If you are taking sildenafil to treat erectile dysfunction, follow your doctor's directions and the guidelines in this paragraph. Take sildenafil as needed before sexual activity. The best time to take sildenafil is about 1 hour before sexual activity, but you can take the medication any time from 4 hours to 30 minutes before sexual activity. Sildenafil usually should not be taken more than once every 24 hours. If you have certain health conditions or are taking certain medications, your doctor may tell you to take sildenafil less often. You can take sildenafil with or without food. However, if you take sildenafil with a high-fat meal, it will take longer for the medication to start to work.
No matter what erectile dysfunction treatment or treatments (whether herbal remedies or not) a man ultimately decides upon, experts say it's important to eat healthily and to avoid smoking and heavy drinking. Moreover, adequate exercise, stress reduction, and sleep can improve erectile dysfunction in many. In addition, says Lamm, "A loving, receptive, and responsive partner is a home run. After all, this is still a couple's issue."
As an alternative, Alprostadil is available as a pellet-like suppository that is inserted into the tip of the penis and absorbed through the lining of the urethra. This can help produce erections lasting for 30 to 60 minutes, according to the Impotence World Association (IWA). Unfortunately, the suppositories are less effective than injections and may cause pain and irritation, according to both Aigen and Beam.
Another potential new treatment consists of penile low-intensity shock wave lithotripsy. This consists of 1500 shocks twice a week for 3–6 weeks. The purpose is to stimulate neovascularisation to the corporal bodies with improvement in penile blood flow and endothelial function. The use of low-intensity shock wave lithotripsy may convert PDE5 inhibitor non-responders to responders.47
In the statistical analysis, the difference between the pre-test and post-test values (changed score) for IIEF score was computed. Student t-test was used to compare the mean changed score values of IIEF. All statistical analysis was performed on an IBM compatible micro computer using SPSS for window version 15.0, (Chicago IL, USA). The probability level for all the above tests was set at 0.05 to indicate significance.

In a recent study, moderate-intensity exercise such as walking briskly and light cycling was shown to boost mood for up to 12 hours. Exercising every day might be best to lift your mood, but strive for at least 5 days a week. Another study showed exercise can improve your body image, regardless of body weight or shape. And feeling good about your body is a great start toward making the bedroom a happier place.
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One of the keys to addressing erectile dysfunction is improving the functioning of the endothelium, which is the inner lining of blood vessels. Wayne Hellstrom, MD, urology professor at Tulane University School of Medicine says keeping endothelium healthy can help you improve erectile functioning. Cardio training helps with this, as does resistance training. Adding weight training to cardio training increases muscle mass and bone strength helps your balance and stability (which can help prevent injuries) and can help lower blood pressure as well. Improved muscle definition can also be great for self-esteem, and that can’t hurt.

Erectile problems can happen to men of any age.  There are many factors that contribute to ED including poor health, untreated medical problems, medications and pornography use.  Many men struggle with understanding when they are experiencing situational sexual dysfunction verses when is your erectile issue an ongoing problem that requires medical help.

A 2011 study of 160 men with moderate or severe erectile dysfunction divided the group in two—80 men were given niacin supplements, and 80 a placebo. The group given niacin reported improved ability to “maintain an erection versus the control group.” It’s not exhaustive research, but still promising. The best part about niacin is that it’s naturally found in foods like turkey, avocado, and peanuts (yum). If you’re not a turkey sandwich fan, you can supplement with a vitamin B complex.


"For men who are unwilling or unable to self-inject alprostadil, the FDA has approved this dissolvable pellet that can be inserted directly into the urethra, the opening of the penis," says Dr. Feloney. MUSE, with an inspiring name that actually stands for medicated urethral system for erection, will trigger an erection in about 10 minutes that may last as long as an hour. Using MUSE to treat ED can result in somewhat unpleasant side effects, however — including an aching sensation, burning, redness, and minor bleeding.
The more you try not to think about your sex problems, the more these problems consume your thoughts! While it appears that your problem is complicated, my Hard and in Control program provides the complete strategy so you can complete mutually satisfying sexual acts. This will enable you to eliminate performance anxiety and restore enjoyment for your partner.
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.
Wistar rats (From Medical Research Institute, Colombo) were obtained and kept in a well ventilated animal house under natural dark light cycle (temperature 28-30°C, humidity; 50-55%). Animals were housed in groups (four per group) until they reached sexual maturity (150-200 g). They were provided with pelleted food and water. Male rats were permitted access to receptive females on three separate occasions and then screened for sexual proficiency. Male rats who displayed consistently vigorous sexual activity were selected for the study.

Aerobic exercises and pelvic floor exercises are two of the best methods to start with. As a matter of fact, you can see improvements on your condition without having to witness the side effects of other male enhancement products. For one, there are certain male enhancement products which should not be taken if you are suffering from other types of medical condition. For instance, if the product contains substances that may react to the male enhancement ingredients of a product, you may suffer from certain consequences.
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
Can apple cider vinegar treat erectile dysfunction? Apple cider vinegar is thought to have many health benefits, but can it help treat erectile dysfunction (ED)? ED can result from cardiovascular problems, diabetes, and other factors. Apple cider vinegar may help improve symptoms of conditions related to ED. Find out how it may help, and how to use it safely. Read now
If you have a neurological disorder or spinal cord injury and other erectile dysfunction treatments aren’t effective, two types of surgical implants could offer solutions to your ED. “An implantable pump can be used to manually create an erection by pumping fluid into cylinders placed inside the penis,” explains Feloney. “The other option is a malleable prosthesis that works like a gooseneck lamp to direct the penis into position for intercourse." Risks for these ED treatments include infection and mechanical breakdown.
The substance that gives hot peppers their kick can also give you some kick in the pants: Studies have associated the natural chemical with increased testosterone levels. In animal studies, capsaicin has also shown to increase the size of sex organs, while simultaneously decreasing belly fat. A 2014 study from France also found that men who ate more spicy food had higher testosterone levels than those who ate less. You can consume capsaicin via peppers, chili powder or a cayenne supplement.
Size matters, so get slim and stay slim. A trim waistline is one good defense — a man with a 42-inch waist is 50% more likely to have ED than one with a 32-inch waist. Losing weight can help fight erectile dysfunction, so getting to a healthy weight and staying there is another good strategy for avoiding or fixing ED. Obesity raises risks for vascular disease and diabetes, two major causes of ED. And excess fat interferes with several hormones that may be part of the problem as well.

Such observations augment the need for the development of care model in sexual medicine, as it happens with every other chronic condition, such as diabetes mellitus and CVD. In addition, it becomes clear that we are running to the era where personalized medicine will replace traditional schema; diagnosis is integrated with therapy for selection of the treatment as well for monitoring the outcome. Development and adaptation of a patient-centered care model in sexual medicine will increase efficacy and safety of currently and future treatments, as well as patients’ adherence, with certain benefits not only for our patients, but also for the healthcare systems, especially in terms of cost-effectiveness.


When men are given supplemental testosterone it can have positive effects on erectile dysfunction as well as the “grumpy old men” syndrome of low energy, loss of drive, low libido, and loss of endurance as well as “man boobs”.  Zinc has a direct effect on the two main enzyme systems that act on testosterone: conversion of testosterone to estrogen via aromatase and the conversion of testosterone to DHT by 5 alpha reductase.   Zinc blocks the testosterone to estrogen pathway leading to more testosterone.  It turns out that only at really high zinc levels does zinc inhibit the 5 alpha reductase enzyme so when we give mild to moderate zinc supplements, DHT actually increases because there is more testosterone to feed into this pathway.   This actually benefits things because DHT has 2-3 times the times the androgen receptor affinity than testosterone.  In any case, we see an increase of testosterone and androgenic activity from DHT with zinc supplements and whether a guy has low or normal T to begin with, there is a positive change in erectile dysfunction and libido in some men due to the increased androgenic activity and less estrogen pulling in the opposite direction.  Conversely we see testosterone levels drop when a diet is low in Zinc as well as a drop in DHT.  It is important to note that this effect of increased testosterone with zinc supplementation, while well established, does not always lead to an improvement of ED and increased Libido.
The role of the endothelium in erectile function became clearer with the observation that the phosphodiesterase type 5 (PDE5) inhibitor, sildenafil, enhanced erectile function. Erection occurs with the release of nitric oxide (NO) from the vascular endothelial cells.17 The reduction in endothelial cell production of NO results in the negative impact on the smooth muscles in the corporal bodies and results in less relaxation of the smooth muscle cells with decrease in blood supply and resulting ED. A similar phenomenon is well known to impact the coronary arterial system resulting in CVD.
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Before a man concludes that oral drugs don’t work for him, he should have his testosterone levels checked to rule out hormone deficiency as the cause of (or as a contributor to) his sexual dysfunction. Other symptoms of low testosterone include a low sex drive and infertility. Checking testosterone levels requires a blood test. If a man’s levels of testosterone are decreased or at the lower end of normal, his doctor may prescribe supplemental testosterone therapy, either as testosterone injections or testosterone gel, which is applied daily to the skin. In some cases, testosterone therapy alone can resolve sexual dysfunction, or it can be combined with the use of oral erectile dysfunction drugs.
Dr. Liou says that some men come to him after getting a prescription from their primary care doctors, claiming that the drug doesn't work. Sometimes it's because they used it incorrectly. "The biggest misconception is that these drugs are an on/off switch for erections," Dr. Liou says. But the drugs don't work well without sexual stimulation. "During that time, you need to be with your partner and have foreplay," Dr. Liou says. "Don't take it, do the taxes or the dishes, and then meet at the bedroom thinking you'll be ready to go. It's not like that."
The power of the mind is not to be underestimated when it comes to believing in remedies so they may sometimes work, even if they do not contain any active substance (this is known as a placebo effect). However, herbal ED remedies offered online can present major health risks. It is important that you understand your treatment options before you take any medication.

Hearing loss or vision loss. Some men have had sudden loss of hearing or loss of vision after taking one of these medications. However, it isn't clear whether vision or hearing loss was directly caused by taking the medication or by a pre-existing condition. If you're taking an oral erectile dysfunction medication and have sudden loss of hearing or vision, seek prompt medical attention.


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PDE5i have been suggested to be beneficial for patients with premature ejaculation, possibly due to a peripheral inhibition of contractile response of vas deferens, seminal vesicles, prostate, and urethra as well as a reduced central sympathetic output through a prolonged NO effect (Abdel-Hamid 2004). Combination of sildenafil with paroxetine prolongs significantly intravaginal ejaculation latency time (IELT) and is associated with better intercourse satisfaction compared with paroxetine alone (Salonia et al 2002). In a group of nonresponders to other treatments, sildenafil combined with paroxetine and psychological -behavioral counseling alleviated premature ejaculation (Chen et al 2003). On the contrary, sildenafil was not superior to placebo or combination treatment with topical lidocain/prilocain cream. Further placebo-controlled, well designed studies are needed to determine whether there is any role for sildenafil in the treatment of premature ejaculation.
There is no evidence that mild or even moderate alcohol consumption is bad for erectile function, says Ira Sharlip, MD, a urology professor at the University of California San Francisco School of Medicine. But chronic heavy drinking can cause liver damage, nerve damage, and other conditions -- such as interfering with the normal balance of male sex hormone levels -- that can lead to ED.
Over the years, myriad treatments and gadgets have been invented to assist with issues related to erections. They run the gamut from vacuum pumps to constriction bands, surgical implants, male hormone therapy, herbal supplements (ginkgo biloba, saw palmetto,  L- arginine, and yohimbe), and even shock-wave therapy. Lifestyle changes include: increasing exercise, decrease smoking, losing weight, and eating healthier. More natural alternative treatments include acupuncture and watermelon juice. In her hilarious and informative book entitled Bonk, researcher Mary Roach explores coupling of science and sex, and dedicates a couple of chapters to in-depth analysis of erectile dysfunction treatments.
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Most patients with multiple sclerosis (MS) report an interest in using dietary supplements to potentially reduce the severity and symptoms of the disease, and more than half of MS patients are already taking them. But which supplements have evidence of a beneficial effect? Researchers reviewed studies on more than 20 vitamin and dietary supplements—including vitamins A, C, D, E, and many B vitamins, as well as caffeine, lipoic acid, probiotics, and other supplements—but found that only one had sufficient evidence to recommend routine supplementation. Click here to find out which one.
Although there have been sufficient data on the relationship between ED and several wellrecognized risk factors which including aging, coronary artery disease, atherosclerosis, diabetes mellitus, dyslipidemia, high blood pressure, and pelvic surgeries, little attention has been paid by the urologists to the role of lifestyle factors in ED. However, accumulating data from basic science and clinical studies have determined a link between the occurrence of ED and a number of lifestyle factors, such as smoking, obesity, alcohol consumption, and lack of physical activity. The application of findings from animal and human studies to the clinical practice regarding the modification of lifestyle factors could help to improve ED as well as reducing the risks of developing cardiovascular diseases (14).

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.
Dealing with erection problems can be a challenge. However, there are lots of treatments and lifestyle changes which can help. While medications such as Viagra improve symptoms in the short term, pelvic floor exercises can help you improve your sexual function in the long term. Find out why pelvic floor, also known as Kegel exercises, can be used to treat ED and how to perform the exercises correctly.
In a recent study, moderate-intensity exercise such as walking briskly and light cycling was shown to boost mood for up to 12 hours. Exercising every day might be best to lift your mood, but strive for at least 5 days a week. Another study showed exercise can improve your body image, regardless of body weight or shape. And feeling good about your body is a great start toward making the bedroom a happier place.
Nearly every primary care physician, internist and geriatrician now understand that many older men retain an interest in sexual activity as they age. Some primary care physicians think that sexual potency in older men is the norm, and that if it is lacking, it is ‘all in the head.’ This viewpoint has not been supported by current literature. The Massachusetts Male Aging Study (MMAS) found that 52% of men between 40 and 70 years old reported having some form of erectile dysfunction (ED).1 The reality is that ED is a natural part of ageing and that the prevalence increases with age. In the MMAS, they found that roughly 50% of men at 50 years old, 60% of men at 60 years old and 70% of men at 70 years old had ED. Thus, nearly all men who live long enough should develop ED. The myths that surround the problems of impotence or ED confound the attempts of patients to receive treatment and the attempts of physicians to help them.1
The first stem cell study for the treatment of ED was published in 2004. This study used embryonic stem cells to treat ED. At this time, there is a total of 36 published basic studies assessing stem cell therapy for ED, with two clinical trials. The mechanism of action of stem cells is to generate angiogenesis with subsequent increase in cavernosal smooth muscle cells within the corporal bodies.46
Adequate daily magnesium intake is slightly lower for younger men than for those in their 30s and older. The University of Maryland Medical Center recommends 400 mg daily for men between the ages of 19 and 30, and 420 mg per day for men 31 and older. While these levels are a good general guideline, you should check with your doctor to determine the proper dosage for a daily magnesium supplement, particularly if you’re using magnesium to help treat or prevent erectile problems.
The idea of using low-energy shock waves to treat erectile dysfunction comes from studies that show that these types of shocks help heart blood vessels regrow, a process called revascularization. Shock wave therapy may also work on the penis, and there have been some promising results, but it’s not currently an approved ED treatment. "It’s similar to the type of shock waves used to break up kidney stones, and it may cause revascularization,” says Bennett. “However, there are not yet any good controlled studies to recommend it to patients."
According to the Centers for Disease Control and Prevention, ingesting levels of zinc in excess of the recommended dietary amount will result in diarrhea, vomiting, and stomach cramps. The maximum amount of daily zinc consumption recommended is 40 milligrams per day. Symptoms of too much zinc intake include nausea and headaches. If you have reason to suspect you have ingested too much zinc, contact a medical professional.
When it comes to keeping your gut healthy and immunity strong, consuming fermented foods and probiotic supplements is essential. Probiotic foods and supplements fortify the ‘good’ bacteria that live in the gut – the all-important microbiome – which in turn protects the gut wall, regulates inflammation, and assists with hormone and neurotransmitter production. Also essential… View Article
A mineral involved in muscle development, muscle is essential for reproductive function in men of every age and activity level. One study that compared athletes to non-active individuals found that supplementing with 22 mg magnesium per pound of body weight of the course of four weeks raised testosterone levels in both groups. And two separate studies, one on a group of men over the age of 65 and a second on a younger 18-30-year-old cohort, present the same conclusion: levels of testosterone (and muscle strength) are directly correlated to the levels of magnesium in the body. These are the best foods for magnesium!

This is one B team you want to get on pronto: A recent report from Harvard University highlighted a study that has linked low levels of B12 to erectile dysfunction. A causal link hasn’t been nailed down, but the B vitamin is used by every system in the body, particularly in cell metabolism and the production of blood — two essential factors in getting and keeping a quality erection.


A study from the University of the West in the United Kingdom found that pelvic exercises helped 40 percent of men with ED regain normal erectile function. They also helped an additional 33.5 percent significantly improve erectile function. Additional research suggests pelvic muscle training may be helpful for treating ED as well as other pelvic health issues.
Exercise lowers blood pressure – a consistently high blood pressure (hypertension) can damage your arteries and cause them to harden, limiting the flow of blood to the penis and leading to cardiovascular problems. Exercise works to reduce the force required to pump blood around your body, protecting your artery linings as a result. You should aim to have a blood pressure less than 140/90mm Hg.
One of the best methods that you can do in order to locate your pelvic floor is to stop your urine in mid-stream several times. These muscles that you clench are the ones that you have to exercise on. In order to perform repetition on Kegel exercises, you can squeeze your pelvic muscles, holding the position for 5 seconds, and then relaxing. You may repeat this for about 10 to 20 times, two to three times in a day. You may also want to do this while in different positions such as standing, sitting, lying down, sitting in a chair, as well as standing.
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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.
There is no evidence that mild or even moderate alcohol consumption is bad for erectile function, says Ira Sharlip, MD, a urology professor at the University of California San Francisco School of Medicine. But chronic heavy drinking can cause liver damage, nerve damage, and other conditions -- such as interfering with the normal balance of male sex hormone levels -- that can lead to ED.
The most common vitamin and mineral supplements that people consume—such as vitamin C, vitamin D, calcium, and multivitamins—do no harm, but don't provide any benefits either, reported authors of a recent meta-analysis. The possible exceptions were folic acid, which may reduce cardiovascular disease and stroke, and niacin and antioxidants, both of which showed possible increases in all-cause mortality. The researchers said that a healthy diet should provide enough vitamins and minerals without the need for supplements. Guess which foods they recommended? If you guessed "ice cream," then you'd better click here to get the real scoop.
Ginseng, known as the “herbal Viagra” has also been found to improve performance. The root of ginseng is steamed and then dried, which produces red ginseng. According to this study in 2008, random clinical tests provided evidence of the effectiveness of red ginseng in improving ED. This particular red ginseng has many excellent reviews of improved sexual performance.
Some men opt for penile implants, which involve the placement of tubes in the penis and a pump in the scrotal sac. The pump (usually the size and shape of a testicle) enables men to obtain an erection whenever and for as long as they desire by pumping a saline solution from a reservoir into the penis. Implants are a last resort, however, says Beam. "Once a prosthesis is implanted, a patient cannot respond to anything else because it alters the natural anatomy."
The penis contains two chambers, called the corpora cavernosa, which run the length of the organ. Erection begins with sensory and mental stimulation. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the chambers. The inflow of blood creates pressure in the corpora cavernosa chambers, making the penis expand. Erection is reversed when muscles in the penis contract, stopping the inflow of blood and causing the blood in the chambers to flow out.
So what causes erectile dysfunction?  Sometimes it is a circulation problem.  Sometimes it is a low testosterone issue.  Sometimes it is not.  Testosterone (T) supplementation can help ED and low libido in cases of low T and even if there is a normal T level at baseline, ED can be helped.  In cases where thyroid under or overactivity is causing T levels to be less than optimal.  Aging is also a problem as T levels drop after mid 20’s and as adipose tissue increases and aromatase enzyme conversion of T to Estrogen correspondingly increases.  This causes an unfavorable E:T ratio which equates to low T.
Vitamin D is primarily known to help bone health and for its role in calcium-phosphorous homeostasis—but a new study found it also improves erectile dysfunction. Men who received vitamin D supplements showed increased testosterone levels and improved erectile function, researchers reported. The trial included only 41 men, so a larger study is needed to confirm the results. But what mechanism might be behind vitamin D's erectile effect? Click here to find out.
According to the Centers for Disease Control and Prevention, ingesting levels of zinc in excess of the recommended dietary amount will result in diarrhea, vomiting, and stomach cramps. The maximum amount of daily zinc consumption recommended is 40 milligrams per day. Symptoms of too much zinc intake include nausea and headaches. If you have reason to suspect you have ingested too much zinc, contact a medical professional.
Does drinking water improve erectile dysfunction? Erectile dysfunction or ED is a common concern for men. Everyday factors, such as hydration levels, may affect a person's ability to get or maintain an erection. Drinking water may, therefore, help some men with ED. In this article, learn about the link between hydration and ED, and other factors that can cause ED. Read now
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