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A prosthetic urologist can provide patients with a complete evaluation or work up and

provide

Regardless of age or health condition, it is important to remember that men are not alone. Erection Problems (Erectile Dysfunction) Topic Overview. A man has erection problems if he cannot get or keep an erection that is firm enough for him to have sex.

Erection problems are also called erectile dysfunction or impotence. Most men have erection problems every now and then.

But they are more common in older men, who often have other health problems.

These include: Physical problems, such as injury to nerves or loss of blood supply to the penis . Other health problems, such as diabetes , high blood pressure , anxiety , and depression . The only symptom of an erection problem is being unable to get and keep an erection that is firm enough to have sex.

But even with an erection problem, a man may still have sexual desire and be able to have an orgasm and to ejaculate. Your doctor can find out if you have an erection problem by asking questions about your health and doing a physical examination.

Your doctor will want to know how often the problem happens. The examination, lab tests, and sometimes mental health tests can help find out the cause of the problem.

Doctors usually start with lifestyle changes and medicines.

They usually don't advise surgery or other treatments unless those

first

Treatment can include: Avoiding tobacco and drugs and limiting alcohol. Talking about the issue with your partner, doing sensual exercises, and getting counselling. Finding and then stopping medicines that may be causing the

problem

These include pills such as sildenafil (for example, Viagra), tadalafil (for example, Cialis), and vardenafil (for example, Levitra). Check with your doctor to see viagra 50 mg tablet buy online if it is safe for you to take one of these medicines with your other medicines. These pills can be dangerous if you have heart disease that requires you to take nitroglycerin or other medicines that contain nitrates.

Taking medicines and getting counselling for depression or anxiety.

Using vacuum devices or getting shots of medicine into the penis.

Erection problems are most often caused by a physical problem. So it's important to eat healthy foods and get enough exercise to help you stay in good health. To reduce your risk of having an erection problem, don't smoke, drink too much alcohol, or use illegal drugs.

You may be able to avoid erection problems related to anxiety and stress by talking with your partner about your concerns.

Health Tools help you make wise health decisions or take action to improve your health.

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Erection problems may be caused by physical problems related to the blood vessels, nerves, and hormones.

Normally, an erection occurs when your imagination or senses (vision, hearing, touch, smell, taste) are stimulated and you become aroused.

Your central nervous system sends nerve impulses that increase blood flow to your penis. Physical problems cause about 8 out of 10 cases of erectile dysfunction.

Physical problems are often the cause of erection problems in men age 50 or older. They include: Side effects of medicines, including some medicines used to treat benign prostatic hyperplasia (BPH), depression, and prostate cancer.

In some cases it may be possible to change the dose of the medicine or to use another medicine.

Stopping or reducing the use of these substances may make the erection problem less severe.

These problems may prevent blood from filling the penis or from staying there long enough to maintain an erection. For example, long-term high blood pressure can cause damage to blood vessels and lead to erection problems. These may prevent arousal signals from travelling from the brain and spinal cord to the penis.

Nerve disorders such as Parkinson's disease , Alzheimer's disease , multiple sclerosis , and stroke may interfere with a man's ability to have an erection.

Nerve damage from diabetes, complications from surgery, and spinal cord injury also may cause problems. Problems with the structure of the penis or its

surrounding

Hormonal factors, such as a low level of the hormone testosterone . Pelvic injuries and complications of prostate or other surgeries that interfere with nerve impulses or blood flow to the penis.

Psychological issues seem to be involved in many cases of erection problems.

These mental issues include: Depression (which also has a physical component). These things interfere with the erection process by distracting the man from things that would normally arouse him.

Erection problems in men younger than 40 who have no physical risk factors are more likely to be caused by mental factors than physical causes. Symptoms of erection problems include being unable to: Have an erection, most of the time. Keep an erection firm enough for sexual intercourse.

Keep an erection long enough to complete sexual intercourse.

Even with an erection problem, a man may still have sexual desire and be able to have an orgasm and to ejaculate.

But when erection problems are lasting, they can affect your self-image, sex life, and relationship.

When you have erection problems often, "performance anxiety" can make the problem worse.

If you cannot keep an erection that is firm enough for intercourse, or if you have an orgasm before or right after entering your partner ( premature ejaculation ), you may feel frustrated and believe you aren't pleasing your partner.

All of these things could affect how you view your relationship. Fortunately, many of the things that cause erection problems can be treated.

Your risk of having an erection problem increases with age. Other things that increase your risk include: Diseases that affect blood vessels, such as diabetes, high blood pressure, and high cholesterol. About half of men with diabetes develop erection problems.

These include multiple sclerosis and Parkinson's disease.

Other health problems, such as low testosterone levels. Injuries to the pelvic area, a spinal cord injury, or treatment such as pelvic surgery or radiation in the pelvic area.

Using substances, such as long-term (chronic) alcohol abuse.

Psychological risk factors, such as depression or a recent life change.

Activities that constrict blood flow to the penis may increase the risk for erection problems. For example, frequent long-distance bicycle riding on a hard, narrow saddle may increase risk.

But the possible link between bike riding and erection problems has not been proved. A vasectomy usually doesn't cause erection problems.

But pain after the operation may affect sexual performance for a time. And if a man

wasn

Call your doctor now or seek medical care right away if: You have an erection that lasts longer than 3 hours. You have taken sildenafil (for example, Viagra) viagra without a doctor prescription paypal or vardenafil (for example, Levitra) in the past 24 hours or tadalafil (for example, Cialis) in the past 48 hours, and you have chest pain. Make sure all the doctors you see know that you took one of these medicines. You have erection problems that occur along with pain or difficulty with getting viagra from doctor urination, fever, or pain in the lower belly.

Call a doctor if erection problems occur: With any type of injury to the back, legs, buttocks, groin, penis, or testicles. With other symptoms such as loss of hair, enlargement of the breasts, or backache. If your erection problem happens just now and then, there is no

reason

If it happens often and upsets you or your partner, it is okay to call your doctor.

If an erection problem doesn't bother you or your partner, you may choose not to call your doctor.

A single episode of an erection problem is often a temporary problem that is easy to reverse. Try to forget about it, and expect a more successful experience the next time. If you or your partner is concerned about it, talk about the problem. If self-care has not helped after 2 weeks and you are concerned about your erection problem, see a doctor who has experience in dealing with these problems.

Your family doctor or general practitioner can evaluate symptoms of erection problems.

You may be referred to an internist or a urologist , depending on what may be causing your erection problem.

If it is possible that a psychological problem is contributing to your erection problem, your doctor may refer you to a health professional such as a: Psychiatrist . Counsellor with special training in sexuality or relationship problems.

Because both physical and mental factors are often involved, it may be difficult to diagnose the exact cause of your erection problem. To start, your doctor may: Review your risk factors for an erection problem. Do a complete physical examination of the abdomen, penis, prostate,

rectum

Prolactin, follicle-stimulating hormone, and luteinizing hormone. If you have low testosterone levels, your doctor may recommend these blood tests. A thyroid hormone level that is too high or too low may cause problems with sexual desire or erections.

A high blood sugar level may mean the presence of diabetes , which can contribute to erection problems. At this point, pills such as sildenafil (for example, Viagra), tadalafil (for example, Cialis), and vardenafil (for example, Levitra) are often recommended unless an easily treated cause (such as a medicine side effect or testosterone deficiency) has been identified.

If pills don't work or if your doctor feels more testing is needed, he or she may recommend: Specific tests for erection problems.

These tests help find out whether physical or mental factors are causing your erection problem. A psychological

evaluation

The cause may be mental, physical, or a combination of both. Many doctors take a step-by-step approach to treating erection problems. The treatment steps are: Looking for and then stopping medicines that may be causing your condition. Trying testosterone or another treatment to fix a hormone problem if tests show you have one.

Trying pills called PDE-5 inhibitors, such as sildenafil (for example, Viagra), tadalafil (for example, Cialis), and vardenafil (for example, Levitra). Trying counselling if a psychological

cause

Trying medicines that are injected or inserted into the penis. Erection Problems: Should I Try Injection Treatments?

If you are taking nitrate-containing

medicines

You also should not take certain alpha-blockers—used to lower blood pressure and to treat an enlarged prostate gland —with these medicines.