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The physical examination can reveal clues for physical causes of erectile dysfunction. For example, if the penis does not respond as expected to touching, a problem in the nervous system may be the cause. Small testicles, lack of facial hair, and enlarged breasts (gynecomastia) can point to hormonal problems such as hypogonadism with low testosterone levels. A reduced flow of blood as a result of atherosclerosis can sometimes be diagnosed by finding diminished arterial pulses in the legs or listening with a stethoscope for bruits (the sound of blood flowing through narrowed arteries). Unusual characteristics of the penis itself could suggest the root of the erectile dysfunction, for example, bending of the penis with painful erection could be the result of Peyronie's disease. Particular attention is paid to any underlying risk factors for erectile dysfunction. viagra prescription online What Causes Male Sexual Problems? Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma. how to get viagra online buy viagra online
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How should tadalafil (Cialis) be administered? The recommended starting dose of tadalafil for most patients is 10 mg taken orally approximately one hour before sexual activity. The dose may be adjusted higher to 20 mg or lower to 5 mg depending on efficacy and tolerability. The maximum recommended dosing frequency is once per day, although for many patients tadalafil can be taken less frequently since the improvement in erectile function may last 36 hours. Tadalafil may be taken with or without food. What Causes Erectile Dysfunction? Common causes of ED include diseases that affect blood flow, such as atherosclerosis (hardening of the arteries) or venous leakage (weak veins); nerve diseases; psychological factors, such as stress, depression, and performance anxiety; and injury to the penis. Chronic illness, certain medications, and a condition called Peyronie's disease (scar tissue in the penis) can also cause ED. Call Your Doctor About Sexual Problems If: You or your partner are experiencing significant distress due to sexual dysfunction, Erections or intercourse are painful, You lack any desire for sexual contact, You are unable to have or maintain a usable erection, You are unable to have an orgasm, You are unable to control the timing of your orgasm, so that you ejaculate extremely early during sexual activity buy viagra online south africa buy viagra
As a rule, a psychological cause is more likely for the ED than a physical cause if there are times when you can get a good erection, even though most of the time you cannot. (For example, if you can get an erection by masturbating, or wake up in the morning with an erection.) Several other medications are being studied for treating erectile dysfunction; these include IC351 (another PDE5 inhibitor), sublingual apomorphine, and the combination of yohimbine and L-arginine. Scientists also are researching gene therapy to treat erectile dysfunction. viagra online to canada viagra online
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In all four studies, vardenafil was significantly better than placebo in improving men's ability to achieve and maintain erections in all age categories (less than 45, 45-65, and greater than 65 years of age) and in all races. For example, one study found that after a course of pelvic floor exercises, about 4 in 10 men with ED had regained normal erectile function, just over 3 in 10 men had improved, but there was no improvement in just under 3 in 10 men. The exercises were done for a time every day for three months. Those found least likely to improve were those with other significant problems such as heart disease, diabetes, or those who drank a lot of alcohol. The conclusion of this study was that pelvic floor muscle exercises should be considered a treatment option for many people with ED. Magnetic resonance angiography (MRA) - This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a "contrast agent" into the patient's bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies.