Chewable viagra online

Extensive investigations are not usually justified.

History A careful history, including a drug history, will usually differentiate organic from psychogenic impotence.

Drugs that are commonly associated with sexual dysfunction include antihypertensives (including diuretics), cimetidine, major tranquillisers and most antidepressants.

Organic impotence generally has a gradual, insidious onset with progressive worsening until no erection is obtained. At first, there may be loss of rigidity and/or difficulty sustaining an erection.

Organic impotence is evident consistently in all situations, whether during attempted intercourse with his regular or another partner, masturbation or in response to erotic stimuli.

Nocturnal erections are markedly diminished and this manifests as a loss of erections on waking.

Psychogenic impotence is more likely to have an abrupt onset.

This is often related to a distinct precipitating event (e.g. a psychologically traumatic episode of sexual failure). The impotence is often inconsistent, occurring only in certain situations. Nevertheless, organic impotence usually invokes a secondary psychological overlay which may complicate evaluation of the aetiology.

This underlines the need for a careful, unhurried approach and empathy during history taking. Androgen deficiency causes more loss of libido than erectile dysfunction.

It is unusual for men complaining of impotence to have androgen deficiency as a cause of their sexual dysfunction.

This is in contrast to the low sexual activity of androgen-deficient men which often causes them little concern. Physical examination Evidence of possible causative factors (e.g. diabetes, pituitary disease, lipid disorders, vascular or neuropathic disease, androgen deficiency) should be sought systematically.

Gonadal status (secondary sexual characteristics, testis size) and visual field defects suggesting pituitary tumour should be assessed.

Altered peripheral pulses and neurological reflexes in the viagra 50 mg tablet online legs can be evidence of vascular or neurological disorders.

Investigation Few investigations of erectile dysfunction lead to specific interventions, so extensive testing cannot be justified in routine practice. Specific correctable underlying causes such as androgen deficiency or pituitary tumour should be sought, even though they are rare. Their treatment may be gratifying and has implications for general health (e.g.

general energy and well-being, risk of osteoporosis).

Serum prolactin, testosterone and luteinising hormone (LH) should be measured and repeated if any is abnormal.

If consistently abnormal, further investigations are required. Although treatment of diabetes or hyperlipidaemia may not improve erectile function, they should not be overlooked.

Apart from measurement of penile blood pressure which may exclude or confirm a vasculogenic basis, other complex investigations are not

usually

Sleep studies with or without determination of nocturnal penile tumescence are not usually justified clinically.

They add information which usually does not influence management. Management The success of most commonly-used therapies will depend on co-operation of the partner. It is important to determine the partner's attitudes to the problem and involve them in discussions of treatment options.

Men who do not have a regular or supportive partner rarely do well with therapies which necessitate treatment at the time of intended intercourse. Psychotherapy A psychological reaction to persistent erectile failure is almost inevitable and universal. This complicates the identification of primarily psychogenic impotence so it is essential to have an insightful and empathetic manner to manage erectile dysfunction effectively.

Even when erectile dysfunction is primarily organic, appropriate counselling provided by the patient's doctor can be reassuring if adequate time is made available. Psychogenic impotence can be improved with the help of an experienced psychiatrist or psychologist.

This psychotherapy requires a supportive and understanding partner willing to participate in couple-oriented behavioural sessions. In some men with psychogenic impotence, a limited trial of empirical intracavernosal therapy may break the self-reinforcing cycle of performance anxiety and failure. This may restore their confidence in the ability to obtain an adequate erection.

Mechanical devices Vacuum erection devices These external devices create a vacuum to induce an erection.

This is then maintained by a thick rubber band placed tightly at the root of the penis. They have a modest role in the treatment of men in whom intracavernosal injection therapy is contraindicated (e.g. These devices have modest efficacy and are suitable mainly for men with psychogenic or partial organic impotence.

Their efficacy and acceptability are limited in men with severe neurovascular impotence.

Apart from occasional penile bruising, they are generally safe if the duration of each use is limited.

Compared with penile implants or long-term intracavernosal injections, their cost is low. Implants Surgical penile implants are an expensive last resort when simpler measures (such as psychotherapy, vacuum devices or intracavernosal injections) are ineffective or inappropriate.

As most cavernosal tissue is excised, the procedure is functionally irreversible.

It is justified only for men with complete organic impotence. Devices vary in complexity from simple semi-rigid rods to fully inflatable with an implanted reservoir.

Satisfaction with the implants is variable, but depends on thorough pre-surgical counselling and close involvement of the partner. Complications include infection, mechanical failure and erosion. Hormonal treatment Treatment with testosterone should never be given without clear evidence of androgen deficiency.

1 Once testosterone starts, the endocrine investigations become confusing and it can take many months to clarify the patient's requirement for ongoing therapy. Furthermore, testosterone therapy has a significant placebo effect in eugonadal men with psychogenic impotence.

Unlike genuine androgen deficiency, such men generally have an inconsistent and poorly maintained response to testosterone treatment.

This further confuses the diagnosis and leads to frustration and disappointment for the patient.

A borderline low plasma testosterone is rarely significant in otherwise healthy men presenting with erectile difficulty, particularly if the plasma LH is normal.

Patients with hyperprolactinaemia require evaluation for a prolactinoma and their management is dictated by the pituitary tumour.

For microprolactinomas, bromocriptine treatment alone can be effective.

The more common macroprolactinomas usually require surgery, sometimes with adjuvant radiotherapy.

Intracavernosal therapy Due to the lack of specific treatments for most causes of erectile dysfunction, intracavernosal injections are in

wide

The original drug used for intracavernosal therapy was papaverine, a smooth muscle relaxant, often supplemented with phentolamine, an alpha adrenergic blocker. Neither is registered for treatment of erectile dysfunction in any country. Despite the wide ad hoc usage of these two drugs and their combination, there is little reliable information on their efficacy or safety.

Indeed, there is doubt that these combinations are chemically compatible, stable or sterile under the usual circumstances of use.

The main reason for the preference for prostaglandin E 1 over the papaverine or papaverine/phentolamine combination is that these older drugs are believed to have a higher incidence of priapism and long-term penile fibrosis. The use of 3 or 4 drug cocktails represents shotgun therapy which is contrary to sound pharmacological principles.

Prostaglandin E 1 Prostaglandin E 1 has the most extensive efficacy and safety record, making it the current drug of choice. It relaxes the smooth muscle of the corpora cavernosa, resulting in a dose-dependent increase in penile blood inflow and tumescence.

The magnitude of the blood flow and erectile response varies between individuals and according to the pathology.

The usual starting dose of prostaglandin E 1 is 2.5-5 micrograms. Generally, men with vasculogenic impotence require higher doses than those with neurogenic or psychogenic impotence.

The optimal dose for each patient varies considerably and must be individually titrated by progressively increasing the dose (up to a maximum of 30 micrograms) with successive test injections until an adequate response is achieved.

In practical terms, this is defined as an erection firm enough for penetration and lasting from 20-60 minutes. The first injection (at least) should be given under the direct supervision of a doctor and the patient subsequently taught how to self-inject.

It is not sufficient just to send the patient home with a prescription and diagram on how to self-inject any more than it is appropriate to ask a diabetic to start insulin self-injection without careful instruction and supervision.

Intracavernosal therapy should generally be supervised by a doctor with appropriate experience. If an inadequate response is achieved with maximal prostaglandin E 1 dosage, combination therapy with papaverine alone or with phentolamine has been reported to improve the response. Reliable clinical trials of such add-on therapy are lacking.

The risk of adverse effects (priapism, fibrosis, hepatotoxicity, hypotension) is higher with such multi-drug regimens.

In addition, the chemical compatibility, stability and sterility of these ad hoc mixtures is not assured.

The most frequent adverse effect of prostaglandin E 1 intracavernosal therapy is penile or perineal

pain

Some chewable viagra online pain occurs after approximately 20% of injections, but is rarely ( Erectile dysfunction treatment.

When Roman started, 80% of Viagra sold online was counterfeit.

It became our mission to make it safe and simple for people to get medication they can trust from a licensed pharmacy, prescribed by a real, US-licensed healthcare professional.

Erectile dysfunction is the inability to get or maintain an erection adequate for sex.

There are many different causes, but ED ultimately occurs when there is too little blood flow into the penis and too much blood flow out, partially due to an enzyme called PDE5.

Oral ED medications block PDE5 to increase blood flow into the penis and decrease blood flow out. ED medication interferes with the breakdown of chemicals required to obtain and maintain an erection. This interference keeps more of those chemicals in action longer, improving the ability to get and maintain an erection. A physician in our network will evaluate whether ED treatment is appropriate for you. If prescribed, we’ll ship it to you in discreet, chewable viagra online unmarked packaging.

Do not use Viagra/sildenafil if you aren’t healthy enough for sex or if you take nitrates for chest pain. Side effects may include headache, flushing, upset stomach, nasal congestion and abnormal vision. To avoid injury, seek immediate attention if you have an erection lasting longer than 4 hours.

Stop taking Viagra/sildenafil and seek care if you experience a sudden loss or decrease in vision or hearing.

Do not use Viagra if you aren’t healthy enough for sex or if you take nitrates for chest pain. Side effects may include headache, flushing, upset stomach, nasal congestion and abnormal vision. To avoid injury, seek immediate attention if you have an erection lasting longer than 4 hours. Stop taking Viagra and seek care if you experience a sudden loss or decrease in vision or hearing.

Do not take Cialis if you aren’t healthy enough for sex or if you take nitrates for chest pain. Side effects may include headache, upset stomach, delayed backache, or muscle ache.

To avoid injury, seek immediate attention if you have an erection lasting longer than 4 hours. Stop taking Cialis and seek care if you experience a sudden loss or decrease in vision or hearing or if you experience an allergic reaction like rash, hives, swelling of the lips, tongue or throat, or difficulty breathing or swallowing.

To learn more about Cialis, please see the Important Safety Information.

Sildenafil & Viagra manufactured by Pfizer in France.

A physician in our network will evaluate which (if any) ED treatment is appropriate for you. Then we’ll ship it to you in discreet, unmarked packaging.

Many people get great results the first time they use the medication. For some, it can take 2-3 uses to see results, and research shows that best

results

If you still don’t see results, your doctor or nurse practitioner may be able to increase your dose or switch you to a different medication. If you experience side effects, message your doctor or nurse practitioner and they’ll help determine if a different medication or dose is better for you. Sexual health and overall health are inherently related. If erectile dysfunction is interrupting your sex life, your general wellbeing (and that of your partner) is impacted greatly. Report your symptoms and medical history to a U.S.-licensed physician or nurse practitioner for evaluation. Your treatment will be sent in discreet packaging, always with free 2-day shipping. Send your doctor or nurse practitioner a message any time to discuss updating your treatment, solving for side effects, or any other questions or concerns. For more information about erectile dysfunction, Roman, Ro and more, visit our FAQ page.

To speak to a care representative, give us a call at (888) 798-8686 or email us at [email protected] .

Roman uses telemedicine technology to provide a discreet, convenient, and affordable way for you to receive erectile dysfunction treatment from a U.S.

Complete the dynamic onboarding, submit your photo, ID, and recent blood pressure reading, and our physicians will determine if you’re a candidate for telemedicine. Erectile dysfunction is often a symptom of a more serious underlying condition—like heart disease, diabetes, high blood pressure, or even depression. That’s why we strongly recommend optional laboratory tests. These tests aren’t required to receive treatment on the Roman platform. But they help identify the underlying cause of your ED. We want you to get the most comprehensive treatment possible. Just send us your most recent blood test and we’ll add it to your account information to help our physicians give you the most comprehensive care from the convenience of your phone.It might sound funny but regular erections are a great barometer of your overall health.

Learn why paying attention to the strength and frequency of your erection might actually save your life.

Which medications do doctors and nurse practitioners on the Roman platform prescribed for ED? The American Urological Association claims that oral PDE-5 inhibitors should be offered as the “first line of therapy for erectile dysfunction.” So that’s what we do.

Physicians on the Roman Platform prescribe the most common PDE-5 oral medications which include: sildenafil (Viagra) and tadalafil (Cialis) Is ED medication effective? Viagra’s FDA approved prescribing information claims that “82% of patients reported an improvement in their erections.” Other PDE-5 inhibitors (Cialis, Levitra) showed similar results.

Oral ED medication is generally considered extremely effective and studies show it works on the majority of men. It’s important to note that everyone’s reaction to a medication is unique.

Your Roman physician may recommend trying the medication multiple times under different circumstances. They may also increase your dose, depending on your reaction to the medication and any side effects.

If you’ve been prescribed ED medication on the Roman platform, please contact a physician on from your account page if you have any questions.

Can a doctor or nurse practitioner diagnose erectile dysfunction remotely? Erectile dysfunction can be diagnosed by a physician based on a patient self-reporting their symptoms and medical history. Physicians on the Roman platform use telemedicine technologies to diagnose ED in the same way they diagnose patients in-person. Doctors ask you questions to evaluate your symptoms and make sure it’s safe and appropriate to prescribe ED medication.

The physicians on the Roman platform use your answers to diagnose your condition and create a treatment plan. That’s why it’s vital you answer each question to the best of your knowledge and

ensure

Why do I need to know my blood pressure to get an ED prescription?

Your blood pressure is an important part of determining whether it’s safe for you to take ED medication. It can be dangerous to take ED medication if your blood pressure is above or below a certain value.

To complete a comprehensive medical

history

If you haven’t had your blood pressure taken within the last 6 months, you can get a free blood pressure reading at thousands of locations across the country. Enter your location into higi or Pursuant Health to find a place near you that offers free, clinically verified blood pressure readings.

If you’re measuring your blood pressure at home, make sure the device has been “clinically validated.” You can purchase a device online or at your local pharmacy.

We recommend an upper arm cuff over a wrist or finger blood pressure monitor.

Before taking your blood pressure, it’s important to avoid the following factors that may cause your blood pressure to temporarily rise: Cold temperatures Exercise Caffeine Stress Smoking Certain medications (check the label on your device) When you’re ready, find a quiet place and sit for 5-10 minutes.

Make sure you’re relaxed and have recently urinated (a full bladder can affect your reading).

Apply the cuff on your upper arm and following the directions on the device.Please make sure to take at least two readings. Enter the higher of sildenafil citrate tablets online purchase the two readings during your online dynamic visit. Do you offer alternative treatments for erectile dysfunction? Oral ED medications are extremely effective, but they don’t work for everyone.

Other treatment options for ED include lifestyle improvements (like exercise, diet, quitting smoking, and limiting alcohol use), surgery, penile vacuum pumps, and other ED medications. Every treatment comes with risks and benefits that you should fully understand before moving forward with any treatment plan. Currently, the only erectile dysfunction treatment we offer are oral PDE-5 inhibitors in the form of: If you’d like to pursue alternative ED treatment, we recommend speaking with a physician in-person. Contact our team at [email sildenafil citrate 100mg tab online protected] and we can recommend a doctor in your area. Orders ship in discreet boxes, with all medication in single use packs.

Child proof packaging is available upon request by emailing [email protected] Orders are shipped 2-day air to ensure medication is received as soon as possible.

Postal boxes and mail forwarding addresses will receive standard postal shipping and not 2-day air at this time. Where can I get my blood pressure measured for free?

Enter your location into higi or Pursuant Health to find the nearest location to get a free, clinically verified blood pressure reading. Higi Stations are available free of charge at Rite Aids nationwide, and Pursuant Health stations are available free of charge at Walmarts nationwide. According to the American Urological Association, oral PDE-5 inhibitors should be offered as the “first line of therapy for erectile dysfunction.” So that’s what physicians on the Roman platform use to treat ED. The most common PDE-5 oral medications they prescribe are: Sildenafil (Viagra) Sildenafil (sildenafil) Tadalafil (Cialis) From treating specific conditions to helping you tackle life-threatening addictions and supporting your body’s natural systems.

Starting at $35/Month* Starting at $25/Month* Starting at $15/Month* *Shipped & billed quarterly. Final price depending on prescribed treatment plan.

From receding hairlines, to thinning hair, to breakouts, to fine lines or wrinkles—tell us what’s bothering you so we can help. Starting at $31/Month* Starting at $22/Month* Starting at $29/Month* *Shipped & billed quarterly. Final price depending on prescribed treatment plan.

Get discreet and genuine prescription medications (if prescribed) or over-the-counter treatment delivered in unmarked packaging. Erectile dysfunction Premature ejaculation Hair loss Cold sores Genital herpes Heart Health Bone Health Stress Relief Prostate Health Testosterone Support Weight management Allergies Nightly Defense skincare Eczema Dandruff Excessive sweating (hyperhidrosis) About Roman. How it works Our story Our medical advisors Our network physicians Transparency Member stories Health Guide Press Careers.

Roman-affiliated physician practices are independently owned and operated by licensed physicians who provide services utilizing the Roman telehealth platform.

Major League Baseball trademarks and copyrights are used with permission of Major League Baseball. Erectile dysfunction Premature ejaculation Cold sores Genital herpes. Hair loss treatment Nightly Defense skincare Eczema Dandruff Excessive sweating (hyperhidrosis) Daily health.

Allergies Heart health Bone health Stress relief Prostate health Testosterone support.

Sildenafil 20mg (generic revatio) Read this Patient Information before you start taking sildenafil 20 mg (Revatio) and each time you get a refill. This information does not take the place of talking with your doctor about your medical condition or treatment.

If you have any questions about sildenafil, ask your doctor or pharmacist.

What is the most important information I should know about sildenafil 20 mg tablets (Revatio)? Your blood pressure could drop quickly to an unsafe level.

Nitrate medicines include: Medicines that treat chest pain (angina) Nitroglycerin in any form including tablets, patches, sprays, and ointments Isosorbide mononitrate or dinitrate Street drugs called “poppers” (amyl nitrate or nitrite) Ask your doctor or pharmacist if you are not sure if you are taking a nitrate medicine. 20 mg sildenafil is a prescription medicine used in adults to treat pulmonary arterial hypertension (PAH).

With PAH, the blood pressure in your lungs is too high. Your heart has to work hard to pump blood into your lungs.

It improves the ability to exercise and can slow down worsening changes in your physical condition.

Sildenafil is not for use in children Adding sildenafil to another medication used to treat PAH, bosentan (Tracleer®), does not result in improvement in your ability to exercise.