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When you are not sexually aroused, the penis is soft and limp. Men may notice that the size of the penis varies with warmth, cold or worry; this is normal and reflects the balance of blood coming into and leaving the penis.

With Erectile Dysfunction (ED), it is hard to get or

keep

When ED becomes a routine and bothersome problem, your primary care provider or a Urologist can help. ED may be a major warning sign of cardiovascular disease indicating blockages are building in a man's vascular system. Some studies have shown men with ED are at significant risk of getting a purchase viagra no prescription heart attack, stroke or circulatory problems in the legs.

ED also causes: Low self-esteem Depression Distress for the man and his partner. If ED is affecting a man's well-being or his relationships, it should be treated.

Treatment aims to fix or enhance erectile function, help circulatory health and help the quality of a man's life.

ED can result from health problems, emotional issues, or from both. Some known risk factors are: Being over age 50 Having high blood sugar (Diabetes) Having high blood pressure Having cardiovascular disease Having high cholesterol Smoking Using drugs or drinking too much alcohol Being obese Lacking exercise. Even though ED becomes more common as men age, growing old is not always going to cause ED. ED can be an early sign of a more serious health problem. Finding and treating the reason for ED is a vital first step. ED happens when: There is not enough blood flows into the penis Many health issues can reduce blood flow into the penis, such as hardened arteries, heart disease, high blood sugar (Diabetes) and smoking.

The penis cannot trap blood during an erection If blood does not stay in the penis, a man cannot keep an erection.

Nerve signals from the brain or spinal cord do not reach the penis Certain diseases, injury or surgery in the pelvic area can harm nerves to the penis.

Diabetes can cause small vessel disease or nerve damage to the penis Cancer treatments near the pelvis can affect the penis' functionality Surgery and or radiation for cancers in the lower abdomen or pelvis can cause ED.

Treating prostate, colon-rectal or bladder cancer often leaves men with ED.

Cancer survivors should see a Urologist for sexual health concerns.

Drugs used to treat other health problems can negatively impact erections Patients should talk about drug side effects with their primary care doctors. Normal sex needs the mind and body working together.

Emotional or relationship problems can cause or worsen ED.

Some emotional issues that can cause ED are: Depression Anxiety Relationship conflicts Stress at home or work Stress from social, cultural or religious conflicts Worry about sex performance. Finding the cause of your ED will help direct your treatment options. Diagnosing ED starts with your health care provider asking questions about your heart and vascular health and your erection problem. Your provider may also give you a physical exam, order lab tests or refer you to a Urologist.

Your doctor will ask you questions about your health history and lifestyle. It is of great value to share facts about drugs you take, or if you smoke or how much alcohol you drink. He/she will ask about recent stressors in your life.

Speak openly with your doctor, so he/she can help you find the best choices for treatment.

Questions about your health: What prescription drugs, over-the-counter drugs or supplements do you take?

Have you had surgery or radiation therapy in the pelvic area? Do you have other health problems (treated or untreated)?

Knowing about your history of ED will

help

However, be assured that your doctor is a professional and your honest answers will help find

the

Do your erections change at different times, like when going in a partner, during stimulation by mouth, or with masturbation?

Do you have problems with ejaculation or orgasm (climax)? How is this problem changing the way you enjoy sex?

Do you have painful with erections, feel a lump or bump in the penis or have penile curvature? These are signs of Peyronie's Disease which can be treated but calls for an expert in urology to assess and manage. Your health care provider may ask you questions about depression or anxiety. He or she may ask about problems in your relationship with a partner. Some health care providers may also ask if they may talk to your sex partner.

Are you often under a lot of stress, or has something recently upset you?

Do you have any anxiety, depression or other mental health issues? Examination focusing on your genitals (penis and testicles) is often done to check for ED. Based on your age and risk factors, the exam may also focus on your heart and blood system: heart, peripheral pulses and blood pressure.

Based on your age and family history your doctor may do a rectal exam to check the prostate.

Most patients do not need a lot of testing before starting treatment. Your health care provider may order blood tests and collect a urine sample to look for health problems that cause ED.

Questionnaires are often used by health experts to rate your ability to initiate and keep erections, gauge your satisfaction with sex and help identify any problems with orgasm. For some men with ED, specialized testing may be needed to guide treatment or re-assess you after a treatment fails. Blood work to check Testosterone and other male hormones Blood work to measure blood sugar (Diabetes) Ultrasonography (penile Doppler) to check blood flow A shot into the penis with a vascular stimulant to cause an erection Pelvic x-rays like arteriography, MRI or CT scanning are rarely needed to check ED unless there is history of trauma or cancer Nocturnal penile tumescence (NPT), an overnight test to check for sleep erection. The treatment for ED starts with taking care of your heart and vascular health.

Your doctor may point out ‘risk factors' that can be changed or improved.

You may be asked to change certain food habits, stop smoking, increase workouts or stop using drugs or alcohol.

You may be offered alternatives to the drugs you take.

(Never stop or change prescription drugs without first talking to your health care provider.) Your health care provider may also suggest treating emotional problems. These could stem from relationship conflicts, life's stressors, depression or anxiety from past problems with ED (performance anxiety).

The treatments below are available to treat ED directly.

Most of the best-known treatments for ED work well and are safe. Still, it helps to ask your health care provider about side effects that could result from each option: Oral drugs or pills known as phosphodiesterase type-5 inhibitors are most often prescribed in the U.S.

for ED (Viagra, Cialis, Levitra, Stendra) Testosterone Therapy (when low testosterone is detected in blood testing) Penile Injections (ICI, intracavernosal Alprostadil) Intraurethral medication (IU, Alprostadil) Vacuum Erection Devices Penile Implants Surgery to bypass penile artery damage for some younger men with a history of severe pelvic trauma. Penile vascular surgery is not recommended

for

by the Food and Drug Administration for the treatment of ED.

Viagra ® (sildenafil citrate) Levitra ® (vardenafil HCl) Cialis ® (tadalafil) Stendra ® (avanafil) For best results, men with ED take these pills about an hour or two before having sex. The drugs require normal nerve function to the penis. PDE5 inhibitors improve on normal erectile responses helping blood flow into the penis.

About 7 out of 10 men do well and have better erections.

Response rates are lower for Diabetics and cancer patients.

If you are taking nitrates for your heart, you SHOULD NOT take any PDE5 inhibitors. Always speak with your health care provider before using a PDE5 inhibitor to learn how it might affect your health.

Most often, the side effects of PDE5 inhibitors

are

The most common side effects are: Headache Stuffy nose Facial flushing Muscle aches Indigestion. In rare cases, the drug Viagra ® can cause blue-green shading to vision that lasts for a short time. In rare cases, the drug Cialis ® can cause purchase viagra no prescription or increase back pain or aching muscles in the back.

In most cases, the side effects are linked to PDE5 inhibitor effects on other tissues in the body, meaning they are working to increase blood flow to your penis and at the same time impacting other vascular tissues in your body.

In those rare cases where a low sex drive and low blood levels of Testosterone are at fault for ED, Testosterone Therapy may fix normal erections or help when combined with ED drugs (PDE type 5 inhibitors). A vacuum erection device is a plastic tube that slips over the penis, making a seal with the skin of the body. A pump at the other end of the tube makes a low-pressure vacuum around the erectile tissue, which results in an erection.

An elastic ring is then slipped onto the base of the penis.

This holds the blood in the penis (and keeps it hard) for up to 30 minutes.

With proper training, 75 out of 100 men can get a working erection using a vacuum erection device. If

oral

Many men who do not respond to oral PDE5 inhibitors can be ‘rescued' with ICI. ICI Alprostadil may be used as a mixture with two other drugs to treat ED. This combination therapy called "bimix or trimix" is stronger than alprostadil alone and has become standard treatment for ED.

Only the Alprostadil ingredient is FDA approved for ED.

The amount of each drug used can be changed based on the severity of your ED, by an experienced health professional. You will be trained by your health professional on how to inject, how much to inject and how to safely raise the drug's dosage if necessary.

ICI therapy often produces a reliable erection, which comes down after 20-30 minutes or with climax. Since the ICI erection is not regulated by your penile nerves, you should not be surprised if the erection lasts after orgasm. The most common side effect of ICI therapy is a prolonged erection. Prolonged erections (>1 hour) can be reversed by a second injection (antidote) in the office.

Men who have penile erections lasting longer than two to four hours should seek Emergency Room care.

Priapism is a prolonged erection, lasting longer than four hours.

Failure to undo priapism will lead to permanent penile damage and untreatable ED. For IU therapy, a tiny medicated pellet of the drug, Alprostadil, is placed in the urethra (the tube that carries urine out of your body). Using the drug this way means you don't have to give yourself a shot, unfortunately it may not work as well as ICI.

Like ICI therapy, IU Alprostadil should be tested in the office, before home usage.

The most common side effects of IU alprostadil are a burning feeling in the penis.

If an erection lasts for over four hours, it will need medical attention to make it go down. The main surgical treatment of ED involves insertion of a penile implant (also called penile prostheses).

Because penile vascular surgery is not recommended for aging males who have purchase viagra no prescription failed oral PDE5 inhibitors,

ICI

These silicone rods give the man's penis the firmness needed for sexual penetration.

The implant can be bent downward for peeing or upward for sex.

With an inflatable implant , fluid-filled cylinders are placed lengthwise in the penis. Tubing joins these cylinders to a pump placed inside the scrotum (between the testicles). When the pump is engaged, pressure in the cylinders inflate the penis and makes it stiff. Inflatable implants make a normal looking erection and are natural feeling for your partner.

Your surgeon may suggest a lubricant for your partner.

With the implant, men can control firmness and, sometimes, the size of the erection.

Implants allows a couple to be spontaneously intimate.

There is generally no change to a man's feeling or orgasm. Penile implants are most often placed under anesthesia. If a patient has a systemic, skin, or urinary tract infection, this surgery should be postponed until all infections are treated. If a man is on blood thinners, then he may need to talk with a medical expert about stopping the medications for elective surgery and healing.

The cut is either above the penis where it joins the belly, or under the penis where it joins the scrotum.

A patient will either go home on the same day or spend one night in the hospital.

Recovery Time after Penile Implants: Most men will feel pain and will feel better with a narcotic pain-relief drug for one to two weeks.

After the first week, over- the-counter pain drugs (such as acetaminophen or ibuprofen) may be substituted for narcotic pain drugs. Discomfort, bruising and swelling after the surgery will last for a few weeks. For the first month, men should limit their physical activity. The surgeon will explain when and how much exercise to do during the healing period. Men most often start having sex with their penile implants by eight weeks after surgery.

If there is persisting swelling or pain, the use of the implant may be delayed. The surgeon or health care expert in the surgeon's office will talk about how to inflate and deflate the implant.

There are risks to prosthetic surgery and patients are counselled before the procedure. If there is a post-operative infection, the implant will likely be removed. The devices are reliable, but in the case of mechanical malfunction, the device or a part of the device will need to be replaced surgically.

If a penile prosthesis is removed, other non-surgical treatments may no longer work. Most men with penile implants and their partners say that they're satisfied with the results, and they return to more spontaneous intimacy. Several restorative or regenerative treatments are under investigation for the future treatment of ED: Extracorporeal shock wave therapy (ESWT) - low-intensity shock waves that aim to fix the erectile tissues and help restore natural erections.

Intracavernosal injection of stem cells - to help cavernous tissue regrowth Intracavernosal injection autologous platelet rich plasma (APRP) - to help cavernous tissue regrowth. These are not currently approved by the FDA for ED management, but they may be offered through research studies (clinical trials). Patients who are interested should discuss the risks and benefits (informed consent) of each, as well as costs before starting any clinical trials. Most therapies not approved by the FDA are not covered by government or private insurance benefits. Supplements are popular and often cheaper than prescription drugs for ED. However, supplements have not been tested to see how well they work or if they are a safe treatment for ED. Patients should know that many over-the-counter drugs have been found on drug testing to have ‘bootlegged' PDE 5 Inhibitors as their main ingredient.

The amounts of Viagra, Cialis, Levitra or Stendra that may be in these supplements is not under quality control and may differ from pill to pill.