Getting (and maintaining) an erection requires a surprising amount of things to go right. You have to get aroused, then pass that signal from your brain, through your nerves and hormones, to your blood vessels and muscles before an erection can even happen. If one thing goes wrong in that complicated exchange between your cardiovascular, and nerve system, and your hormone levels, blood vessels, and even your mood the result is usually erectile dysfunction. In other words, getting an erection is hard.
Poor cardiovascular health reduces your body’s ability to deliver blood needed to produce erections. In a study published in 2004, researchers followed male participants for 25 years. The researchers found that heart disease risk factors predicted which men were most at risk of future ED. Numerous studies have strongly tied four major cardiovascular risk factors to ED:
Combination therapy has proven effective for some men who don’t respond adequately to oral medicines. The idea is to use two drugs with different mechanisms of action for better results. Commonly, sildenafil is used in combination with pellets of alprostadil (synthetic prostaglandin E1) that are inserted into the urethra (the tube in the penis that carries urine from the bladder to the outside of the body). Alprostadil also increases the blood supply to the penis, but by different means.
Performance anxiety can be another cause of impotence. If a person wasn’t able to achieve an erection in the past, he may fear he won’t be able to achieve an erection in the future. A person may also find he can’t achieve an erection with a certain partner. Someone with ED related to performance anxiety may be able to have full erections when masturbating or when sleeping, yet he isn’t able to maintain an erection during intercourse.

Lifestyle choices that impair blood circulation can contribute to ED. Smoking, excessive drinking, and drug abuse may damage the blood vessels and reduce blood flow to the penis. Smoking makes men with atherosclerosis particularly vulnerable to ED. Being overweight and getting too little exercise also contribute to ED.  Studies indicate that men who exercise regularly have a lower risk of ED.
But when you or your partner notice a change in your erections, it’s important to talk to a doctor to discover the underlying cause of your ED. Erectile dysfunction is often an early warning sign of serious health conditions, like heart disease. High blood pressure, diabetes, low testosterone, and high cholesterol are all causes of ED in otherwise healthy men. Don’t assume that it’ll pass—especially if symptoms get worse over time.

Having learned a great deal more about erectile dysfunction including its risk factors and causes, you should be equipped to assess your own erectile function. If you have experienced erectile issues or you have some of the risk factors mentioned above, it may be worth making a trip to your doctor’s office. If you choose to seek help, give your doctor as much information as you can about your symptoms including their frequency and severity as well as the onset. With your doctor’s help, you can determine the best course of treatment to restore sexual function.
A full battery of labs was ordered and returned normal. A PCDU was ordered which revealed normal arterial inflow with velocities greater than >40 cm/sec with increased end diastolic velocities suggestive of venous leak. After pharmacologic erection, he developed a partial erection that resolved within 1 minute. This was consistent with a diagnosis of venous leak impotence. Pharmacologic cavernosography was performed and revealed bilateral crural leakage. He underwent infrapubic bilateral crural ligation of the penis, which cured his ED. The patient returned to clinic 6 months later with recurrent impotence. A pharmacologic cavernosography revealed recurrent venous leak. Additional crural ligation via a perineal approach was performed. Two months later he reported normal penile erections, and the result has lasted for more than 5 years. He continues to follow up annually in clinic.

There is also a significant population, which has psychogenic sexual dysfunction, which is likely in a situation of marital conflict, which commonly exists in the families of alcoholics.[18] There is some evidence of this with more than a third of the subjects reporting dissatisfaction with their spouses' responses and / or decreased frequency. This cannot be conclusive without data on nocturnal erection or sexual activity in alternate situations. One of the limitations of this exploratory study is that marital functioning was not specifically assessed.
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L-arginine is an amino acid that occurs naturally in the human body and helps make that magic nitric oxide so important for supporting an erection. A 1999 study observed the effects of six weeks of L-arginine administered daily among men with ED. One third of those who took five grams per day of L-arginine experienced significant improvements in sexual function.

It was recommended that the patient focus on relaxation techniques, increase cardiovascular exercise, take cialis 5 mg PO prn as it is effective, and to start scheduled terazosin 1 mg po at bedtime to relax the hypertonic cavernous smooth muscle. It was recommended that he utilize lubricants for masturbation, that he decrease the frequency of masturbation, and that he investigate vibrators to increase glanular stimulation if necessary. It was also recommended that he stop using the various alternative therapies that he has been using for the past 6 months (topicals, lasers, electromagnetic therapies, hyperbaric oxygen), which were likely confounding the issue. At follow up, 4 weeks after the initial visit, the patient reported 60% improvement in his symptoms with seldom use of PDE5 inhibitors.
Though it's most common among older men, it's possible for young men to get erectile dysfunction. When young men develop ED, it's usually a result of psychological problems such as anxiety, stress, depression or relationship problems. However, physical problems such as diabetes, nerve problems, injury or other medical conditions may also lead to erectile dysfunction in younger men. If you're having frequent or ongoing trouble getting or keeping an erection long enough to have sex, talk to your doctor.
In some cases, however, these drugs may be unsuitable for patients with heart disease. If you are considering one of these drugs and you have heart disease, as many diabetics do, be sure to tell your doctor. In rare cases, the pills may create “priapism,” a prolonged and painful erection lasting six hours or more (although reversible with prompt medical attention).
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