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A very rare but more serious visual complication is shared by all PDE5 inhibitors. This would be non-arteritic anterior ischemic optic neuropathy (NAION). A number of cases have been reported and generally risk factors for this very rare form of blindness are severe cardiovascular conditions. In summary, men at high-risk for cardiovascular disease with congestive heart failure or unstable angina should not receive treatment for sexual dysfunction until their cardiac condition has stabilized. The FDA advises patients to stop taking these medicines and call a doctor immediately, if they experience sudden or decrease vision loss in one or both eyes. Furthermore, patients taking or considering taking these products should inform their healthcare professionals if they have ever had severe loss of vision, which may reflect a prior episode of NAION. Such patients are at an increased risk of developing NAION again. .
Even when there is an initial physical reason, when this has passed you may still feel anxious about having sex and this can add to the problem.
27. Rodriguez JJ, al Dashti R, Schwarz ER. Linking erectile dysfunction and coronary artery disease. International Journal of Impotence Research 2005 17:1. 2005;17(1):S12-S18.
VEDs are generally safe (although there have been some very rare but serious complications). Pros Cons Works Well No drug effects Cheapest option Cumbersome Unnatural erection Bruising or burst blood vessels Penile pain Pain with ejaculation Numbness "Hinging" or instability of erection Penis may feel cold to partner Poor overall satisfaction ED Injections
There are also specific treatments for some of the causes of erectile dysfunction. Treatments for some causes of erectile dysfunction Possible cause Treatment Narrowing of penis blood vessels, high blood pressure, high cholesterol Medicine to lower blood pressure, statins to lower cholesterol Hormone problems Hormone replacement (for example, testosterone) Side effects of prescribed medicine Change to medicine after discussion with GP
Though erections may seem straightforward, the science behind them is complicated. At a basic level, erections happen thanks to a balance of blood flow into and out of the penis. When vascular, hormonal, nerve, or other physical or psychological changes disrupt blood flow, it’s harder to get and keep erections.
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The predose and postdose measurements of blood pressure for the placebo medication showed no postural drop in mean blood pressure (fig 1). One hour after active medication there was a change in the average mean blood pressures of 5 mm Hg, 9 mm Hg, and 9 mm Hg in the lying, sitting, and standing positions respectively.
If the pills don’t work or aren’t safe for you to take, your doctor may prescribe a drug called alprostadil. It helps boost blood flow to the penis, triggering an erection within minutes.
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On the horizon is gene therapy that would deliver genes that produce products or proteins that may not be functioning properly in the penile tissue of men with ED. Replacement of these proteins may result in improvement in erectile function. Experimental animal models have demonstrated improvement in erectile function with gene therapy. Human studies may also demonstrate success with this therapy. Gene therapy may take a long time for regulatory approval and public acceptance.
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Side effects, when they happen, tend to be mild and commonly include some of the following: Headache A sensation of flushing in the face Nasal congestion Nausea or indigestion Muscle pain Dizziness
The patient considering prosthesis implantation, should be aware of the different types of prosthesis, risks of infection and erosion, mechanical failure and resulting re-operations, differences from the normal flaccid and erect penis including the possibility of penile shortening, and the potential reduction in the effectiveness of other therapies if the device is subsequently removed.
Geriatrics: Healthy elderly volunteers (65 years or over) had a reduced clearance of sildenafil, resulting in approximately 84% and 107% higher plasma AUC values of sildenafil and its active N-desmethyl metabolite, respectively, compared to those seen in healthy younger volunteers (18-45 years). Due to age-differences in plasma protein binding, the corresponding increase in the AUC of free (unbound) sildenafil and its active N-desmethyl metabolite were 45% and 57%, respectively [see DOSAGE AND ADMINISTRATION, and Use In Specific Populations]