These drugs only work when you’re aroused – medical treatments for erectile dysfunction will only treat your physical ability to get and keep an erection sufficient for sex. They also only work if you are sexually aroused in the first place. This means that taking a drug like Sildenafil won’t lead to an erection on its own – you need to combine ED treatment with sexual arousal.
Talk with your doctor about going to a counselor if psychological or emotional issues are affecting your ED. A counselor can teach you how to lower your anxiety or stress related to sex. Your counselor may suggest that you bring your partner to counseling sessions to learn how to support you. As you work on relieving your anxiety or stress, a doctor can focus on treating the physical causes of ED.

Despite all the options and alternatives, sometimes there’s no suitable alternative to a prescription that contributes to ED. You might have an adverse reaction to an particular medication or an alternative is unavailable in your state, health insurance plan, or your budget. There are good reasons you were prescribed your original medication in the first place.


Many men are extremely uncomfortable discussing erectile dysfunction or any other issue that has the potential to disrupt their sense of themselves as men. To do so is interpreted as a failure of male functioning and evidence they are not “real men”. Men resist disclosing any experience of erectile dysfunction for fear of being mocked or ridiculed. As such, this is not a topic likely to be discussed at barbecues.
While self-esteem can be affected by the perceptions of others, it is largely how you feel about yourself. If you have a negative view of yourself and your abilities, it is going to color your experience and actions on a daily basis. Many people with low self-esteem get so caught up in their own perception of themselves, that they begin to project it onto others. For example, a man with low self-esteem might believe that he is not capable of satisfying a woman and, as a result, he becomes unable to perform in the bedroom. Low self-esteem can also be a sign of other psychological issues such as depression.  
An injury to the nerves, arteries, or veins of the pelvis has the potential to cause sexual problems. Men with spinal cord injuries have increased rates of erectile and ejaculatory problems, for example. However, spinal cord injury does not necessarily prohibit sexual function. Some people with complete spinal cord injuries still experience arousal and orgasm from non-genital stimulation. In addition, desire and interest are unlikely to be affected by spinal cord injury.
Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing some men to function normally. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in men who get normal erections.

Understanding both the impact of a disorder and the effects of its treatment on both the patient and their partner are critical to providing good clinical care. It is important for the clinician to acknowledge and encourage discussion regarding sexual function, as well as enquire about the impact of drugs on sexual function. This will ensure patients and their partners understand their sexual difficulties and treatment options.

Getting an erection is a complicated process that involves hormones, nerves, and blood pressure changes. When prescription medication changes how one of these factors works—like a drop in blood pressure—ED is a common side effect. And the problem is that when most men experience ED as a side effect of medication, they typically do one of two things:


Sexual dysfunction and ED become more common as men age. The percentage of complete ED increases from 5% to 15% as age increases from 40 to 70 years. But this does not mean growing older is the end of your sex life. ED can be treated at any age. Also, ED may be more common in Hispanic men and in those with a history of diabetes, obesity, smoking, and hypertension. Research shows that African-American men sought medical care for ED twice the rate of other racial groups.
Most men may not openly talk about their erection problems, but erectile dysfunction — when a man cannot achieve or maintain an erection well enough or long enough to have satisfying sex — is very common. According to the National Institutes of Health, 5 percent of 40-year-olds and 15 to 25 percent of 65-years old have ED. But while ED is more likely to occur as a man gets older, it doesn’t come automatically with age.

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).
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Describing the epidemiology of ED in young men requires, first of all, defining what it is meant by youth. While the definition of old age is matter of discussion and a precise threshold does not exist, the most shared definition in Western Countries is age above 65 years (http://www.who.int/healthinfo/survey/ageingdefnolder/en/). Considering that most of the epidemiological studies on general populations aimed at studying health changes with age, enrol men more than 40 years, it seems reasonable to define young age as below 40 years. Epidemiological studies on erectile function, which considered the prevalence of ED according to age bands, consistently find a significant increase with ageing. Advancing age remains one of the most important unmodifiable risk factors for ED (1). Studies on ED mostly involve middle-aged and older men, with younger aged men often overlooked. In a multi-centre worldwide study, involving more than 27,000 men from eight countries, Rosen et al. (2) showed an ED prevalence of 8% among men aged 20–29 years and 11% among those aged 30–39 years. Most of the studies involving younger men and conducting age-stratified analyses have been performed in Europe, where the prevalence of ED in men younger than 40 years ranges between 1% to 10% (3-10). The prevalence reported in these studies is highly variable due to different methodologies used in defining ED, population accrual, acquisition of data and choice of tools for investigating erectile function. A smaller number of studies on this topic have been conducted outside Europe. Both in Australia (11,12) and in America (13-15), the available information suggests a similar range of prevalence of ED among young subjects, with the same extent of variability among studies. According to these data, ED in younger men, although still not extensively studied and largely overlooked by the scientific community, is a quite common condition. In a recent study conducted in a Urology Clinic, it has been observed that one out of four men seeking medical care for ED was younger than 40 years (16). In our Sexual Medicine and Andrology Unit, established in an Endocrinology setting at the University of Florence, medical consultations for younger men are infrequent, with a prevalence of men aged less than 40 years at only 14.1% of more than 3,000 men complaining of ED. However, when considering the new referrals to our Unit during the last 6 years, we can notice a progressive increase in prevalence of men below 40 years seeking medical care for ED (Figure 1). According to these data, ED is becoming a common concern even among young men, and the clinical practitioner in sexual medicine must become aware of how to manage the problem and avoid underestimating a symptom. The identification of ED in a young man may potentially provide a great deal of useful information that can help improve their quality and even length of life.
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.
Sure, this condition might be common – but isn’t erectile dysfunction a problem that only middle and senior-aged men get? It is true that erectile problems are common in older men. It often happens due to lower levels of testosterone and reduced blood flow to the penis. But this study showed that a quarter of all men under the age of 40 experience erectile dysfunction of some kind!
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Vacuum devices for erectile dysfunction, also called pumps, offer an alternative to medication. To use a pump, the penis is placed inside a cylinder. Then the pump draws air out of the cylinder to create a partial vacuum around the penis causing it to fill with blood, leading to an erection. An elastic band worn around the base of the penis is used to maintain the erection during intercourse. Individuals should discuss the use of this device, and especially the elastic band use to avoid potential penile damage.
Another approach to avoiding ED is some simple pelvic floor exercises, also known as Kegel exercises. These can help improve blood flow to the penis and strengthen the muscles around your groin. You can do these almost anywhere – clench your pelvic muscles and hold for 5 seconds, and then release. Repeat these exercises a few times with a rest in between and change positions between sitting and standing now and again. You should repeat these exercises 2 to 3 times a day to get the most benefit out of them.
Information contained in the Ask the Pharmacist column by Dr. Armon B. Neel Jr. is intended to help individuals and their families become more informed about medication usage and interactions, and be better health care consumers. Any advice or information provided should not be followed in lieu of a personal consultation with a trained medical professional.

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.
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Once observed that the organic component of ED is the most important one in younger patients (Figure 2), the summarized evidence underlines that metabolic and CV risk must not be underestimated in younger men even when they are apparently healthy. In fact, it is particularly in these men that recognizing the presence of risk factors can help in changing life-style, thus really changing the natural history of metabolic and CV diseases. In older men the damage is often already established and the identification of further risk factors usually does not add information to the estimation of CV risk. ED is a symptom that can provide a chance for both the patients and physicians to unearth the presence of CV risk factors and improve both the quality and length of life of these men.

Another approach to avoiding ED is some simple pelvic floor exercises, also known as Kegel exercises. These can help improve blood flow to the penis and strengthen the muscles around your groin. You can do these almost anywhere – clench your pelvic muscles and hold for 5 seconds, and then release. Repeat these exercises a few times with a rest in between and change positions between sitting and standing now and again. You should repeat these exercises 2 to 3 times a day to get the most benefit out of them.
Sildenafil is available as oral tablets at doses of 25 mg, 50 mg, and 100 mg. Patients should take sildenafil approximately one hour before sexual activity. In some men, the onset of action of the drug may be as early as 11-20 minutes. It's best for men to take sildenafil on an empty stomach for best results since absorption and effectiveness of sildenafil can be diminished if it is taken shortly after a meal, particularly a meal that is high in fat. Sildenafil and the other PDE5 inhibitors don't cause an immediate erection. Sexual stimulation is necessary for these medications to work.
Begot, I., Peixoto, T. C. A., Gonzaga, L. R. A., Bolzan, D. W., Papa, V., Carvalho, A. C. C., ... & Guizilini, S. (2015, March 1). A Home-Based Walking Program Improves Erectile Dysfunction in Men With an Acute Myocardial Infarction. The American Journal of Cardiology, 115(5), 5741-575. Retrieved from http://www.ajconline.org/article/S0002-9149(14)02270-X/abstract
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