to feel either abnormal or in need of a cure. This report will help you talk intelligently with your doctor about when sex-enhancing drugs may be appropriate and when other steps-including leaving well enough alone-are enough. Despite the increasing use of testosterone to stoke waning sexual desire, our consultants say that it's rarely worthwhile, for several reasons.

There is little or no correlation between libido, sexual performance, and the normal age-related decline in testosterone.

There's little evidence of the therapy's long-term efficacy and

safety

And many other factors—from stress and lack of sleep to changed feelings about a partner—can contribute to decreased sex drive. When low testosterone levels are well below normal, sexuality and performance may be affected. But those declines often stem from correctable health problems, notably pituitary or testicular disorders.

Even when those causes have been ruled out, taking testosterone is still a gamble. In men, while it can boost libido in those who have clearly low levels, side effects include breast enlargement and decreased sperm production.

And it may speed the growth of prostate cancer and increase the risk of blood clots. In women, some research suggests that restoring testosterone to a high normal level can increase sexual desire, at least temporarily.

But it can also cause hair growth and acne, and may raise the risk of breast cancer. And other possible

risks

Moreover, the only testosterone product (EstraTest) approved for women in this country uses a combination that can reduce HDL (good) cholesterol. And while some doctors and pharmacists now compound special testosterone formulations for women, or use creams or gels intended for men, the safety and efficacy of such products or such use is even less well understood. The reservations about testosterone apply doubly to DHEA, which is still allowed to be sold as a dietary supplement.

That's because there's even less evidence of its safety and benefits and because it may increase both estrogen and testosterone levels.

Further, dietary supplements are largely unregulated, so you don't know if what's on the label is in the bottle.

And your use of this potentially potent hormone is unlikely to be monitored by a physician.

What to do : Our consultants advise avoiding DHEA entirely, and taking testosterone only after evaluation by an endocrinologist, a specialist in hormone therapy. (See "Testosterone Treatment in Men and Women," below). Other measures—treating underlying disorders, adjusting drug dosages, reducing stress, or addressing problems in your relationship with your partner, with a therapist's help if necessary—should generally be tried first.

The therapist could be a traditional one, a marriage counselor, or a sex therapist who focuses on negative sexual attitudes or beliefs.

And remember that a lack of sexual desire is only a problem if you think it is. A recent study published in the November 2008 issue of Obstetrics & Gynecology found, for example, that while 43 percent of women report sexual problems, most commonly reduced libido, only about 12 percent were actually bothered by it. Testosterone treatment in men and women Despite its increasing use, testosterone should be prescribed only in very limited circumstances, described below.

Men Women Comments Consider testosterone replacement therapy if… You have signs of testosterone deficiency, notably bothersome decline in libido and potency, enlarged breasts, loss of body or facial hair, or osteoporosis, particularly before age 65. AND Other causes of addyi flibanserin buy online low testosterone or the associated problems have been ruled out or addressed. AND You understand that long-term risks, especially for men with moderately low levels, are largely unknown.

You have bothersome decline in libido starting after ovary removal or possibly after menopause.

AND Other causes of low testosterone or reduced libido have been ruled out or addressed.

AND You understand that long-term risks are unknown. · Measuring testosterone may not help determine women's need for therapy since tests aren’t accurate for women and normal levels have not been determined. · Women should avoid testosterone if they've had breast or uterine cancer or liver or heart disease.

· Men should avoid it if they've had breast or prostate cancer or have high prostate or breast-cancer risk, major prostate enlargement, or elevated red-blood-cell count. Treatment options include… Injections (Delatestryl, Depo-Testosterone, Testro-La), patches (Androderm, Striant, Testoderm), or gels (AndroGel, Testim).

· For women, some doctors use low doses of men's creams or gels or create special formulas, though their safety is

unknown

Sildenafil ( Viagra ), tadalafil ( Cialis ), and vardenafil ( Levitra ) can help improve men's potency by dilating blood vessels in the penis, to allow for the increased blood flow necessary for an erection. However, such drugs should be used cautiously, since they can cause potentially serious side effects.

Those risks may include an increased chance of heart attack or stroke among men already at risk of such events-including those with coronary disease-as well as fertility problems and worsened sleep apnea.

In some men, the drugs may also cause temporary vision or hearing problems. And they can interact with many medications, most notably nitrates (used to relieve angina) and certain herbs, including St.

What to do: Addressing coronary risk factors—reducing blood pressure, cholesterol levels, and weight, stopping smoking, exercising more, and rigorously treating diabetes—may help correct erectile dysfunction. Pelvic-muscle exercises called Kegels—where you tightly tense the muscles that interrupt the flow of urine or passage of gas—may be worth trying as well.

If reducing risk factors and performing Kegels don't help, men could consider erection-boosting medication.

Tadalafil, which lasts for about 36 hours compared with 4 hours for the other two drugs, may be a good choice for men who value spontaneity, though side effects may also be prolonged.

Men considering any impotence drug should first have a doctor assess their risk of heart disease and review all of their medications for possible interactions.

Reduced vaginal lubrication and clitoral sensitivity may sometimes stem from the same cardiovascular problems that can cause erectile dysfunction.

But more often those problems stem from declining estrogen levels after menopause. Sildenafil ( Viagra ) and related drugs may improve sexual function in some women, including those who experience side effects from antidepressant drugs such as fluoxetine ( Prozac and generic), paroxetine ( Paxil and generic), and sertraline ( Zoloft and generic), according to preliminary research. Supplemental estrogen can also help relieve that problem as well as vaginal dryness.

But both treatments pose risks, so should be used cautiously. What to do: In theory, reducing coronary risk factors may improve sexual function in women as it does in men.

Extended foreplay and nonpetroleum lubricants like K-Y Jelly and Replens can usually provide sufficient moisture. Staying sexually active may also help keep the vagina moist and responsive. Those steps, combined if necessary with treatment of a partner'order sildenafil online s sexual problems or of issues that impair libido, may improve a woman's ability to achieve orgasm as well.

Women who want to try estrogen for dryness or possibly insensitivity can use creams (Estrace, Premarin) or vaginal inserts (Estring), which allow you to use smaller doses that are less likely to increase the risk of breast cancer and heart disease.

If those don't help, consider short-term use of low-dose estrogen pills or patches, provided you're not at high risk of those diseases. Women with antidepressant-related sexual problems should try other measures before talking with their doctor about possibly trying sildenafil.