Erectile dysfunction can be caused by a diversified variety of factors. Ageing, suffering from certain diseases, smoking, substance abusing, taking certain types of drugs, feeling depressed, stressed out or tired can make your erectile potency dwindle significantly. Viagra online canadian pharmacy can successfully deal with erectile dysfunction brought on by the majority of these factors. However, you should check with your urologist or andrologist if you can safely take sildenafil and have your blood panels taken regularly before and while you do.

A complete evaluation often determines likely etiological factors for ED. The evaluation of ED follows the same pattern as evaluation of any medical disorder, including a pertinent history, physical examination, and laboratory tests. However, this history must include a sexual history. A well-organized brief sexual history can be an effective diagnostic tool. It is better not to accept the patient’s label for a disorder without first questioning and obtaining a clear picture of the complaint. Often, less educated patients misuse medical or technical terminology. For example, because some men con-fuse ED with premature ejaculation, asking if the erection is lost before or after ejaculation can clarify the problem. Learning about the patient’s sexual and relationship histories can also be very revealing.

Questions generally review the phases of male sexual response and focus on problems of desire, arousal/erection, orgasm/ejaculation, and sexual pain. Offering the patient several phrases that describe the same phenomenon in different ways can make communication more clear.

For desire phase disorder, physicians can ask, “Do you still feel in the mood, feel desire, have sexual thoughts or fantasies?” ED preceded by loss of desire can signal hormonal problems, relationship difficulties, adverse effects from medication, and depression. It is difficult for most men to sustain an erection if they feel no desire.

For arousal/erection difficulties, physicians can ask, “Do you have trouble getting or keeping an erection, getting or keeping hard? Or both?” An easy method of distinguish-ing most psychogenic ED disorders from potentially organically induced disorders is to ask if the patient ever has a spontaneous or sexually induced erection at any time? A positive response strongly hints at stress or anxiety as the trigger of the ED rather than a physical cause or medication adverse effect.

For orgasm/ejaculatory phase problems physicians can ask, “Do you feel you ejacu-late, ‘come,’ too quickly (or too slowly or not at all?)?” ED is common in men who, for any reason, became increasingly anxious about quick ejaculations, delayed ejaculation, or perceived absence of ejaculation, as can occur with retrograde emission.

To reveal Peyronie’s disease or pain disorders, a physicians can ask about “a bend to the penis” or pain during or after sexual activity.

Questions about sexuality need to be sensitive to cultural and religious differences. Using terminology that is clear, simple, and respectful of the patient’s feelings can facil-itate communication. Further general questions about sex may reveal deeper misunder-standings or mishaps with sexual activity in the past. These frequently require referral to a sex therapist or viagra australia online shop.

The medical history should include review of risk factors and screening for psycho-logical difficulties. A review of medications, including over-the-counter preparations, may reveal the source of the problem, because medications have been implicated in up to 25% of cases of ED. Medications have adverse effects on all phases of sexual functioning, making clarification of the patient’s complaint a priority before ascribing symptoms to side effects of specific medications. Brief screening for depression, including such questions as “Do you sometimes feel blue, down in the dumps?” may elicit more honest responses than “Are you depressed?” Other psychiatric conditions, such as anxiety, may also be responsible for ED. The social history, which determines stress surrounding a relationship or substance abuse (including alcohol and cigarettes),

Etiology

Inhibited ejaculation (IE) consists of delayed ejaculation (DE) and anejaculation (AE), two conditions along the same clinical spectrum. Inhibited ejaculation refers to persistent or recurrent difficulty, delay in, or the inability to achieve ejaculation despite sufficient sexual stimulation.

Delayed ejaculation and AE may be lifelong or acquired, constant or situational, and patients with DE and AE may or may not experience concurrent orgasm. Viagra sublingual – cheap ed treatment.

Delayed ejaculation and AE can be caused by a number of factors, including medical conditions, surgical procedures, and psychological issues. Any factors affecting the central control of ejaculation, the afferent and/or efferent nerve supply to the vas deferens, bladder neck, penis, and pelvic floor, can potentially lead to DE or AE. Aging is a leading risk factor for IE. Aging-related changes suggested by some authors that lead to IE include: progressive loss of the fast conducting peripheral sensory axons, collagen infiltration of myelin, and atrophy of the dermis, which collectively can lead to an aging-related hypoanesthesia of the penis. Spinal cord injury can also lead to IE. In contrast to erectile function, a man’s ability to ejaculate increases as the level of his spinal cord injury descends, and less than 5% of men with complete upper motor neuron lesions have intact ejaculatory capability. Sometimes, surgical procedures can result in IE. Such procedures include aortic bypass surgery, repair of aortic aneurysms, or other operations involving the periaortic region or pelvis. A particular example of this type of surgery that is familiar to urologists is retroperitoneal lymph node dissection. Retroperitoneal lymph node dissection is often used in treating testicular cancer and may involve the removal of the postganglionic sympathetic nerves emanating from the sympathetic chain and hypogastric plexus. The result of this intervention is ablation of the efferent stimulation for seminal emission and bladder neck closure, essential components of successful ejaculation. Nerve-sparing techniques using modified templates to preserve the essential sympathetic nerves are now commonly employed and result in a high degree of retained ejaculatory function. Even with a nerve-sparing approach, other factors such as large retroperitoneal tumor mass or preoperative chemotherapy increase the risk of postoperative ejaculatory dysfunction. Clomid Australia

Medical conditions can also lead to IE. While much has been written recently about the negative effects of diabetes mellitus (DM) on erectile function, the issues of ejaculatory dysfunction associated with DM are less well studied.

Fact: You Need a Model for Your Sexuality as a Man

So, what is your model for male sexuality? Who is your role model for a sexually healthy man? How can you think positively about the multiple dimensions of your masculinity? How can you create your standard for healthy sexuality? Your model defines what—for you—is sexual health. It includes your assumptions about what is good sex and what causes sexual problems. This framework determines your understanding of the nature and purposes of sex, your attitude toward your body and your partner’s body, your feelings, the value of fantasies, sexual growth and maturity, your expectations about sex, your relationship expectations, what a sexual dysfunction is, your attitudes toward friendships with men and women, your philosophy of life, the relationship between spirituality and sex, and your definition of sexual satisfaction.

Your sexual model will have a valence; sex is either fundamentally positive or negative—sex is good or sex is bad. Your model needs to focus on you as an individual and on your sexual relationship. Focus your model on accurate knowledge, feelings (satisfaction), and behavior (sexual function). You want to avoid being simplistic or one-dimensional. Ensure that your model of sexuality is inclusive, multidimensional, and well integrated with your body and mind. As much as we all wish important things in life could be simple, the fact is that life is complex, and so is sexuality. Canadian health care mall pharmacy

Exercise: Creating Your Model of Male Sexual Health

Consider the following questions about your thoughts, beliefs, and values about male sexuality:

• Do you think that you can be in poor physical condition and still have a good quality sex life?
• How do you understand your body to be “programmed”? What is it sexually designed to do?
• For you, what are the most important purposes for sex?
• If you feel that you are ugly or have a small penis, can you find sexual satisfaction?
• What do you think is the relationship between your physical and sexual health?
• Could you be happy as a celibate man? What are your specific sexual needs?
• What is the interaction between your sexual thoughts, feelings, and actions?
• Do you think sex is the one area of your life where you should be free and not need to regulate feelings or behavior?
• Is your sexuality your own, or is sex meant to be shared with a loving partner?
• Do you believe that sex is serious or playful?
• Where does your sex drive come from? Body? Emotions? Relationship? Do you think playfulness during sex is valuable for your relationship? Can you sexually disappoint your partner and still have satisfying sex and feel good about yourself?
• How important is a good sex life to an intimate, long-term relationship?
• Do you think sex should rely more on physical desire than emotional closeness?
• How much do you value intimacy? How much eroticism? Can these be integrated into your relationship? Viagra online Canadian pharmacy

Reflection: There are no simple responses, no correct or incorrect responses to these considerations. Ask yourself:

• What thoughts stand out as you reflect on these questions?
• What do you learn about yourself?
• Your values?
• Your model of male sexual health?