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Cardiovascular diseases account for nearly half of all cases of erectile dysfunction in men older than 50 years. Cardiovascular causes include those that affect arteries and veins. Damage to arteries that bring blood flow into the penis may occur from hardening of the arteries (atherosclerosis) or trauma to the pelvis/perineum (for example, pelvic fracture, long-distance bicycle riding).
Erectile dysfunction. We’ve all heard of it. And Pfizer’s advertising campaign when it introduced its blockbuster ED drug Viagra (sildenafil) made it a household phrase. Up to 30 million men in the US have trouble getting or maintaining an erection sufficient for sexual intercourse, according to recent estimates. It can affect men of all races and ages, though rates are moderately higher among men aged 70 and older, compared to men in younger age groups.

These commonly prescribed medications affect sexual function in different ways depending on the specific type of drug and how it works. “Central regulation of erections relies on dopamine and serotonin, so any impact on these processes can worsen erectile function,” says Trost. He notes that Wellbutrin (buproprion) and Remeron (mirtazipine) are the antidepressants that likely have the least impact on erectile function.


This medication is sold under the brand names Propecia and Proscar and is used to treat male hair loss. It “diminishes dihydrotestosterone levels and suppresses libido in about 10 percent of men but is much more profound in younger guys,” according to Jesse N. Mills, MD, an associate professor of urology at the David Geffen School of Medicine at the University of California, Los Angeles, and director of The Men’s Clinic at UCLA. “Try stopping and using minoxidil instead for hair preservation,” if you have ED that is caused by this drug, he advises.

When looking at the potential causes of erectile dysfunction, it's important to understand that often more than one factor is involved or, as the American Urological Association puts it, "erectile function is the result of a complex interplay between vascular, neurologic, hormonal, and psychologic factors." Keep this in mind as you read through the wide-ranging list of causes and risk factors for ED, which includes medications, health conditions, injury, smoking, and more.
The surgery for placement of a penile prosthesis is typically an outpatient surgery. Doctors often perform a penile prosthesis through a single incision, and all of the components are hidden under the skin. Health care professionals often give patients antibiotics at the time of surgery and often after the surgery to decrease the risk of developing an infection. Depending on your health history, a health care provider may leave a catheter in your penis to drain your bladder overnight.
Not enough info for you? No problem. Nerd out on erectile dysfunction with these studies and research from the most trusted sources on the interwebs. If you have any questions or you think we missed something important, leave a comment or book a consultation with me or one of these trained professionals and we’ll get you on the way to a healthier manhood.
Acupuncture may help treat psychological ED, though studies are limited and inconclusive. You’ll likely need several appointments before you begin to notice any improvements. When choosing an acupuncturist, look for a certified practitioner who uses disposable needles and follows U.S. Food and Drug Administration guidelines for needle disposal and sterilization.

Other medical therapies under evaluation include ROCK inhibitors and soluble guanyl cyclase activators. Melanocortin receptor agonists are a new set of medications being developed in the field of erectile dysfunction. Their action is on the nervous system rather than the vascular system. PT-141 is a nasal preparation that appears to be effective alone or in combination with PDE5 inhibitors. The main side effects include flushing and nausea. These drugs are currently not approved for commercial use.
Options: Talk with your doctor or other health care provider about the possibility of reducing dosage or switching to another antipsychotic drug. If you or a loved one has been prescribed one of these drugs for Alzheimer’s-related depression or agitation, talk to the doctor immediately. Antipsychotics pose heightened death risks for older people with dementia.
Today me and my girlfriend which I have been dating for a couple of months now, attempted to have sex for the first time. The whole time we were together I had no problem getting aroused and was permanently hard, only when I reached the point of penetrating her it all went down hill and no matter how hard I tried I just couldn't get it up again. This led me to think that I suffer from psychological ED as this precise problem has happened to me before with another girl. I desperately want to get to the core of this problem so it can be resolved.
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CBT is perhaps one of the most useful forms of therapy for addressing ED, especially related to performance anxiety, low self-esteem, and loss of sexual arousal. CBT is a proactive and actionable therapy targeted at helping you change the way you think and behave. It privileges the idea that thoughts, feelings, and physical sensations are all interlinked.

Erectile dysfunction related to medical/physical causes is often treatable but less commonly curable. In some cases of medication-induced erectile dysfunction, changes in medication may improve erections. Similarly, in men with a history of arterial trauma, surgical intervention can restore erectile dysfunction. In most cases of ED associated with a medical condition, treatment allows one to have an erection "on demand" or with the aid of medications/device (but not spontaneous).


The vacuum device creates a vacuum to pull blood into the penis. Unlike a normal erection, the inflow of blood does not continue once the individual removes the vacuum device. The rubber band placed at the base of the penis constricts the penis to prevent the blood from leaving the penis. As there is no inflow or outflow of blood when the rubber band is in place, it is uncommon for the tip of the penis (the glans) to appear a little blue and the penis to be cooler. Once intercourse is completed, the individual removes the rubber band and the blood drains out of the penis.
The ‘senate focus’ exercise is particularly popular, where both partners agree to abstain from sex for a few weeks but increase non-sexual bodily contact and understanding. You gradually begin to incorporate sexual elements into your touching until you are both ready for sex, increasing the other person’s understanding of how you like to be touched.
Psychotherapy can be beneficial for an individual, but couples therapy sessions are also helpful. Connolly says it's often good for a couple to attend an initial session together to address issues and concerns. Individual sessions can then address issues with each partner, leading up to the couple working together. This approach "can help reach under the outward problems and uncover what needs to be dealt with and talked about in order to enjoy physical and emotional intimacy," Connolly says.
Surgery to repair arteries (penile arterial reconstructive surgery) can reduce impotence caused by obstructions that block the flow of blood to the penis. The best candidates for such surgery are young men with discrete blockage of an artery because of a physical injury to the pubic area or a fracture of the pelvis. The procedure is less successful in older men with widespread blockage of arteries.
Treatment involves addressing the underlying causes, lifestyle modifications, and addressing psychosocial issues.[1] In many cases, a trial of pharmacological therapy with a PDE5 inhibitor, such as sildenafil, can be attempted. In some cases, treatment can involve inserting prostaglandin pellets into the urethra, injecting smooth muscle relaxants and vasodilators into the penis, a penile prosthesis, a penis pump, or vascular reconstructive surgery.[1][2] It is the most common sexual problem in men.[3]
Penile implants: This treatment involves permanent implantation of flexible rods or similar devices into the penis. Simple versions have the disadvantage of giving the user a permanent erection. The latest (and most expensive) device consists of inflatable rods activated by a tiny pump and switch in the scrotum. Squeezing the scrotum stiffens the penis, whether the person is aroused or not. The penis itself remains flaccid, however, so the diameter and length are usually less than a natural erection, and hardness is lacking, although it's sufficient for intercourse.
As you can imagine, these symptoms can make it difficult to take pleasure in much of anything, let alone sex. A study published in a 1998 edition of Psychosomatic Medicine shows a clear link between depression and erectile dysfunction in men. Using data obtained from the Massachusetts Male Aging Study, researchers were able to conclude that a relationship between depressive symptoms and erectile dysfunction existed and was independent of aging and demographics.
Some men should not take PDE5 inhibitors. They can cause hypotension (abnormally low blood pressure that can lead to fainting and even shock) when given to patients who are taking nitrates (medications taken for heart disease). Therefore, patients taking nitrates daily should not take any of the PDE5 inhibitors. Nitrates relieve angina (chest pain due to insufficient blood supply to the heart muscle because of narrowing of the coronary arteries); these include nitroglycerine tablets, patches, ointments, sprays, and pastes, as well as isosorbide dinitrate and isosorbide mononitrate. Other nitrates such as amyl nitrate and butyl nitrate also are in some recreational drugs called "poppers."

^ Latini, DM; Penson, DF; Colwell, HH; Lubeck, DP; Mehta, SS; Henning, JM; Lue, TF (Nov 2002). "Psychological impact of erectile dysfunction: validation of a new health related quality of life measure for patients with erectile dysfunction". Journal of Urology. 168 (168(5)): 2086–91. doi:10.1097/01.ju.0000034365.57110.b7 (inactive 2019-02-16). PMID 12394715.
There are risks to prosthetic surgery and patients are counselled before the procedure. If there is a post-operative infection, the implant will likely be removed. The devices are reliable, but in the case of mechanical malfunction, the device or a part of the device will need to be replaced surgically. If a penile prosthesis is removed, other non-surgical treatments may no longer work.
Alprostadil should not be used in men with urethral stricture (scarring and narrowing of the tube that urine and the ejaculate pass through), balanitis (inflammation/infection of the glans [tip] of the penis, severe hypospadias (a condition where the opening of the urethra is not at the tip of the penis, rather on the underside of the penis), penile curvature (abnormal bend to the penis), and urethritis (inflammation/infection of the urethra).
The link between chronic disease and ED is most striking for diabetes. Men who have diabetes are two to three times more likely to have erectile dysfunction than men who do not have diabetes. Among men with erectile dysfunction, those with diabetes may experience the problem as much as 10 to 15 years earlier than men without diabetes. Yet evidence shows that good blood sugar control can minimize this risk. Other conditions that may cause ED include cardiovascular disease, atherosclerosis (hardening of the arteries), kidney disease, and multiple sclerosis. These illnesses can impair blood flow or nerve impulses throughout the body.
In prescribing sildenafil, a doctor considers the age, general health status, and other medication(s) the patient is taking. The usual starting dose for most men is 50 mg, however, the doctor may increase or decrease the dose depending on side effects and effectiveness. The maximum recommended dose is 100 mg every 24 hours. However, many men will need 100 mg of sildenafil for optimal effectiveness, and some doctors are recommending 100 mg as the starting dose.
If you’ve been diagnosed with depression and are taking antidepressants, it’s important to be aware that they may cause low sex drive and/or ED as side effects. Speak with your GP if you think you’re experiencing this side effect, as they may be able to find an alternative medication or change your dosage. But, don’t stop taking your medication without speaking with your doctor first.  

There are lifestyle changes that you can make to help improve erectile dysfunction. Losing weight if you are overweight will greatly improve your overall health. A healthier diet and regular exercise will help you to achieve and maintain a healthy weight, which can impact your sexual health. It also improves circulation and can help keep heart problems and diabetes under control.


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.
The best policy is honesty and clarity. If you understand the cause of your ED, as well as the solution, you can enlighten your partner and allow both of you to enjoy sexual intimacy along with everything else you both enjoy about each other. It doesn’t have to be a secret shame, because it’s a medical condition just like any other and fortunately its very treatable.
Your health our health. And you don’t have to stop taking life-saving medication to treat ED. Talk to your doctor to see if you can alter the medication that’s causing your ED toIf you’re experiencing ED.  A frank discussion can lead to alternative medications or treatments, and a better discussion about ED. Just remember that you should never stop taking a prescription medication without the supervision of a doctor.
Three types of blood-pressure medications — diuretics (or “water pills”), beta-blockers and alpha-blockers — have been found to have the highest incidence of sexual side effects. Some diuretics, for example, not only interfere with blood flow to the sex organs but increase the body’s excretion of zinc, which is needed to produce testosterone. And beta-blockers can sabotage a satisfying sex life at least three ways — by making you feel sedated and depressed, by interfering with nerve impulses associated with arousal and by reducing testosterone levels.

Drugs causing your erectile dysfunction can be checked during your assessment – during your medical assessment, your doctor will assess your full medical history including any drugs you are currently taking. This is to work out whether your ED is a side effect of a medication, and also to work out which types of ED treatment are safe for you to use.


Guilt is a painful and gut-wrenching emotion. It is identified in this article as one of the possible causes of psychological impotence. If your guilt is strong enough, it interrupts the signals between your brain and body, stopping you from getting an erection. It’s almost as if the unconscious mind punishes you by denying you pleasure in response to the guilt that you feel.
Many common prescription drugs—like allergy medication, antidepressants, and blood pressure pills—can cause erectile dysfunction. In fact, 8 of the 12 most commonly prescribed medications list “erectile dysfunction” as a side effect. Prescription medication can cause decreased libido, reduced sensitivity, and even interfere with normal blood flow. Prescription drugs that commonly cause medically induced erectile dysfunction include:
The various PDE5 inhibitors for the treatment of ED share several common side effects, including headache, flushing, nasal congestion, nausea, dyspepsia (stomach discomfort), and diarrhea. Differences exist in side effects of the different PDE5 inhibitors, and thus it is important to be familiar with the prescribing information of the PDE5 inhibitor you are prescribed.
In fact, one study showed that men who use these medications recreationally, when they’re not really needed, were more likely to develop psychological impotence! Therefore, instead of wasting money, risking one’s physical health and worsening one’s erectile function, men with psychological impotence should opt for treatment strategies that truly address the root of the trouble.

Treatment depends on the underlying cause. In general, exercise, particularly of the aerobic type, is effective for preventing ED during midlife. Exercise as a treatment is under investigation.[23]:6, 18–19 For tobacco smokers, cessation often results in a significant improvement.[24] Oral pharmacotherapy and vacuum erection devices are first-line treatments,[23]:20, 24 followed by injections of drugs into the penis, as well as penile implants.[23]:25–26 Vascular reconstructive surgeries are beneficial in certain groups.[25]

If you suffer from erectile dysfunction and you can’t blame it on underlying health conditions, you might feel like your problems are all in your head. While psychological issues may be at the root of your problem, they are just as valid as many physiological causes for ED. Keep reading to learn more about the psychological causes of ED and what you can do to resolve them.
Many men who suffer from erectile dysfunction feel guilty about being unable to please their partner. If the problem persists, the guilt becomes more than just a side effect – it can contribute to the ongoing cycle of ED as well. Guilt is often paired with low self-esteem, and not just in men with erectile dysfunction. Guilt and shame are feelings that are commonly linked to mental health issues such as depression. In fact, feelings of worthlessness and inappropriate guilt is one of the clinical criteria for major depressive disorder, according to the DSM-5.

While we are not against drugs as one possible pathway to greater confidence, we believe starting with more natural, holistic solutions should be first. We work with many men who deal with erectile dysfunction and want you to know that for many of you, there are alternative solutions, especially when the root of erectile dysfunction is psychological as opposed to physiological.


Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus.
While erectile dysfunction can occur at any age, the risk of developing erectile dysfunction increases with age. According to the Massachusetts Male Aging Study, the prevalence of erectile dysfunction was 52% in men 40-70 years of age. The prevalence of complete erectile dysfunction increases from 5% at 40 years of age to 15% among men 70 years of age and older.
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If on one hand, depression and anxiety can lead to ED, drugs commonly used for their treatment can cause ED, as well. Sexual dysfunctions are common side effects of several psychotropic drugs that can disrupt sexual health by several different mechanisms (83). In particular, ED has been reported in subjects using serotonin selective re-uptake inhibitors (SSRI), lithium and benzodiazepines (83). SSRI are associated with a broad spectrum of sexual dysfunctions, but the most commonly reported complaints are delayed ejaculation or anorgasmia and reduced sexual desire (84). Several mechanisms could be advocated including the agonist effect on serotonin receptors type 2 and the increase in PRL levels. ED is a frequent complaint as well (84,85). The relationship between the use of SSRI and ED can be secondary to loss of sexual desire but SSRI, in particular paroxetine, are also able to inhibit cholinergic receptors and nitric oxide synthase (86). In addition, it has been observed that SSRIs might down-regulate hypothalamic-pituitary-testis axis in depressed men (87).


I found an interesting e-book about sexual performance methods by a porn star Aaron Wilcoxxx recently. He shares inside informations about how do male porn stars have so much sexual stamina and able to get it up and keep it up without drugs, erectile dysfunction and premature ejaculation. The Internet is a great place, even a gold mine to find for everything including sexual related informations, so you can even check out this book that might help you too guys to improve your sex life. bit.ly/pornstarstamina
Medications for erectile dysfunction don't work for everyone and may cause side effects that make a particular drug hard to take. "Work with your doctor to find the right treatment. There are still options for people who fail at medical treatment," advises Feloney. Alternatives to erectile dysfunction drugs include vacuum pump devices, medications injected into the penis, testosterone replacement if needed, and a surgical penile implant.
The common PDE5 inhibitor drugs approved in the United States are sildenafil (Viagra), vardenafil (Levitra and Staxyn, the generic form), tadalafil (Cialis), or avanafil (Stendra). All of the currently approved PDE5 inhibitors work in the same way. They differ in the number of available doses, how quickly they work and last in your system, the dosing, and to some extent in the side effects. However, they generally share the same indications and contraindications. Currently, tadalafil is the only medication that patients can take on a daily basis and is approved for the treatment of both ED and BPH (benign enlargement of the prostate).
In most healthy men, some of the drug will remain in the body for more than two days after a single dose of tadalafil. Metabolism (clearing of the drug from the body) of tadalafil can be slowed by liver disease, kidney disease, and concurrent use of certain medications (such as erythromycin, ketoconazole, and protease inhibitors). Slowed breakdown allows tadalafil to stay in the body longer and potentially increase the risk for side effects. Therefore, doctors have to lower the dose and frequency of tadalafil in the following examples:
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These prescription drugs increase the levels of nitric oxide in your blood. Nitric oxide is a vasodilator, meaning it makes your blood vessels widen to help increase the blood flow. These drugs are especially effective at widening the blood vessels in your penis. More blood in your penis makes it much easier for you to get and maintain an erection when you are sexually aroused.

Erectile dysfunction, or ED, is the inability to achieve or sustain an erection suitable for sexual activity. Causes vary and include: adverse side effects to certain medications, chronic illnesses such as diabetes and heart disease, poor blood flow to the penis, low testosterone, physical trauma, mental health issues, alcohol and/or drug abuse or misuse, and fatigue.

How they can cause sexual dysfunction: While high blood pressure in itself can lead to sexual dysfunction, studies show that many of the drugs used to treat this condition also can cause sexual difficulties. In men, the decreased blood flow can reduce desire and interfere with erections and ejaculation. In women, it can lead to vaginal dryness, a decrease in desire, and difficulties achieving orgasm.

^ Latini, DM; Penson, DF; Colwell, HH; Lubeck, DP; Mehta, SS; Henning, JM; Lue, TF (Nov 2002). "Psychological impact of erectile dysfunction: validation of a new health related quality of life measure for patients with erectile dysfunction". Journal of Urology. 168 (168(5)): 2086–91. doi:10.1097/01.ju.0000034365.57110.b7 (inactive 2019-02-16). PMID 12394715.
Erectile dysfunction can be a warning sign of serious underlying disease. Research has found that erectile dysfunction is a strong predictor of heart attack, stroke, and even death from cardiovascular disease. All men with erectile dysfunction should be evaluated for cardiovascular disease. Notably, this does not mean every man with erectile dysfunction will develop heart disease, or that every man with heart disease has erectile dysfunction; however, erectile dysfunction patients should be aware of the link.
Currently, placement of a penile prosthesis is the most common surgical procedure performed for erectile dysfunction. Penile prosthesis placement is typically reserved for men who have tried and failed (either from efficacy or tolerability) or have contraindications to other forms of therapy including PDE5 inhibitors, intraurethral alprostadil, and injection therapy.
Erectile dysfunction can be embarrassing and difficult to talk about for some men. Many men may feel like they need to hide their diagnosis from their partner. "Failure to communicate openly about erectile dysfunction can result in both partners drawing away from the relationship," warns Feloney. Remember that your partner is also affected by your problem; being open and honest is the best way to decrease fear and anxiety. Discuss options for achieving sexual satisfaction together, and be positive — most erectile dysfunction problems can be treated.
Not enough info for you? No problem. Nerd out on erectile dysfunction with these studies and research from the most trusted sources on the interwebs. If you have any questions or you think we missed something important, leave a comment or book a consultation with me or one of these trained professionals and we’ll get you on the way to a healthier manhood.
So many couples have sex the way they think it is supposed to be or they think their partner wants it to be without ever exploring and sharing their fantasies with each other. In order for sex to be hot enough for you to get hard, some of what is in your fantasy life needs to show up in your bedroom. Instead of living one life where you put exactly what you want into your porn searches and then have sex that doesn’t do it for you with your partner, it’s time to start bringing those naughty ideas to your partner so you can play them out or fantasize about them together!
Getting (and maintaining) an erection requires a surprising amount of things to go right. You have to get aroused, then pass that signal from your brain, through your nerves and hormones, to your blood vessels and muscles before an erection can even happen. If one thing goes wrong in that complicated exchange between your cardiovascular, and nerve system, and your hormone levels, blood vessels, and even your mood the result is usually erectile dysfunction. In other words, getting an erection is hard.
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