The Food and Drug Administration (FDA) does not recommend alternative therapies to treat sexual dysfunction.[28] Many products are advertised as "herbal viagra" or "natural" sexual enhancement products, but no clinical trials or scientific studies support the effectiveness of these products for the treatment of ED, and synthetic chemical compounds similar to sildenafil have been found as adulterants in many of these products.[29][30][31][32][33] The FDA has warned consumers that any sexual enhancement product that claims to work as well as prescription products is likely to contain such a contaminant.[34]
Erectile dysfunction is more common than most people think. About 40% of men will notice some degree of problem by age 40. The aging of the penis can begin as early as the late 20s but becomes severe enough to notice typically starting in the 40s. As men get older, their odds of getting erectile dysfunction increases by about 10% per decade, and the severity of the problem also increases.
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.
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Heart disease and diabetes are often linked together because coronary artery damage is a complication of diabetes as well. Coronary artery disease also can affect sexual function on its own, but erectile dysfunction is nine times as likely in men who suffer from both coronary artery disease (CAD) and diabetes than men who have diabetes without the addition of CAD. Erectile dysfunction is so prevalent in both coronary artery disease and diabetes that it could be considered a risk factor for both. 
A physical cause can be identified in about 80% of cases.[1] These include cardiovascular disease, diabetes mellitus, neurological problems such as following prostatectomy, hypogonadism, and drug side effects. Psychological impotence is where erection or penetration fails due to thoughts or feelings; this is somewhat less frequent, in the order of about 10% of cases.[1] In psychological impotence, there is a strong response to placebo treatment.
Circulatory problems: An erection occurs when the penis fills with blood and a valve at the base of the penis traps it. Diabetes, high blood pressure, cholesterol, clots, and atherosclerosis (hardening of the arteries) can all interfere with this process. Such circulatory problems are the number one cause of erectile dysfunction. Frequently, erectile dysfunction is the first noticeable symptom of cardiovascular disease.
Fully restoring sexual health with treatment of a medical condition (such as high blood pressure with diet and/or exercise or by controlling diabetes or other chronic diseases) may not be possible. Identification and treatment of these conditions may prevent the progression of ED and affect the success of various ED therapies. Nutritional states, including malnutrition, obesity, and zinc deficiency, may be associated with erectile dysfunction, and dietary changes may prove a sufficient treatment. Masturbation and excessive masturbation are not felt to cause ED, however, if one notes weak erections with masturbation, this may be a sign of ED. Some men who masturbate frequently may have troubles with achieving the same degree of stimulation from their partner, but this is not ED.

“Anything that depresses nerves, such as Xanax, Ativan, Valium, alcohol, Neurontin (gabapentin), Lyrica (pregabalin), and any of the sleep aids often impact erectile function,” says Trost. The effect is reversible and is most likely caused by direct suppression of nerve signals or possibly by changes in hormonal signaling. Mills adds that “narcotic use causes suppression of testosterone which can alter blood flow to the penis.”

The penis is composed of three cylinders: two on the top, the corpora cavernosa and one on the bottom, the corpus spongiosum. All of these are involved in the process of an erection. The corpora cavernosa are composed of potential spaces that can distend with blood, causing rigidity of the penile shaft. The corpus spongiosum is important for rigidity of the glans of the penis. When aroused, stimulated chemicals are released from the nervous system (nitric oxide is one) that stimulate the arteries to the penis to relax and increase blood flow into the penis. These potential spaces, like a sponge, can expand when more blood flow comes in the penis. Each corpora cavernosa is surrounded by an outer coating the tunica albuginea. When the penis fills with blood, these potential spaces, the sinusoids, compress the veins in the corpora against the side of the tunica albuginea, thus preventing blood from leaving the penis. It is this compression of the veins that allows for the erection to become fully rigid.
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.
Since the decrease in T levels is often a consequence of obesity or weight gain (51), the milestone of treating testosterone deficiency in obese men is encouraging substantial lifestyle changes, including physical activity and weight loss. In fact, it is universally recognized that a low calorie diet or bariatric surgery can induce a significant increase in T plasma levels, reaching 10 nmol/L with the most invasive surgical procedures (62). Weight loss-induced T rise is more evident in young individuals (62), and, therefore, it must be strongly recommended in this age band.
Tadalafil should not be used with alpha-blockers (except Flomax), medicines used to treat high blood pressure, and benign prostate hypertrophy (BPH) because the combination of tadalafil and an alpha-blocker may lower the blood pressure greatly and lead to dizziness and fainting. Examples of alpha-blockers include tamsulosin (Flomax), terazosin (Hytrin), doxazosin (Cardura), alfuzosin (Uroxatral), and prazosin (Minipress). Tamsulosin (Flomax) is the only alpha-blocker that patients can use safely with tadalafil. When tadalafil (20 mg) was given to healthy men taking 0.4 mg of Flomax daily, there was no significant decrease in blood pressure and so patients on this dose of tamsulosin (Flomax) can be prescribed tadalafil. The only alpha-blocker not tested with tadalafil is alfuzosin (Uroxatral), and no recommendations can be made regarding the interaction between the two.

Association between metabolic syndrome (MetS) at baseline and incidence of major adverse cardiovascular events (MACE) during a mean follow-up of 4.3 years. Panel A represents the Kaplan Meier curves for incidence of MACE in a population of 211 men aged 18–52 years having or not MetS at baseline. This group represents the first tertile of age of a sample of patients (n=619) consulting the Sexual Medicine and Andrology Unit of the University of Florence for erectile dysfunction and followed-up for a mean of 4.3 years for the occurrence of MACE. Panel B represents the Cox analyses for the age- and smoking habit-adjusted incidence of MACE associated with the number of MetS components at baseline (glycaemia ≥100 mg/dL, triglycerides ≥150 mg/dL, HDL <40 mg/dL; blood pressure ≥135/80 mmHg, waist circumference >102 cm), according to the tertile of age, in the same population, during the same follow-up. The first, second and third tertile include 211, 199 and 209 patients aged 18–52, 53–60 and 61–88 years, respectively.
Ultrasound with Doppler imaging (ultrasound plus evaluation of blood flow in the arteries and veins) can provide additional information about blood flow of the penis and may help in the evaluation of patients prior to surgical intervention. This study is typically performed after the injection of a chemical that causes the arteries to open up, a vasodilator (prostaglandin E1), into the corpora cavernosa in order to cause dilation of blood vessels and promote blood flow into the penis. The rate of blood flow into the penis can be measured along with an evaluation of problems with compression of the veins.
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All three of these involve specific bodily systems including the hormones, muscles, blood vessels, nervous system, and emotions. If any of these systems become compromised, it can cause ED. In the case of anxiety and stress, these things can affect the brain’s ability to send the necessary signals to trigger the desired physical response – an erection. Stress and anxiety can also contribute to an ongoing cycle of ED, as mentioned earlier.
Epidemiological studies consistently show that prevalence of erectile dysfunction (ED) increases with ageing. Nonetheless, complaints of ED even in younger men are becoming more and more frequent. Healthcare professionals working in Sexual Medicine but even those operating in different clinical contexts might be adequately prepared to answer this increasing requirement. ED in younger men is likely to be overlooked and dismissed without performing any medical assessment, even the most basic ones, such as collection of medical history and physical exam. This is due to the widespread assumption that ED in younger individuals is a self-limiting condition, which does not deserve any clinical evaluation or therapy and can be managed only with patient reassurance. However, evidence shows that, in younger subjects, organic, psychological and relational conditions can contribute to the pathogenesis of ED and all these conditions might be evaluated and treated, whenever necessary. Among the organic conditions contributing to the onset of ED, metabolic and cardiovascular (CV) risk factors are surprisingly of particular relevance in this age group. In fact, in younger men with ED, even more than in older ones, recognizing CV risk factors or conditions suggestive of cardio-metabolic derangements can help identifying men who, although at low absolute risk due to young age, carry a high relative risk for development of CV events. In this view, the assessment of a possible organic component of ED even in younger individuals acquires a pivotal importance, because it offers the unique opportunity to unearth the presence of CV risk factors, thus allowing effective and high quality preventive interventions.

Venous leaks: In order to maintain an erection, blood has to be supplied to and remain in the penis. Some research suggests that men with high blood pressure may have trouble maintaining an erection because the increased pressure forces blood out of the erectile tissues of the penis and into the veins. In this theory, the “push” on the small closing valves of the veins is stronger than the veins’ ability to resist, meaning the veins can't “close” tightly enough to stop blood from passing out of the penis.
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

Erectile dysfunction, also known as impotence, is defined as not being able to get or keep an erection firm enough for sex. Remember, occasional erectile dysfunction is not uncommon, but if it’s persistent, erectile dysfunction can be the sign of a more serious health issue, and so you should visit your doctor.Here are 8 surprising causes of erectile dysfunction:High cholesterol. Having a raised cholesterol increases the risk of atherosclerosis where the arteries become narrowed and clogged, resulting in impaired blood flow. When this happens to the arteries in the penis, it can prevent enough blood to create an erection from reaching the penis.Depression. This can cause a lack of interest in sex. See your doctor if this happens to you.Smoking. Smoking causes damage to blood vessels, including those that supply the penis which can result in difficulty in achieving an erection.Cycling. Long hours in the saddle without changing position can cause compression of the perineal nerves and blood vessels, resulting in nerve damage which causes erectile dysfunction. Some saddles are worse than others. If cycling is causing you symptoms of tingling or numbness in your penis, adjust your riding position and take a break.  You might want to look at a different saddle, too. Rodeo riding can have the same effect.Medicines. Erectile dysfunction can be a side-effect of many medicines, including some antipsychotics and antidepressants, cholesterol-lowering medicines, high blood pressure medicines, and epilepsy medicines.Stress. Feelings of stress and anxiety can overflow onto your sex life, and you may find you can’t perform as well as you normally could. 'Performance anxiety' is a common cause of erectile problems.Diabetes. Diabetes raises the risk of erectile dysfunction threefold by its effects on nerves and blood vessels.Peyronie’s disease. This disease causes curvature of the penis due to a hardened area of scar tissue, which results in pain when the man has an erection.If you suffer from erectile dysfunction, don’t be embarrassed – it affects one in 5 men over 40. Remember your doctor can help identify the cause of your erectile dysfunction,  and put you on the path to successful treatment. Read erectile dysfunction – visiting your doctor to find out what to expect when you visit your doctor. Last Reviewed: 18 February 2016

Quitting smoking, exercising regularly, losing excess weight, curtailing excessive alcohol consumption, controlling hypertension, and optimizing blood glucose levels in patients with diabetes are not only important for maintaining good health but also may improve or even prevent progression of erectile dysfunction. It is unclear if such lifestyle changes can reverse erectile dysfunction. However, lifestyle improvements may prevent progression of the erectile dysfunction. Some studies suggest that men who have made lifestyle improvements experience increased rates of success with oral medications.

"Smoking is a short- and long-term cause of erectile dysfunction," warns Feloney. "In the short-term nicotine constricts the blood vessels that you need to get an erection, and in the long-term nicotine contributes to hardening of the arteries that can cause erectile dysfunction." Some approaches for quitting include making a clean break, avoiding the triggers of smoking, trying a nicotine patch or gum, and joining a smoke cessation program.
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.
Hello. My name is Roberta Farrell. My husband had issues but our TCM doctor gave him herbs and they worked fantastically but they tasted awful. After 3 years of working with my Chef and the Doctor and my other partner we now have them wrapped up in chocolates. Yay. There is no cannabis in this mixture just wonder herbs that Dr. Wei has used for 40 years on his clients in Ottawa Canada. Please feel free to let everyone know these work really well and they give lovely energy too.
Nice information which you shared with us. Nowadays most of the men are suffering from this sexual difficulty because of these crisis relations breaks. But do not worry about this problem. Currently many generic medications are available in the market which can heal male sexual difficulty very easily. For example Generic Viagra is the most admired drugs prescribed to repair the difficulty of male impotence. Most of the people are satisfied with the generic Viagra. There are many drugs are available to treat ED such as Penegra, Kamagra soft tabs, Caverta, Tadalis etc. to know more you can visit http://www.assertmeds.com

Difficulty maintaining an erection happens from time to time and often has no underlying causes. It’s very common and doesn’t always mean that anything is wrong. Sometimes all it takes is trying new things with your partner(s) and focusing on ways to help sex work for you. Focusing on past experiences of losing erections can increase feelings of anxiety.
Malleable implants usually consist of paired rods, inserted surgically into each of the corpora cavernosa. The rods are stiff, and to have an erection, one bends them up and then when finished with intercourse one bends them down. They do not change in length or width. The malleable implants are the least mechanical and thus have the lowest risk of malfunction. However, also have the least "normal appearance."

Some men say certain alternative medicines taken by mouth can help them get and maintain an erection. However, not all “natural” medicines or supplements are safe. Combinations of certain prescribed and alternative medicines could cause major health problems. To help ensure coordinated and safe care, discuss your use of alternative medicines, including use of vitamin and mineral supplements, with a health care professional. Also, never order a medicine online without talking with your doctor.
Other hormone levels: Measurement of other hormones beside testosterone (luteinizing hormone [LH], prolactin level, and cortisol level) may provide clues to other underlying causes of testosterone deficiency and erectile problems, such as pituitary disease or adrenal gland abnormalities. Doctors may check thyroid levels in some individuals as both hypothyroidism (low thyroid function) and hyperthyroidism (overactive thyroid function) can contribute to erectile dysfunction.
A recent observational study of schizophrenia found that in patients with diminished sexual desire, ziprasidone was preferred over olanzapine.30 The majority of antipsychotics cause sexual dysfunction by dopamine receptor blockade. This causes hyperprolactinaemia with subsequent suppression of the hypothalamic–pituitary–gonadal axis and hypogonadism in both sexes. This decreases sexual desire and impairs arousal and orgasm. It also causes secondary amenorrhoea and loss of ovarian function in women and low testosterone in men.31,32 Although poorly understood, other neurotransmitter pathways including histamine blockade, noradrenergic blockade and anticholinergic effects may also be affected by antipsychotics.
Erectile dysfunction is a highly prevalent medical problem affecting a significant proportion of men. It is important for a number of reasons, causing impairment of quality of life and, if related to drug therapy, leading to non-compliance. Drug therapy accounts for erectile dysfunction in approximately 25% of cases and is mostly readily reversible when the offending agent is stopped, or a suitable alternative is substituted. Many classes of drug may be responsible, interfering with the normal physiological processes leading to penile erection in a dose-related fashion, and in ways which can usually be predicted from their pharmacology. The most commonly implicated classes of drug include antihypertensives such as thiazide diuretics and beta-adrenoceptor antagonists and psychotherapeutic drugs, especially selective serotonin reuptake inhibitor (SSRI) antidepressants. We review the agents which can cause erectile dysfunction, the evidence for this adverse effect and the physiological mechanisms involved. We present an approach to the management of the patient with erectile dysfunction in whom concomitant drug therapy may be responsible. We recommend that drug therapy should always be considered as a possible cause of erectile dysfunction before specific investigation and therapy is considered.
Communication is key: don’t try to hide your erectile dysfunction from your partner, or to avoid discussing it out of embarrassment or shame. Sometimes just admitting that you are concerned can reduce the stress and anxiety you’re feeling. Remember, your partner may be just as confused and upset by this as you are, so try initiating a frank and open discussion on the issue.
Is your erectile dysfunction due to psychological (stress, relationship problems, etc.) or physical factors? Your doctor may ask if you note erections at night or in the early morning. Men have involuntary erections in the early morning and during REM sleep (a stage in the sleep cycle with rapid eye movements). Men with psychogenic erectile dysfunction (erectile dysfunction due to psychological factors such as stress and anxiety rather than physical factors) usually maintain these involuntary erections. Men with physical causes of erectile dysfunction (for example, atherosclerosis, smoking, and diabetes) usually do not have these involuntary erections. Men with psychogenic erectile dysfunction may relate the onset of problems to a "stressor," such as failed relationship. Your doctor may suggest a test to determine if you have erections during sleep, which may suggest that there may be a psychological cause of the erectile dysfunction.
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."

Alprostadil is injected into the side of penis with a very fine needle. It's of great value to have the first shot in the doctor's office before doing this on your own. Self-injection lessons should be given in your doctor's office by an experienced professional. The success rate for getting an erection firm enough to have sex is as high as 85% with this treatment. Many men who do not respond to oral PDE5 inhibitors can be ‘rescued' with ICI.
Psychological causes are less common than we thought but more often the cause in younger men. Performance anxiety triggers the release of adrenaline. Adrenaline causes blood to flow TO the vital organs, such as the heart, lungs and brain, and AWAY from less vital structures like the fingers, toes and the penis. Our bodies do this to cope with the physical stress of a physical attack or physical challenge, but sexual anxiety also triggers this reflex.
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!
When blood fills two chambers in the penis (known as the corpora cavernosa) an erection occurs. This causes the penis to expand and stiffen, much like a balloon as it is filled with water. The process is triggered by nerve impulses from the brain and genital area. Anything that interferes with these impulses or restricts blood flow to the penis can result in erectile dysfunction.
The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of hims, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.
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