The physical examination can reveal clues for physical causes of erectile dysfunction. For example, if the penis does not respond as expected to touching, a problem in the nervous system may be the cause. Small testicles, lack of facial hair and enlarged breasts can point to hormonal problems such as hypogonadism with low testosterone levels. A reduced flow of blood as a result of atherosclerosis can sometimes be diagnosed by finding diminished arterial pulses in the legs or listening with a stethoscope for bruits (the sound of blood flowing through narrowed arteries). Unusual characteristics of the penis itself could suggest the root of the erectile dysfunction, for example, bending of the penis during erection could be the result of Peyronie's disease. Contraindications Related Health News Often there can be a psychological or relational problem. Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this can often be helped. Notably in psychological impotence, there is a strong response to placebo treatment. Erectile dysfunction, tied closely as it is to cultural notions of potency, success and masculinity, can have severe psychological consequences. an underlying medical problem Talk to your doctor about any herbal products you are considering before trying them. All makers of herbal penis enlargement pills are convinced that every one we tend to need to get rid of erectile dysfunction may be a few natural ingredients. They claim that this can be simply as effective as different ED treatments, however the sole side effects embody better sex performance and boosted libido. According to the American Lung Association, COPD is actually a catch-all for two lung diseases that often strike in tandem -- chronic bronchitis and emphysema. In both cases, airflow is obstructed, impeding normal breathing. Lifestyle: alcohol and drugs, obesity, cigarette smoking (Incidence of impotence is approximately 85 percent higher in male smokers compared to non-smokers., Smoking is a key cause of erectile dysfunction. Smoking causes impotence because it promotes arterial narrowing. See also Tobacco and health. ) canadian pharmacy viagra online Patients who are refractory to sildenafil may benefit from vardenafil or tadalafil therapy. If none of these is successful, combine the agent with an injection of prostaglandin E-1. Gutierrez et al demonstrated that this combination was more effective than either one alone. Other successful combinations include using a PDE-5 inhibitor with MUSE.5 Uncontrolled high blood pressure (greater than 170/110 mm Hg) viagra online Some health professionals, including doctors and mental health professionals, may not feel comfortable discussing sexuality and erection problems. Ask your health professional if he or she feels comfortable with and has experience in working with men who have erection problems. A condition called "corporal fibrosis" -- where the tubes of penile "spongy tissue" that maintain erection are gradually replaced by inactive, fibrous scar tissue -- remains largely untreatable. The disorder occurs when the penis' sensitive spongy-tissue cells don't get the oxygen they need to survive, usually because of a chronic reduction in blood flow. In experiments with mice, researchers showed that Viagra (sildenafil) improved heart performance by preventing the breakdown of a compound called cGMP, which relaxes smooth muscle. Men who might not otherwise be diagnosed with something potentially fatal may become aware of the problem when they go to the doctor seeking a prescription.