It is a well-known fact that older men are more prone to erectile dysfunction than younger men. This is because the natural levels of nitric oxide in the body decrease as one gets older. Nitric oxide is a naturally occurring molecule in the body. It is produced in order to relax blood vessels, thereby allowing good blood flow through them. When there are low levels of this chemical in the body, men not only experience erectile dysfunction, but they also experience a range of other cardiovascular issues. The low-level of this chemical in the body means that there is insufficient blood flow through the blood vessels in the penis. This results in weak erections that do not last for a long time.

Fortunately, there are ways in which the levels in the body can be improved. One of the best ways is through exercise. The type of exercise to have good levels of nitric oxide in the body is that which raises the heart rate. Such exercise naturally raises the level of nitric oxide in the body. Because the heart rate increases through exercise the body requires more blood flow to the muscles. This then forces the production of nitric oxide to facilitate the easy blood flow through the blood vessels and arteries. Older men should therefore engage in regular cardiovascular exercises in order to maintain healthy levels of nitric oxide in their bodies and thereby have healthy erections.

Other than exercise, a good lifestyle is very important to produce good levels and prevent erectile dysfunction. A good lifestyle includes a healthy diet. Cholesterol from fatty, processed foods will increase the levels in the body line. A healthy diet will prevent this. In addition, smokers should quit smoking as this also increases the level in the body decline.

For people who want a quick fix there is the option of taking male enhancement pills that improve the production of nitric oxide in the body. Such male enhancement pills include Cialis and Viagra Australia. Unfortunately, these drugs are only available through a prescription from a doctor. Another disadvantage of these drugs is that they increase the levels of this only temporarily after they have been taken and the results last just a few hours and so they can only be used for the purposes of sexual intercourse and must be taken right before. They will not assist with the overall production of this in the body. These pills can be very expensive. So it is much better to try the natural ways of increasing the production in the body.

Men who are experiencing erectile dysfunction should seek medical attention. This is because this condition is often a symptom of a more serious cardiovascular issue that could even be life threatening. If it turns out there is a cardiovascular issue the doctor will prescribe the relevant treatment and the erectile dysfunction will also be healed as a consequence. Viagra Australia pills – impotence treatment medications.

However, it is important to note that erectile dysfunction is not always a consequence of a health problem or low levels of nitric oxide in the body. Sometimes the condition results because of a psychological or emotional problem. In these cases the doctors are still able to recommend the relevant treatment or refer the patient to a psychologist or sex therapist. In some men stress is the cause of their erectile dysfunction and increasing the levels of nitric oxide in the body is not an overall solution to their problems.

The proper goal-oriented evaluation of a man proactive and complaining of erectile dysfunction requires a sympathetically elicited history, a focused physical examination and various carefully selected special investigations.

PHYSICAL EXAMINATION

Physical examination in erectile dysfunction should involve careful assessment of the external genitalia to detect the presence of cutaneous penile lesions, a Peyronie’s plaque or testicular abnormalities. Rectal examination should be performed to exclude benign prostatic hyperplasia or induration/nodularity suggestive of prostatic cancer. A focused neurological evaluation, including assessment of anal sphincter tone, should be performed and peripheral pulses palpated to detect signs of vascular disease. The distribution of body hair may provide a clue to androgen status. Blood pressure should be recorded with the patient both standing and lying down, and the presence or absence of obesity and/or gynecomastia noted. The abdomen should be palpated to exclude aortic aneurysm.

SPECIAL INVESTIGATIONS

Blood and urine testing
A key condition to exclude is undiagnosed diabetes mellitus. This is best accomplished by random measurement of blood sugar, as dipstick testing of urine to detect glycosuria does not reliably exclude the diagnosis. Because renal failure is also frequently associated with erectile dysfunction, electrolytes and creatinine should also be measured in addition to liver function tests, especially in those who admit to a high alcohol intake. Documentation of a full blood count and erythrocyte sedimentation rate is also a sensible precaution. Evaluation of the androgen status of the patient is usually indicated, as some may respond to hormone replacement therapy.
A serum testosterone (best measured as an early-morning sample) and sex hormone binding globulin (SHBG) should be requested. In addition, if the free testosterone level is low, a prolactin level should be measured, as hyperprolactinemia is associated with erectile dysfunction and may be corrected by treatment with bromocriptine. Some specialists also advocate testing of thyroid function, although this is a relatively unusual cause of erectile dysfunction, at least in younger men. If prostate cancer is a possibility, then a prostate-specific antigen (PSA) test should be requested, especially if treatment with androgen replacement therapy is being contemplated, as this may stimulate occult prostate cancer cells.

Nocturnal penile tumescence testing
Although still advocated by some, nocturnal penile tumescence testing is a rather cumbersome way to differentiate psychogenic from organic impotence. The same information (whether or not an erection develops during sleep) may be gleaned with the use of the snap gauge device or even with a strategically located ring of postage stamps. Only a few laboratories continue to employ nocturnal penile tumescence testing as a routine assessment of patients with erectile dysfunction.

Diagnostic intracorporeal injection
Injection of a vasodilator substance into one or other of the paired corpora cavernosa provides the clinician with two valuable pieces of information.

1. First, it confirms that a normal vasodilatory response is capable of developing (although a failure to respond does not necessarily indicate organic erectile dysfunction, since the response may be inhibited by excessive nervousness).
2. Second, this technique assesses the feasibility of self-injection pharmacotherapy as a treatment option. Originally, papaverine, with or without the α-blocker phentolamine, was used in this context. Nowadays, PGE1 (5–20 mg in 1 ml) is preferred, sometimes in combination with other agents such as papaverine, because of a lower incidence of prolonged erectile responses and priapism.

Color duplex Doppler ultrasound assessment of intracorporeal blood flow
More precise quantitative information concerning the erectile response to intracorporeal vasoactive agents such as PGE1 may   be obtained by imaging the cavernosal arteries with color duplex Doppler ultrasonography as the erectile response develops.   Normally, the velocity of blood flow through these vessels increases rapidly in response to PGE1 to more than 30 cm/s. As the   erection develops during systole, there is forward flow whereas, during diastole, the flow is reversed because of high   intracorporeal pressures. Thus, this test may help to distinguish between venous leakage and arterial insufficiency. Viagra Australia discount shop – myviagrainaustralia.com

Dynamic infusion cavernosometty and cavernosography
If veno-occlusive dysfunction is suggested by color Doppler ultrasonography investigation, then its presence and location may   be confirmed by dynamic infusion cavernosometry and cavernosography (DICC). This investigation involves pre-dosing with   intracavernous PGE1, followed by infusion of saline with simultaneous measurement of intracorporeal pressure and flow   required to maintain erection. Venous leak is characterized by an infusion of ≥120ml/min being necessary to maintain   erection. The source of the venous leakage may be visualized by performing cavernosography using a 50:50 solution of   radiographic contrast and saline. Leakage is usually visualized from the deep dorsal vein and/or the deep crural veins as well   as into the corpus spongiosum of the glans. Although deep dorsal venous leakage is one of the most common appearances   (Figure 52), multiple rather than single leakage sites are the rule rather than the exception.

Functional selective pharmacopudendal angiography
Pharmacopudendal angiograms may be indicated in the relatively small number of patients whose penile Doppler ultrasound   studies suggest arterial insufficiency and who are candidates for arterial reconstruction. The selective pudendal angiogram   may be performed under local anesthesia and some sedation through a single femoral percutaneous puncture. The test should   also include a non-selective pelvic angiogram with the catheter above the aortic bifurcation—the pelvic flush—and a selective   pudendal angiogram on each side. The non-selective pelvic angiogram is used to identify lesions of the common and internal   iliac arteries as well as to visualize the inferior epigastric arteries, which are the potential future donor vessels for penile   bypass surgery. Occasionally, an arteriovenous fistula is detected and its embolization may restore erectile function.

Definition

As defined by the NIH, erectile dysfunction (ED) is the repeated inability to get an erec­ tion firm enough for sexual intercourse. The International Consultation on Sexual Medicine defined ED as the consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual perfor­ mance. These definitions exclude other causes of sexual dysfunction including decreased libido and premature ejaculation. According to most recent studies, 15–30 million men report sexual dysfunction. There has also been an increase in self­reported ED according to the National Ambulatory Medical Care Survey, as men are seeking out simple treatments such as oral phosphodiesterase inhibitors (PDE5).

Historical Perspective

Impotence has been studied for hundreds of years, but not until the past few decades have we been able to understand and treat so effectively. Even in the early 1900s it was known that vascu­ lar, neurologic, and hormonal milieu played a part in erections as physicians performed dorsal vein ligations and testicular transplants. Aphro­ disiacs were the oral therapy of the day and included Chinese herbs and other common plant and food items that supposedly affected both desire and potency.

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However, the complex physi­ ologic, neurologic, and psychological interaction is only just starting to be appreciated. With the dawn of pharmacologic treatment in the 1980s and advancement in ultrasound tech­ niques, physicians were able to create erections and monitor blood flow into and out of the penis and have a way of measuring efficacy of treat­ ment. Intracavernosal therapy was the primary and most efficacious treatment at that time until the discovery of nitric oxide (NO) and its role in erection physiology. Pharmacological treatment has changed as we understand more about the eti­ ology of ED. It has been eleven years since the FDA approved sildenafil (Viagra®), an oral phos­ phodiesterase inhibitor, and there is a new algo­ rithm of treatment, which is centered on patients’ goals and motivations and evidence­based princi­ ples. Over 70% of ED can now be treated with oral medications. Oral pharmacotherapy is the first­line treatment without question for almost all types of ED according to the AUA/EUA guide­ lines and the WHO­sponsored International Consultation on treatment for ED.

First Line Therapy

With the availability and efficacy of oral medica­ tions, primary care physicians are now evaluat­ ing and counseling men with ED and beginning treatment. In 2002, the majority of Viagra® pre­ scriptions were written by primary care physi­ cians (69%) as compared to urologists (13%). With this transition, it is important to be thoughtful in our treatment of ED. First, it is important to know all the different treatment options and not just write a prescription for the patient. Secondly, with more recent evidence, it has been shown that ED may be a precursor to coronary artery disease and is associated with other chronic illnesses such as diabetes melli­ tus, hyperlipidemia, obesity, hypertension, and depression. When treating ED, it is important to see the patient as a whole and consider medi­ cation side effects, interactions, and efficacy in certain populations. As the population ages and men continue to seek out treatment for ED, it is necessary for healthcare providers to be equipped with the proper knowledge about available ther­ apy for ED in order to provide the most appro­ priate goal­directed therapy. This chapter will focus on the current first line oral pharmacotherapy for treatment of ED while also looking at the trends toward future oral therapy. Other treatment options will be described in other chapters.

Merriam-Webster defines erectile dysfunction (ED) as “the chronic inability to achieve or maintain an erection satisfactory for sexual intercourse.” How an erection is achieved depends a lot on blood circulation and a complex series of processes beginning with a man’s arousal. For men diagnosed with ED, it’s important to understand what causes their condition and what treatments are available to them.

Erectile Dysfunction Causes

ED can have a physical or a psychological cause. Sometimes, it’s a combination of both. Diabetes, high blood pressure, alcoholism are the most common physical causes, while stress, performance anxiety and depression top the list of psychological causes.

Other conditions that can cause ED include: obesity, hormonal imbalances, prostate cancer, spinal cord injuries, nervous system disorders, and valve problems in the penis.

Erectile Dysfunction Treatments

The best treatment should be tailored to the type of ED you have. Your best bet, of course, would have to be impotence drugs such as sildenafil (generic Viagra) and tadalafil (generic Cialis Canada). These can be used in conjunction with sex therapy or relationship counseling, especially if your condition is caused by a combination of physical and psychological factors.

Other options you can try are injections into the penis, penal rings, penis pumps, and surgery. There are also herbal formulations you can sample, but the safety of these products has often been questioned. No matter which treatment you go for, always assume that there are risks and benefits associated with these options. It’s up to you to choose the one that is perfect for your needs.

Should you decide to buy erectile dysfunction drugs, make sure to buy only from legitimate establishments such as your local drugstore or a reputable online pharmacy! Always think twice before buying from an internet pharmacy without prescription, unless you have checked for yourself that said establishment will not sell you counterfeit or sub-potent drugs.

A team of scientists in Italy have recently published research that offers hope of the development of a new type of erectile dysfunction medication, but from a very unlikely source – the smell of rotten eggs. Strange as it sounds, there is a strong link between the noxious gas and a good sex life, namely that when the penis is erect, just before penetration hydrogen sulphide is released, the same gaseous compound that makes old eggs and car exhausts smell so repulsive.

The intriguing discovery was even made in a rather offbeat way, through tests done on the discarded penile tissue of male-to-female transsexuals, into which the gas was injected. The suggestion has been made that the gas helps cause the nerve cells to relax, allowing blood to flow to the penis and enable erection.

The discovery is so exciting because it has echoes of the research that lead to the development of the universally popular erectile dysfunction medication canada Viagra, one of the first treatments to be sold that helps men suffering from this very common problem. There are at the moment only three treatments that doctors agree are effective at combating the problem, Viagra, Levitra and Cialis. The drugs are available for patients with certain conditions on the NHS, though many who are not eligible decide to buy Viagra and the other medications privately. However a spokesman from the Sexual Dysfunction Association has said that there is certainly a need for an “alternative…(as Viagra) is only about….80% to 85% effective for the general population“.

The field of erectile dysfunction medication is an interesting one, as many men still feel embarrassed to visit their GP with impotence problems, preferring to buy on the internet. As a recent application to sell Viagra over the counter was recently denied, it still can only be sold with a prescription from the doctor, but there are a small number of legal online clinics who do offer this service, which has proved extremely popular.

However the continued stigma attached to the disorder has resulted in a massive boom in illegal internet pharmacies offering ‘generic’ and counterfeit medications. Viagra, have led the fightback by the drugs companies, launching an aggressive campaign highlighting the dangers of buying illegal medication.

If a new erectile dysfunction medication is subsequently developed as a result of this research, the battle between the drugs companies will intensify still further. Though Pfizer no longer has the monopoly over ED medication, Viagra is still by far the drug with the most amount of brand recognition, but Cialis is remarkable for offering a markedly different result to Levitra and Viagra, which function in very similar ways. If the new treatment is noticeably different to the three already on the market, not only will men have greater choice but increased competition may result in a drop in prices, which will perhaps go some way to combating the growing sales in illegal pills.

For us men, masculinity is the matter of proud. We rule the world and therefore, the earth have become the male driven planet. Unfortunately, this is not the complete picture. There is a bitter truth – millions of men in the world lack very basic thing about maleness. These are suffering from erectile dysfunction. Not to worry, this article is on Generic Viagra, the miraculous treatment for impotence or ED. This is the drug that brings a ray of hope for people who are suffering from this problem.

If you are also suffering from erectile dysfunction, probably you know how tough it’s to deal with this problem. When impotence happens it causes several serious personal and social problems. Impotence hurts male ego. Because of the inability to satisfy female partner sexually, the person suffering from this problem have to undergo depression, lack of self esteem, and several other related ailments.

Apart from personal problems, erectile dysfunction also leads to bitter family relations among couples. In many situations it even results in broken marriages and social disorder. However, thanks to the medicines such as Generic Viagra, erectile dysfunction problem can be solved effectively.

In erectile dysfunction, the flow of blood into penis area decreases. There are many reasons behind this problem but the enzyme called phosphodiesterase-5 (PDE-5) is the primary reason that decreases cGMP. As the result male cannot achieve and sustain penis erection.

Generic Viagra have Sildenafil as an active ingredient. It’s a phosphodiesterase inhibitor. This drug increases the blood circulation into the penis that enables patients to achieve and sustain erection. Generic Viagra is easy to take. When you need, it can be taken with water. For the best results, take it couple of hours before sexual activity. Avoid high fat food just before taking this medicine. This way, you can enjoy the eternal joy of copulation.