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Then, the study participants were given 50 milligrams of oral sildenafil; 45 minutes later, resting and post-exercise blood pressure readings were taken again. (continued) brand viagra sale Physical Examination Call your doctor if: Investigate the hypothalamic-pituitary-gonadal axis by evaluating testosterone levels (a morning serum free and total testosterone level is suggested) in most patients, especially if the patient has a history of reduced libido. Penile biothesiometry: This test involves the use of electromagnetic vibration to determine sensitivity and nerve function. A decreased sensitivity to these vibrations may indicate nerve damage. * Pelvic trauma, surgery, radiation therapy Advertising Disclaimer If the man's life expectancy is low due to old age or other factors, surgery or radiation for prostate cancer might actually do more harm than good, some doctors feel. Figure 1. Arteries (top) and veins (bottom) penetrate the long, filled cavities running the length of the penis—the corpora cavernosa and the corpus spongiosum. Erection occurs when relaxed muscles allow the corpora cavernosa to fill with excess blood fed by the arteries, while drainage of blood through the veins is blocked. The physical examination should focus on the vascular, neurological and endocrine systems.28,31 Testes size should be noted and the penis shaft examined to rule out a penile deformity (Peyronie's disease). With respect to laboratory investigations, recommendations vary,30,31 and investigations should follow clinical suspicion of specific disorders. Hemoglobin A1c and serum glucose may be measured to detect occult diabetes, and a lipid screen performed to assess the presence of dyslipidemia. Hormonal screening is controversial; however, it is reasonable to measure testosterone levels in the face of erectile dysfunction combined with loss of libido.28 Patients in whom hyper- or hypothyroidism is suspected should have their thyroid-stimulating hormone level checked.30 These drugs are called phosphodiesterase-5 (PDE5) inhibitors. Treatment If One of These Drugs Isn't Effective for Erectile Dysfunction, Can I Try Another? Side effects are not common but they can occur. Side effects can include: What are the causes of erectile dysfunction? Of course, feelings of sexual insecurity can reinforce any performance anxiety a man experiences and create a vicious cycle of repeated failures and increasingly negative feelings. One way to know if the cause is physical or psychologic is to determine if you are having nighttime erections. Normally, men have 3 to 5 erections per night, each lasting up to 30 minutes. Your doctor can explain a test to find out if you are having the normal number of nighttime erections. LH = luteinizing hormone; FSH = follicle-stimulating hormone; CT = computed tomographic; MRI = magnetic resonance imaging; TSH = thyroid-stimulating hormone; T4 = thyroxine; CAGE = Have you ever felt you ought to Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning (Eye-opener)?--questions used to assess the presence of alcohol abuse; two 'yes' responses indicate a positive screen. brand viagra online sale

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