Erectile dysfunction (ED) is the inability to achieve or maintain an erection firm enough for satisfactory sexual activity. It can be occasional or chronic and affects men of all ages, though incidence rises with age and certain health conditions.
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Difficulty initiating an erection
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Trouble maintaining an erection through sexual activity
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Reduced rigidity of erections
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Decreased sexual desire or libido
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Vascular Issues: Atherosclerosis, high blood pressure, high cholesterol impair blood flow
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Neurological Disorders: Diabetes neuropathy, multiple sclerosis, spinal injuries
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Hormonal Imbalances: Low testosterone or thyroid dysfunction
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Psychological Factors: Stress, anxiety, depression, relationship conflicts
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Medications & Substance Use: Antidepressants, antihypertensives, smoking, alcohol
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Acute Stress or Anxiety: Work pressure or performance worries
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Fatigue & Poor Sleep: Disrupt hormonal balance and libido
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Heavy Alcohol Intake: Impairs neural and vascular function
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Uncontrolled Blood Sugar: In diabetics, spikes worsen neuropathy
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Relationship Tension: Emotional disconnect can manifest physically
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Medical History & Physical Exam: Review of health conditions, medications, and lifestyle
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Questionnaires: IIEF-5 (International Index of Erectile Function) to gauge severity
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Blood Tests: Assess blood sugar, lipids, testosterone, thyroid function
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Nocturnal Tumescence Testing: Measures nighttime erections to distinguish physical vs. psychological causes
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Vascular Studies: Penile Doppler ultrasound to evaluate blood flow in more complex cases
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PDE5 Inhibitors:
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Sildenafil (Viagra®) 50–100 mg: Onset in 30–60 min, duration ~4 h
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Tadalafil (Cialis®) 10–20 mg: Onset in 30 min, duration up to 36 h
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Vardenafil (Levitra®) 10–20 mg: Onset in 25–60 min, duration ~5 h
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Avanafil (Stendra®) 100–200 mg: Fast onset in 15–30 min, duration ~6 h
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Hormone Therapy: Testosterone replacement when low levels are confirmed
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Lifestyle Modifications: Smoking cessation, weight loss, regular exercise
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Psychosexual Counseling: For anxiety or relationship-related contributors
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Adjunctive Devices: Vacuum erection devices or penile implants in refractory cases
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Q1: How soon before intimacy should I take ED pills?
A: Take Sildenafil or Vardenafil about 1 hour prior; Avanafil about 15–30 minutes; Tadalafil can be taken up to 2 hours before.
Q2: Can I take ED pills daily?
A: Tadalafil is approved for once-daily dosing at lower strengths (2.5–5 mg); others are typically used “as needed.”
Q3: Are there side effects?
A: Common ones include headache, flushing, nasal congestion, and indigestion. Rarely, visual changes or priapism require medical attention.
Q4: Do ED pills interact with other meds?
A: Avoid nitrates (e.g., nitroglycerin) and certain alpha-blockers. Always review your medication list with a healthcare provider.
Q5: What if ED pills don’t work?
A: Discuss alternative therapies—vacuum devices, injections, or referral to a urologist for further evaluation.