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The urethra runs along the underside of the corpora cavernosa in the corpus spongiosum and is the channel for urine and ejaculate. An erection is a complex, involuntary, neuropsychological, hormone-mediated, vascular event, which begins with both sensory and mental stimulation. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, which allows rapid blood flow to fill the spongy chambers, thus creating pressure in the corpora cavernosa and expanding the penis. An erection is sustained when the tunica albuginea helps trap the blood within corpora cavernosa, but is reversed when the muscles in the penis contract, which stops the inflow of blood and opens the outflow channels. As previously mentioned, there is a well-defined sequence of events that take place to enable an erection. ED can occur when any of these events are disrupted. Brooks & Jordan (2001) viagra pills shoppers states the cause in more than 75 % of the cases is physical rather than psychological and that the most common cause is damage either to arteries, smooth muscles or fibrous tissues and those damages accounts for approximately 70 % of the cases. The condition can be categorized as psychological or physical or both. Psychological factors include stress, anxiety, and guilt, lack of self-esteem, depression, and fear of sexual failure. Physical factors are more prominent, and can be things such as: System diseases, for example: cardiac, hepatic, renal, pulmonary, cancer, metabolic, post organ transplant, pelvic irradiation. Androgen deficiency, as androgen resistance, other endocrinopathies. Vascular insufficiency, like atherosclerosis, pelvic steal, penile ... More

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External Mechanical Devices: This category of treatments includes external vacuum therapies: devices that go around the penis and produce erections by increasing the flow of blood in, while constricting the flow out. Such devices imitate a natural erection, and do not interfere with orgasm. External vacuum therapy mechanisms are approximately 95 percent successful in causing and sustaining an erection. All are portable, and costs range between $200-$500, covered under most insurance plans and Medicare Part B. The vacuum constriction device consists of a vacuum cylinder, various sizes of tension rings, and a vacuum pump, either hand-operated or electric. The penis is placed in a cylinder to which a tension ring is attached. Air is evacuated from the cylinder by means of the pump, creating a vacuum, which produces the erection. The cylinder is removed, leaving the tension ring at the base of the penis to maintain the erection. You must use the correct-size tension ring and remove it, to prevent penile bruising, after sustaining the erection for 30 minutes. Such devices may be unsuitable for men with certain bleeding disorders. In general, vacuum constriction devices are successful in management of long-term ED. “Rejoyn” is an inexpensive, nonprescription alternative to the vacuum-actuated devices. Described by its manufacturer as a “support sleeve,” it does not “cause” an erection, but rather supports the flaccid penis as if it were erect (one wears it under a condom). Counseling: The great majority of ED cases in diabetic men have a physical cause, such as neuropathy or circulatory problems. In some cases, however, the cause of ED is psychological, including depression, ... More

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These included 219 cardiovascular events (MI, arrhythmia, cardiac arrest, collapse), 140 sudden deaths, and 18 cerebrovascular accidents. The reporting period represented about 4 million to 5 million men and approximately 9 million prescriptions, which translates to approximately 8.5 deaths per million men per month (4). However, it was determined from an analysis of adverse events reported to the FDA between March 1998 and August 1999 that important data were missing from these reports, such as medical histories, cause of death and sildenafil citrate dosing (42). As of September 30, 2001, Pfizer's clinical safety database contained information on the extent of exposure to sildenafil citrate from 124 completed and ongoing double-blind and open-label clinical trials involving 5054 placebo-treated and 6896 sildenafil citrate-treated patients, representing 2593 PY of observation (43). Analysis of these data revealed that the overall MI incidence rate was similar in marley drugs viagra placebo-treated (0.95/100 PY) and sildenafil citrate-treated patients (0.85/100 PY; P = 0.801). For the open-label studies, analysis of data from patients representing 10,859 PY of sildenafil citrate exposure demonstrated an MI incidence rate of 0.53/100 PY. The overall MI rate for double-blind and open-label sildenafil citrate-treated patients was 0.58/100 PY. Similar rates have been reported in a number of epidemiologic studies (44). The database also contains (as of September 30, 2001) reports of 5 deaths (from all causes) among double-blind placebo-treated patients and 9 deaths among sildenafil citrate-treated patients. This corresponds to all-cause mortality rates of 0.53/100 PY and ... More

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Questions about your ED symptoms: How long have you had these symptoms? Do you wake up in the morning or during the night with an erection? Do your erections change at different times, like when going in a partner, during stimulation by mouth, or with masturbation? Do you have problems with ejaculation or orgasm (climax)? How is this problem changing the way you enjoy sex? Do you have painful with erections, feel a lump or bump in the penis or have penile curvature? These are signs of Peyronie's Disease which can be treated but calls for an expert in urology to assess and manage. Your health care provider may ask you questions about depression or anxiety. He or she may ask about problems in your relationship with a partner. Some health care providers may also ask if they may talk to your sex partner. Are you often under a lot of stress, or has something recently upset you? Do you have any anxiety, depression or other mental health issues? Examination focusing on your genitals (penis and testicles) is often done to check for ED. Based on your age and risk factors, the exam may also focus on your heart and blood system: heart, peripheral pulses and blood pressure. Based on your age and family history your doctor may do a rectal exam to check the prostate. Most patients do not need a lot of testing before starting treatment. Your health care provider may order blood tests and collect a urine sample to look for health problems that cause ED. Questionnaires are often used by health experts to rate your ability to initiate and keep erections, gauge your satisfaction with sex and help identify any problems with orgasm. For some men with ED, specialized testing may be needed to ... More

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This will keep the needle from bending as you insert it into the rubber stopper. Holding the vial upright and the syringe downward, insert marley drugs viagra the needle through the circle in the center of the rubber stopper. Push the plunger down to inject the air into the vial (see Figure 1). You must replace the amount of medication you remove from the vial with air. Turn the vial and syringe upside down (see Figure 2). Hold the syringe with the hand you use to write with and the vial with your other hand. Make sure the tip of the needle is in the medication. Rotate the syringe so you’re looking at the numbers and lines on the syringe. You must inject the medication into a specific area of your penis. This is so you don’t inject into a nerve or blood vessel. You will give the injection in the middle third of your penis at the 10 o’clock (left side) or the 2 o’clock (right side) position (see Figure 3). To prevent trauma to your penile tissue, always change sides of your penis each time you inject the medication (right side, then left side). Don’t inject into any vein you can see or feel because it could cause a large bruise on your penis. Don’t inject straight down on the top or the bottom of your penis. This will allow your penis to be more fully stretched. It’s easiest to inject if your penis is viagra pills shoppers pulled straight out in front of you. If you aren’t circumcised, pull your foreskin back before grasping the head of your penis. This will prevent the needle marley drugs viagra from going between the skin and erectile tissue. For your injection to work, the medication needs to go into the erectile tissue. Locate the area to be injected (the middle ... More

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Furthermore, treatment efficacy when compared to placebo occurs despite LOI or American Spinal Injury Association (ASIA) score characterizing impairment related to the injury (59,61). compared the effectiveness and satisfaction associated with use of several ED therapies including sildenafil alone, intracavernosal injections (ICI) followed by sildenafil after ICI discontinuation and vacuum erections devices (VED) followed by sildenafil therapy after VED discontinuation (60). Seventy percent of men receiving vasoactive medications preferred sildenafil to ICI, even though rigidity was superior in the ICI group. All men using VEDs were dissatisfied with that form of therapy. The duration of erections is also improved by sildenafil in men with SCI. showed that sildenafil use increased the duration of erections from 8.4 to 10 minutes when compared to baseline. Men using sildenafil were also more confident that they could maintain their erection compared to prior therapies such as VEDs (65). compared sildenafil to vardenafil and tadalafil (69). Sildenafil was effective in 85% of SCI patients, 74% of the patients on vardenafil and 72% of the patients on tadalafil. Sildenafil was associated with more rigid and longer lasting erections. Additionally, 50 mg of sildenafil was effective in 55% of patients compared to more than 70% of the patients on vardenafil and tadalafil requiring 20 mg for a similar response. Men who used tadalafil were able to achieve erections 24 hours after administration, improving overall satisfaction related to the possible spontaneity of sexual encounters. Del Popolo also evaluated the time/duration effectiveness of PDE5i sildenafil 50 mg versus ... More

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“By injecting a medication will increase the blood flow to that area, the man has a very good chance to restore erections and get that important part of his and his partner’s life back.” Injection therapy? But it’s a tiny needle, and your doctor won’t just hand it to you and say, “Good luck, buddy.” You will be taught how to use it. “Injection therapy allows a man to have sexual intercourse again,” says Bivalacqua. Very important: “We know that the more blood flow there is throughout the penis following a nerve-sparing radical prostatectomy, either with a pill like Viagra or with an injection of a pharmacological agent, the better the chances of regaining erections.” Bivalacqua explains: “If you don’t have enough blood flow within the penis after surgery, it becomes ischemic; it does not get the nutrients it needs to stay healthy.” Let’s take a moment to think about rehabilitation – say, after a bad injury. Maybe a man needs to learn to walk again, or use his hands, or how to talk again. If that guy just sits around and hopes it will happen and gets frustrated when it doesn’t , you may agree that he’s not taking the approach most likely to guarantee success. To put it bluntly, your penis needs rehab, too: “By increasing the flow of oxygenated blood to the penis, whether it is from a pill or an injection, we are able to preserve the erectile bodies (called the corpora cavernosa; these are chambers where blood flows to provide a rigid erection), so they will respond once those nerves start to work again.” How injection therapy works: As its name suggests, Tri-mix is actually three drugs (papaverine, phentolamine, and prostaglandin E-1). “The specific formulation of these ... More

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The primary measure in the principal studies was a sexual function questionnaire (the International Index of Erectile Function - IIEF) administered during a 4-week treatment-free run-in period, at baseline, at follow-up visits, and at the end of double-blind, placebo-controlled, at-home treatment. Two of the questions from the IIEF served as primary study endpoints; categorical responses were elicited to questions about (1) the ability to achieve erections sufficient for sexual intercourse and (2) the maintenance of erections after penetration. The patient addressed both questions at the final visit for the last 4 weeks of the study. The possible categorical responses to these questions were (0) no attempted intercourse, (1) never or almost never, (2) a few times, (3) sometimes, (4) most times, and (5) almost always or always. Also collected as part of the IIEF was information about other aspects of sexual function, including information on erectile function, orgasm, desire, satisfaction with intercourse, and overall sexual satisfaction. Sexual function data were also recorded by patients in a daily diary. In addition, patients were asked a global efficacy question and an optional partner questionnaire was administered. The effect on one of the major end points, maintenance of erections after penetration, is shown in Figure 6, for the pooled results of 5 fixed-dose, dose-response studies of greater than one month duration, showing response according to baseline function. Results with all doses have been pooled, but scores showed greater improvement at the 50 and 100 mg doses than at 25 mg. The pattern of responses was similar for the other principal question, the ... More

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Two independent reviewers evaluated all identified publications, and any disagreement between reviewers was resolved by a third reviewer. The methodological quality was assessed using the Jadad score, with a Jadad score ?3 indicating a high-quality article [16]. Data extractions were performed by one reviewer and checked by a second reviewer. Information was extracted from the studies that met the above-mentioned inclusion criteria using a structured form. The first author, publication year, sample size, therapy that the patients received and assessment indices, including the IIEF, the men’s preference, the Self-Esteem and Relationship questionnaire (SEAR), total Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) scores and TEAEs, were collected for each study. A meta-analysis of comparable data was performed using RevMan 5.0. Statistical heterogeneity between studies was assessed using the I 2 statistic. Pronounced heterogeneity was indicated by a P value ?0.05 and an I 2 value ?50%; in these cases, a randomized effects model was executed. A P value ?0.05 and I 2 ? 50 indicated no obvious heterogeneity between the studies, and a fixed effects model was chosen for the meta-analysis. Continuous data are presented as weighted mean differences (WMDs), and odds ratios (ORs) were calculated for sildenafil 200mg price dichotomy [both with 95% confidence intervals (CIs)]. Egger’s test was performed to evaluate the risk of publication bias. Additionally, a sensitivity analysis was performed to assess the stability of the outcome when low-quality and highly heterogeneous trials were included in the analysis. A total of 1657 articles were identified through the ... More

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8 Animal studies have demonstrated both smooth-muscle disruption and decreased production of neural nitric oxide synthase in cigarette-exposed animals. Some evidence exists to suggest that chronic inflammation associated with metabolic syndrome also plays a role in endothelial dysfunction and erectile function, possibly due to oxidative stress. Examples of common neurologic conditions that can lead to ED include cerebral vascular accident, multiple sclerosis, Parkinson’s disease, and spinal cord injury. Microvascular disease associated with diabetes is thought to compound the endothelial and neural injuries associated with this disease. Pelvic surgery may disrupt both neural and vascular pathways, resulting in ED. Hormone deficiency or hypogonadism, whether primary or secondary, has been thought to impact erectile function. Approximately a third of men in the European Male Aging Study demonstrated low testosterone, suggesting that hypogonadism is overrepresented among men with ED. 11 Hormone deficiency, however, is less frequently the cause of ED than diabetes or vascular disease. Many entities with a strong relationship to ED also diminish bioavailable testosterone, including obesity, diabetes, and opioid use. Other hormones involved in testosterone metabolism or availability, like thyroid stimulating hormone and gonadotropins, also may impact erectile quality, presumably through regulating bioavailable testosterone. Understanding the relationship between testosterone and ED has been impaired by a lack of standardized measurement of this hormone and the cyclic nature of its release and consumption. Some self-administered measures may be useful in the primary care ... More

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Spinal cord injury (SCI) ED is a common occurrence after SCI, occurring in up to 80% of men, and results from disruption of the nerve pathways essential for erection (24,25). Different degrees of ED may occur depending on the spinal cord level of injury (LOI), extent of lesion and timing from injury. Reflexogenic erections can occur with lesions above L3 or L4 when the erectile spinal reflex arc remains intact. Psychogenic erections can occur with low lesions in the sacral and lumbar spinal cord but may not occur in complete lesions above T9 that can damage sympathetic outflow. Additionally, reflexogenic erections are not likely to occur in the spinal shock period that occurs after the initial cord trauma. Conversely, their occurrence may signal that the period of shock is over (26). Typically SCI affects younger men in their “sexual prime” and ED is associated with decreased quality of life (27). Cerebrovascular accident (CVA/stroke) A CVA can occur anywhere through the brain, midbrain, brainstem and spinal cord leading to varying degrees of SD depending on location. A decline in libido, erection and ejaculation are frequent in men who have had a CVA, with a reported prevalence of ED that varies from 17% to 48% (28,29). Right hemispheric infarcts seem to affect erections more so than left-sided ones. The exact effects of CVA on sexual function are complex and multifactorial, as disability, psychological and emotional status can affect sexual function aside from the location of the CVA. ED varies in men with seizure disorders, occurring in 3% to 58% of men with epilepsy (30). The cause of ED is likely multifactorial, with neurologic, endocrine, iatrogenic, psychiatric ... More

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Since Viagra is used as needed, you are not likely to miss a dose. If you miss a dose of Revatio , take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Drinking alcohol with this medicine can cause side effects. Grapefruit may interact with sildenafil and lead to unwanted side effects. Avoid using any other medicines to treat impotence, such as alprostadil or yohimbine, without first talking to your doctor. What are the possible side effects of oral sildenafil? Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking sildenafil and get emergency medical help if you have: heart attack symptoms --chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating; vision changes or sudden vision loss; or erection is painful or lasts longer than 4 hours (prolonged erection can damage the penis). Call your doctor at once if you have: severe shortness of breath, cough with foamy mucus; ringing in your ears, or sudden hearing loss; irregular heartbeat; swelling in your hands, ankles, or feet; a seizure; or (convulsions); or a light-headed feeling, like you might pass out. Common side effects may include: flushing (warmth, redness, or tingly feeling); headache, dizziness; abnormal vision (blurred vision, changes in color vision) runny or stuffy nose, nosebleeds; sleep problems (insomnia); muscle pain, back pain; or upset stomach. This is not a complete list of side effects and others may occur. Call your doctor for medical advice ... More

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Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects. dizziness flushing (warm or burning feeling, usually in the face) headache indigestion stuffy nose. Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention. Check with your doctor as soon as possible if any of the following side effects occur: abnormal vision (e.g., decreased vision, blurry vision, increased sensitivity to light, changes in the ability to tell the difference between blue and green) decrease or loss of hearing temporary memory loss. Stop taking the medication and seek immediate medical attention if any of the following occur: an erection that lasts longer than 4 hours (this could permanently damage your penis) a partial or complete loss of vision chest pains, an irregular heartbeat, or shortness of breath when starting sexual activity (if you have a heart condition) signs of an allergic reaction (e.g., rash; itching; shortness of breath; swollen face, lips, or throat) Some people may experience side effects other than those listed. Check with your doctor pfizer buy online if you notice any symptom that worries sildenafil tablet buy online you while you are taking this medication. Are there any other precautions or warnings for this medication? Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect ... More

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Sildenafil citrate may offer a potential therapeutic strategy to improve uteroplacental blood flow in FGR pregnancies. FETAL GROWTH RESTRICTION (FGR), when the fetus fails to attain its growth potential, affects approximately 8% of all pregnancies contributing to infant prematurity ( 1). FGR is responsible for considerable perinatal mortality and morbidity; infants are at increased risk of perinatal complications such as fetal distress, asphyxia, neonatal encephalopathy, hypothermia, hypoglycemia, and poor feeding as well as risks of long-term neurological and developmental disorders ( 2, 3). These direct effects of FGR have massive implications for the delivery of health care ( 4). Infants of FGR pregnancies may show modification of metabolic/hematological pathways and altered immune function ( 5). In the long term, deficient growth in utero is related to an increased incidence of hypertension, diabetes mellitus, and coronary heart disease in adulthood ( 6– 8). The underlying pathology of FGR is multifactorial and poorly understood. For example, growth restriction has been shown to have a genetic component such as trisomies and cases of placental mosaicism ( 9) or be a result of physiological factors such as maternal undernutrition ( 10, 11) or smoking during pregnancy ( 12). However, the reduced growth of the FGR fetus is typically associated with placental insufficiency, i.e . abnormalities in placental growth, development, and function. In normal pregnancy (NP), uterine blood flow increases dramatically from approximately 50 ml/min (8.3 ? 10 ?4 liter/sec) at 10 wk gestation to over 1200 ml/min (0.02l liter/sec) at term ( 13); this massive increase in flow is ... More

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Psychological causes of ED include depression, anxiety and relationship issues. In most cases, erectile dysfunction can be successfully managed, with treatment options depending on the root cause of the disorder. [1] Treatment may involve forms of sex therapy and counseling, exercises and lifestyle changes, ED drugs, including pills and topical medications, pumps and ‒ in more severe cases ‒ prosthetics. The symptoms of erectile dysfunction may include: An inability to get an erection An inability to maintain an erection during sexual activity. These symptoms may come and go over time or be situational, for example not present during masturbation but present with a partner. [2] If symptoms occur regularly or semi-regularly, visiting a doctor is advised. The onset of ED may be different, depending on whether it is caused by physical or psychological factors: If the causes of erectile dysfunction are physical in origin, the condition is more likely to appear gradually, with the problem occurring intermittently before becoming more frequent. A person’s sex drive is unlikely to be affected, unless the root cause is hormonal in nature. Psychological causes typically result in the sudden onset of the condition. If a person is able to get and maintain a healthy erection sometimes, for example when masturbating or on waking, it may be a sign that their erectile dysfunction is psychological in origin. If you are affected by unexplained ED, you can get a free symptom assessment at any time by downloading the Ada app. Finding a treatment approach that can cure erectile dysfunction usually depends on identifying its root cause. Erectile dysfunction can be caused by a variety ... More

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