At his last visit, Mr. Jones was prescribed Imdur (isosorbide mononitrate) to help with his heart condition. Reading through the notes, it looks like the Imdur worked. He was feeling better, so much better that he wanted to start having sex with his wife again. And here was the problem: Mr. Jone’s doctor had renewed his Cialis prescription. Quickly, I went from a moment of elation to consternation.
General health. If you have liver or kidney problems, Viagra’s effects could last for longer, although it might not be safe to take Viagra with these conditions. The reason it lasts longer is because the tablet will take longer to be broken down by your body, this means there is a bigger risk of having more serious side effects. You must always mention these conditions during a doctor assessment for Viagra treatment
It is important for clinicians prescribing these drugs to make the patient aware of the action of the drugs especially the fact that they do not result in an immediate erection, and that they do not cause an erection without sexual stimulation. There is frequently a great expectation when men begin using these drugs and it is wise to temper their enthusiasm and explain they do not work immediately, and may not work every time, but also let the patient know that if these drugs do not work, there are other options.

The Institute of Medicine recommends cumulative daily vitamin D intake of 600 international units (IU) for adults between 18 and 70 years of age , and 800 IU for those over 80. A 3oz serving of salmon contains about 450IU, while an 8oz. glass of milk only has about 100IU. Low vitamin D levels may be an independent, potentially modifiable risk for ED, so it’s worth taking Vitamin D supplements for your “D.” However, keep your daily vitamin D supplement intake below 4,000IU, as too much vitamin D can be toxic.


A Russian study of men with ED taking vardenafil (Levitra) every other day found that they had much better erections and their blood vessels expanded more than men who took the drug only when needed for sex. Cialis has now been approved for everyday use, so that is an option for you. You could ask for referral to a urologist specializing in sexual function to obtain these meds.
The Princeton Consensus Recommendations were developed to provide instructions to physicians who treat men with CVD and ED and answer the most common question: is it safe to take PDE5i and engage in sexual activity? (Kostis et al 2005). Physicians should consider the cardiovascular status of their patients seeking treatment for ED since there is a degree of risk associated with sexual activity. Three risk categories of CVD were described. Patients in the low risk category (controlled hypertension, stable angina, successful coronary revascularization, history of uncomplicated myocardial infarction, mild valvular disease, and no symptoms with <3 cardiovascular risk factors) can be safely encouraged to initiate or resume sexual activity or receive treatment for their sexual dysfunction. Patients in the intermediate-risk category include those with moderate angina, recent myocardial infarction (<6 weeks), left ventricular dysfunction and/or class II congestive heart failure, non-sustained low-risk arrhythmias and ≥3 risk factors for coronary artery disease. These patients should receive further cardiologic evaluation to determine if they can be restratified into the low- or highrisk cardiovascular categories. Finally, patients in the high-risk category should be stabilized for their cardiac condition before resuming sexual activity or receiving treatment for their sexual dysfunction. It is important to emphasize that the use of any form of nitrate with all PDE5i is contraindicated because of the increased likelihood of hypotension.

This scenario raises a key concern for us (and should for you as well) about what is recommended to treat erectile dysfunction. I performed a quick Google search on kegels as treatment for the pelvic floor, and found hundreds of websites instructing men to perform kegels to ameliorate erectile dysfunction, have longer and stronger erections – a quick and easy fix. I found a few sites instructing men to perform anywhere from 50-100 repetitions per day (insanity). I discovered a new book called Male Pelvic Fitness, a “user manual to your man parts
According to the Cleveland Clinic, “because erectile dysfunction is caused by a complex set of psychosocial, neurologic, and vascular factors, a specific cause in a patient may remain ambiguous.” The root causes are often related to a blockage or dysfunction of blood vessels. For example, ED can be due to conditions like atherosclerosis or diabetes, hormonal imbalances or problems related to mental health. It’s been found that common causes typically include one or more of the following factors: (2)

It is important to understand that ED is frequently, if not usually, directly related to endothelial dysfunction, and that the release of NO by the vasculature of the penile arteries is directly related to the function of intact, healthy endothelium. In the face of endothelial dysfunction, the process of erection fails to occur in a normal fashion.16


A cold slice of watermelon can do more than just satisfy thirst and hunger during the warm summer months; it can help with bedroom satisfaction. Citrulline, the amino acid found in high concentrations of watermelon, is found to improve blood flow to the penis. A 2011 study revealed men who suffered from mild to moderate ED and took L-citrulline supplementation showed an improvement with their erectile function and were very satisfied. Natural watermelon juice, or “nature’s Viagra,” can also be easier on the stomach, since taking pills like Viagra can cause nausea and diarrhea.
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