Erectile dysfunction (ED) affects 50% of men older than 40 years,  exerting substantial effects on quality of life.  This common problem is complex and involves multiple pathways. Penile erections are produced by an integration of physiologic processes involving the central nervous, peripheral nervous, hormonal, and vascular systems. Any abnormality in these systems, whether from medication or disease, has a significant impact on the ability to develop and sustain an erection, ejaculate, and experience orgasm.
If you have unstable heart disease of any kind, heart failure or unstable, what we call angina, contraindication to using the medications. All right? So if you’re in an unstable medical state, these medications are not a good idea. Now, there are relative issues. If you may be taking a blood pressure medicine or a medicine for your prostate which dilates your blood vessel a little bit– you know, the typical ones are what we call the alpha blockers– you may have an additive effect from the medication. But for the most part, the medicines are incredibly safe.
For obvious reasons, ED can be a sensitive subject, one that until relatively recently men were more likely to try to hide than to deal with. Fortunately, a deeper understanding of the variety of causes of erectile dysfunction has led to medications, therapies, and other treatments that can be more individualized and more likely to be effective—and more open discussion about addressing the concern.
Exercise and lifestyle modifications may improve erectile function. Weight loss may help by decreasing inflammation, increasing testosterone, and improving self-esteem. Patients should be educated to increase activity, reduce weight, and stop smoking, as these efforts can improve or restore erectile function in men without comorbidities. Precise glycemic control in diabetic patients and pharmacologic treatment of hypertension may be important in preventing or reducing sexual dysfunction. 
Another thing that people should do after reading this article and learning how to treat impotence at home naturally is that you should read another article which also helps to cure the erectile dysfunction issue – the Home Remedies For Erectile Dysfunction – the entire collection of other home remedies that are proven useful and work well for males suffering from the erectile dysfunction problem. The remedies contained in this article have already successfully cured a lot of cases from mild to moderate without leading to any unwanted side effect so that readers should read the article I recommended above and also make use of the treatments it reveals to overcome this sexual issue with ease and without losing too much time, money, and effort.
The PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally.: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. Penile injections, on the other hand, can involve one of the following medications: papaverine, phentolamine, and prostaglandin E1, also known as alprostadil.:25
In order to establish whether normal erections are occurring overnight (nocturnal erections), the doctor may organise nocturnal penile tumescence (NPT) testing. This involves wearing a monitor overnight in your own home. The data from this monitor is then assessed to analyse how often erections occurred, how long they lasted, and how rigid and large the penis was during the erections. If NPT testing is normal, the cause of erectile dysfunction is usually psychological. If not, further testing of the blood flow in the genital area may be required to see if there is blockage or leakage. The doctor may also organise a blood test of levels of hormones such as testosterone, prolactin and thyroid stimulating hormone to see if these are contributing to the erectile dysfunction.
Oral medicines: The best known ED medications are the Big Three: Viagra (sildenafil citrate, made by Pfizer, Inc.), Levitra (vardenafil HCl, made by Bayer and GlaxoSmithKline), and Cialis (tadalafil, made by Eli Lilly). The three are chemically very similar, and all have proven very effective. Because they are effective, convenient, and relatively inexpensive (about nine dollars per pill), these medicines have become the treatment of choice for most men experiencing ED.
In a prospective study from the Prostate Cancer Prevention Trial database, Thompson et al reported that men presenting with ED had a significantly higher chance of developing a cardiovascular event over a 7-year follow-up period.  The hazard ratio was 1.45, which is in the range of risk associated with current smoking or a family history of MI.
Dr Kenny du Toit is a urologist practicing in Rondebosch, Cape Town. He is also consultant at Tygerberg hospital, where he is a senior lecturer at Stellenbosch University. He is a member of the South African Urological Association, Colleges of Medicine South Africa and Société Internationale d’Urologie. Board registered with both the HPCSA (Health professions council of South Africa) and GMC (General medical council UK). He has a keen interest in oncology, kidney stones and erectile dysfunction.http://www.dutoiturology.co.za
Alteration of NO levels is the focus of several approaches to the treatment of ED. Inhibitors of phosphodiesterase, which primarily hydrolyze cGMP type 5, provided the basis for the development of the PDE5 inhibitors. Chen et al administered oral L-arginine and reported subjective improvement in 50 men with ED.  These supplements are readily available commercially. Reported adverse effects include nausea, diarrhea, headache, flushing, numbness, and hypotension.
Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley dropped his trousers and demonstrated to a shocked Urodynamics Society audience his papaverine-induced erection. The drug Brindley injected into his penis was a non-specific vasodilator, an alpha-blocking agent, and the mechanism of action was clearly corporal smooth muscle relaxation. The effect that Brindley discovered established the fundamentals for the later development of specific, safe, and orally effective drug therapies.[better source needed][better source needed]
DR WONDERS HERBAL CREAM HELPED ME TO ENLARGE MY PENIS SIZE FROM 3.5 INCHES TO 10 INCHES WITHIN TWO WEEKS OF TREATMENT hello everyone in this forum i am a bit ashamed to share this story about a great DOCTOR called DR WONDERS who helped me enlarge my small penis size through his herbal mixture cream,i was heartbroken before because i have a very small penis about 3.5 inches which was so annoying and shameful i could not satisfy my wife in bed ,,my marriage was really breaking and i needed help urgently,i have used pills,vaccines,drugs,surgery but none worked...so one faithful day as i was browsing through the internet i saw few comments on a forum about DR WONDERS and how He helped Mr MARK from UK to enlarge his penis and also cured his MOM diabetes type 2 disease,,i contacted him through his email drwondersenlargementhome.... he replied and gave me steps to follow and i did just as he said ,and he sent me the herbal cream to me through UPS and i received it within 4 days and i used the herbal cream for just 14 days to my greatest surprise my penis that was 3.5 inches before enlarge to 10 inches long when fully erected ,for just two weeks of using his herbal mixture cream ,,wow my wife loved me more and was so happy that i can satisfy her very well now in bed ,,i even last longer than 2hours in bed. thank you so much DR WONDERS for making life a better one to live in ..so if you are out there having similar problems please contact him now on his email drwondersenlargementhome..... or you can also whatsapp or call him on his mobile number +2347036517871 contact him now and all your problem shall be solve...
Phosphodiesterase type V inhibitors (PDE-5 inhibitors) are the most commonly used therapy for erectile dysfunction. These medications work by preventing the breakdown of chemicals that stimulate increased blood flow into the penis. Several different PDE-5 inhibitors are available, which differ slightly in how to use them and their side effects. They appear to be equally effective in the treatment of erectile dysfunction in general, but some individuals may respond to one of these medications more effectively than another.
Research has even found possible links to frequent ejaculation and a lower risk of prostate cancer. In one study of 32,000 men published in 2016 in the journal European Urology, for example, men who ejaculated at least 21 times per month while in their 20s were less likely to be diagnosed with prostate cancer than those who ejaculated four to seven times per month. And men who ejaculated more often in their 40s were 22 percent less likely to get a prostate cancer diagnosis.
The great majority of ED cases in diabetic men have a physical cause, such as neuropathy or circulatory problems. In some cases, however, the cause of ED is psychological, including depression, guilt, or anxiety. With a thorough exam, the doctor should be able to determine whether the ED is psychological or physical in nature. If the cause is psychological, your doctor may refer you to a psychiatrist, psychologist, sex therapist, or marital counselor. Do not view such a diagnosis as an insult. Most psychologically-based ED is easily and successfully treated.
Get past your dislike of the doctor's office. Millions of men who experience erectile dysfunction (ED) each year are too embarrassed to talk about it with their doctor. ED is a very common disorder, but it is not considered to be a "normal" part of aging. ED is often a signal that there is an underlying problem that needs to be treated. Before attempting to overcome ED on your own, it's very important to make an appointment with your doctor and clear up any other issues that might be affecting your ability to sustain an erection.
Erectile dysfunction (ED) is one of the most common conditions affecting middle-aged and older men. Nearly every primary care physician, internist and geriatrician will be called upon to manage this condition or to make referrals to urologists, endocrinologists and cardiologists who will assist in the treatment of ED. This article will briefly discuss the diagnosis and management of ED. In addition, emerging concepts in ED management will be discussed, such as the use of testosterone to treat ED, the role of the endothelium in men with ED and treating the partner of the man with ED. Finally, future potential therapies for ED will be discussed.
What happens is that the blood vessels of the penis are rather small, and a small amount of plaque in the penile arteries is going to result in erectile dysfunction. You need more plaque before the person’s actually symptomatic from a heart problem, but they’re linked. And so when anybody, any man has an erectile issue, it’s incumbent upon the physician to make certain that their cardiac status is healthy.
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.
Thinking about sex creates a burst of dopamine, which is a brain chemical that’s linked to excitement, motivation and pleasure. It also plays a crucial role in helping you to get an erection! In a man who is bored with or indifferent about sex, thinking about the act is unlikely to be accompanied by that dopamine burst, making it likely that the man will experience erectile dysfunction.