Fast Facts on Erectile Dysfunction and What Are Surgical Treatment Options for ED?

Fast facts on erectile dysfunction:

      • Erectile dysfunction (ED) is defined as persistent difficulty achieving and maintaining an erection sufficient to have sex.
      • Causes are usually medical but can also be psychological.
      • Organic causes are usually the result of an underlying medical condition affecting the blood vessels or nerves supplying the penis.
      • Numerous prescription drugs, recreational drugs, alcohol, and smoking, can all cause ED.

The following list summarizes many of the most common physical or organic causes of ED:

      • heart disease and narrowing of blood vessels
      • diabetes
      • high blood pressure
      • high cholesterol
      • obesity and metabolic syndrome
      • Parkinson’s disease
      • multiple sclerosis
      • hormonal disorders including thyroid conditions and testosterone deficiency
      • structural or anatomical disorder of the penis, such as Peyronie disease
      • smoking, alcoholism, and substance abuse, including cocaine use
      • treatments for prostate disease
      • surgical complications
      • injuries in the pelvic area or spinal cord
      • radiation therapy to the pelvic region

Atherosclerosis is a common cause of blood flow problems. Atherosclerosis causes a narrowing or clogging of arteries in the penis, preventing the necessary blood flow to the penis to produce an erection.

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Having erection trouble from time to time isn’t necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

If you’re concerned about erectile dysfunction, talk to your doctor — even if you’re embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.

Inflatable penile prostheses are implanted during outpatient surgery. Once they are part of a man’s body, they enable him to have an erection whenever he desires. The use of a prosthesis preserves penile sensation, orgasm and ejaculation for most men.

The most commonly used penile implant consists of a pair of inflatable cylinders that are surgically implanted in the erection chambers of the penis. The cylinders are connected through tubing to a reservoir of fluid under the lower abdominal muscles, and to a pump inside the scrotal sac.

To inflate the penile prosthesis, the man compresses the pump a number of times to transfer fluid from the reservoir to the cylinders. This causes the penis to become erect. When inflated, the prosthesis makes the penis stiff and thick, which is very similar to a natural erection.

A penile prosthesis does not change the sensation on the skin of the penis or a man’s ability to achieve orgasm or ejaculate. Pressing on a deflation valve attached to the pump returns the fluid to the reservoir, which returns the penis to a flaccid state.

The surgical procedure is performed through one or two small incisions that are generally well hidden. Other people will be unable to tell that a man has an inflatable penile prosthesis. Complications following surgery are not common, but primarily include infection and mechanical device failure.

Approximately 95% of penile implant surgeries are successful in producing erections that enable men to have sexual intercourse. Moreover, patient satisfaction questionnaires show that up to 90% of men who have undergone penile implants say they would choose the surgery again, and overall satisfaction ratings are higher than those reported by men using oral medication or penile injection therapy.

Education and Communication and other Non-surgical Treatments for Erectile Dysfunction (ED)?

Education and communication

Education about sex, sexual behaviors, and sexual responses may help a man overcome his anxieties about sexual dysfunction.

Talking honestly with your partner about your needs and concerns may also help to overcome many barriers to a healthy sex life.

Medication

Medications such as

    • sildenafil (Viagra®),
    • vardenafil (Levitra®),
    • or tadalafil (Cialis®)

may help improve sexual function in men by increasing blood flow to the penis. Men who are on medicines that contain nitrates such as nitroglycerine should not take oral ED medications. The combination of nitrates and these specific medications can cause low blood pressure (hypotension).

The most common side effects of these medications are indigestion, nasal congestion, flushing, headaches and a temporary visual disturbance.

Mechanical aids

Aids such as vacuum devices and penile constriction rings serve as erectile aids for some men.

A vacuum constriction device (above) is a cylinder that is placed over the penis. The air is pumped out of the cylinder, which draws blood into the penis and causes an erection. The erection is maintained by slipping a band off of the base of the cylinder and onto the base of the penis. The band can stay in place for up to 30 minutes. The vacuum device can be safely used to treat most causes of erectile failure. Lack of spontaneity, discomfort, and cumbersomeness of the device seem to be the biggest concerns of patients.

Figure 3. Choosing an injection site

Penile injection therapy (intracavernosal injection therapy)

Men are taught how to inject medications directly into the erection chambers of the penis to create an erection. Injection therapy is effective in treating a wide variety of erection issues caused by blood vessel, nerve and psychological conditions.

The tissue that causes you to get an erection (erectile tissue) is a muscle. Going long periods of time without an erection is unhealthy for erectile tissue and may damage it.

We believe that having erections keeps erectile tissue healthy. A penile injection helps you have an erection. It works best if it’s given about 5 to 15 minutes before you want an erection.

Using a tiny needle and syringe, the man injects a small amount of medicine into the side of his penis. The medicine relaxes the blood vessels, allowing blood to flow into the penis. This treatment has been widely used and accepted since the early 1980s. The three most common medicines are prostaglandin E1 (alprostadil), papaverine (Papacon®), and phentolamine (Regitine®).

The most common side effects are pain and penile scarring (fibrosis). In extremely rare cases, patients with cerebral and vascular disease or severe cardiovascular diseases might not be able to tolerate the dizziness and high blood pressure occasionally caused by injection therapy.

A painful erection that lasts longer than two to three hours is called priapism and may occur with injection therapy. This can be lessened with proper dosing and by following the treatment guidelines.

The 3 most commonly used medications for injection therapy are Trimix, Bimix, and Papaverine. Most men begin injection therapy with Trimix, which is a mixture of 3 ingredients: alprostadil, phentolamine, and papaverine. These ingredients work by relaxing the smooth muscle and opening the blood vessels in your penis, causing an erection. Your APP will decide whether Trimix or a different medication is best for you.

 

Psychology and sex therapies

Psychological causes may contribute to erectile failure even when there is a clear organic cause.

Therapy with a trained counselor can help a person address feelings of anxiety, fear or guilt that may have an impact on sexual dysfunction.

Sex therapy can be beneficial to most men when counseling is provided by a skilled sex therapist. Sex therapy also helps a man’s partner accept and cope with the problems.

A patient whose ED has a clear psychological cause should receive sex therapy counseling before any invasive treatments are pursued.

When you seek out sex therapy, you need to look for a relationship or marriage counsellor, psychotherapist or psychologist who uses specialised clinical skills and theoretical knowledge about human sexuality. In addition to having post-graduate training in couples and marriage counselling, we get specific sex therapy training to help you deal with your sexual difficulties or concerns.

Sex therapists are qualified counsellors or healthcare professionals who have had extensive training in human sexuality, in addition to being well-trained couples and marriage counsellors and therapists.

Sexual issues can often cause distress and conflict in relationships and sex therapists can assist you with these difficulties.

Some sexual concerns include:

      • Lack of sexual knowledge or education
      • Believing wrong/harmful information about sex from the media or religious institutions
      • Struggle to understand sex, desire, eroticism, privacy versus secrecy
      • Erectile and/or ejaculation difficulties
      • Performance anxiety and lack of confidence
      • Problems reaching orgasm
      • Low sexual desire concerns for both men and women
      • Intimacy problems
      • Relationship and marriage difficulties
      • Painful sex or intercourse
      • Sexual problems or changes due to illness, ageing, surgery or stress
      • Compulsive sexual behaviours, or out of control sexual behaviours (wrongly called sexual addiction)
      • Sexual trauma
      • Questioning your sexual identity, orientation or preferences
      • LGBTQI issues
      • Gender identity issues
      • Interest in kink
      • Cross dressing or other fetishes

Hormone

Low hormone levels may play a role in ED. Hormone replacement in the form of topical gels, creams, patches, injections and pellets are only used after physician evaluation.

Which Drugs are Good for Erectile Dysfunction?

What are the differences between erectile dysfunction drugs? About half of men ages 40 to 70 have erectile dysfunction (ED) to some degree, although only one in 10 report a complete inability to have erections. Taking an ED drug produces an erection sufficient to start intercourse in about 70% of otherwise healthy men.

Does it make any difference which of the four drugs for erectile dysfunction you take? “Yes, there can be differences,” says Dr. Louis Liou, chief of urology at Harvard-affiliated Cambridge Health Alliance in Boston. “For new patients, I have them try different ones to see what works best.”

Sildenafil (Viagra) is often the first drug your doctor offers. It’s been on the market longest and its side effects and the medications and foods it interacts with are well known.

But the main challenge to finding the best ED drug for you may turn out to be health insurance rules—not biochemistry. It’s a common practice among insurers to limit the number of pills you can obtain per month. After you hit your limit, the out-of-pocket cost for a single pill can be very high. “The main obstacle in my practice is the cost,” Dr. Liou says. You’ll need to work with your doctor to get the pill you need at a price you can afford.

What erectile dysfunction pills are available?

In addition to Viagra, other ED drugs available in the United States include avanafil (Stendra), tadalafil (Cialis) and vardenafil (Levitra). These all improve blood supply to the penis. In combination with sexual stimulation, the drugs can produce an erection sufficient to initiate and complete intercourse.

There is also a fast-dissolving form of Levitra, called Staxyn, that you put under your tongue.

  • Viagra
  • Cialis
  • Levitra

One ED drug, Cialis, is FDA-approved for use daily in a dose of 2.5 or 5 milligrams. This helps to produce erections on demand and may also help relieve urinary problems, like difficulty starting urination, that result from an enlarged prostate.

 

How well do ED pills work?

ED drugs produce an erection sufficient for intercourse in about 70% of men. But the results vary quite a bit from one individual to another. A man with nerves or arteries damaged by prostate surgery, diabetes, or cardiovascular disease will not respond as strongly to ED drugs. “There are some men in whom none of these drugs work,” Dr. Liou says.

 

How quickly do ED pills work?

How soon the drugs start working ranges from 15 to 60 minutes. Neither Viagra nor Levitra will work if you take them after a meal, which blocks their absorption. However, neither Cialis nor Stendra interact with food this way. The onset time determines how soon you can engage in intercourse. Stendra and daily-use Cialis are closest to being an “on demand” erectile drug; using the others requires more planning.

 

How to use ED pills properly

Dr. Liou says that some men come to him after getting a prescription from their primary care doctors, claiming that the drug doesn’t work. Sometimes it’s because they used it incorrectly. “The biggest misconception is that these drugs are an on/off switch for erections,” Dr. Liou says. But the drugs don’t work well without sexual stimulation. “During that time, you need to be with your partner and have foreplay,” Dr. Liou says. “Don’t take it, do the taxes or the dishes, and then meet at the bedroom thinking you’ll be ready to go. It’s not like that.”

 

How long do ED pills last?

The ED drugs break down at different rates in the body. The durations of action range from four hours to more than a day (for Cialis in the higher doses). Each dose should be sufficient to provide a full cycle of intercourse, from erection to climax.

“Will it last through another cycle? It’s not guaranteed,” Dr. Liou says. To have sex more than once a day, Cialis is your best bet.

 

What are the side effects of ED pills?

The most common side effects of ED drugs, in order of most to least common are headache, flushing, upset stomach, nasal congestion, vision problems, diarrhea, dizziness, and rash. A man who has an erection that lasts four hours or more needs to get to a hospital or risk permanent damage.

None of the ED drugs is safe to take with cardiac drugs called nitrates because it could cause a dangerous drop in blood pressure. Drugs that many men take for urinary symptoms, called alpha blockers, can also lower blood pressure, so take them at least four hours apart from ED drugs. Your doctor may start you on a smaller dose of the ED drug if you already take an alpha blocker or may recommend the alpha blocker tamsulosin (Flomax), which affects blood pressure less.

 

Heart health and erectile dysfunction

ED is often an early warning sign of underlying cardiovascular disease, such as clogged arteries (atherosclerosis). “It can predate a diagnosis of cardiovascular disease by at least a few years,” Dr. Liou says. We don’t have strong proof yet that starting to live a healthier lifestyle can reverse erectile problems, but it can’t hurt.

 

ED drugs: How soon they start working and how long they last

Medication Onset Duration
avanafil (Stendra) 15-30 minutes 6-12 hours
sildenafil (Viagra) 30-60 minutes 4-5 hours
tadalafil (Cialis) 30-45 minutes 24-36 hours
tadalafil (Cialis) daily continuous continuous
vardenafil (Levitra) 30-60 minutes 4-5 hours

Looking for natural solutions to ED?

What kinds of Health Conditions May Cause ED ?

What is Erectile dysfunction (ED) ?

Erectile dysfunction (ED) is the inability to get and keep an erection firm enough for sexual intercourse. Estimates suggest that one of every 10 men will suffer from ED at some point during his lifetime. It is important to understand that in most cases, ED is a symptom of another, underlying problem. ED is not considered normal at any age, and may be associated with other problems that interfere with sexual intercourse, such as lack of desire and problems with orgasm and ejaculation.

How common is erectile dysfunction?

Approximately one in 10 adult males will suffer from ED on a long-term basis.

Many men do experience occasional failure to achieve erection, which can occur for a variety of reasons, such as drinking too much alcohol, stress, relationship problems, or from being extremely tired.

The failure to get an erection less than 20% of the time is not unusual and typically does not require treatment. However, the failure to achieve an erection more than 50% of the time generally means that there is a problem and treatment is needed.

ED does not have to be a part of getting older. While it is true that some older men may need more stimulation, they should still be able to achieve an erection and enjoy intercourse.

Erectile dysfunction or ED May be Caused by following Health Conditions [1]

An erection occurs when blood flows into the corpora cavernosa (erection bodies) and gets trapped there. If the blood has problems getting to or staying in those erection bodies, you may have erectile dysfunction.

Physical causes of erectile dysfunction

In many cases, erectile dysfunction is caused by something physical. Common causes include:

  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Obesity
  • Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
  • Parkinson’s disease
  • Multiple sclerosis
  • Certain prescription medications
  • Tobacco use
  • Peyronie’s disease — development of scar tissue inside the penis
  • Alcoholism and other forms of substance abuse
  • Sleep disorders
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord
  • Low testosterone

Psychological causes of erectile dysfunction

The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

  • Depression, anxiety or other mental health conditions
  • Stress
  • Relationship problems due to stress, poor communication or other concerns

There are many potential causes for erectile dysfunction, such as these conditions/circumstances:

  • Vascular conditions:
    • High blood pressure
    • Elevated cholesterol
    • Cardiovascular disease
  • Diabetes
  • Trauma:
    • Spinal cord injury
    • Pelvis injury
  • Neurologic disease:
    • Stroke
    • Parkinson’s disease
    • Alzheimer’s disease
  • Radiation to the pelvis for cancer
  • Endocrine:
    • Hypogonadism (low testosterone)
    • Hyperprolactinemia (high prolactin levels)
  • Pelvis surgery:
    • Radical prostatectomy (a surgical procedure for the partial or complete removal of the prostate)
    • Surgeries for rectal cancer or bladder cancer
  • Medication side effects:
    • Antidepressants
    • Antihypertensives (high blood pressure medicine)
    • Antiandrogens (testosterone blockers)
    • Antiarrhythmics (heart rhythm medicine)
  • Alcohol
  • Cigarette smoking
  • Cocaine and marijuana

What medications could cause erectile dysfunction (ED)?

Erectile dysfunction (ED) is a common side effect of a number of prescription drugs. While these medications may treat a disease or condition, in doing so they can affect a man’s hormones, nerves or blood circulation, resulting in ED or increasing the risk of ED.

If you experience ED and think that it may be a result of the medication you are using, do not stop taking the medication. If the problem persists, contact your doctor and he or she may be able to prescribe a different medication. Common medications that may list ED as a potential side effect include:

  • Diuretics (pills that cause increase urine flow).
  • Antihypertensives (high blood pressure drugs).
  • Antihistamines.
  • Antidepressants.
  • Parkinson’s disease drugs.
  • Antiarrhythmics (drug for irregular heart action).
  • Tranquilizers.
  • Muscle relaxants.
  • Nonsteroidal anti-inflammatory drugs.
  • Histamine H2-receptor antagonists.
  • Hormones.
  • Chemotherapy medications.
  • Prostate cancer drugs.
  • Anti-seizure medications.

Other substances or drugs that can cause or lead to ED include these recreational and frequently abused drugs:

  • Alcohol.
  • Amphetamines.
  • Barbiturates.
  • Cocaine.
  • Marijuana.
  • Methadone.
  • Nicotine.
  • Opiates.

These drugs not only affect and often suppress the central nervous system, but can also cause serious damage to the blood vessels, leading to permanent ED.

Diabetes & ED

Half of men with diabetes will experience ED within 10 years of their diagnosis. High blood sugar levels can damage the nerves that control sexual stimulation. They can also damage the blood vessels needed to provide adequate blood flow to the penis in order to have and maintain an erection.

While oral medications are a common first step for therapy, they only tend to work in about 50 percent of men with diabetes. Diabetic men are more likely to move on to other treatment options, such as the pump, penile injection therapy, and penile implants. However, the penile implant has the highest satisfaction rate of all treatment options.

ED & Heart Disease

Erectile dysfunction can be a warning sign of current or future heart disease sometimes. In fact, ED can precede coronary artery disease in almost 70 percent of cases.

When you have heart disease, or coronary artery disease (blocked blood vessels), it will affect the tiny arteries in your penis sooner. Many times, we will refer you to a cardiologist to determine if you have cardiovascular disease that is causing your ED.

Improving your heart health can help lower your risk for ED. You can start by:

  • increasing physical activity,
  • quitting tobacco products,
  • losing weight, and
  • consuming a healthy, well-balanced diet.

Prostate Cancer & ED

Erectile dysfunction is a potential complication following prostate cancer treatments. The nerves that control an erection lie very close to the prostate and may be injured during treatment. However, some men may regain their previous level of erectile function with nerve-sparing procedures. But it may take up to a year while some men may never recover their ability to have a natural erection.

Radiation for prostate cancer can cause ED symptoms to appear gradually, usually within two to three years after treatment. If you are experiencing ED after undergoing prostate cancer treatment, you can get a healthy sex life back. We can help you choose the best treatment options for you.

What prescription drugs may cause erectile dysfunction?

Erectile dysfunction (ED) is a common side effect of a number of prescription drugs. While these medications may treat a disease or condition, in doing so they can affect a man’s hormones, nerves or blood circulation. The result may be ED or an increase in the risk of ED.

If you have ED and think that it may be a result of the medication you are using, do not stop taking the medication. If the problem persists, contact your doctor and he or she may be able to prescribe a different medication. Common medications that may list ED as a potential side effect include:

  • Diuretics (pills that cause an increase in urine flow).
  • Antihypertensives (medication for high blood pressure).
  • Antihistamines.
  • Antidepressants.
  • Parkinson’s disease drugs.
  • Antiarrhythmics (medication for irregular heart action).
  • Tranquilizers.
  • Muscle relaxants.
  • Non-steroidal anti-inflammatory drugs.
  • Histamine H2-receptor antagonists.
  • Hormones.
  • Chemotherapy medications.
  • Prostate cancer drugs.
  • Anti-seizure medications.

What other substances or drugs may cause erectile dysfunction?

opioids and Pain Medications
opioids and Pain Medications

Other substances or drugs that can cause or lead to ED include these recreational and frequently abused drugs:

  • Alcohol.
  • Amphetamines.
  • Barbiturates.
  • Cocaine.
  • Marijuana.
  • Methadone.
  • Nicotine.
  • Opiates.

Aside from the well-known complications that the use and abuse of these drugs can cause, ED is not often mentioned. However, use of these drugs is a risk factor for ED. These drugs not only affect and often times slow down the central nervous system, but can also cause serious damage to the blood vessels, leading to permanent ED.

What is Erectile Dysfunction ? and How is Erectile Dysfunction Treated?

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Having erection trouble from time to time isn’t necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

If you’re concerned about erectile dysfunction, talk to your doctor — even if you’re embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.

ED can be treated in many ways, including:

      • Oral medications.
      • Sex therapy.
      • Penile injections.
      • Vacuum devices.
      • Intraurethral medication.
      • Surgery (penile implant).

Each type has its own pros and cons. Discuss your options with your doctor to determine the best treatment for you.

The first step to treating ED is to find the underlying cause. Then the appropriate treatment can begin. There are a number of non-surgical and surgical options that can help a man regain normal sexual function.

 

Best Alternatives to Viagra: Treatments That Last Longer and What is the Difference Between Cialis and Viagra ?

Viagra is the most popular medication for erectile dysfunction. It was the first medicine approved to treat ED in 1998. It works quickly and can be used to treat men of all age groups. If you cannot use this drug for some reason or just want to try similar medications, you should know that there are good alternatives to sildenafil.

Cialis is the best analogue of Viagra, which has won an excellent reputation among men. The main active ingredient of Cialis is tadalafil, which, like sildenafil, belongs to the category of PDE5 inhibitors. Tadalafil causes an active blood flow to the perineum and penis of a man, due to which a good persistent erection occurs. The drug works only in the presence of natural stimulation, instantly increasing libido and sexual desire. Many men prefer Cialis because this is an ultra-long-acting ED drug – its duration is up to 36 hours;

Levitra is another worthy substitute for Viagra. The main active ingredient of Levitra is vardenafil, This drug is ideal for the symptomatic treatment of male sexual impotence. This medicine, like other drugs for improving potency, is prescribed by the doctor on an individual basis after a thorough examination. Levitra lasts about 8-12 hours and, unlike Viagra, is compatible with alcohol

Stendra is one more medication used to treat erectile dysfunction. It contains the active ingredient avanafil. It has a quick onset of action in comparison to other ED drugs available and starts working just 15 minutes after taking the pill. It is one of the newest drugs to be released for ED. Avanafil remains effective for 6 hours and may maintain benefits longer in some patients.

Compare the information about popular ED drugs in the table below:

Cialis vs. Viagra quick comparison

Cialis Generic
Cialis Generic
  • Cialis (tadalafil) and Viagra (sildenafil) are phosphodiesterase-5 (PDE5) inhibitors used for treating impotence (erectile dysfunction, or ED).
  • Adcirca is another brand name of tadalafil.
  • Common side effects of Cialis and Viagra that are similar include flushing (redness or warmth of the face, neck, or chest), headaches, stomach pain or upset, flu-like symptoms (such as stuffy nose, sneezing, or sore throat), memory problems, muscle or back pain, blurred vision and changes in color vision (such as an inability to differentiate between the colors green and blue), dizziness, diarrhea, nausea, low blood pressure, abnormal ejaculation, and prolonged erections (priapism), loss of hearing, and ringing in the ears.
  • One difference between the drugs is how long they stay in your system. Cialis provides penile hardness (the ability to obtain an erection) over a longer period than Viagra because it lasts up to 18 hours, while Viagra only lasts for about 4 to 6.

 

What are Cialis and Viagra?

 

Cialis (tadalafil) and Viagra (sildenafil) are oral drugs that are used for treating impotence (the inability to attain or maintain a penile erection) and benign prostatic hyperplasia (BPH). They are in a class of drugs called phosphodiesterase-5 (PDE5) inhibitors that also includes vardenafil (Levitra, Staxyn ODT), and avanafil (Stendra).

Penile erection is caused by the engorgement of the penis with blood. Under normal conditions, sexual stimulation leads to the production and release of nitric oxide in the penis. Nitric oxide then activates the enzyme, guanylate cyclase, which causes the production of cyclic guanosine monophosphate (cGMP). It is the cGMP that is primarily responsible for the erection by affecting the amount of blood that the blood vessels deliver and remove from the penis. Cialis and Viagra inhibit an enzyme called phosphodiesterase-5 (PDE5) which destroys the cGMP. Thus, Cialis and Viagra prevent the destruction of cGMP and allows cGMP to accumulate and persist longer. The longer cGMP persists, the more prolonged the engorgement of the penis.

What is the dosage of Cialis vs. Viagra?

 

Cialis

For most individuals, the recommended starting dose of tadalafil is 10 mg per day taken before sexual activity (tadalafil for use as needed).

Depending on the adequacy of the response or side effects, the dose may be increased to 20 mg or decreased to 5 mg a day. The effect of tadalafil may last up to 36 hours. Individuals who are taking medications that increase the blood levels of tadalafil should not exceed a total dose of 10 mg in 72 hours (See drug interactions). For once daily use without regard to sexual activity, the recommended dose is 2.5 to 5 mg daily. Tadalafil should not be taken more than once daily.

The recommended dose for BPH, or BPH and ED is 5 mg daily taken about the same time each day. Tadalafil may be taken with or without food since food does not affect its absorption from the intestine.

The dose of tadalafil may require adjustment for patients with reduced kidney or liver function.

Viagra

  • The usual recommended dose is 25 to 100 mg 1 hour before sexual activity.
  • The maximum dose is 100 mg daily.
  • The elderly (over 65 years of age) should start at 25 mg before sexual activity.
  • Sildenafil is rapidly absorbed. Maximum observed plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state. When sildenafil is taken with a high fat meal, the rate of absorption is reduced, with an average delay in the time to maximal concentration of 1 hour.

What is the Common Side effects of Erectile Dysfunction Medicines ?

What is erectile dysfunction?

 

The malady formerly known as impotence, erectile dysfunction (ED) is the inability to get or maintain an erection sufficient for satisfying sex. That might include erections that don’t last as long as you want or aren’t as firm as you’d like. ED is very prevalent among American men: Experts estimate that more than 30 million American men have experienced these kinds of erection issues (Nunes, 2012).

What Is the Erectile dysfunction Medications ?

 

Erectile dysfunction (ED), also called impotence, can affect your quality of life by decreasing your satisfaction from sex. ED can have many causes, both psychological and physical. ED from physical causes is fairly common in men as they age. Medications are available that can help treat ED for many men.

The most well-known ED medications include:

  • tadalafil (Cialis)
  • sildenafil (Viagra)
  • vardenafil (Levitra)
  • avanafil (Stendra)

These prescription drugs increase the levels of nitric oxide in your blood. Nitric oxide is a vasodilator, meaning it makes your blood vessels widen to help increase the blood flow. These drugs are especially effective at widening the blood vessels in your penis. More blood in your penis makes it much easier for you to get and maintain an erection when you are sexually aroused.

However, these drugs can also cause side some effects. Here are seven of the most common side effects from ED medications.

 

Headaches

Headaches are the most common side effect associated with ED medications. The sudden change in blood flow from the increased levels of nitric oxide causes the headaches.

This side effect is common with all forms of ED medications, so switching brands won’t necessarily alleviate your symptoms. If you have headaches from your ED drug, talk to your doctor about how to prevent them.

Body aches and pains

Some people have muscle aches and pains throughout their bodies while taking ED medications. Others have reported specific pain in their lower back. If you have these types of pain while taking ED medication, over-the-counter (OTC) pain medication may help.

However, you should talk to your doctor about other possible causes of your pain. Your doctor can help you choose an OTC medication that is safe to take with your ED medications and with any other medications you take.

Digestive system problems

Your ED medication may cause uncomfortable digestive system side effects. The most common are indigestion and diarrhea.

To help relieve minor problems, consider making dietary changes to reduce upset stomach. Drinking water instead of caffeinated beverages, alcohol, or juice may help. If changing your diet doesn’t work, talk to your doctor about OTC remedies that may help.

Dizziness

An increase in nitric oxide can cause some men to become dizzy. The dizziness caused by ED medications is generally mild. However, any dizziness can cause discomfort during everyday activities.

In rare cases, dizziness from ED medications has led to fainting, which can become a serious health issue. You should tell your doctor if you experience dizziness while taking ED medications. If you faint while taking these medications, see your doctor right away.

Vision changes

ED medications can change the way you see things — literally. They can temporarily alter your eyesight and even cause blurry vision. ED medications aren’t recommended if you have had vision loss, or a retinal disorder called retinitis pigmentosa.

A complete loss of vision or changes that don’t go away can signify a more serious issue with your ED medication. Seek emergency medical care if you experience these symptoms.

Flushes

Flushes are temporary periods of redness of the skin. Flushes usually develop on your face and may also spread to parts of your body. Flushes can be mild, like blotchy skin, or severe, like rashes. Although the appearance may make you uncomfortable, flushes typically aren’t harmful.

Flushes from ED medications may get worse when you:

  • eat hot or spicy foods
  • drink alcohol
  • are outside in warm temperatures

Congestion and runny nose

Congestion or a runny or stuffy nose can be a common symptom of ED medications. In most cases, these side effects go away without treatment. Talk to your doctor if they persist.

Recognizing uncommon, severe side effects

Minor side effects are common when taking ED medication. Still, there are a few side effects that aren’t as common, and some can even be dangerous. Severe side effects of ED medications can include:

      • priapism (erections that last longer than 4 hours)
      • sudden changes in hearing
      • vision loss

Contact your doctor immediately if you have any of these severe side effects.

Certain men are more at risk of these side effects than others. This may be because of other conditions they have or other medications they take.

 

Serious side effects of ED medication

Go to the emergency room immediately if you experience any of the following symptoms or side effects:

      • Chest pain
      • Shortness of breath
      • Severe headaches
      • Fainting
      • Erections that last longer than four hours
      • Visual changes (like loss of sight)
      • Or anything out of the ordinary—even lightheadedness

If you notice any severe or prolonged symptoms at all, contact a healthcare provider immediately. It doesn’t matter how rare a side effect is if you’re the one experiencing it.

When discussing ED treatment with your doctor, it’s important to tell them about all drugs that you take and other health conditions you have. If ED drugs aren’t right for you, your doctor may suggest other treatment options, such as surgery or vacuum pumps.

What drugs interact with Cialis and Viagra?

Cialis

The breakdown and elimination of tadalafil from the body may be decreased by erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox), indinavir (Crixivan) and ritonavir (Norvir). Therefore, these drugs may increase the levels of tadalafil in the blood. If these drugs are being used at the same time as tadalafil, the dose of tadalafil should be reduced to 10 mg every 72 hours when used as needed or 2.5 mg when used daily in order to avoid side effects from high levels of tadalafil.

Rifampin, carbamazepine (Tegretol, Tegretol XR, Equerto, Carbatrol), phenytoin (Dilantin, Dilantin-125), and phenobarbital may decrease blood levels of tadalafil, possibly reducing the effect of tadalafil.

Tadalafil exaggerates the increases in heart rate and lowering of blood pressure caused by nitrates, for example, nitroglycerin, isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, Ismo, Monoket), nitroglycerin (Nitro-Dur, Transderm-Nitro) that are used primarily for treating heart pain (angina). In patients who take nitrates for angina, tadalafil could cause heart pain or possibly even a heart attack by exaggerating the increase in heart rate and the lowering of blood pressure. Therefore, tadalafil should not be used with nitrates.

Tadalafil also exaggerates the blood pressure lowering effects of some alpha-blocking drugs for example, terazosin (Hytrin) that primarily are used for treating high blood pressure or enlargement of the prostate (BPH). Individuals who take these alpha-blockers should be on a stable dose of the alpha-blocker before tadalafil is started. In such situations, tadalafil should be started at the lowest dose. If the patient is already taking tadalafil, the alpha-blocker should be started at the lowest dose. Combining tadalafil with alpha-blockers for treatment of BPH is not recommended.

Tadalafil and alcohol both lower blood pressure. Therefore, combining tadalafil with alcohol may cause excessive drops in blood pressure and cause dizziness, headaches, and increased heart rate.

PDE5 inhibitors may affect platelet function and therefore prolong bleeding. Tadalafil should be used cautiously in patients with bleeding disorders or active ulcers. Tadalafil should not be combined with Adcirca (another form of tadalafil) or other PDE5 inhibitors, for example, vardenafil (Levitra) or sildenafil (Viagra, Revatio).

Viagra

Viagra increases the effects of the blood pressure lowering medications. It also increases the blood pressure lowering effects of nitrates, for example, isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, Ismo, Monoket), nitroglycerin (Nitro-Dur, Transderm-Nitro) that are used primarily for treating angina. Patients taking nitrates should not receive Viagra.

Patients should not combine Viagra with other PDE5 inhibitors (for example, vardenafil [Levitra], tadalafil [Cialis]).

Cimetidine (Tagamet), erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox), atazanavir (Reyataz), and mibefradil (Posicor) can cause marked increases in the amount of Viagra in the body. Patients taking these medications should be observed carefully if sildenafil is used.

It is expected that rifampin will decrease blood levels of Viagra and probably reduce its effectiveness.

Viagra can Make your Penis Harder and Save your Penis from Injury as well

It’s no secret that Viagra makes your penis harder for penetrative sex. But what you might not know is that it can save your penis from injury — if you start taking it early enough.

If you’re experiencing erectile dysfunction but wait to talk to your doctor until you can’t achieve an erection hard enough for penetrative sex, you may damage your penis. Having sex with an erection that’s barely “hard enough” can bend it and tear tissues that may scar as they heal, Dr. Montague says.

Scar tissue isn’t elastic like healthy penile tissue, so it will force your penis to bend with future erections, creating a condition known as Peyronie’s disease.

This affects 9 percent of men between the ages of 40 and 75. Many of these men have what Dr. Montague calls erectile insufficiency — erections that are not as firm as they used to be. During intercourse, bending may damage the penis. Taking Viagra could help prevent the problem and avoid an injury with lifelong consequences, he says.

No matter what your concern is, talk with your doctor. “If you’re having erectile dysfunction problems, you should feel confident going to your doctor. It’s a common issue,” Dr. Montague says. “Many men are embarrassed, but they shouldn’t be. Help is available, and it’s worth a try.”

What you should know before you take viagra ?

Don’t drink alcohol after taking

If you like a glass of wine or another alcoholic bev to unwind before sexy time, you should be fine.

But drinking more than that after taking Viagra could put a major damper on your rendezvous.

Moderate to heavy drinking can make it — er — harder for you to get an erection. Also, Viagra can lower blood pressure. Combining it with alcohol can increase this effect.

If your blood pressure drops, symptoms like dizziness, lightheadedness, and headache could also hinder your hard-on and mood.

How does the time frame compare with other ED meds?

Like Viagra, most ED drugs can be taken 30 to 60 minutes before sex.

The exception is Stendra (avanfil), which is the fastest-acting ED medication available. It only takes 15 to 30 minutes to kick in, depending on the dose.

When it comes to duration, Cialis (tadalafil) is the longest lasting and works for up to 36 hours.

Can Viagra Cause Hours-long Erections ?

The facts: While this may sound intriguing theoretically, this condition (known as priapism) can be harmful.

Fortunately, it doesn’t really happen if you’re only taking Viagra.

 

 

“To my knowledge, Viagra has never caused a prolonged erection by itself,” Dr. Montague says. “But, it can happen if you’re also getting penile injection therapy.”

Combining the treatments has a cumulative effect — penile injection therapy makes your erections hard, and adding Viagra makes them harder and even more long-lasting. So, stay on the safe side and don’t pair them, he says.

How do you use Viagra?

Always take Viagra exactly as prescribed to you by your doctor. Viagra is an oral medication taken in pill form as and when the patient wishes to use it. This is typically between 30 minutes to 1 hour before engaging in sexual activity, although it’s possible to take the drug up to four hours in advance.

It’s usual to start taking Viagra with one 50mg tablet. A doctor may prescribe a lower dose for men over 65.

If you find your prescribed dosage isn´t working for you speak to your doctor. Don´t just increase the amount you take on your own as this could cause side effects.

Also, if the tablet you have taken doesn´t seem to be working at all do not take another. This could be dangerous and cause a painful erection that lasts several hours and damages the penis tissue. Speak to your doctor before commencing with further doses.

Your diet and your overall health will affect how Viagra works for you, including how long its effects last. The average length of time it lasts is between 2 and 3 hours. You may achieve more than one erection after taking one Viagra tablet but you will not have a continuous erection. After ejaculation you may or may not get another erection, depending on your metabolism. And you will only achieve more erections with further sexual stimulation.

You can take Viagra with or without food. If you take it after food or a heavy meal it may take longer to work.

There are many common misconceptions about Viagra, or Viagra more generally. In order for the drug to be effective, you will have to engage in normal sexual stimulation, it will not work on its own or sporadically. If you feel relaxed and comfortable the medication is likely to be more effective and act sooner.

If you do not experience erectile dysfunction then it is not advisable to take Viagra. It will not have any effect, it does not increase libido, penis size, or act as an aphrodisiac. This is a common myth. Viagra also won’t cause an erection without stimulation or for prolonged periods of time. It should be used as an aid for treating erectile dysfunction only.

Why do I need to answer questions to get Viagra Connect?

When trying any new medication it is important that this has been deemed suitable for you to protect your health and well-being. As Viagra Connect is available without a prescription you will no longer need to see a GP, however you will need to complete a discreet and easy questionnaire when you purchase Viagra Connect.

Or if you’d prefer you can chat in-store to a pharmacist, they will be able to answer any additional questions you may have whilst checking your suitability for this treatment. Your pharmacist may ask to review your Summary Care Record or Patient Medication Record to check whether you have any conditions or are on any medication that could react with Viagra Connect.

How can I complete a consultation?

1. Online

If you choose to purchase Viagra Connect online, you’ll be prompted to complete a quick online consultation. The majority of the questions you will be asked simply require a yes or no answer, although you will need to fill in a small part about any medication that you are currently taking.

Once you have completed your answers they’ll be sent to our team to review. They’ll check that you are suitable for Viagra Connect.

You then have the option to get Viagra Connect discreetly delivered to your home for free or next day, or alternatively to click and collect to pick it up in your local LloydsPharmacy or Sainsbury’s store at a time that is convenient for you.

There is a very small chance that you won’t be suitable for Viagra Connect. In this instance Online Doctor offers a wide range of erectile dysfunction treatments, with a variety of strengths and ingredients, so with the help of a GP you’ll find one that is just right for you.

2. In-store

You can speak to an expert pharmacist in complete confidence within your local LloydsPharmacy store at a time that suits you. You don’t need to book an appointment to speak to a pharmacist about purchasing Viagra Connect and whether this medication is right for you.

You’ll have the option to either chat to the pharmacist on the shop floor or go into a discreet consultation room. Your pharmacist will run through a set of pharmacy questions to determine whether Viagra Connect is the right treatment for you. They can also answer any additional questions or concerns you may have whilst offering any extra advice to put your mind at ease.

What questions will I be asked?

If you order Viagra Connect via Online Doctor you will be asked to complete a confidential questionnaire consultation containing straightforward questions. The majority of these require a simple yes or no answer, or multiple choice.

These questions will focus on your overall fitness for sex, to find out if you get out of breath quickly or experience any chest pain when undertaking physical activity.

You’ll also be asked about the health of your heart, any underlying medical conditions, whether you are allergic to any of the ingredients in Viagra Connect and what other medication you are currently taking. It’s important that our doctors understand any medical issues that you may have or any medication that you may be taking.

After you have completed the consultation your answers will be reviewed by a member of our clinical team to determine if you are suitable for Viagra Connect. If you have decided to talk to a Pharmacist in store rather than order online you will be asked a similar set of confidential questions, and the Pharmacist will also be able to answer any questions that you may have.

Viagra Connect and Sildenafil – what’s the difference?

We’ve created a helpful table to compare generic Sildenafil with branded Viagra. If you’re looking to compare our variety of ED treatments and their active ingredients, explore your options at LloydsPharmacy Online Doctor.

  Sildenafil (generic) Viagra (branded)
Active ingredient  Sildenal citrate Sildenafil citrate
Available dosage (mg) 25, 50, 100 25, 50, 100
Pack size 4, 8, 16 4, 8, 16
When to take Effective within one hour, up to four hours Effective within one hour, up to four hours
How to take On an empty stomach On an empty stomach
Prices on Online Doctor from £3.25/pill £5.31/pill

 

What are the possible side effects of Viagra Connect?

As with any medication there are always possible side effects, the most commonly reported ones include:

  • Headache
  • Facial flushing
  • Nausea
  • Nasal congestion
  • Dizziness
  • Blurred or blue-tinted vision
  • Indigestion and heartburn

Can I use Viagra Connect if I have a medical condition?

Whether you can use Viagra Connect to treat your erectile dysfunction depends upon the nature of your medical condition and the medication you’re taking. Your Pharmacist will decide if Viagra Connect is suitable for you during your confidential consultation, or a doctor will review your suitability using the answers you provided in your online questionnaire.

How do I take Viagra Connect?

The recommended dose of Viagra Connect is one 50mg tablet to be taken an hour before sexual activity. Viagra Connect usually works within 60 minutes and the effects can be seen up to four hours after the initial dose. You cannot take more than one 50mg tablet a day.

Prices correct April 2020

References

Image for illustrative purposes only. Posed by models.

Can Viagra Cause any Negative Long-lasting Effects?

Viagra is for adult men seeking to treat impotence, or erectile dysfunction. ED is the lack of blood flow to the penis, making it impossible to achieve or maintain an erection for long enough to have satisfactory intercourse. ED can happen due to age, a medical condition or it can be psychological.

Erectile dysfunction is often an embarrassing issue for those who suffer from it and can have many negative effects. Erectile problems can lead to stress in relationships, low self-esteem, and a decreased sex drive. Viagra (Sildenafil) can be an effective treatment for erectile dysfunction if taken correctly, as instructed by a doctor.

Often, men suffering from ED have already tried non-medical remedies to treat it, such as changing their diet, increasing exercise and reducing stress before deciding to seek medical treatment such as Viagra. If you have decided that Viagra is the right option for you we advise you to request a prescription through a doctor to ensure you take the right dosage.

Viagra works alongside sexual stimulation to achieve an erection. When a man becomes aroused something called cyclic GMP is released. This causes the blood vessels to relax and expand and more blood to enter the penis. The result of this is an erection. Cyclic GMP is broken down by an enzyme known as PDE5. Viagra (Sildenafil) works to stop this break down occurring and therefore helps maintain the erection.

Maintaining a healthy sex life is important for psychological and physical well-being. Viagra is an aid for men who have insufficient blood flow to the penis and therefore problems having sex.

When using ED pills, you should be aware of potential risks. Keep in mind that the uncontrolled use of sildenafil medication (for example, when using the drug in excessive doses, or more frequently than recommended, or when the drug is combined with other ED medications from Canadian Pharmacy or narcotic substances) can lead to a condition known as priapism.

It’s a long-lasting painful erection that needs medical help. Priapism is a disease named after the mythical ancient Greek god of fertility Priapus, who had a permanent erection. If a man has priapism, his erection has nothing to do with sexual arousal and the penis does not relax even after ejaculation and after a while it becomes painful. This condition can seriously damage the penis as it can cause blood stasis.

If your erection lasts for more than 4 hours and you feel pain, you should contact your doctor immediately.

In rare cases, Viagra can cause negative effects but they are unlikely to be long-lasting. The common side effects associated with the use of this medication include headache, redness of the face, hot flashes, dizziness, vision problems, sensitivity to light, nasal congestion, and stomach upset.

To avoid side effects of any kind, you should consult a doctor prior to taking these pills. You should be informed that sildenafil medication should not be used in combination with nitrates (medicines used to treat angina pectoris), as this can lead to a severe drop in blood pressure levels, which can lead to shock and sometimes even death.

In 2020, Viagra is considered safe when prescribed correctly.

Important: Prolonged use of ED pills can worsen the fertilizing potential of ejaculate and cause dependence (if you abuse stimulant drugs, one day an erection may simply not come). This is a crime against yourself. There is no need to risk health (and sometimes life). If you take ED medication in the recommended doses and do not abuse it, it won’t harm your health in any way!

The Effects of Viagra on the Body
The Effects of Viagra on the Body

The Effects of Viagra on the Body

Viagra is a powerful drug that increases blood flow to the penis so you can get and maintain an erection. It’s effective, but it can also cause some side effects.

Viagra is a brand-name version of the generic drug sildenafil. It’s a phosphodiesterase type 5 (PDE5) inhibitor. PDE5 is an enzyme that regulates certain chemicals in your blood, but as a result can make it harder for you to get and keep an erection.

Viagra is used to treat erectile dysfunction (ED). While it helps you temporarily maintain an erection so you can have sex, it doesn’t cure ED. It doesn’t affect sexual desire either. You still need mental or physical stimulation to get an erection.

This medication is only available with a doctor’s prescription.

Circulatory system

It takes a finely choreographed series of events to produce an erection. It begins with arousal signals from your brain, and it all hinges on good blood flow to the penis.

Within the penis are two chambers called the corpora cavernosa. Nitric oxide (NO) is released in the chambers during sexual stimulation. NO activates an enzyme called guanylate cyclase. That increases levels of cyclic guanosine monophosphate (cGMP), which causes muscles to relax.

The chambers also contain a network of blood vessels. When those blood vessels relax and widen, blood rushes in. The resulting pressure is what causes an erection.

PDE5 can dampen the effect of cGMP. Viagra works by inhibiting PDE5.

Viagra is rapidly absorbed into the bloodstream. Maximum concentrations are reached within about an hour.

One of the more common side effects is flushing, or redness.

This medication can also cause a decrease in blood pressure, particularly one to two hours after taking it. If you already have low blood pressure, discuss the pros and cons of Viagra with your doctor.

For most people, sexual activity is good for cardiovascular health. However, if you have cardiovascular disease, you should ask your doctor if it’s safe for you to take Viagra. You should also avoid Viagra if your doctor advised you not to have sex.

You shouldn’t take Viagra if you’ve had a stroke or heart attack or if you have unstable angina.

Certain drug interactions can harm your heart. Avoid taking PDE5 inhibitors if you also use long-lasting alpha-blockers or take medications that contain nitrates.

Reproductive system

Viagra can be quite effective, but it’s no magic pill. It does nothing for the libido. You still need some kind of stimulation to get an erection.

The effects of Viagra usually last about 4 hours, though they may last longer for some men. A rare, but serious side effect, is priapism. That’s when you get an erection that lasts for a long period of time. It can become quite painful.

If you have an erection that lasts for more than 4 hours, seek immediate medical attention.

You should also be wary of PDE5 inhibitors if you have an anatomical abnormality of the penis. If you have Peyronie’s disease, your doctor may advise against taking Viagra.

Viagra is a temporary fix and doesn’t cure ED. It offers no protection from sexually transmitted infections (STIs).

Central nervous system

Viagra helps to improve blood flow to the penis, but your brain is still your most valuable sex organ. Viagra won’t work if you’re not in the mood.

Some potential side effects of Viagra are headache and a runny or blocked nose, or a nosebleed. Some men feel lightheaded or dizzy. In rare cases, Viagra can cause fainting. Some men taking PDE5 inhibitors report back or muscle pain.

It’s not common, but some men experience ringing in the ears, hearing loss, or vision loss after taking PDE5 inhibitors.

Avoid PDE5 inhibitors if you have a history of an eye condition called non-arteritic anterior ischemic optic neuropathy (NAION). NAION is characterized by the interruption of blood flow to the optic nerve.

If you have hearing or vision loss while taking Viagra, seek immediate medical help.

Excretory and digestive system

Viagra is dispensed in a film-coated tablet. You can take Viagra with or without food, and it’s best to take it about an hour before you plan to have sex.

Don’t take Viagra more than once per day.

About 80 percent of Viagra leaves your body in your feces. The rest is washed out with your urine.

One fairly common side effect of Viagra is indigestion or stomach upset. PDE5 inhibitors can sometimes cause nausea or vomiting.