Sildenafil soft tabs

For example, long-term high blood pressure can cause damage to blood vessels and lead to erection problems. These may prevent arousal signals from travelling from the brain and spinal cord to the penis. Nerve disorders such as Parkinson's disease , Alzheimer's disease , multiple sclerosis , and stroke may interfere with a man's ability to have an erection.

Nerve damage from diabetes, complications from surgery, and spinal cord injury also may cause problems. Problems with the structure of the penis or its surrounding tissues. Hormonal factors, such as a low level of the hormone testosterone . Pelvic injuries and complications of prostate or other surgeries that interfere with nerve impulses or blood flow to the penis.

Psychological issues seem to be involved in many cases of erection problems. These mental issues include: Depression (which also has a physical component). These things interfere with the erection process by distracting the man from things that would normally arouse him.

Erection problems in men younger than 40 who have no physical risk factors are more likely to be caused by mental factors than physical causes.

Symptoms of erection problems include being unable to: Have an erection, most of the time.

Keep an erection firm enough for sexual intercourse. Keep an erection long enough to complete sexual intercourse.

Even with an erection problem, a man may still have sexual desire and be able to have an orgasm and to ejaculate. But when erection problems are lasting, they can affect your self-image, sex life, and relationship. When you have erection problems often, "performance anxiety" can make the problem worse. If you cannot keep an erection that is firm enough for intercourse, or if you have an orgasm before or right after entering your partner ( premature ejaculation ), you may feel frustrated and believe you aren't pleasing your partner.

All of these things could affect how you view your relationship. Fortunately, many of the things that cause erection problems can be treated. Your risk of having an erection problem increases with age. Other things that increase sildenafil soft tabs your risk include: Diseases that affect blood vessels, such as diabetes, high blood pressure, and high cholesterol.

About half of men with diabetes develop erection problems. These include multiple sclerosis and Parkinson's disease. Other health problems, such as low testosterone levels. Injuries to the pelvic area, a spinal cord injury, or treatment such as pelvic surgery or radiation in the pelvic area.

Using substances, such as long-term (chronic) alcohol abuse.

Psychological risk factors, such as depression or a recent life change.

Activities that constrict blood flow to the penis may increase the risk for erection problems. For example, frequent long-distance bicycle riding on a hard, narrow saddle may increase risk. But the possible link between bike riding and erection problems has not been proved.

A vasectomy usually doesn't cause erection problems.

But pain after the operation may affect sexual performance for a time. And if a man wasn't comfortable with his decision to have a vasectomy, or if he's having second thoughts, it could affect him psychologically. Call your doctor now or seek medical care right away if: You have an erection that lasts longer than 3 hours. You have taken sildenafil (for example, Viagra) or vardenafil (for example, Levitra) in the past 24 hours or tadalafil (for example, Cialis) in the past 48 hours, and you have chest pain. Make sure all the doctors you see know that you took one of these medicines.

You have erection problems that occur along with pain or difficulty with urination, fever, or pain in the lower belly.

Call a doctor if erection problems occur: With any type of injury to the back, legs, buttocks, groin, penis, or testicles.

With other symptoms such as loss of hair, enlargement of the breasts, or backache.

If your erection problem happens just now and then, there is no reason to call your doctor.

If it happens often and upsets you or your partner, it is okay to call your doctor. If an erection problem doesn't bother you or your partner, you may choose not to call your doctor. A single episode of an erection problem is often a temporary problem that is easy to reverse.

Try to forget about it, and expect a more successful experience the next time. If you or your partner is concerned about it, talk about the problem. If self-care has not helped after 2 weeks and you are concerned about your erection problem, see a doctor who has experience in dealing with these problems.

Your family doctor or general practitioner can evaluate symptoms of erection problems.

You may be referred to an internist or a urologist , depending on what may be causing your erection problem. If it is possible that a psychological problem is contributing to your erection problem, your doctor may refer you to a health professional such as a: Psychiatrist .

Counsellor with special training in sexuality or relationship problems. Because both physical and mental factors are often involved, it may be difficult to diagnose the exact cause of your erection problem. To start, your doctor may: Review your risk factors for an erection problem. Do a complete physical examination of the abdomen, penis, prostate, rectum, and testicles.

A low level of testosterone may reduce sexual desire, leading to an erection problem.

Prolactin, follicle-stimulating hormone, and luteinizing hormone.

If you have low testosterone levels, your doctor may recommend these blood tests.

A thyroid hormone level that is too high or too low may cause problems with sexual desire or erections.

A high blood sugar level may mean the presence of diabetes , which can contribute to erection problems.

At this point, pills such as sildenafil (for example, Viagra), tadalafil (for example, Cialis), and vardenafil (for example, Levitra) are often recommended unless an easily treated cause (such as a medicine side effect or testosterone deficiency) has been identified. If pills don't work or if your doctor feels more testing is needed, he or she may recommend: Specific tests for erection problems.

These tests help find out whether physical or mental factors are causing your erection problem. A psychological evaluation, if a mental issue is suspected. An ultrasound may be done if your doctor thinks you may have a circulation problem ( peripheral arterial disease ).

Treatment for an erection problem depends on the cause of the problem.

The cause may be mental, physical, or a combination of both.

Many doctors take a step-by-step approach to treating erection problems. The treatment steps are: Looking for and then stopping medicines that may be causing your condition. Trying testosterone or another treatment to fix a hormone problem if tests show you have one. Trying pills called PDE-5 inhibitors, such as sildenafil (for example, Viagra), tadalafil (for example, Cialis), and vardenafil (for example, Levitra).

Trying counselling if a psychological cause is suspected. Trying medicines that are injected or inserted into the penis. Erection Problems: Should I Try Injection Treatments? If you are taking nitrate-containing medicines, such as nitroglycerin, you cannot use sildenafil (for example, Viagra), tadalafil (for example, Cialis), or vardenafil (for example, Levitra). You also should not take certain alpha-blockers—used to lower blood pressure and to treat an enlarged prostate gland

—with

There is a risk of a dangerous drop in blood pressure. Check with your doctor to see whether you can take PDE-5 inhibitors with your alpha-blocker. Oral medicines are commonly tried first before other medicine or surgery.

It is important to involve your partner in your decision, regardless of the treatment you choose. Many men overestimate how important being able to have erections is to their relationships. Some men find that when they are able to have erections again, the hassle of using the treatment isn't worth the effort.

Other men may find that being able to have erections doesn't change their relationship as much as they or their partners had expected.

You may be able to avoid erection problems related to anxiety and stress by taking a more relaxed approach to sex. Talk to your partner about your problems and concerns. If you and your partner talk about sex, it will help reduce your stress and anxiety.

Erections may gradually become more difficult to get and keep as you get older.

But foreplay—erotic stimulation before intercourse—and the right environment can help increase your ability to have an erection, regardless of your age.

Here are some other things you can do that may reduce your risk for erection problems: Quit smoking. Even small amounts of alcohol can cause erection problems.

Keep your cholesterol level low to reduce the risk of hardening of the arteries (atherosclerosis).

Keep your blood sugar in your target range if you have diabetes. In some cases, occasional episodes of erection problems can be treated at home, without a doctor's help. And don't be embarrassed about seeking professional help if erection problems are consistent and troublesome. You may be able to help yourself by: Some men may try methods available in health food stores or through magazine ads. Most of these methods have never been medically proved to work.

Making lifestyle changes such as quitting smoking and drinking less alcohol can also help make erection problems less likely. Medicines that can help produce an erection may be used to treat erection problems that are caused by blood vessel (vascular), hormonal, nervous system, or psychological problems. They also may be used along with counselling to treat erection problems that have psychological causes.

Commonly used oral medicines include: PDE-5 inhibitors such as sildenafil (for example, Viagra), tadalafil (for example, Cialis), and vardenafil (for example, Levitra).

Other medicines that may be used include: Injected medicines. Hormones and other medicines may be prescribed for men who have low testosterone or high prolactin levels.

Erection Problems: Should I Try Injection Treatments?

Although oral medicines for erection problems can be purchased over the Internet, you need to talk with your doctor before using this medicine.

This is especially important if you have a heart problem.

PDE-5 inhibitors should never be used if you may need to take a nitrate-containing medicine, such as nitroglycerin. Taking nitroglycerin and a PDE-5 inhibitor within 24 hours of each other may greatly lower your blood pressure. This could lead to a heart attack, stroke , or death.

Talk with your doctor about whether medicines for erection problems are safe for you if you: Have heart disease. If you are taking a PDE-5 inhibitor and are going to have a test for heart disease, make sure that your doctor knows you are taking it.

You should not take sildenafil (for example, Viagra) or vardenafil (for example, Levitra) for 24 hours before the test.

Do not take tadalafil (for example, Cialis) for at least 48 hours before the test.

Then if you have a problem during the test, it will be safe to use nitrate-containing medicines such as nitroglycerin.

If you are using a combination of drugs for high blood pressure, PDE-5 inhibitors could cause low blood pressure (hypotension). Also for this reason, you should not take alpha blockers—used to lower blood pressure and to treat an enlarged prostate—with these medicines without talking to your doctor.

The combination could cause a dangerous drop in blood pressure. If you have a heart condition and have not been sexually active for a while, talk with your doctor to make sure you can engage in sexual activity safely.

In a few cases, surgery may be an option to treat erection problems. Surgery will rarely be recommended before non-surgical treatment and counselling have been tried.

Think carefully about non-surgical options and about the possible risks of surgery.

Doctors who specialize in conditions of the urinary tract (urologists) do most penile implants. Specially trained urologic surgeons usually do blood vessel repair surgery. Vacuum devices are useful for all types of erection problems—physical, psychological, or both. You pump the device to create a vacuum that leads to an erection.

Counselling (psychotherapy) is recommended for men whose erection problems are caused, at least in part, by psychological factors.

It focuses on ways to improve attitudes toward sex. Evidence shows that group therapy helps with erection problems in some men. Adding group therapy to treatment with sildenafil (for example, Viagra) helped more than sildenafil alone.

Men who were taking part in group therapy also were more likely to keep taking their medicine.

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 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 need more research before doctors can know if they work for sure. It has been shown to work for some men who have erection problems.

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).