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Low testosterone levels: Testosterone (the primary sex hormone in men) is not only necessary for sex drive (libido) but also is necessary to maintain nitric oxide levels in the penis. Therefore, men with hypogonadism (diminished function of the testes resulting in low testosterone production) can have low sex drive and erectile dysfunction. kamagra online buy kamagra online pharmacy
Monitoring erections that occur during sleep (nocturnal penile tumescence) can help distinguish between erectile dysfunction of psychological and physical causes. A band is worn around the penis for two to three successive nights and it can signal intensity and duration of erections if they occur. If nocturnal erections do not occur, then the cause of erectile dysfunction is likely to be physical rather than psychological, however, tests of nocturnal erections are not completely reliable. Scientists have not standardized the tests and have not determined in whom they should be done. Erection begins with sexual stimulation. Sexual stimulation can be tactile (for example, by touching the penis) or mental (for example, by having sexual fantasies). Sexual stimulation or sexual arousal generates electrical impulses along the nerves going to the penis and causes the nerves to release nitric oxide, which in turn increases the production of cyclic GMP (cGMP) in the smooth muscle cells of the corpora cavernosa. The cGMP causes the smooth muscles of the corpora cavernosa to relax and allow rapid blood flow into the penis. The incoming blood fills the corpora cavernosa, making the penis expand. How Are Male Sexual Problems Diagnosed? To diagnose a man's sexual problem, the doctor likely will begin with a thorough history of symptoms and a physical exam. He or she may order other tests to rule out any medical problems that may be contributing to the dysfunction. The doctor may refer you to other health professionals, including a urologist (a doctor specializing in the urinary tract and male reproductive system), sex therapist, and other counselors. Many common medications for treating hypertension, depression, and high blood lipids can contribute to erectile dysfunction (see above). Treatment of hypertension is an example. There are many different types (classes) of anti-hypertensive medications (medications that lower blood pressure); these include beta-blockers, calcium channel blockers, diuretics (medications that increase urine volume), angiotensin converting enzyme inhibitors (ACE inhibitors), and angiotensin receptor blockers (ARBs). Anti-hypertensives may be used alone or in combination to control blood pressure. Different classes of anti-hypertensives have different effects on erectile function. Inderal (a beta blocker) and hydrochlorothiazide (a diuretic) are known to cause erectile dysfunction, while calcium channel blockers and ACE inhibitors do not seem to affect erectile function. On the other hand, angiotensin receptor blockers (ARBs) such as losartan (Cozaar) and valsartan (Diovan) may actually increase sexual appetite, improve sexual performance, and decrease erectile dysfunction. Therefore, choosing an optimal anti-hypertensive combination is an important part of treating erectile dysfunction. Buy cialis online online apotheke levitra rezeptfrei buy levitra
Surgery: There are different types of surgery. Implanted devices, known as prostheses, can restore erection in many men. These can come in different forms. For instance, paired rods can be inserted into the corpora cavernosa to enable the user to manually adjust the position of the penis. Alternatively, inflatable cylinders can be inserted inside the penis and expanded using pressurized fluid. In some cases doctors may attempt to repair blockages in damaged arteries. However, this usually only works if the blockages are not widespread. generic viagra online australia viagra online
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Depression and anxiety: Psychological factors may be responsible for erectile dysfunction. These factors include stress, anxiety, guilt, depression, widower syndrome, low self-esteem, posttraumatic stress disorder, and fear of sexual failure (performance anxiety). It is also worth noting that many medications used for treatment of depression and other psychiatric disorders may cause erectile dysfunction or ejaculatory problems.