Legal generic viagra

The good news is that ED can often be treated safely and effectively.

Feeling embarrassed about ED may prevent many men from getting the medical attention they need.

This can delay diagnosis and treatment of more serious underlying conditions. ED itself is often related to an underlying problem such as heart disease, diabetes, liver disease, or other health conditions.

Talk with your healthcare provider if you have problems with ED. Erectile dysfunction (ED) or impotence means you can’t get an erection. It can also mean you are not happy with the size or hardness of erections, or how long erections last.

Mental health problems, physical problems, certain diseases and health conditions, certain prescription medicines, and lifestyle choices have all been linked to ED.

Physical and psychological exams are a key part of diagnosing ED. Lab tests done on urine and blood may also be used.

Treatments are based on the cause of the problem and can range from lifestyle changes to prescription medicines to penile implants.

ED can be a strain on a couple, and many times the man’s partner is involved in the diagnosis and treatment of ED.

Tips to help you get the most from a visit to your healthcare provider: Know the reason for your visit and what you want to happen.

Before your visit, write down questions you want answered.

Bring someone with you to help you ask questions and remember what your provider tells you. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests.

Also write down any new instructions your provider gives you.

Know why a new medicine or treatment is prescribed, and how it will help you.

Ask if your condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could

mean

Know how you can contact your provider if you have questions. Erectile dysfunction (impotence) affects many men, mainly as they age.

In some cases it has psychological roots but it can also be an early indication of other conditions, particularly those relating to blood flow (vascular disease) and the heart.

We offer expert diagnostic advice, rapid access to a range of tests that can help identify the cause.

Erectile dysfunction (or impotence) affects many men – particularly those over 40. Research suggests that up to 45% of men aged between 40 and 70 have some difficulty getting or maintaining an erection (source: Journal of Urology 2012 May). We understand that suffering with erectile dysfunction can be distressing.

It can undermine your self-confidence and self-esteem and prevent you having a full relationship with your partner.

Although it is often caused by psychological factors, impotence can also be an early warning sign of more serious physical health conditions. We have the skills and expertise to be sensitive to patient privacy and treat you as an individual.

Our expert consultants and experienced multi-disciplinary care teams can help diagnose the causes of your impotence and work with you in agreeing appropriate treatment.

Some of the tests we offer will establish whether your impotence is related to risk factors associated with vascular (blood vessels such as veins and arteries) or cardiac disease.

Knowing the underlying cause(s) of

your

This might include certain treatments such as artery stenting or penile implants.

Recognising the complex factors at play, we’ll draw on the expertise of experienced and caring clinicians from a range of backgrounds and use a variety of tests to identify the causes of your impotence. Working in modern, well-equipped hospitals, they are dedicated to your wellbeing.

Your treatment will be tailored around you, with your choice of location and timing.

We pride ourselves on our clinical excellence, you'll be looked after by an experienced multi-disciplinary care team. A fixed price for this treatment may be available on enquiry and following an initial consultation. Spire Healthcare can provide you with a single, fixed price so there are no surprises. Please read Spire Healthcare's terms and conditions for full details of what’s included and excluded in your fixed price when paying for yourself.

Finance options are available through our partner Omni Capital Retail Finance Ltd , 10 Norwich Street, London, EC4A 1BD.

Our patients are at the heart of what we do

and

To us, that means you can choose the consultant you want to see, and when you want. All of our consultants are of the highest calibre and benefit from working in our modern, well-equipped hospitals.

Our consultants have high standards to meet, often holding specialist NHS posts and delivering expertise in complex sub-specialty surgeries. Many of our consultants have international reputations for their research in their specialised field.

You will have a formal consultation with a healthcare professional.

During this time you will be able to explain your medical history, symptoms and raise any concerns that you might have. We will also discuss with you whether any further diagnostic tests, such as scans or blood tests, are needed. Any additional costs will be discussed before further tests are carried out.

We've tried to make your experience with us as easy and relaxed as possible.

For more information on visiting hours, our food, what to pack if you're staying with us, parking and all those other important practicalities, please visit our patient information pages.

Our dedicated team will also give you tailored advice to follow in the run up to

your

We understand that having any medical tests and procedures, particularly those of a highly personal medical condition, can cause anxiety.

Our professional and caring medical staff will be there to reassure you throughout.

Depending on your clinical history, you may require a blood test or ECG (echocardiogram) both of which are relatively straightforward procedures. If you have previously been unresponsive to standard therapies then you and your consultant may also consider requesting discount viagra sales a doppler ultrasound and pelvic angiogram. Your consultant will discuss the results with you and determine the best course of treatment for you - such as penile stenting or penile implants.

Both the penile stenting and the penile implants will require a hospital stay as a day case patient.

You will be admitted to your private room with en-suite facilities where your privacy will be maximised throughout you stay. The operation for penile stenting is normally performed under local anaesthetic which means you'll be awake but won't feel any pain.

One of our nurses will be with you to provide reassurance and you may be offered sedation to help ensure that you are relaxed and comfortable. The first part of the operation, when your consultant uses X-ray control to guide a catheter to the affected artery, legal generic viagra is very much like an angiogram.

The catheter, a small, thin tube will be inserted through a small cut made in your groin or your wrist. The small balloon is attached to a thin wire which your surgeon will guide to the fatty deposits in the artery with the help of the catheter.

They'll then inflate the tiny balloon to push the fatty deposits against the artery wall so blood can flow more freely. The catheter might also be used to insert a stent (a short wire tube) into the artery to help blood flow freely through the artery over a longer term. You and your doctor can also discuss appropriate treatment or next steps and we will provide with you any advice and information relevant to your particular circumstances.

We will talk to you about the possible risks and complications of having this procedure and how they apply to you. If you have any questions or concerns, we’re ready to help.

The treatment described on this page may be adapted to meet your individual needs, so it's important to follow your healthcare professional's advice and raise any questions that you may have with them.

Erectile Dysfunction (ED) (Impotence) , MD, Sidney Kimmel Medical College of Thomas Jefferson University. 3D Models (0) Audios (0) Calculators (0) Images (1) Lab Test (0) Sidebars (1) Tables (2) Videos (0) Every man occasionally has a problem achieving an erection, and such occurrences are considered normal.

Achieves erection briefly but not long enough for intercourse. ED is called primary if the man has never been able to attain or sustain an erection. ED is called secondary if it is acquired later in life by a man who was previously able to attain erections.

In the United States, about 50% of men aged 40 to 70 are affected somewhat, and the percentage increases with aging. However, ED is not considered a normal part of aging and can be successfully treated at any age. To achieve an erection, the penis needs an adequate amount of blood flowing in, a slowing of blood flowing out, proper function of nerves leading to and from the penis, adequate amounts of the male sex hormone testosterone , and sufficient sex drive (libido), so a disorder of any of

these

atherosclerosis

Certain drugs such as those viagra tablets pharmacy used to treat high blood pressure or an enlarged prostate and those that act on the central nervous system, such as drugs used to treat depression. Occasional inability to achieve an erection is normal and does not mean that a man has erectile dysfunction.

Almost half of men older than 65 and some men older than 80 can usually have erections adequate for penetration.

Low levels of testosterone tend to decrease sex drive rather than cause erectile dysfunction. Combinations of drugs injected into the penis and devices that constrict or apply suction to the penis are highly effective and lack some of the side effects of oral drugs. Sexual counseling can help even when erectile dysfunction has a physical cause.

For example, a man with a slight decrease in erectile function caused by diabetes or peripheral vascular disease can develop severe ED after starting a new drug or if stress increases. Atherosclerosis may partially block blood flow to the legs (peripheral vascular disease).

Usually, arteries to the penis are also blocked, decreasing the amount of blood flow to the penis and causing ED.

Diabetes, high cholesterol levels, high blood pressure, and smoking contribute to atherosclerosis and therefore to ED.

Sometimes blood leaks out of the veins in the penis too fast, decreasing blood pressure in the penis and thus interfering with achieving or maintaining an erection (called veno-occlusive dysfunction).

If the nerves sending messages to the penis are damaged, ED can occur.

In addition to causing atherosclerosis, diabetes can also affect the nerves that supply the penis.

Because legal generic viagra nerves to the penis run along the prostate gland, prostate surgery (such as for cancer or an enlarged prostate) often causes ED. Less common nerve disorders that cause ED include spinal cord injury, multiple sclerosis, and stroke.

Also, prolonged pressure on the nerves in the buttocks and genital area (the so-called saddle area), as may occur during long-distance bicycle riding, can cause temporary ED. Hormonal disturbances (such as abnormally low levels of testosterone ) tend to decrease sex drive but can also result in ED. In Peyronie disease, scar tissue develops inside the penis, resulting in curved and often painful erections and causing ED.

In Peyronie disease, inflammation inside the penis causes scar tissue to form. Because the scar tissue does not enlarge during an erection, the erect penis is curved, making penetration during sexual intercourse difficult or impossible. The scar tissue may extend into the erectile tissue (corpora cavernosa), causing erectile dysfunction.

Drugs, including alcohol and illicit drugs such as cocaine and amphetamines, can also cause or contribute to ED. Sometimes psychologic problems (such as performance anxiety or depression) or factors that decrease a man's energy level (such as illness, fatigue, or stress) cause or contribute to ED. Erectile dysfunction may be situational, involving a particular place, time, or partner.

Prolonged, painful erection (priapism) may damage the erectile tissue of the penis, leading to ED. An occasional episode of erectile dysfunction (ED) is not uncommon, but men who are consistently unable to achieve or maintain an erection should see their doctor because ED may be a sign of a serious health problem, such as atherosclerosis or a nerve disorder. The following information can help men know when to see a doctor and what to expect during the evaluation. In men with ED, certain symptoms and characteristics are cause for concern.

Absence of erections during the night or upon awakening in the morning.

Numbness in the area between and around the buttocks and genital area (called the saddle area) Painful cramping in the muscles of the legs that occurs during physical activity but is relieved promptly by rest (claudication) When to see a doctor. Although ED may diminish a man's quality of life, it is not itself a dangerous condition. However, ED may be a symptom of a serious medical disorder. Because numbness in the groin or leg can be a sign of spinal cord damage, men who suddenly develop such numbness should see a doctor right away. Men who

have

Doctors legal generic viagra first ask

questions

Sexual dysfunction (for example, vaginitis or depression) in the man's partner. Even though men may be embarrassed to talk to their doctors about some of these subjects, the information is important in determining the cause of ED. The physical examination focuses on the genitals and prostate, but doctors also look for signs of hormonal, nerve, and blood vessel disorders and examine the rectum. For example, ED may occur soon after prostate surgery or beginning a new drug. One important clue is whether erections are present at night or on awakening.

When erections are present, a physical cause is less likely than a psychologic cause because physical causes typically inhibit erections at all times.

Other factors that suggest a psychologic cause are sudden development in a young healthy man, occurrence of symptoms only in certain situations, and resolution of ED without any treatment. Claudication or coolness or a blue color in the toes or feet may indicate a problem with the blood vessels such as peripheral vascular disease or vascular disease caused by diabetes. Common Causes and Features of Erectile Dysfunction.

Claudication (painful, aching, cramping, or tired feeling in the muscles of the legs that occurs regularly and predictably during physical activity but is relieved promptly by rest) Usually risk factors (for example, high blood pressure, diabetes, or abnormal blood levels of cholesterol and lipids) Comparison of blood pressures measured in the ankle and arm at the same time (called the ankle-brachial index) Testing for risk factors (for example, elevated blood glucose [sugar] and blood lipid levels) Ultrasonographic measurement of blood flow in the arteries of the penis.

Venous leak (when the veins in the penis cannot prevent blood from leaving the penis during an erection, as they normally do) Erections that occur but cannot be sustained. Ultrasonographic testing of the arteries of the penis.

Nerve damage caused by diabetes (diabetic neuropathy) Sometimes numbness, burning, or other pains of the feet. Sometimes electromyography and nerve conduction studies. Intermittent episodes of weakness or numbness in different parts of the body at different times. Sometimes spinal tap (lumbar puncture) and tests of spinal fluid.

Nerve injury during pelvic surgery or radiation legal generic viagra therapy.

Known surgery (such as radical prostatectomy) or radiation therapy.

Spinal cord disorders (such as tumors or injuries) Numbness in the area between the penis and anus.

Usually other symptoms of spinal cord disorder (for example, numbness and weakness of legs and incontinence) Prolonged pressure in the buttocks and genital area (the so-called free viagra without prescription saddle area), as occurs when riding a bicycle or a horse.

Usually competitive athletes who bicycle for long periods. Prostatitis (inflammation of the prostate) Pain in the pelvic or groin area and bothersome urinary symptoms, such as pain, a burning sensation, blood in the urine, having to urinate frequently, or having difficulty starting to urinate. Hypogonadism ( testosterone deficiency) Loss of sex drive, sleep disturbances, and depression or mood changes.

Eventually, decreases in the size of muscles and testes, bone density, and body hair.

Eventually, an increase in body fat and breast size.

Measurement of the testosterone level in the blood. Round face, increased body fat in the trunk, purple streaks on the abdomen, high blood pressure, and mood changes. Severe hyperthyroidism (thyroid hormone excess) Restlessness, increased heart rate and blood pressure, tremor, weight loss, and inability to tolerate heat.

Measurement of levels of thyroid hormone in the blood.

Severe hypothyroidism (thyroid hormone deficiency) Sluggishness, decreased heart rate and blood pressure, thickened skin, decreased appetite, weight gain, and inability to tolerate cold. Measurement of levels of thyroid hormone in the blood. Peyronie disease (formation of scar tissue in the erectile tissue of the penis) Firm tissue in the penis. Ultrasonography of the penis to

detect

Features mentioned are typical but not always present. If the level is low, doctors measure levels of other hormones. ED = erectile dysfunction; MRI = magnetic resonance imaging. Some Commonly Used Drugs That Can Cause Erectile Dysfunction.

Drugs to treat high blood pressure (antihypertensives) Beta-blockers (such as atenolol , carvedilol , metoprolol , and propranolol ) Diuretics (such as furosemide , hydrochlorothiazide , and chlorthalidone ) Alpha-adrenergic blockers (such as terazosin , doxazosin , tamsulosin , and silodosin ) 5-Alpha-reductase inhibitors (such as finasteride and dutasteride ) Hormonal drugs (such as leuprolide , triptorelin, and goserelin ) Drugs that affect the central nervous system.

Benzodiazepines (such as alprazolam , chlordiazepoxide , diazepam , and lorazepam ) Cocaine or amphetamines, with chronic use. Monoamine oxidase inhibitors (such as phenelzine , selegiline , and tranylcypromine ) Opioids (such as codeine , heroin, hydromorphone , methadone , morphine , or oxycodone ), if used chronically. Selective serotonin reuptake inhibitors (such as citalopram , escitalopram , fluoxetine , paroxetine , and sertraline ) Tricyclic antidepressants (such as amitriptyline , desipramine , imipramine , and nortriptyline ) Androgen antagonists (such as megestrol ) Anticancer drugs (most cancer chemotherapy drugs) Drugs with anticholinergic effects (such as many antihistamines and some antidepressants) Testing.

Laboratory tests include the measurement of the level of testosterone in the blood.

If the testosterone level is low, doctors measure additional hormones.

Depending on the results of the history and physical examination, blood tests may also be done to check for previously unrecognized diabetes, thyroid disorders, and lipid disorders. Usually, these tests provide doctors with enough information to plan treatment.

Occasionally, doctors inject a drug into the penis that stimulates erection and then use ultrasonography to assess blood flow in the arteries and veins of the penis.

Rarely, doctors may recommend the use of a home monitor that detects and records erections during sleep. Sometimes other drugs, mechanical devices, or surgery. Any underlying disorder is treated, and doctors often stop drugs that may be causing erectile dysfunction (ED) or switch the man to a different drug. However, men should talk with their doctor before they stop taking any drug.

Excess weight is a risk factor for many disorders that may cause ED, so weight loss may improve erectile function. Smoking is a risk factor for atherosclerosis, so stopping smoking may also improve erectile function.

Stopping or decreasing alcohol use, if excessive, can also help.

Even ED caused by a physical disorder usually has a psychologic component, so doctors offer reassurance and education (including of the man's partner whenever possible). Couples counseling by a qualified sex therapist can help improve partner communication, reduce performance pressure, and resolve interpersonal conflicts that contribute to ED. Supplemental testosterone can help restore erections in men with low testosterone levels.

These testosterone preparations can be applied daily as a patch or a gel.

Testosterone nasal products and

below-the-skin

Noninvasive methods (mechanical devices and drugs) are tried first. Sometimes men must try the method a

few

Drugs injected into the penis just before intercourse are effective and often tried second. Although most men prefer drugs to other methods of treating ED, mechanical devices have the advantages of being highly effective and, because they are free of drug side effects, usually very safe. Penile implant surgery with an inflatable prosthesis is the last used, but most effective, way to achieve intercourse. Men who can develop but not sustain an erection may use a constriction ring.

As soon as erection occurs, an elastic ring is placed around the base of the penis, helping prevent blood from flowing out and maintaining the firmness of the penis. If the man cannot develop an erection, a hand-held vacuum erection device can be applied over the penis.

This device draws blood into the penis by exerting a gentle vacuum

effect

The primary drugs for ED are oral phosphodiesterase inhibitors. Other drugs include prostaglandins that are injected into the penis or inserted into the urethra. Oral phosphodiesterase inhibitors are used much more often than other drugs

because

both

Oral phosphodiesterase inhibitors ( sildenafil , vardenafil , avanafil , and tadalafil ) increase blood flow to the penis.