Online Canadian Pharmacy Blog

Definition of Erectile Dysfunction (ED):
“The inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance” (NIH Consensus Development Panel on Impotence)
Prevalence of ED
-Approximately 5% of men at age 40, increasing to 15% – 25% by age 65
-Massachusetts Male Aging Study (community based survey of men 40-70 years) – 52% of all respondents reported some degree of ED
-Prevalence increases with age, but ED is not an inevitable and untreatable consequence of aging
ED and Quality of Life
-ED reduces quality of life

-ED may be associated with
Depression
Loss of self-esteem
Poor self-image
Increased anxiety with one’s sexual partner

Relevance of Sexual Health Issues to Primary Care
-Sexual health important to overall health
ED may signal serious underlying disease, eg:
Diabetes
Hypertension
Cardiovascular diseasePeripheral vascular diseaseNeurologic disorders
Questions on sexual function should be part of medical history/physical exam

Causes of ED
Vascular disease
Neuropathy
Latrogenicfactors
Congenital abnormalities
Peyronie’s disease
Psychological processes

Oral Pharmacologic Treatments
Viagra online – Viagra is a prescription drug used to treat erection difficulties, such as erectile dysfunction (ED).
Cialis – Cialis, or Super Viagra, is used to treat erectile dysfunction, more commonly known as impotence. A man is impotent if he cannot achieve or sustain an erect penis for sexual activity.
Generic Viagra – Generic Viagra, containing Sildenafil Citrate, enables many men with ED to achieve or sustain an erect penis for sexual activity.
Levitra – LEVITRA is a new FDA-approved oral prescription medication for the treatment of erectile dysfunction (ED) in men.

Physical examination.

Signs of hypogonadism, such as gynecomastia or the loss of axillary and pubic hair, should be noted. The size and consistency of the testes should be noted. The penis should be examined for fibrosis and plaques indicative of Peyronie’s disease. The bulbocavernosus and cremasteric reflexes should be assessed. The bulbocavernosus reflex is elicited by squeezing the glans penis while observing for contraction of the external anal sphincter.

Laboratory tests

A urinalysis, complete blood count and basic chemistry panel will help to rule out most metabolic and renal diseases. In elderly men, thyroid-stimulating hormone level should be measured to rule out thyroid dysfunction. A free testosterone level should be obtained in all men aged 50 and older and in those younger than 50 who have symptoms or signs of hypogonadism (eg, decreased libido, testicular atrophy, reduced amount of body hair).

Sildenafil ( Viagra) inhibits the conversion of cGMP to guanosine monophosphate in the corpus cavernosum. Sildenafil is effective in men with erectile dysfunction of organic, psychogenic or combined causes.

The most common side effects of sildenafil are headache, flushing and dyspepsia. A small percentage of patients report an alteration in color perception.

Sildenafil is contraindicated in patients taking nitrates because of the potential for sudden severe hypotension.

Erection appropriate for intercourse is attained in 72% of the men receiving 25 mg, 80 percent of those receiving 50 mg, and 85 percent of men those given 100 mg of sildenafil.

Sildenafil should initially be prescribed at 50 mg to be taken one hour before anticipated intercourse. The dose can be increased to 100 mg if needed.

Sildenafil should not be used more than once a day.

Online canadian pharmacy recommends:
Cialis soft tabs – A Soft Tab is an oral lozenge, mint in flavor, containing pure Tadalafil Citrate that is placed under your tongue and dissolved.
Levitra – may be able to help you get and keep a quality erection, so that you can make the most of each sexual experience. You may notice improvements in both erection hardness and your ability to maintain your erection during sex.

Erectile dysfunction is defined as the persistent inability to achieve or maintain penile erection sufficient for sexual intercourse. Between the ages of 40 and 70 years, the probability of complete erectile dysfunction triples from 5.1 percent to 15 percent.

Physiology of erection

Penile erection is mediated by the parasympathetic nervous system, which when stimulated causes arterial dilation and relaxation of the cavernosal smooth muscle. The increased blood flow into the corpora cavernosa in association with reduced venous outflow results in penile rigidity.

Nitric oxide is a chemical mediator of erection. This substance is released from nerve endings and vascular endothelium, causing smooth muscle relaxation, resulting in venous engorgement and penile tumescence.

History and physical examination

The history should include the frequency and duration of symptoms, the presence or absence of morning erections, and the quality of the relationship with the sexual partner. The sudden onset of erectile dysfunction in association with normal morning erections or a poor relationship suggests psychogenic impotence. Chronic disease such as atherosclerosis, hypertension or diabetes mellitus should be sought. Decreased libido and symptoms of hypothyroidism should be evaluated.

Common pharmacologic causes of erectile dysfunction include antihypertensive drugs, most notably the centrally acting agents, beta-blockers and diuretics. Antipsychotic and antidepressant drugs are also frequently implicated. Excessive alcohol intake, heroin use and cigarette smoking are common causes.

Erectile dysfunction (Impotence) is a sexual frustration as a result of which the man cannot reach and-or support  a sexual member, sufficient for fulfilment of the sexual certificate. The impotence is not connected directly with ability to eaculation. There are many reasons of an impotence, for example a diabetes. Some reasons of an impotence are irreversible.  As impotense – the phenomenon of delicate character, it made long time some kind of табу and has served as a subject of many city legends. From the middle of 30th years, national means from an impotence have started to be advertised widely. In 90th years, with the invention of Viagra, interest to a subject of an impotence and its treatment has increased, substantially owing to active advertising of a new preparation.