A sexual problem, or sexual dysfunction, refers to a problem during any
phase of the sexual response cycle that prevents the individual or couple from
experiencing erectile dysfunction medication
from the sexual activity. The sexual response cycle
has four phases: excitement, plateau, orgasm and resolution.

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.

What Causes Sexual Problems?

Sexual dysfunction can be a result of a physical or psychological
problem.

• Physical causes: Many physical and/or medical conditions can cause problems
  with sexual function. These conditions include diabetes, heart and vascular
  (blood vessel) disease, neurological disorders, hormonal imbalances, chronic
  diseases such as kidney or liver failure, and alcoholism and drug abuse. In
  addition, the side effects of certain medications, including some
  antidepressant drugs, can affect sexual desire and function.
• Generic prices viagra
  causes: These include work-related stress and anxiety,
  concern about sexual performance, marital or relationship problems, depression,
  feelings of guilt and the effects of a past sexual trauma.

Who Is Affected by Sexual Problems?

Both men and women are affected by sexual problems. Sexual problems occur in
adults of all ages. Among those commonly affected are those in the geriatric
population, which may be related to a decline in health associated with
aging.

How Do Sexual Problems Affect Men?

The most common sexual problems in men are ejaculation disorders, erectile
dysfunction and inhibited sexual desire.

What Are Ejaculation Disorders?

There are different types of ejaculation disorders, including:

• Premature ejaculation: This refers to ejaculation that occurs before or
  soon after penetration.
• Inhibited or retarded ejaculation: This is when ejaculation is slow to
  occur.
• Retrograde ejaculation: This occurs when, at orgasm, the ejaculate is
  forced back into the bladder rather than through the urethra and out the end of
  the penis.

In some cases, premature and inhibited ejaculation are caused by
psychological factors, including a strict religious background that causes the
person to view sex as sinful, a lack of attraction for a partner and past
traumatic events. Premature ejaculation, the most common form of sexual
dysfunction in men, often is due to nervousness over how well he will perform
during sex. Certain drugs, including some anti-depressants, may affect
ejaculation, as can nerve damage to the spinal cord or back.

Retrograde ejaculation is common in males with diabetes who suffer from
diabetic neuropathy (nerve damage). This is due to problems with the nerves in
the bladder and the bladder neck that allow the ejaculate to flow backward. In
other men, retrograde ejaculation occurs after operations on the bladder neck
or prostate, or after certain abdominal operations. In addition, certain
medications, particularly those used to treat mood disorders, may cause
problems with ejaculation.

What Is Erectile Dysfunction?

Also known as impotence, erectile dysfunction is defined as the inability to
attain and/or maintain an erection suitable for intercourse. Causes of erectile
dysfunction include diseases affecting blood flow, such as sildenafil citrate viagra
(hardening of the arteries); nerve disorders; psychological factors, such as
stress, depression, and performance anxiety (nervousness over his ability to
sexually perform); and injury to the penis. Chronic illness, certain
medications, and a condition called Peyronie’s disease (scar tissue in the
penis) also can cause erectile dysfunction.

What Is Inhibited Sexual Desire?

Inhibited desire, or loss of libido, refers to a decrease in desire for, or
interest in sexual activity. Reduced libido can result from physical or
psychological factors. It has been associated with low levels of the hormone
testosterone. It also may be caused by psychological problems, such as anxiety
and depression; medical illnesses, such as diabetes and high blood pressure;
certain medications, including some anti-depressants; and relationship
difficulties.

It is important to talk with your doctor to learn about the disease
and what you can do to help manage CAD and prevent its progression.

Making healthy lifestyle changes can delay and possibly reverse the
course of CAD. Quitting smoking, eating a low-fat and low-cholesterol diet, and
getting regular exercise are the most important steps you can take to reduce
your risk of developing coronary artery disease.²⁶ For
more information, see:

Exercising for a healthy heart.

For more information on how to make healthy lifestyle changes, see
the Prevention section of this topic.

Most people are able to control
angina by taking medications as prescribed and
nitroglycerin when needed. See
how
to use nitroglycerin pills under the tongue. Remaining as active as
possible is important for most people. However, if angina is not controlled by
the above, consider these tips:

• If an activity causes angina, slow it
  down.
• Ease into activities in the morning, and reduce activity
  immediately after meals.
• Change your eating patterns. Eat smaller,
  more frequent meals rather than 2 or 3 large meals.

When angina is more severe and cannot be controlled, the following
tips may be useful:

• If it is feasible, it may help to move to a
  different home to avoid physical stress caused by climbing stairs, shoveling
  snow, or mowing lawns. Or, find other ways to get chores done, such as hired
  help, family members, or trading for other services that are easier to
  do.
• It may be necessary to change the kind of work you perform to
  avoid physical stress. This may be especially important if your work involves
  heavy labor.

Taking nitroglycerin before an activity may reduce or eliminate the
chest pain associated with the activity. Discuss with your doctor the use of
nitroglycerin to prevent chest pain.

Do not use the erection-enhancing medication
sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) if you are
taking nitroglycerin or other nitrates. Combined, these two drugs can result in
a life-threatening drop in blood pressure. If you are taking an
erection-enhancing medication and develop chest pain, be sure to alert the
health professionals caring for you about your use of this medication so that
they do not generic prices viagra
give you nitroglycerin or another type of nitrate.
There are other oral blindness causing citrate sildenafil medicines that may be generic viagra usa.

Alert your doctor immediately if there is a sudden change in your
angina symptoms or if angina begins to occur cialis medication sample viagra
or when you are at
rest.

Nitroglycerin comes in a quick-acting tablet or spray form, or as
a long-acting pill. The quick-acting pill or spray forms are used under the
tongue (sublingually). Your health professional will prescribe the right amount
for you; do not use another person’s nitroglycerin.

When do I use nitroglycerin under the tongue?

Your health professional will advise you when to use your
nitroglycerin. Generally, nitroglycerin under the tongue is used:

• To relieve sudden angina.
• Before
  stressful activities that can cause angina, such as walking uphill or having
  sexual intercourse.

How do I use nitroglycerin under the tongue?

• Sit or lie down to take your nitroglycerin.
  If you are driving, pull over and park the car. Taking nitroglycerin can lower
  your blood pressure, which sometimes may cause you to pass out, especially if
  you are standing up.
• For sudden episodes of angina, use
  nitroglycerin in a tablet or liquid spray form.
  • The tablet should be placed under your
    tongue and left until it dissolves. If you erectile dysfunction meds
    swallow the tablet,
    take another. The medicine won’t work if it is swallowed.
  • To use
    the spray, lift your tongue and depress the spray canister button once.
• Take one tablet or spray dose. If after 5
  minutes the chest pain is not better or gets worse, call 911 or other emergency
  services immediately.
• After calling
  911 , continue to stay on the phone with the emergency
  operator; he or she will give you further instructions.
• Regardless
  of what happens, you should let your health professional know that you had an
  episode of angina. If this is unusual for you, your angina episodes are
  occurring more frequently or lasting longer, or you need more medicine to
  control them, tell your health professional. Report any change in your chest
  pain (unstable angina) to your health professional.

A fresh tablet should taste bitter and sting when you put it
under your tongue. If it does not, it probably is not effective and you should
take another.

Are there side effects or interactions with other drugs I should be aware of?

Normal, temporary side effects of nitroglycerin include a warm or
flushed feeling, headache, dizziness, or erectile dysfunction remedy
. You may also feel a
burning sensation under your tongue.

Do not take the erection-enhancing medicine sildenafil (Viagra),
vardenafil (Levitra), and tadalafil (Cialis) if you are taking nitroglycerin.
Combining nitroglycerin with any of these medicines can cause a
life-threatening drop in blood pressure. If you develop chest pain and have
taken one of these erection-enhancing medicines, be sure to tell your health
professional so that you are not given nitroglycerin or another nitrate
medicine.

Do not take the
pulmonary hypertension medication sildenafil (Revatio)
if you are taking nitroglycerin or another nitrate medication.

How should I store nitroglycerin?

Store nitroglycerin pills in a erectile pill
(such as brown),
airtight, glass container that you cannot see through. Keep nitroglycerin pills
and liquid spray away from heat or moisture. Remove the cotton stopper from the
bottle.

Can nitroglycerin get old and lose potency?

If nitroglycerin is old, the tablets may not work well. Get a new
prescription as soon as possible if your supply is past the expiration date.
Usually you should replace your tablets every 3 to 6 months.

There are ways to tell whether your nitroglycerin is still
effective. You should have a headache when you use it. Or if you use
nitroglycerin under your tongue, you should feel a slight tingle or burn when
you place it there. If you do not notice these signs, your nitroglycerin is
probably old. In this case, contact your health professional to get a new
prescription. Fill the prescription as soon as possible, and discard your
out-of-date nitroglycerin.

To treat erectile pills
(ED), you have to lower your blood pressure
first. Some people are able to do that through lifestyle changes alone. Others
need help from prescribed blood pressure medication.

A problem for many men, however, is that some types of blood pressure
medicines can actually cause erectile dysfunction. That may make it
difficult to stay on your medication, especially if your high blood pressure
never caused any symptoms before. An estimated 70% of men who have side effects
from blood pressure medicine stop taking it.

Many drugs used to treat high blood pressure have been linked to erectile
dysfunction. But some are much less likely than others to cause problems.
Certain of the blood pressures drugs may even improve erectile
dysfunction for some men.

It’s known that diuretics (or water pills, like hydrochlorothiazide) and
beta-blockers (like Atenolol) can cause erection problems. These are also the
first drugs that a doctor is likely to prescribe if you are not able to lower
your blood pressure through diet and exercise.

If you’re taking a diuretic, you should stay on your medicine until your
blood pressure is under control. If your erection problem persists, or your
blood pressure goes back up, then your doctor might switch you to a drug that’s
less likely to cause erectile dysfunction. Or, a erectile dysfunction vacuum therapy
of medications
might work better to control your blood pressure and reduce the risk of
erectile dysfunction.

If you take a beta blocker you may also want to ask your doctor if it might
cause erectile dysfunction. You might be better off on a medication less likely
to cause a problem.

Erection-Friendly High Blood Pressure Drugs

Some families of high blood pressure drugs rarely cause erectile dysfunction
as a side effect:

• ACE inhibitors
• Alpha-blockers
• Calcium channel blockers
• ARBs

ACE (angiotensin converting enzyme) inhibitors — such as Lotensin, Capoten,
Zestril, Prinivil, etc. — widen blood vessels and increase blood flow.
Erectile dysfunction is rarely a side effect, occurring in less than 1% of
patients. There are several different medications in the category. This seems
to be true of all of them.

There are also medications known as calcium channel blockers, such as
Diltiazem, Verapamil, or Amlodipine. As a group, they rarely cause erectile
dysfunction. But erection problems may be less common with some individual
drugs within that group than with others. Your doctor can tell you which.

In general, alpha-blockers do not often cause erection problems either. In
one study published in the journal Dysfunction pill
in 1997, a small
number of men actually had a 100% ed meds
in their erectile dysfunction
after two years on the alpha-blocker Cardura.

Drugs known as ARBs (angiotensin II receptor blockers, like Losarten) are
not only unlikely to cause erection problems, but they may actually
improve sexual function in men with high blood pressure.

A 2001 study published in the American Journal of the Medical
Sciences looked at the drug Cozaar, an ARB. At first, just 7% of men and
women in the study said they felt sexually satisfied overall. After 12 weeks of
Cozaar, about 58% said they were sexually satisfied. The percentage of men who
reported having erectile dysfunction dropped from 75% to 12%.

Another study compared the drug Diovan, an ARB, with Coreg, a beta-blocker.
The study, published in the American Journal of Hypertension in 2001,
compared the effect of the two drugs on blood pressure and frequency of sexual
intercourse.

The drugs controlled blood pressure equally well. But people who took the
ARB reported having sex more often during the 16 weeks of treatment. They said
they had sex about eight times a month before, and 10 times a month after.
People taking the beta-blocker had sex much less often: eight times a month
before, and four times a month after.

Steps to Take If Your Medicine Causes Erection Problems

Tell your doctor if you think your blood pressure medicine may be causing
problems with your erections.

If it is your medication, and not just your high blood pressure,
switching to another prescription may solve the problem. Never stop taking your
medicine without your doctor’s OK.

But high blood pressure itself still could be to blame for your erectile
dysfunction. In that case, ask about trying an erectile dysfunction drug like
Viagra, Cialis, or Levitra.

You should only take these drugs once your blood pressure is under control.
They are not safe for men with untreated high blood pressure. They are also not
safe for men taking alpha-blockers, or men taking nitrate drugs for heart
disease.

As part of the initial evaluation, your health professional
may:

• Review your risk factors for an erection
  problem. For more information, see the What Increases Your Risk section of this
  topic.
• Ask
  questions about your sexual function.
• Do a
  complete physical dysfunction erectile pill
  of the abdomen, penis, prostate, rectum, and
  testicles.
• Do laboratory tests for:
  • Erectile dysfunction pills
    .
    A low drug dysfunction erectile
    level may reduce sexual desire, leading to an erection
    problem.
  • Prolactin. A
    high level of prolactin (cure dysfunction erectile herbal) may indicate a small tumor in the
    brain, which can affect other hormone levels in the body. When hormone levels
    are affected, an erection problem may result.
  • Thyroid hormone. Either a high or low level of thyroid
    hormone may cause problems with sexual desire or erections.
  • Blood glucose. Elevated blood sugar (glucose) levels
    may indicate the presence of
    diabetes, which can contribute to
    erection problems.

At this point, oral medications such as
Viagra, Levitra, or Cialis are often recommended
unless an easily treated cause (such as a medication side effect or
testosterone deficiency) has been identified. If oral medications do not work
or your doctor feels more testing is necessary, he or she may recommend:

• Specific tests for erection problems, such as a
  nocturnal penile tumescence testing (rigidity test) and an intracavernosal
  injection test. These both help determine whether physical or psychological
  factors are causing your erection problem.
• A psychological
  evaluation, if a psychological issue is suspected.

An
ultrasound may be done if your doctor suspects you
have a circulation problem (peripheral arterial disease). Even if
the blood vessels cannot be repaired, it may be helpful to know if you have
this condition because it may indicate you have a risk for other blood vessel
(vascular) problems. In very rare instances, you may have angiography-an X-ray
test of blood flow through an artery. Its usefulness is limited because
treatment to repair the blood vessels that supply blood to the penis is
statistics on viagra usage
for very few men.