Viagra no prescription needed

Researchers examining the role of drug exposures in the prevalence of erectile dysfunction found that hypertensive patients taking selected antihypertensive therapy increased the odds of ED prevalence, compared with patients not taking selected antihypertensive therapy (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.6-5.9).

Despite the high prevalence of erectile disorders, identifying the presence of this condition remains challenging for the physician as patients are often reluctant to discuss this sensitive problem. Although patients may be more inclined to share these issues when the discussion is initiated by viagra no prescription needed their healthcare provider, physicians' themselves may also have some uneasiness with this conversation. A recent review of several studies found that the prompt recognition and treatment of ED symptoms associated with underlying endothelial cell dysfunction may improve ED related outcomes by decreasing the development or progression of vascular comorbidities.

Approximately 80% of men diagnosed with ED will have organic disease; thus the AUA diagnosis generic medication for viagra and treatment guidelines recommend a thorough medical history and physical examination for all patients viagra no prescription needed with suspected ED to identify underlying vascular, neurologic, or hormonal abnormalities. 14 The medical history should include a complete assessment of risk factors associated with organic ED and identification of comorbidities (ie, Peyronie's disease, history of penile surgery) that may present unique viagra no prescription needed challenges to developing an effective treatment response.

Patients should also be assessed for co-occurring anxiety or depressive disorders to rule out a psychogenic etiology.

Several tools have been developed to assess treatment outcomes such as the International Index of Erectile Function (IIEF), the Erectile Dysfunction of Inventory of Treatment Satisfaction (EDITS), and the Premature Ejaculation Tool.

The IIEF is a self-administered questionnaire that contains 15 questions which assess several domains, such as: erectile function, orgasm, sexual desire, and satisfaction. 1 The IIEF-5 is an abbreviated version of the IIEF which serves as a useful measure of treatment response and is generally more applicable to a clinical practice setting.

Patient diaries, such as the Sexual Encounter Profile (SEP), are also commonly utilized to document improvement in clinical outcomes. Questions 2 and 3 from the SEP address a patient's ability to attain an erection sufficient for intercourse (SEP2) and the viagra no prescription needed maintenance of the erection through completion of intercourse (SEP3).

Currently available agents for the management of ED include: the oral phosphodiesterase type 5 (PDE 5) inhibitors, intraurethral and intracavernous prostaglandin E 1 formulations, injectable phentolamine and papaverine, and testosterone preparations. Trazodone, yohimbine, and herbal products have been utilized in the treatment of ED but are not recommended for use by the AUA. The arrival of sildenafil (Viagra) to the US market in 1998 was the first FDA approved oral PDE 5 inhibitor.

It was followed shortly by vardenafil (Levitra) and tadalafil (Cialis) in 2003, marking a shift in the management of ED as more patients began to seek treatment with the availability of these more convenient pharmacologic options.

All 3 agents exert their effect by selectively blocking PDE 5 in cavernosal smooth muscle cells, which leads to a greater concentration of cGMP, thereby enhancing the effects of smooth muscle relaxation and cavernosal blood flow resulting in prolonged erectile function. The efficacy of the PDE 5 inhibitors has been demonstrated in several patient populations with ED due to organic and psychogenic causes.

In a pooled analysis of several sildenafil studies, 63%, 74%, and

82%

18 Two studies in tadalafil-treated patients showed that generic no prescription viagra 62% and 77% of patients were successful with SEP2, compared to 39% and 43% of placebo-treated patients, respectively ( P 17 Despite a lack of trials that compare these agents, all are considered equally effective for the treatment of ED by the AUA. As a result of their mild vasodilatory effects, caution should be exercised when the PDE 5 inhibitors are coadministered with other antihypertensive agents.

The administration of nitrate-containing preparations are contraindicated with sildenafil, vardenafil, and tadalafil due to the profound hypotensive effects of this drug combination.