Viagra could perform its part effectively, never the less but it also accounts for its devastating side effects that include wonky willies flatulence, toothache and hiccups!

A health watchdog reports that the drug has been a demon in responsible for 109 deaths in the UK.

In Britain, more than 1,000 reports are filed listing more than 1,500 side effects.

The drug is prescribed more than one million times a year.

31 patients also complained of a painful medical condition Priapism in which the erect penis does not resume its flaccid state, despite the absence of both physical and psychological stimulation, within four hours. This could be a potentially harmful condition.

Two other patients, though rare, complained of a Peyronie?s disease where the male organ begins to take shape of a U-bend. Other side effects include two people who complained of getting deaf and blind.

An MHRA spokesman told the Daily Star Sunday: “The submission of a suspected report does not necessarily mean that it was caused by the drug. Many factors have to be taken into account in assessing causal relationships including the underlying disease that was being treated.” he added.

What are the side effects of Viagra? Read answer on www.ViagraFaq.net

York District Hospital based in York and the St James University Hospital in Leeds specifically wanted to examine whether the fact that the Cialis erectile dysfunction medication had a longer half life than Viagra and Levitra meant that the side effects would be more severe. The conclusion was that the men who used Cialis were more likely to suffer from the side effects for a longer time but they were not more severe. In fact the researchers noted that men using Cialis reported less problems with one of the PDE-5 side effects which is facial flushing.

Over 400 men were recruited for this study and the results showed that the mean duration for side effects with Cialis was 14.9 hours compared to 3.9 hours for Viagra and 7.7 hours for Levitra. Thirty percent of the men using Cialis said that they had side effects which lasted less than twelve hours. The side effects were measured using something called a Visual Analogue Scale or VAS in which the men responding to the questions could specify their level of agreement or disagreement to a particular statement by marking a position along a fixed line between two points.

The side effects of the erectile dysfunction drugs Viagra, Cialis Levitra tend to be minimal or nonexistent in most men. However they do include headaches, painful red eyes, increased intra-ocular pressure, dizziness and nasal congestion. You should start the use of erectile dysfunction medications with the smallest dose possible and then increase the dose as you see fit.

Always take advice from a doctor and make sure you have a prescription for erectile dysfunction medication before you use it.

Source: http://www.ukmedix.com

Their success in part is due to the simple fact that they work without having to rely on penile injections which some men find intimidating, and surgery which can be the most expensive option.

So how and why do they work? Well, we need to go back to the mechanics of an erection. When blood is pumped into the penis and the veins to allow it to flow out are constricted, the heart pumps the penis up in much the same way as air or fluids are used to inflate any closed system. The more blood that enters the system, the harder the erection becomes. The vacuum device works on exactly the same principle except that the erection is created by drawing the blood into the penis rather than by a pumping action.

So now we enter what may at first sight seem a slightly surreal world of technology. You take the hollow tube, usually made out of clear plastic and insert the latex constriction band into the base. Now, place the device over your penis and press it against your body to create a seal. Next, we have to create the vacuum. The actual method depends on the sophistication of the device you have bought. The simple mechanical models have a hand pump or squeeze bulb which slowly extracts the air. Others have a battery-driven pump. As the vacuum develops, the penis physically expands which draws blood into it. It takes about three minutes of exposure to this vacuum to draw enough blood into the penis to create a hard erection. The latex ring is then detached from the base and this constricts your penis to prevent the blood from simply flowing back out into your body. Depending on the model, this can require some degree of physical dexterity. The better devices have a “hands-free” system for releasing the ring.

Once the ring is in place, the air can be allowed back into the device, and the device can be removed. The ring maintains the erection for about twenty minutes. In reality, the erection can be maintained for longer but as time extends, so the risk of damage to the penis increases. Twenty minutes is a safe limit.

So is this a good device for you? Well, the scientists who did all the research (a fascinating area of medical research to pioneer and place on your resume) found that this works best in men who retain some ability to get an erection naturally. In fact, if you get a full erection but it deflates soon afterwards, you can use the latex constriction bands to maintain the hardness. Alternatively, you and your partner should engage in whatever foreplay you find works best to get your maximum natural response. Then use the device. Unlike the use of oral medications like Viagra, Cialis and Levitra, this piece of equipment cannot be concealed. It can only be used when you and your partner are completely comfortable with it. You may need joint counselling so that it can be integrated into a sexual routine for you both to enjoy. As it is, some couples do find it interferes with foreplay as it builds to what should be a natural conclusion.

But, you are shaking your head, dismissing this as a clumsy thing to have in your bed. But consider. This is cheaper than surgery or the long-term use of injections. It is completely non-invasive. You are not injecting yourself. You are not spending time on an operating theatre table for a prosthesis to be installed. This is a simple-to-use device that creates an erection in almost every situation in which erectile dysfunction occurs (it is only inadvisable to use this device if you have problems with blood clotting or you already take blood thinners). You can use it whenever you want, as many times as you want without any side effects. The only slight disadvantage is that the erection is only created above the constrction band. Unless you get the ring sited close to the body, there can be a certain lack of overall rigidity. You also have to remove the band before you can ejaculate and allow the semen to pass after orgasm.

• the brain has to recognise that we are in the sex zone – sexual stimulation is not just a physical thing, the brain has to be in on the act so it can send those vital messages down to the guys operating the valves,
• “Start releasing the nitric oxide!”
• The chemical factory starts to churn and, before you can say, “Geronimo!” or whatever other words come to mind at a time like this,
• guanylate cyclase (GMP) and cyclic guanosine monophosphate are pumping out into the muscles
• and artery dilation, here we come.

This may look simple on paper, but if anything throws a spanner in the works to disrupt the sequence, the result is nada.

So let’s start breaking it down in manageable chunks.

We have to start in the brain. If anything is wrong with the initial response to the stimulation, there is no physical response of any kind. This can be a problem with the neurotransmitters – the chemicals that transfer messages between neurons and cells – or it can be psychological which can be just as terminal as a physical cause.

If we have messages, they then have to travel down the spinal cord and transfer to the area around the penis. Any damage that prevents the nerve messages from arriving at their destination, means there is no physical response.

If the messages arrive, you then depend on muscles to respond as they should to dilate arteries and compress veins, and fibrous tissue must absorb the blood.

So any damage to the central or peripheral nervous system, to the musculature, blood vessels or fibrous tissue can be the cause of the ED. This damage is most usually caused by disease. The most likely candidates are:

• kidney disease;
• liver diseases including fatty liver, hepatitis and cirrhosis which are associated with alcoholism;
• multiple sclerosis which affects the central nervous system;
• diabetes mellitus which may lead to cardiovascular disease or nerve damage;
• arteriosclerosis or other vascular diseases – about 40% of men with diabetes suffer with ED;
• hormonal problems, for example producing low levels of testosterone; and
• neurodegenerative disorders including Alzheimer’s, Parkinson’s and Huntington’s disease, amyotrophic lateral sclerosis, etc.

The way we live our lives may also actively contribute to our lack of sexual success, particularly if our choices have begun to cause cardiovascular problems. So heavy smokers, those who are carrying excessive weight and those who never take exercise are most at risk. Those who play sport or pick up an injury in an accident can fall prey to ED if there is damage to the penis itself, or to the spinal cord, pelvis, prostate or bladder.

Then we come to the unintended consequences of necessary surgery. For those who are diagnosed with cancer, sometimes radical surgery is required to cut away as much of the affected tissues and organs as possible. If these operations are for cancer of the prostate or bladder, the risk of damage to the nervous system and blood vessels near the penis is high. Similarly, we may already be taking medication that causes ED as a side-effect. The most common classes of drugs that can have this undesirable effect are:

• for the relief of hypo or hypertension;
• antihistamines;
• tranquillisers and antidepressants;
• appetite suppressants; and
• used to treat heartburn and stomach ulcers, e.g. Tagamet.

Finally, there are a range of psychological conditions including:

• stress;
• anxiety;
• low self-esteem;
• guilt; and
• depression.

Whether directly or indirectly, all these mental states may contribute to performance anxiety where we develop an unreasonable fear of of sexual failure. It is estimated that about 15% of all ED cases have a psychological component. The difficulty with this estimation is that men who have physical illnesses also have the same list of possible feelings, so distinguishing cause and effect can be problematic.

Well, that’s a fair list of causes – probably a few more than you thought. Some of them are on the serious side which should send you warning messages that going to the doctor is always a good idea. ED is just a symptom. If all you do is to take Viagra, Cialis or Levitra you are leaving the underlying condition undiagnosed and untreated.

Do you really want to take that risk?

Whenever groups of people come together, a society emerges. No matter how primitive or sophisticated, people develop a culture which lays down what patterns of human behavior are acceptable (or not) and establishes a basic system of signs and symbols to allow everyone to judge the importance and significance of what is done (or not done).

So whatever happens, we have a general agreement about what it means. This may be words, gestures, scents, tastes, textures, sounds, images, and so on. The test of acceptability depends on the context. Words or gestures may be acceptable from an individual wearing a particular set of clothes, e.g. a uniform, in a particular place, but offensive from another who does not display the right status to behave in that way.

We will also distinguish between different classes and groups. Whether we become members will depend on our social identity. Do we speak with an accent or speak a dialect, do we write in sentences or in SMS format, where do we live, what work do we do, how do we dress, and so on. More fundamentally come issues of sexual identity and gender which tend to fix the power structures. Most cultures have proved to be patriarchal, i.e. male dominated. From this come the rules of behavior deciding how much private space we should enjoy, whether and where people may touch or stare at each other, and so on. As we grow up we are socialized and learn how to fit into this complex society through our facial expressions, gestures and dress.

Because most cultures are male and men have political and social power, male imagery also tends to dominate. Maleness and male potency is equated with more general access to power and success in society. In its most extreme form, machismo in some cultures applauds obvious displays of masculinity and requires men to demonstrate a strong sense of pride and honor both in themselves and in their roles as leader of the family and father of their children.

So in male dominated cultures, when something goes wrong with a man’s ability to have sexual intercourse, this can have devastating psychological effect. Men affected are likely to feel intense shame and loss. They will change their behavior to conceal their inadequacy, fearing the judgment of their male peers and the loss of respect from women. This extreme defensiveness is often completely unnecessary because, in most cases, Viagra, Cialis or Levitra can quickly resolve the problem. But some men feel so deeply inhibited, that a strong culture of silence prevents them from discussing the matter with anyone.

Research suggests that, at some time during their lives, the majority of men may experience some degree of ED. There are all kinds of reasons for this. It is most usually situational, e.g. some emotionally disturbing event has just occurred and this disturbs the mood and motivation. At other times, there may be a physical injury or some other passing illness that makes sexual intercourse temporarily unavailable or unacceptable. More generally, it is estimated that about 10% of the male population will experience recurring impotence problems at some point in their lives. But a significant number do not seek treatment.

Many men focus on the fact that ED has affected them to the exclusion of the more relevant questions of what the cause might be and whether treatment is available. Had it not been for the publicity surrounding the development and launch of Viagra, it is probable that this omerta (to borrow a words from the mafia) would have persisted in the West. As it is, an increasing number of men affected by ED are prepared to admit the problem and do something about it. The most responsible do go to their doctors to get professional guidance. The remainder are still inhibited and exploit the privacy of the internet to buy Viagra or now Cialis and Levitra online.

No matter how medication is acquired, ED is less of a problem in relationships and, even if men are still silently anxious about how they will perform in the future, their partners are released from their short-term difficulties. For while their men are unable to perform, they are defensive and difficult to live with. Worse, the culture often does not permit partners to ask their men about the problem. Women are therefore condemned to suffer in silence. If men are at least able to resume intimacy and the mood of desperation has lifted, the general quality of life has been improved for their partners.

Can I say that here? Sorry, I’ll be back with you in a minute. I just have to ask the editor of this site whether I can be so obviously sexist. We’ve been getting so politically correct about what we can or cannot say, I get confused about how much of what I think I can write. OK. He says I can keep the meaning but I should write it in a more subtle way.

Subtle I can do.

Now where was I?

Our world had come crashing down (along with everything else that should have been rising up). And then this drug company comes along and tells us they’ve invented a cure!

A cure! That’s great!!!! It’s a what? It’s a tablet. And it’s only available on prescription?

But that means I have to tell someone I have ED. I can’t get the cure unless I tell someone.

What kind of a cure is that?!?!!?

Why can’t they just put it in the water supply so we can all be cured without having to tell anyone?

Is Pfizer run by women? Have they devised this plot to humiliate us?

[The editor is telling me this is not subtle enough. We all know that Pfizer is run by men - as a top US company, there's only the usual token woman on the Executive leadership Team of ten (http://www.pfizer.com/about/leadership_and_structure/meet_executive_leaders.jsp)]

Damn! It’s not a conspiracy, then.

So we gotta go and see a doctor? That’s the price we have to pay for this cure?

What about this internet thing? Why can’t we just buy Levitra online?

Whaddya mean I could be sick? I’m not sick! There’s nothing wrong with me. This is just a temporary difficulty.

So this ED could just be a symptom of something more serious?

Perhaps I should go see a doctor.

But ten years ago, the medical profession was not prepared for the scale of demand. Before Viagra hit the market, doctors in general practice had not seen many patients wanting to discuss their sexual problems. There were a number of specialised units in both public and private hospitals and, of course, there were a number of commercial clinics offering a confidential service. But the spirit of wounded male pride barred the doors and, because there was no easy remedy for ED, not many men would break down those doors to get advice. This also allowed doctors the luxury of never having to confront their own prejudices. They did not have to discuss sensitive issues with their patients.

Then the advertising hype generated demand. The trickle of male patients became a flood. Doctors were overwhelmed and reacted in the only rational way possible. They gave out prescriptions for Viagra without a professional investigation of the cause of each patient’s ED. There just was not time (and many of the doctors were like their patients and felt too embarrassed to talk about ED and perform the necessary physical examinations) so everyone got what they wanted – quick and easy access to Viagra, a tablet that proved to be as good as its advertising hype.

Well, ten years is a long time. Today, the medical profession is back on track. Education and training have been modified to prepare all newly qualified doctors for dealing with cases of sexual difficulties. Existing doctors have had updating courses. The necessary lab resources are in place. New technology offers better diagnostic options. New drugs are available with Cialis and Levitra joining the market alongside Viagra.

Yes, the process will take a little longer than those original consultations ten years ago, but that is to your advantage. Back then everyone was gambling that there was nothing too seriously wrong with you. Now, quick and easy tests are available in a carefully devised schedule so that you only escalate to the more serious tests if there is a real need. Doctors have taken the lottery out of diagnosis without spending big bucks to investigate the problem unless it is absolutely necessary.

It is better to be safe and leave those big bucks to the bedroom where they belong!

If you do seek advice and a depressive illness is confirmed, your physician will offer treatment. In such cases, the issue of cause and effect can become complicated. The ED may have been caused by the anxiety or depression itself, or there may have been an independent cause. But what began as a small problem can be aggravated as a side effect of the antidepressant medications you are prescribed. It is somewhat ironic that one of the factors depressing you may be your declining sexual performance, but the treatment for that depression can complete deprive you of your desire to have sex. As if it could get worse, the selective serotonin reuptake inhibitors (SSRIs) antidepressants not only affect sexual performance, but may also disturb sleep patterns and cause weight gain. Not surprisingly, this prompts many patients to stop taking the medication. Thus, although treatment using one or more antidepressants is usually successful in 90% of all cases, less than one third of patients complete the course of medication, and the incidence of relapse is high.

This creates real problems for the physicians trying to balance treatments for both the depressive illnesses and the ED. Because there may be adverse reactions between the different medications, you should not take Viagra, Cialis or Levitra on your own initiative if you are already taking any other medications. Your physician has a number of options:

• The first and most obvious possibility is to change to another antidepressant with fewer side effects. In a number of clinical double-blind studies, Serzone (Nefazodone) and Wellbutrin (bupropion) were shown to cause fewer problems on sexual function than SSRIs. If you respond well to either of these, you may find that you feel less depressed and your sexual performance improves. Wellbutrin is also less likely to cause weight gain which may aid your choice of medication.
• It may be possible to lower the dose of the current antidepressant so that you still get some relief from the depression and your sexual performance improves. For example, in one clinical trial of Prozac (fluoxetine hydrochloride) some people responded as well to a dosage of 5-10mg as the more usual 20mg.
• With some drugs, e.g. Zoloft (sertraline) and Anafranil (clomipramine), it may be possible to change the medication regime. If you have a fairly consistent time when you engage in sexual activity, this should be timed when the drug’s level in your body would be at its lowest, i.e. you would take your daily dose after sexual intercourse.
• There are some case reports and small clinical studies that have found some additional medications can modify the effect of the antidepressant. For example, in an off-label test, Amantadine has been shown to relieve the SSRI-induced inability to reach an orgasm in some but not all people.
• Then your physician may authorise you to take one of the specific ED medications such as Viagra, Cialis or Levitra. In a 2003 randomised study of ninety men suffering from antidepressant-induced ED, 54% of those treated with Viagra (sildenafil citrate) as against the placebo showed improvement. Note that only slightly over half the sample showed improvement. There are limits to the effectiveness of Viagra, Cialis and Levitra.
• If you are taking Zoloft (sertraline) and Paxil (paroxetine), it may be possible to change your schedule to include a two-day break each week. During this time, your sexual function should return without losing the effectiveness of the antidepressant.

All this has assumed that the ED was in fact caused by the depression or the medication to treat that depression. If there are alternative explanations for the ED, those should also be thoroughly investigated. It would compound the irony if the true cause of your ED should prove not to be the antidepressants but a condition requiring a different treatment.

You sit, you pass the test of courage and, for the first time, tell a health professional that you have erectile dysfunction (ED) – perhaps not using those words, but your physician gets the message and makes the predictable reassuring noises. There is a momentary pause and you manage to get your first question out about buying Viagra online.

A hand is gently raised. Yes, everything will probably be all right. Yes, he will almost certainly be writing out a prescription for Viagra, Cialis or Levitra. But first, there are one or two questions.

This is not the happiest moment in your life. What is he going to ask? Well, at least one good thing has happened already. Your physician is obviously used to dealing with ED cases. If there was any lack of confidence, he would have referred you on to a specialist. He’s checking your medical records. His mouth is opening. You are determined not to be shocked. You stay calm. The first question comes:

• I see you’re in a permanent relationship. Has this problem come suddenly or have you slowly been finding it difficult to get an erection?
• How many times have you failed to get an erection?
• Is this a complete failure? Not even the slightest swelling? Or do you get some erection for a short while that then goes away?
• While you have an erection, is it hard enough for penetration?
• If you can manage to get penetration, does it go away almost immediately?
• Can you get it back?
• Is there anything your partner can do or you can think about that will bring back the erection?
• Do you have any lovers? How many partners do you have at present?
• Are you bisexual? How many male partners do you have?
• Does this problem with getting or keeping an erection only happen with one of them, or with some of them, or with all of them?
• Do you wake up some mornings to find an erection?
• Can you get an erection to masturbate?
• Do you smoke? If so how many cigarettes a day?
• Do you drink a lot? If so what do you drink and how much?
• In addition to the medications in your file, are you doing any drugs whether recreational or medicinal? What about health foods, diet supplements, that kind of thing?

It doesn’t stop there of course. He will go on to ask many other questions about your general health and lifestyle. We’re just giving you a list of the highlights so you can ready yourself. Yes, this is going to be intrusive and highly personal. But there is a very good medical reason behind every one of these questions. You should answer truthfully. Do not be shy or embarrassed. This is a private and confidential service. If you want access to the many possible treatments including a prescription for Viagra, Cialis or Levitra, you must trust your physician to do his job and make a proper diagnosis. This is not a time for half-truths and evasions. You must probably be more honest with your physician than you are with your current partner(s). And, no, we have not forgotten. We can safely leave your question about how to buy Viagra until our next session together.

Hmmm. This needs thought! Why can I not simply pop a Viagra, Cialis or Levitra?

Well, no matter how successful they are for most men regardless of age and regardless of the underlying cause of erectile dysfunction (ED), there are limits to the PDE-5 inhibitors. These limits may be physical – the underlying cause of the ED is sufficiently far advanced that Viagra, Cialis or Levitra simply will not work. Or you may already be taking medications for those underlying causes which, for now, make it impossible for you to take one of the PDE-5 inhibitors at an effective dosage.

This forces us to discuss a range of alternative treatments. The first for these purposes, is a penile injection.

These injections have been available for almost twenty years so we doctors are not experimenting on you. The technology and the medications are well tested and routinely used. The first and the only one with Food and Drug Administration (FDA) approval for use in the treatment of erectile dysfunction is prostaglandin E1, sold as Alprostadil and Prostin VR. It is a naturally occurring chemical released by the smooth muscle cells of the penis when you are sexually stimulated. As such, it has the best success records with the fewest side effects and, if you are resident in the United States, the cost is covered by most prescription plans.

It is also available as a small pellet sold under the brand name, Muse, which you insert into the tube through which urine passes from the bladder out of your body. Now this is slightly more complicated than it sounds. You have to use a device which opens up the canal sufficiently to allow the tablet to be inserted inside your penis. This may not be a completely comfortable process either in the insertion or when the penis closes around the pellet. As you will realise, the tablet slowly dissolves and so the pressure on the penis diminishes fairly rapidly. Some men report a slight burning sensation as the medication is absorbed into the penis. There can also be a drop in your blood pressure so you should not be taking any other medication which may have an additive effect. It is also not advisable to consume alcohol before using Muse.

Papaverine is a vasodilator used to relax blood vessels and it was adapted for this purpose almost twenty years ago. It rarely causes any pain although it has a slightly higher risk of causing priapism (an unnaturally long and painful erection which should be treated as an emergency to avoid damage to the penis) because it remains active in the body for a longer period of time than Alprostadil. It may also be slightly more likely to cause scarring if you hit the same injection point too often. You should not use this medication if you are drinking too much caffeine, alcohol or taking any other recreational drugs. Heavy smokers should also take care. You also cannot mix this medication with:

• the barbiturates used for inducing sleep or treating seizures;
• medicines such as temazepam or diazepam for sleeping or anxiety problems;
• medicines to control Parkinson’s disease; or
• some narcotic pain killers such as morphine or tramadol.

The third drug is also a vasodilator: phentolamine sold as Regitine or Rogitine. It is rarely used on its own but usually in combination with one of the other two medications mentioned above.

Neither of the latter two medications have been approved by the FDA for this purpose – all this means is that the manufacturers have not gone through the expensive process of getting approval. But off-label use under medical supervision is quite common. So if either you or your partner are prepared to learn how to give the injections, this is a good system, available to use whenever you want with no real preparations required. Once given, they produce erections that are close to the body’s own spontaneous erections and allow you to have an orgasm and an ejaculation. The erections last for between thirty minutes and two hours which is normally long enough for sexual intercourse to be satisfying. This is a cost-effective alternative to the more expensive and invasive surgical option. The only drawback is that the use of the injections is usually limited to three or four times per week to reduce the risk of scarring to your penis.

So here’s the bad news. No matter how much you may want to consider ED a private matter. No matter how defensive and resentful you may feel if your physician tactfully asks you how you are getting on in “that” department, there’s a real need to openly discuss ED with your physician. And you are going to get asked the question by any physician who keeps up-to-date with best practice. Erectile dysfunction can have destructive effects on your relationship with your partner, and the diagnosis and treatment of the problem will not only have a positive effect on you as a couple, but it will also help to bridge between you and your physician as tests prove whether those first symptoms of ED really are an early warning of vascular problems. That’s either your heart itself, or the blood vessels taking the blood round your body, or the pressure of the system. To continue the bad news, avoiding any trip to consult your physician and simply buying Viagra online, or Cialis or Levitra is potentially dangerous. You may be leaving a serious heart condition as a time bomb in your system.

How do we know this?

In the Massachusetts Male Aging Study (MMAS), just over half the thirteen hundred men aged between forty and seventy years experienced one or more periods of ED – about 10% had a complete loss of function. It established a clear link between diabetes, cardiovascular disease and ED. About nine years later, a second team of researchers polled the same group of respondents2. The prevalence rate of ED was found to increase with age and was most common among those with below average levels of education diagnosed with high blood pressure, heart disease and diabetes. This confirmed a general trend of data that about 80% of cases of ED have an organic origin, and arteriosclerosis is probably the most common. This is where the walls of the arteries thicken, and fatty substances, cholesterol, dead cells, calcium and fibrin (a clotting material in the blood) slowly accumulate and limit the flow of blood.

Continuing the flow of good news: as part of the ageing process, the layer of cells lining the interior surface of all blood vessels, called the endothelial layer, decreases the production of nitric oxide. This makes erectile dysfunction more likely when blood flow is reduced through the penis. More generally, endothelium helps to control blood pressure, blood circulation and the clotting process, so poor sexual performance is a critical first symptom of what may become heart disease if not treated. This is even more of a threat to long-term smokers because nicotine both directly affects the vascular endothelium and restricts the smooth-muscle contraction in the cavernosal body producing ED.

In a study completed in 2002(1), 980 patients who reported ED were diagnosed as follows:

• 18% of patients had undiagnosed high blood pressure;
• 16% had diabetes;
• 15% had a benign growth in the prostate;
• 5% had heart disease resulting from a reduced flow of blood,
• 4% had prostate cancer, and
• 1% had depression.

Just so we are absolutely clear, the main link between ED and cardiovascular disease is the vascular endothelium. If you have less nitric oxide, ED can be the first major symptom of what will become a more general endothelial cell dysfunction leading to cardiovascular disease or diabetes (1).

So, if that is all the bad news, the good news is that there are many ways to treat ED – successfully in most cases. Because of the choices of treatment, we can usually find combinations of treatment that are compatible (and, yes, this may be a choice between Viagra, Cialis and Levitra, or one of the other slightly more invasive medications or devices). In the past, some of the medications to reduce high blood pressure and to lower the level of lipids in your blood were incompabile with the treatments for ED. If we physicians are involved early enough, we can also help you to stop smoking and reduce your weight, both of which will give you many more years of active life.

1. M. Kirby; G. Jackson; J. Betteridge et al. Is erectile dysfunction a marker for cardiovascular disease? International Journal Clinical Practice 2002; 55(9):614-8.

2. C.B. Johannes; A.B. Araujo; H.A. Feldman et al. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts Male Aging Study. Journal of Urology 2000; 163(2):460-3.