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How do I know I have erectile dysfunction, and when should I see a doctor?
If you repeatedly have trouble getting an erection or staying erect for sexual activity, you may have erectile dysfunction (ED), ED is usually caused by health problems such as high blood pressure and diabetes. ED can be a side effect of medications such as antidepressants, blood pressure medications, antihistamines, tranquilizers and appetite suppressants. ED can also be caused by emotional issues such as depression, stress and anxiety. (Editor's Note: Antidepressants may increase the risk of suicide or worsen depression, especially when the medication is started or when the dose is changed.)
Take heart. You aren't alone. Perhaps as many as 30 million American men may have the condition. With more publicity about ED, more men are asking their doctors about this problem. Much of this increased interest can be attributed to the development and marketing of three prescription medications: Viagra® (sildenafil), Levitra® (vardenafil HCl) and Cialis® (tadalafil).
If you are having trouble having or maintaining and erection, and you are distressed because of it, talk to your doctor. You are not the first person to ask your doctor about ED, and most men with ED are successfully treated.
How well do these drugs work?
Very well. These drugs increase the satisfaction with the hardness of erections and maintain the erection throughout intercourse. Once intercourse is over, the erection goes away. Keep in mind that the cause of your ED does play a role in how effective these medications are. For instance, chronic health conditions such as poorly controlled diabetes may interfere with how well these medications work.
What are the differences between the three medications?
Not a whole lot. All three work on the same actions in the body in order to create an erection only when the man is sexually stimulated. Viagra, Levitra and Cialis are in a class of medications called PDE5 inhibitors. When a man becomes sexually stimulated, his brain sends out nerve signals, which cause a release of a chemical called nitric oxide. This chemical relaxes muscles in the penis to allow more blood to flow in, causing a hard, erect penis. These drugs help enhance the effects of the nitric acid.
The three drugs only work when you are sexually stimulated. The differences are largely in their timing. Doctors recommend that you take Viagra and Levitra 30 to 60 minutes before sexual activity. Cialis should be taken about 30 minutes before. Viagra and Levitra may be effective for up to four hours. Cialis may be effective for 24 to 36 hours.
Who shouldn't take these drugs?
Men who take nitrates such as nitroglycerin commonly used for chest pains should not take Viagra, Levitra or Cialis. Combining any one of these medications with nitrates can cause a sudden and dangerous drop in blood pressure. Also, men who take alpha-blockers, which are used to treat enlarged prostates or high blood pressure, should not use these ED treatments because of the risk of a dangerous drop in blood pressure. The combination of the ED drugs with nitrates or alpha-blockers can cause dizziness, fainting or even a heart attack or stroke. Commonly prescribed medications that may affect sexual function include blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug). Review your entire list of medications with your physician.
If your doctor says you are not fit for sexual activity, do not take these ED drugs.
These drugs aren't approved by the Food and Drug Administration to treat sexual dysfunction in women, although there has been some study with Viagra.
What are the possible side effects?
Each of the three drugs has the potential to cause side effects. Levitra can cause headaches, flushing, or stuffy or runny nose. Viagra users may have headache, facial flushing, and upset stomach. Viagra may also briefly cause bluish or blurred vision or sensitivity to light. Cialis may cause headache, indigestion, back pain, muscle aches, flushing and stuffy or runny nose. These effects usually go away within a few hours. Back pain and muscle aches usually go away within 48 hours.
Less common side effects include vision changes such as seeing a blue tinge to objects or having trouble seeing the difference between the colors blue and green for men taking Cialis or Levitra. Viagra may briefly cause bluish or blurred vision or sensitivity to light.
FDA warns people to stop taking these medicines and call a doctor right away if they have any sudden vision loss in one or both eyes. A small number of people haves reported sudden vision loss, attributed to NAION (non arteritic ischemic optic neuropathy), a condition where blood flow is blocked to the optic nerve.
All three medications may cause a rare side effect called priapism, which is an erection that won't go away. If you have an erection lasting for four hours, go to the emergency room. If it lasts as long as six hours, you may have lasting damage to your penis, leading to problems with erection.
How do I get these medications?
You should have a complete medical history and exam to determine the cause of your ED.
These three medications are only available through a prescription that your doctor gives you. Be aware that counterfeit and illegal versions of these drugs are being sold over the Internet or over the counter. Counterfeit versions can seriously endanger your health. DO NOT TAKE THEM. Only get your medications through your doctor's orders and from your local pharmacy or accredited Web sites.
If you do buy your medications online, check with the National Association of Boards of Pharmacy at http://www.nabp.net/indexvipps2.asp to find out if a Web site is a licensed pharmacy in good standing. Make sure the site requires a prescription and has a pharmacist available for questions. Don't provide personal information such as credit card numbers unless you are sure the site will protect them.
How do I take these medications?
All three are taken by mouth and should not be taken more than once a day. You and your doctor can determine the right dosage for you.
Do I have to take these with food?
No. These medications are just as effective without or with food. Absorption is not affected.
Does the ED condition have to be severe for these medications to work?
No. They can successfully treat mild, moderate and severe ED problems - whether the problem is occasional or constant.
Can you be too old or too young to take these?
No. Age is not a factor in whether or not men can take this or if the medications will work. ED, by the way, can strike men at any age.
What if I have a medical condition such as diabetes or high blood pressure?
ED medications are generally considered safe and effective. However, do not take these medications if you are taking any medication that contains nitrates, such as nitroglycerin. This combination can lower blood pressure dangerously, possibly leading to a stroke or a heart attack. Check with your doctor about taking ED medications if you are taking a drug called an alpha-blocker-used to treat high blood pressure or an enlarged prostate. Also, talk to your doctor about these drugs if you have heart disease, heart failure and low blood pressure, and are taking drugs for high blood pressure.
Do these medications protect against sexually transmitted diseases (STDs)?
No, they do not protect either partner from an STD, including HIV. You must practice safe sex by using a latex condom and limiting the number of sexual partners you have.
Will I get an erection as soon as I take one of these?
No. You can only get an erection when you are sexually aroused.
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External Source
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The Food and Drug Administration
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This article was reviewed and updated June 2007.
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