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Erectile Dysfunction

Erectile Dysfunction

Erectile dysfunction (formerly called impotence) is the persistent inability to achieve or maintain an erection adequate for intercourse. It’s an enormous problem that has really only gotten the attention it deserves since the introduction in 1998 of the first erection-enhancing pill, Viagra (since then, two other erection-enhancers have been introduced).  The largest study done to date estimates that between 20 and 30 million men in the US experience some degree of erectile dysfunction, with the incidence increasing steadily with age.

Erectile dysfunction (ED) is caused by an interplay of normal aging and a host of other factors that increase your risk of having ED:

  • Smoking
  • Diabetes
  • Alcohol
  • Many prescription medications
  • Obesity
  • High cholesterol
  • Injury to the groin area

Whether or not a man has erectile dysfunction is something he and his partner judge for themselves based on their personal experience. All men occasionally can’t get it up, the question is how often that happens and to what degree the man and his partner are bothered by it.

Although erectile dysfunction may begins as a purely physical problem with blood vessels, nerves or other parts of the male reproductive machinery, it can rapidly acquire a complicated psychological dimension. For example, if a man fails to have an erection on one occasion, he may become anxious that he’ll fail again the next time. The anxiety releases hormones such as adrenaline that clamp down on blood vessels, including those feeding the penis, thereby making an erection that much harder to obtain.  A vicious cycle is created that can be hard to break.

Both men and their partners can misinterpret an instance of erectile failure. The man may mistakenly think that he no longer finds his partner sexually attractive, or the woman may think it’s because they’re not sexy enough or that they’re doing something wrong, sexually. The result can be a psychological domino-effect leading to less and less sex, feelings of emotional distance, abandonment or rejection.

The easiest, and most popular, way to treat ED is with one of the three FDA-approved medications for this problem. Here’s a summary:

Onset of action Duration of action Recommended Dose Not suitable for Limits of Use
Viagra 30-60 min. 4 hours 50 mg to start, with adjustments up to 100 mg or down to 25 mg. depending on response. Men taking nitrate medications such as nitroglycerine Should not be used more than once a day
Levitra 25-30 min. 4-5 hours 10 mg, with adjustment to 20 mg if needed Men taking nitrate medications or alpha-blocker medications Should not be used more than once a day
Cialis 16-60 min. Up to 36 hours 10 mg, with adjustment to 20 mg if needed Men taking nitrate medications or alpha-blocker medications Should not be used more than once a day


If pills don’t work, that’s a sign of more severe damage to either the blood vessels or nerves involved with erections.

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