How an erection occurs An erection is obtained by the spongy tissues in the penis becoming engorged with blood. This vascular process is initiated by a signal from the brain that travels down the spinal cord through the pelvis directing blood vessels in the penis to dilate. There are chemical factors involved in this vascular process and the mechanism that traps the blood in the penis is known as the veno-occlusive mechanism. cialis This may occur as a psychological issue when anxiety is present during sexual activity or as a consequence of the physical changes of ageing and the effects of other medical conditions such as diabetes and coronary artery disease. The causes of ED The causes of ED may involve problems with the brain and nervous system, the arteries and veins in the penis and the penile spongy tissues (cavernosal tissues).

Some medications used to treat these medical conditions may affect the erection process and these include blood pressure and cholesterol lowering tablets. Excessive alcohol intake and substance abuse are other known factors. ED may occur after surgery to the abdomen, pelvis and prostate. ED can also associated in older men who have urinary changes from benign prostate enlargement. ED due to psychological causes is called performance anxiety, often seen in younger men but can be present across all age groups. It may involve anxiety and lack of confidence at the beginning of a sexual relationship or may present with difficulty maintaining the erection when applying a condom. The anxiety with erections can result from relationship stress or other stresses like financial issues or as a result of other sexual issues such as premature ejaculation. Performance anxiety can improve in time but may require education and counselling and the use of medication.

Order cialis from canada. ED is an increasing issue in older men. About 1 in 3 men over the age of 50 complain of erectile difficulties.
It is important to stress that the change in erections with age is not necessarily a physical disorder requiring treatment, often an understanding of the nature of these changes is sufficient treatment alone. The firmness of the erection changes with age and the time taken (the refractory period) to re-engage in sexual activity increases in time with age. Investigation of ED As ED may be associated with vascular conditions particularly present in the older man, it is thus important to carry out a full general health check including the heart. Overnight erection testing may assist in establishing in a younger man whether the cause is physical or psychological. It is usual for a man to experience during rapid eye movement sleep between 3 to 5 erections each night. High cholesterol and high glucose are checked with blood tests, which can also check the health of the liver, kidneys, iron stores, thyroid, prostate as well the level of the male hormone testosterone. Men with suspected venous leak undergo Duplex Doppler ultrasound scan of the penile blood flow to check the status of the arteries and erection tissues and a procedure called cavernosography or cavernosogram to view the site of the venous leakage and check penile pressures. Counselling can benefit relationship issues that may be contributing to the erection problems. Oral medication: A common and popular treatment these days is the use of oral medications known as PDE5 inhibitors. These medications are taken as required 1-2 hours before planned sexual intercourse. Buy cialis walmart.
These medications are effective in most situations but cannot be used if the patient is not fit enough to engage in sexual intercourse or is on nitrate medication. For further information, see document on PDE5 inhibitors. Penile injections: When oral medication is not effective, penile injection therapy may work.
The injection is self administered into the shaft of the penis, the dose needs to be carefully regulated so that a prolonged erection (priapism) does not occur. If the single medication injection is not adequate, then a compounded triple mixture that contains PGE1, phentolamine and papaverine is obtained through an approved compounding chemist. Occasionally a visit is required to the local emergency room to drain the priapism. Vacuum device: A less invasive treatment is the use of a vacuum erection device that allows an erection to occur by creating a vacuum with a plastic cylinder placed over the flaccid penis. The induced erection is then held in place by a constricting band placed around the base of the penis for a maximum time of 30 minutes. Shock wave therapy: Low intensity extra corporeal acoustic shock wave therapy is a recent innovation relying on the effects of sound waves when applied to the shaft of the penis creating new blood vessels (angiogenesis). Shock wave therapy works best in men with ED arising from penile blood flow changes (vasculogenic ED). It may change a poor PDE5i responder to an improved PDE5i responder. Surgery: In some cases regular treatments are not effective and a final treatment option is to insert a penile prosthesis or implant which is an internally placed hydraulic device that has no obvious external appearance of the genitals. This operation is performed by a urologist. Buy cialis retail.
Vascular surgery is mainly performed in younger men when trauma has damaged the blood vessels leading to the genitals. Some men with venous leakage may benefit from erectile restoration vein surgery or vein stripping surgery.

The intention of this informatioin is for educational purpose only and not to be used as a guide for self-management. Consult with your specialist or GP. How to order generic cialis.
This is associated with the inability to delay ejaculation on all or nearly all penetrations. So the definition always involves the ejaculation time and the amount of distress to the man and his partner. Research has shown that the average ejaculation time is 5. Ejaculation physiology Ejaculation involves emission controlled by the hypogastric nerves at T12 to L1 and expulsion involving the pudendal nerve at S1 to S3. It involves a number of chemicals including dopamine, serotonin and prolactin. The stages of normal ejaculatory physiology consist of emission where the bladder neck closes, ejection of the seminal fluid associated with coordinated pelvic floor contractions and the pleasurable sensation of orgasm. Treatment of PE Treatment of premature ejaculation involves psychological, pharmacological, sexology and behavioural approaches. Even though there may not be a psychological cause of the PE, any man having this condition may develop a secondary performance anxiety that can benefit from psychological help. The classic behavioural exercise is the stop start technique which involves repetitive stimulation of the penis each time stopping short of the point of ejaculatory inevitability allowing the arousal to temporarily subside. Over time this repetitive stimulation pushes back the point of ejaculation though it does require persistence and commitment over some months.
The stop start technique can be carried out in 3 stages involving use of a dry hand, lubricated hand and finally penetration. Another ejaculation delaying technique is the squeeze technique where the tip of the penis is firmly squeezed for about 10-15 seconds just before penetration. Cheap cialis for sale.
Medication: The use of an anaesthetic spray combined with a condom may delay ejaculation. Pelvic floor exercises are said to improve erection quality and improve control of ejaculation. This medication is a short acting SSRI anti-depressant medication that is taken as a single dose between 1 and 3 hours before planned sexual activity. SSRI medication can be used off label on a daily basis though the medication must be taken daily without interruption for up to 1-2 years. Sex therapy and counselling can help PE even if the cause is physiological as the inevitable secondary psychological component can be treated which can help improve the outcome. This involves putting aside a 15-20 minute session about 2 or 3 times a week but not at a time when stressed or tired. Using yoga type relaxing breathing techniques during mindfulness exercises can be helpful. The idea is to create an erotic focus not just in the genital region but other pleasurable areas of the body. These exercises can be done on ones own or together with a partner.
The genitals can be touched but are not necessarily the focus of the exercise though the stop start exercise for PE can be incorporated into this routine. Please view the separate document on mindfulness exercises. A well known US sexologist Stan Althof has described three causes of delayed ejaculation, these being insufficient stimulation, psychic conflict and masturbation and desire disorders. Physiology of inhibited ejaculation Just as some men are born with premature ejaculation, some men are born with delayed ejaculation as simply part of their makeup. However this problem can appear as a normal part of ageing, in the presence of reduced testosterone level and as a result of diabetes and excessive alcohol intake. Excessive use of porn in some men can habituate their masturbatory style to the point where they struggle to ejaculate in a realistic non-fantasy sexual situation. Also unusual masturbatory techniques can also result in conditioned habituation where the erect penis cannot achieve enough stimulation with penetration. Inhibited ejaculation may also be a complication of the use of anti-depressant SSRI medication and can be a result of any form of radical pelvic surgery including removal of prostate cancer by radical prostatectomy. Men who are unable to ejaculate vaginally are often referred to fertility specialists in order for conception to occur. This situation can be stressful for couples where fertility is sought.