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In England, four PDE-5 inhibitors are available for treating erectile dysfunction.

They are: sildenafil – sold under the brand name Viagra tadalafil – sold under the brand name Cialis vardenafil – sold under the brand name Levitra avanafil – sold under the brand name Spedra.

Sildenafil, vardenafil and avanafil work for about eight hours and they are designed to work 'on demand'. Tadalafil lasts for up to 36 hours and is more suitable if you require treatment for a longer period of time, for example, over a weekend. Depending on the type of PDE-5 inhibitor you are taking and the dose, it should take about 30-60 minutes before it starts to work.

With sildenafil, vardenafil and avanafil, you should be able to have sex from one to 10 hours after taking the medicine. After taking tadalafil, the effects will last for up to 36 hours. It may take longer to notice the effects if the tablet is taken with food, so it's best to take it on an empty stomach. You can then eat after an hour without affecting the medicine.

Your GP should explain the benefits of each medication and how it works. The choice may depend on: how often you are sexually active whether you have tried any of the medications before. There have been many studies to test the effectiveness of

these

In general, at least two-thirds of men report having improved erections after taking one of these medicines.

If you do not find that PDE-5 inhibitors are effective it may be because: you have not waited long enough after taking the dose you have waited too long after taking the dose the dose is not high enough you have not had enough sexual stimulation. These medications are triggered by sexual stimulation, so you also need to be aroused for it to work. PDE-5 inhibitors should be used with caution in men who have cardiovascular disease, such as coronary heart disease.

However, sexual activity is also likely to be beneficial for your cardiovascular health. You should discuss the risks and benefits with your GP.

PDE-5 inhibitors should also be used with caution in men who have anatomical problems with their penis, such as Peyronie's disease (a condition that affects the tissue of the penis).

PDE-5 inhibitors should also be used with caution in men who: are at risk of priapism – a painful erection that lasts for several hours are also taking long lasting alpha-blockers – a medication used to treat a number of conditions, such as high blood pressure (hypertension) Do not take PDE-5 inhibitors if you are also taking medicines or recreational drugs that contain nitrates.

The combination of the two substances can have a dangerous effect on your heart.

Organic nitrates are often used to treat angina, and butyl nitrate is a recreational drug that is more commonly known as 'poppers'. You are also warned not to take PDE-5 inhibitors if you: have been advised not to take part in sexual activity or in activities that widen your blood vessels have low blood pressure (hypotension) have recently had a stroke – a medical emergency that occurs when the blood supply to the brain is interrupted have unstable angina – an underlying heart condition that causes symptoms such as chest pain have had a heart attack – a medical emergency where the blood supply to the heart is suddenly blocked have a history of non-arteritic anterior ischaemic optic neuropathy – an eye condition that causes a sudden loss of vision. PDE-5 inhibitors can cause some side effects, including: headaches and migraines flushing (redness) indigestion nausea (feeling sick) vomiting (being sick) a blocked or runny nose back pain vision disturbances muscle pain. A vacuum pump consists of a clear plastic tube that is connected to a pump, which is either hand or battery operated. You place your penis in the tube and pump out all of the air.

This creates a vacuum that causes the blood to fill your penis, making it erect.

You then place a rubber ring around the base of your penis to keep the blood in place, allowing you to maintain an erection for around 30 minutes. It may take several attempts to learn how to use the pump correctly, but they are usually effective.

After using a vacuum pump, nine out of 10 men are able to have sex, regardless of the cause of their ED. You should not use a vacuum pump if you have a bleeding disorder or if you are taking anticoagulant medicines, which reduce the ability of your blood to clot.

Side effects of vacuum pumps include pain or bruising, although these occur in less than a third of men. Men who qualify for NHS prescriptions for erectile dysfunction treatments may be able to get a vacuum pump on the NHS (see above for more details).

The Sexual Advice Association produces a number of factsheets, including one on vacuum pumps that provides details of companies that supply them. If your erectile dysfunction doesn't respond to treatment, or you are unable or unwilling to use PDE-5 inhibitors or a vacuum pump, you may be given a medicine called alprostadil. This is a synthetic (man-made) hormone that helps to stimulate blood

flow

If your partner is pregnant, use a condom during sex if you are inserting alprostadil into your urethra. Alprostadil will usually produce an erection after five to 15 minutes. How long the erection lasts will depend on the dose. In men who did not respond to PDE-5 inhibitors, alprostadil injections were successful in 85 out of 100 men.

Alprostadil inserted into the urethra is successful for up to two-thirds of men.

Alprostadil should not be used: in men at risk of priapism (a painful erection that lasts for several hours) – for example, those with sickle cell anaemia alongside other erectile dysfunction medications if you have a penile implant or if you have been advised to avoid sexual activity.

Urethral application may also not be used in: some men who have anatomical problems with their penis (conditions that affect the physical structure of the penis) men who have infections of their penis, such as balantis (inflammation of the head of the penis) Side effects.

Alprostadil can cause some side effects including: changes in your blood pressure dizziness headache pain in your penis urethral burning or bleeding reactions at the site of the injection, such as swelling.

As with PDE-5 inhibitors, NHS prescriptions for alprostadil may only be available for men with particular health conditions or those receiving some types of medical treatments.

If you need to pay the full prescription cost, a single injection of alprostadil sildenafil teva 5343 costs around ?8 to ?22, depending on the dose.

A single dose of alprostadil for urethral application is around ?10.

If a hormonal condition is causing erectile dysfunction, you may be referred to an endocrinologist (who specialises in the treatment of hormonal conditions). Many hormonal conditions can be treated using injections of synthetic (man-made) hormones to restore normal hormone levels. Surgery for erectile dysfunction is usually only recommended if all other treatment methods have failed. It may also be considered in: younger men who have experienced serious injury to their pelvic area – for example, in a car accident men with a significant anatomical problem with their penis.

In the past, surgery was used if there was clear evidence of a blockage to the blood supply of the penis. The surgeon could unblock the blood vessels to restore a normal supply of blood. However, research now suggests that the long-term results of this type of surgery are poor, so it's unlikely to be used. Penile implants are a type of surgery that may be

considered

These can be: semi-rigid implants – which may be suitable for older men who do not have sex regularly inflatable implants – which consist of two or three parts that can be inflated to give a more natural sildenafil cheap erection.

Penile implants are not usually available on the NHS and inflatable implants may be very expensive. However, around three-quarters of men report being satisfied with the results of this type of surgery. As with all types of surgery, having penile implants inserted carries a risk of infection. If you take preventative antibiotics, the rate of infection is around two or three in 100. Mechanical problems with the implants may occur within five years in five per cent of cases. If your erectile dysfunction has an underlying psychological cause then you may benefit from a type of treatment called sensate focus.

If conditions such as anxiety or depression are causing your erectile dysfunction, you may benefit from counselling (a talking therapy).

Sensate focus is a type of sex therapy that you and your partner complete together. It starts with you both agreeing not to have sex for a number of weeks or months. During this time, you can still touch each other, but not in the genital area (or a woman’s breasts).

The idea is to explore your bodies knowing that you will not have sex. After the agreed period of time has passed, you can gradually begin touching each other’s genital areas.

You can also begin to use your mouth to touch your partner, for example, licking or kissing, them.

You can find out more about sensate focus from the College of Sexual and Relationship Therapists (COSRT). Psychosexual counselling is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues that may be contributing to your erectile dysfunction. By talking about the issues, you may be able to reduce any anxiety that you have and overcome your erectile dysfunction.

The counsellor can also provide you with some practical advice about sex, such as how to make effective use of other treatments for erectile dysfunction to improve your sex life. Psychosexual counselling may take time to work and the results achieved have been mixed.

Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (CBT) is another form of counselling that may be useful if you have erectile dysfunction.

CBT is based on the principle that the way you feel is partly dependent on the way you think about things.

CBT helps you realise that your problems are often created by your mindset.

It is not the situation itself that is making you unhappy, but how you think about it and react to it.

Your CBT therapist can help you to identify any unhelpful or unrealistic thoughts that may be contributing to your erectile dysfunction – for example, to do with: your self-esteem (the way you feel about yourself) your sexuality your personal relationships. Your CBT therapist will be able to help you to adopt more realistic and helpful thoughts about these issues.

Some studies have suggested that, in a few cases, it may be beneficial to exercise your pelvic floor muscles.

These are a group of muscles around the underside of the bladder and rectum, as well as at the base of the penis. Pelvic floor muscle exercise involves strengthening and training the muscles used to control the anus (back passage) and urinate.

If your GP feels this type of exercise could be beneficial, then you may want to discuss it with a physiotherapist to learn it correctly. By strengthening and training these muscles, you may be able to reduce the symptoms of erectile dysfunction. Some complementary therapies, such as acupuncture, have claimed to treat erectile dysfunction. In some cases, they may even include ingredients that could interact with other medications and cause side effects.

Always speak to your GP before using any complementary therapies.

Healthdirect Free Australian health advice you can count on. If you need urgent medical help, call triple zero immediately.

healthdirect Australia is a free service where you can talk to a nurse or doctor who can help you know what to do.

Erectile dysfunction, or impotence, means not being able to get or keep an erection that is sufficient for sexual intercourse.

Many men have erectile dysfunction at some time in their lives. It is estimated erectile dysfunction affects about 1 million men in Australia. Erectile dysfunction can have a range of causes, both physical and psychological. Physical factors that can cause erectile dysfunction include: general ageing health problems that affect your nerves, like spinal cord injury, multiple sclerosis (MS), diabetes, surgery that affects the pelvic area or spinal cord (prostate or bowel surgery), Parkinson’s disease and Alzheimer’s disease reduced blood flow to the penis, caused by atherosclerosis (clogging of the arteries) conditions like prostate disease, high blood pressure, underactive thyroid gland (hypothyroidism), cardiovascular disease, obesity or sleep disorders alcohol, some medicines, smoking or substance abuse Peyronie's disease (scar tissue inside the penis) treatments for prostate cancer or an enlarged prostate. Psychological factors that can cause erectile dysfunction include: unresolved problems, conflicts or issues within a sexual and emotional relationship anxiety about sexual performance (this is most common at the start of a new relationship, especially if a man has had previous problems with sexual performance) stress problems with mental health such as depression.

It is common for a man who is impotent to be affect by a combination of physical and psychological causes. Your doctor will first treat any health conditions that may be causing your erectile dysfunction.

You may need treatment for both physical and psychological causes of erectile dysfunction. Although it usually can’t be completely cured, there are treatments that will allow you to get an erection so you can have sex. For physical causes, your doctor will usually suggest medicine.

Other treatment options include a penis pump, implants, injections or surgery.

Treating erectile dysfunction that is caused by psychological factors could involve counselling, such as cognitive behavioural therapy, or sex therapy undertaken with your partner. Medicines for erection problems should be obtained only from an authorised Australian prescriber, such as your doctor, specialist nurse or erectile specialist.

Medicines bought on the internet may be of poor quality and may contain ingredients that are not safe when taken in combination with other medicines you are on. They may also be unsafe due to other health problems you have.

If you are worried that you might have been sold counterfeit (fake) medicines, then report it to the Therapeutic Goods Administration.

If you are still concerned about your erectile dysfunction, check your symptoms with healthdirect's online Symptom Checker to get advice on when to seek medical attention. The Symptom Checker guides you to the next appropriate healthcare steps, whether it's self-care, talking to a health professional, going to a hospital or calling triple zero (000). Penis Erectile dysfunction medicines Testosterone Test Sexual Health. These trusted information partners have more on this topic. If you have impotence (erectile dysfunction), the treatment your doctor recommends sildenafil cheap will depend on the severity of your symptoms and the underlying cause of your impotence.

Find out the physical and psychological causes of impotence, also called erectile dysfunction or ED.

Erectile dysfunction: visiting your doctor - myDr.com.au.

Find out what questions a doctor may ask when discussing erectile dysfunction (ED, or impotence). Erectile Dysfunction - Causes & Treatment | Healthy Male. Your doctor’s appointment Resources and videos Resources Filter resources Type: Information guide Fact sheet Clinical summary guide Video Video Video Video Video Video RESET Information guide Erectile dysfunction information guide Download PDF Fact sheet Erectile dysfunction fact sheet Download PDF Clinical summary guide Erectile dysfunction clinical summary guide (#9) Download PDF Video Erectile dysfunction and general men's health WATCH VIDEO Video Erectile dysfunction: A comprehensive guide WATCH VIDEO Video What are the causes of erectile dysfunction?

WATCH VIDEO Video What are the causes of erectile dysfunction?

WATCH VIDEO Video What are the treatment options for erectile dysfunction?

WATCH VIDEO Video Erectile dysfunction WATCH VIDEO SEE ALL RESOURCES.

Read more on Healthy Male - Andrology Australia website.

Erectile dysfunction is the inability to develop or maintain an erection rigid enough to allow penetration of the vagina, and therefore functional sexual intercourse. Read more on myVMC – Virtual Medical Centre website.

Erectile Dysfunction: Impact on Other Diseases and Conditions | myVMC. Erectile dysfunction is associated with many systemic health conditions, which affect a man's physical health, can impact negatively on the treatment of erectile dysfunction, and in some cases are life-threatening. Read more on myVMC – Virtual Medical Centre website.

How do stress and anxiety affect sexual performance and erectile dysfunction?

During the COVID-19 pandemic, it is completely normal and expected to feel a certain level of stress and anxiety. The current situation may impact our mental and physical health in different ways. Read more on Healthy Male - Andrology Australia website. Diabetes and erectile dysfunction Diabetes and low testosterone Diabetes and low sex drive Diabetes and retrograde ejaculation Diabetes and balanitis Resources and videos Resources Filter resources Type: Fact sheet Video Video RESET Fact sheet Diabetes and reproductive health fact sheet Download PDF Video Diabetes and androgens WATCH VIDEO Video Diabetes and reproductive health WATCH VIDEO SEE ALL RESOURCES.

Read more on Healthy Male - Andrology Australia website. Sexual health A healthy sexual relationship can be an important part of someone's life.

Sex therapy refers to a group of treatments which are used to resolve sexual difficulties, for example difficulties relating to sexual desire, arousal and ability to orgasm.

Read more on myVMC – Virtual Medical Centre website.

Finasteride provides relief of symptoms related to benign prostatic hyperplasia. Authors' conclusions: Finasteride improves long-term urinary symptoms versus placebo, but is less effective than doxazosin.

Read more on Cochrane (Australasian Centre) website.

Drugs for benign prostatic hypertrophy - NPS MedicineWise. Alpha1a adrenergic receptor inhibition with selective (tamsulosin, silodosin, terazosin, alfuzosin) or non-selective (prazosin) drugs treat the dynamic component of

benign

Sexual difficulties in the menopause - Australasian Menopause Society.

Sexual difficulties can be life-long or recently acquired, but they are a common presentation at the menopause.

Read more on Australasian Menopause Society website.

Adverse effects of sports supplements in men | Australian Prescriber.

Up to 1 in 5 sports supplements contain banned substances.

Find out what to look for and how to manage patients with adverse effects.

Medical management of chronic stable angina | Issue 4 | Volume 38 | Australian Prescriber. Stable angina pectoris is characterised by typical exertional chest pain that is relieved by rest or nitrates.Risk stratification of patients is important to. Low testosterone in men | Issue 6 | Volume 37 | Australian Prescriber.

Male hypogonadism is a clinical syndrome of symptoms and signs confirmed by the presence of low testosterone. Chronic heart failure | Issue 4 | Volume 40 | Australian Prescriber | Australian Prescriber.

Managing chronic heart failure which drugs should be used in which patients? Healthdirect Australia is not responsible for the content and advertising on the external website you are now entering.

Erectile dysfunction (male impotence) You may find it embarrassing if you are having difficulty maintaining an erection, or finding it hard to ejaculate, but you sildenafil cheap are not alone.

As many as two and a half million men around the UK may have some sort of sexual dysfunction at any one time. Although it may not be something you want to discuss with your friends, it is important that you get some advice if you are worried about it. The most common cause of erectile dysfunction for young men is anxiety.

This may include concerns about getting someone pregnant, not wanting to appear inexperienced, or worrying about using a condom without embarrassment or losing your erection while putting a condom on.

Common causes of erectile dysfunction for middle aged men may include sildenafil cheap stress, guilt, or having sex with a new partner after many years of monogamy.

Although 70% of men over the age of 70 are still sexually active, erectile dysfunction does get more likely as you get older.

This may be linked to the deterioration to the blood vessels that carry blood to the penis, and also to the deterioration of heart or brain arteries. Both men and women can – and do - have problems that affect their sex lives.

You may have lost interest in sex, or been unable to maintain an erection, or have difficulty with premature ejaculation, or be having difficulty having an orgasm.

There are many reasons why men may experience sexual problems.

Physical reasons for erectile dysfunction may include: Side effects from medication (mainly medication for blood pressure or depression) Other illness or infection Diabetes Smoking and or excessive drinking Being unfit or overweight Deterioration of the arteries, common in older men especially those with high blood pressure Use of recreational drugs such as cocaine. Psychological reasons for erectile dysfunction may include: Stress, which may be related to sex and or other parts of your life Concerns about your current sexual relationship(s) Depression and related fatigue Any feelings of guilt about your sexual performance or your sexual health.