In randomized controlled trials, an estimated 60% of men with diabetes, and 80% of men without diabetes experienced improved erections with sildenafil. Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both conditions, an intact neural system is required for a successful and complete erection. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems. Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also be caused by prolonged exposure to bright light. Drug therapy for erectile dysfunction: In a small number of cases, people who have taken sildenafil have complained of headaches, flushing and stomach-ache. It can also cause some visual problems, including an increased sensitivity to light, blurred vision or an inability to tell the difference between blue and green. Men who are already taking medicines that contain nitrates, such as nitro-glycerine (usually for angina or heart disease), are strongly advised not to use Viagra as this is dangerous and may result in a heart attack. Other similar drugs are tadalafil (‘Cialis’)and vardenafil (‘Levitra’). viagra online bestellen zonder recept buy viagra online
Sexual Problems in Men:While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor. best place to purchase cialis online cialis online no prescription
Viagra fast Can low testosterone level be replaced? Because of potential adverse effects and complex metabolism, the use of testosterone replacement therapy (TRT) is limited to men with symptoms of erectile dysfunction and a testosterone level of less than 200 nanogram per deciliter. Preparations available in the U.S. are topical, injectable, and transbuccal (placing inside mouth between the cheek and upper gum) testosterone. Oral preparations are not available in the U.S. pfizer viagra buy online in india viagra online
When there is angina or heart failure, the doctor may need to determine whether the heart has enough reserve to safely carry out the work necessary for sexual activity by performing cardiac treadmill stress testing. A useful and simple way to distinguish between physiological and psychological impotence is to determine whether the patient ever has an erection. If never, the problem is likely to be physiological; if sometimes (however rarely), it could be physiological or psychological. The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for impotence.