With coronary artery disease, a buildup of plaque inside the arteries can limit the amount of blood that’s able to flow through them. If the flow of oxygen-rich blood to your heart muscle is reduced or blocked by this hardening of the arteries, the result can be angina (chest pain) or a heart attack.17 Because the arteries that supply blood to the penis are much smaller than the ones that feed the heart, the problem may show up earlier as having difficulty getting an erection.18
Changing to an alternative drug is recommended for men and women taking antihypertensives. Alpha blockers, ACE inhibitors and calcium channel blockers are not considered to cause erectile dysfunction,54 while several studies have suggested that angiotensin II receptor antagonists may even improve sexual function. Beta 1 -selective beta blockers such as nebivolol may have potential advantages in these patients.55
Diabetes is an example of an endocrine disease that can cause a person to experience impotence. Diabetes affects the body’s ability to utilize the hormone insulin. One of the side effects associated with chronic diabetes is nerve damage. This affects penis sensations. Other complications associated with diabetes are impaired blood flow and hormone levels. Both of these factors can contribute to impotence.

When you become aroused, your brain sends chemical messages to the blood vessels in the penis, causing them to dilate or open, allowing blood to flow into the penis. As the pressure builds, the blood becomes trapped in the corpora cavernosa, keeping the penis erect. If blood flow to the penis is insufficient or if it fails to stay inside the penis, it can lead to erectile dysfunction.
Alcohol is a depressant, not an aphrodisiac or a libido enhancer. Excessive consumption can interfere with the ability to achieve an erection at any age, and even occasional drinking can make erectile dysfunction worse in older men. Feloney advises using alcohol in moderation: "In small amounts, alcohol can relieve anxiety and may help with erectile dysfunction, but if you drink too much, it can cause erectile dysfunction or make the problem worse."
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 (ED) is the inability to get an erection or to keep one that's firm enough or that lasts long enough for a man to have a satisfying sexual experience. Occasional bouts of ED aren't unusual. In fact, as many as one in five men deal with erectile dysfunction to some degree. Symptoms, of course, are rather obvious. And while age can be a risk factor, so can medication use, health conditions, lifestyle factors (like smoking), and other concerns. Treatment is available and may involve prescriptions, habit changes, or other options.
Men taking antipsychotics report erectile dysfunction, decreased orgasmic quality with delayed, inhibited or retrograde ejaculation, and diminished interest in sex. Women experience decreased desire, difficulty achieving orgasm, changes in orgasmic quality and anorgasmia. Dyspareunia, secondary to oestrogen deficiency, can result in vaginal atrophy and dryness. Galactorrhea is experienced in both sexes.28
Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualized by infusing a mixture of saline and x-ray contrast medium and performing a cavernosogram.[22] In Digital Subtraction Angiography (DSA), the images are acquired digitally.
You’ve probably heard of Viagra, but it’s not the only pill for ED. This class of drugs also includes Cialis, Levitra,  Staxyn, and Stendra. All work by improving blood flow to the penis during arousal. They're generally taken 30-60 minutes before sexual activity and should not be used more than once a day. Cialis can be taken up to 36 hours before sexual activity and also comes in a lower, daily dose. Staxyn dissolves in the mouth. All require an OK from your doctor first for safety.
The PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally.[23]:20–21 Additionally, a cream combining alprostadil with the permeation enhancer DDAIP has been approved in Canada as a first line treatment for erectile dysfunction.[26] Penile injections, on the other hand, can involve one of the following medications: papaverine, phentolamine, and prostaglandin E1, also known as alprostadil.[23]:25
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.
Many men who suffer from ED worry so much about their partner and what their partner thinks of them that they ignore all of their natural impulses of desire. This denial of your natural impulses can cause a constant interruption to your arousal curve making it very difficult to get or keep an erection. If you want your body to respond as it naturally should, follow your impulses of desire. Your partner will thank you because what she really wants from you is to feel desired!

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.

Illegal drugs don’t just affect and suppress the central nervous system. They cause serious damage to blood vessels. And any damage to blood vessels or normal blood flow will eventually cause erectile dysfunction. Some experts even argue that a single use of any of these chemicals can lead to subsequent ED. Chronic use raises the risk even more. If you have a substance addiction speak to your physician. There’s always help available.

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