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A spontaneous and simple-appearing sexual act, in fact, is a series of meticulously synchronized processes. The preceding activities of the nerve endings cause dilatation of arterioles by relaxing their smooth muscle coat, which in turn causes filling of the spaces of corpora cavernosa resulting in its expansion.
After the penis is inserted in the vagina, an act of sexual intercourse or copulation takes place, and continues until the time of orgasm and subsequent ejaculation.
Friction between the glans penis and vaginal mucosa, reinforced by several other afferent stimuli and psychogenic factors, causes a reflex discharge along the sympathetic to the seminal pathway, the muscle coats of the epididymis, ductus deferens, the seminal vesicles, and the prostate gland.
After ejaculation and cessation of exotic stimuli, sympathetic tonic discharge resumes; this results in the contraction of smooth muscles around sinusoidal spaces and arterioles. Aging has the strongest association with erectile dysfunction, and may be a common denominator in many patients. Psychogenic causes include, among others, states of anxiety, depression, a troubled relationship, and fear of performance. Diabetes[16,17] and alcoholic neuropathy,[20,21] spinal cord injury, nerve damage, multiple sclerosis, and cerebrovascular accidents are significant contributory factors for organic impotence.
Erectile dysfunction has also been reported in patients on psychotherapeutic drugs, which produce central nervous system depression. Sleep laboratories monitor patients for rapid eye movement (REM) sleep, when an erection is seen. Some physicians advocate intracavernosal injection of a small amount (10 mg of prostaglandin E1) of alprostadil. A test of questionable value, duplex Doppler ultrasonography, has been used to evaluate arterial and venous blood flow of the penis. Vacuum constriction devices, were once a popular noninvasive method of treating impotence.[5,11] The vacuum, created in the cylinder of the vacuum constriction device, causes the flow of blood in the corpora cavernosa of the penis. Online pharmacies are strictly regulated in the United Kingdom by several government agencies that oversee the healthcare industry: the Care Quality Commission, the General Pharmaceutical Council, the Medicines and Healthcare products Regulatory Agency and the General Medical Council. The regulating agencies are there to ensure the highest standards in online healthcare, we as consumers must ensure we only deal with regulated healthcare services as it is in our best interests. The Care Quality Commission (CQC)The CQC is the official regulator of private healthcare in the UK including online clinics. Pharmacies and chemists that dispense and despatch medicines are regulated by the General Pharmaceutical Council (GPhC).
The MHRA has responsibility for standards of safety, quality and performance of medicines and enforces strict rules on advertising. Services below are CQC registered, employ GMC doctors and post medicine from GPhC registered pharmacies. Yes - there is legal framework in the UK for doctors to issue prescriptions online for delivery in most European countries.
Estimates vary, but around 40% of men suffer from ED, also known as impotence, at some time in their lives. Erectile dysfunction is not always the result of any other illness and it sometimes happens to men who are otherwise very healthy and medically fit.
Middle aged men who are troubled by erectile dysfunction often have no one specific problem which explains their symptoms.
Anything which affects the circulation, such a high cholesterol or high blood pressure can cause impotence. Text books divide erectile difficulties into few types - circulatory causes (vascular) or erection difficulties caused due to problems with the nervous system (neurogenic) or due reduced hormone levels (endocrine) or even those caused by emotional or psychological factors (psychogenic). ED and diabetes: Diabetes not only affects the blood circulation in the body, it also affects the nervous system. ED and alcohol and smoking: Not every man who smokes or drinks alcohol suffers from ED, but it is known that men who do smoke and drink alcohol are more likely to get ED. ED and cardiovascular diseases: Most number of heart ailments happen due to either narrowing of arteries or due to reduced blood supply to the heart because of some blockages in the arteries. All men with erectile difficulties should inform their doctors about it as it could sometimes be an indicator to general problem with circulation. Online clinics can provide advice and information, and assessments of ED and can be a reliable source of genuine medication, but care must be taken to use only reputable clinics.
ED is also considered to be a warning for problems in the blood flow which can cause other major ailments.
At times, ED can also be caused as a result of some previous surgery or as a side effect to certain medicine and in both the cases it becomes imperative to tell the doctor as quickly as possible so that he can find both the cause and solution of this problem. The most popular and common treatment given by doctors to ED patients are pills containing PDE5 inhibitors, such as Cialis, Viagra or Levitra. These pills are often combined with psychological counseling of the patients which helps them cope with their stress, anxiety and other such concerns. There are other treatments apart from tablets, which may be more appropriate in some cases, for example, where erection problems starts after an operation, or results from spinal injury or where PDE5 drugs are ineffective or are contraindicated. Counselling can be effective when the erectile problems are more situational and emotional.
Testosterone injections were a popular treatment in some parts or the world a few years ago and are coming back into favour with some doctors in the UK. When obtaining medication online it is important that checks for contraindications are undertaken and that only genuine tablets and not fakes are supplied. These tablets are available online from reputable clinics although prices vary greatly and care is needed in selecting an online clinic to ensure only genuine medication and not fakes are obtained. PDE5 inhibitors are truly special amongst all medications in that they almost exclusively work in the correct areas of the body when the man needs it with minimal side effects. All the 3 PDE5 inhibitors work only if the man is aroused - they do not cause automatic erections and neither are they aphrodisiac. These oral medicines increase a chemical that promotes blood flow in the penis thereby causing healthy strong erections. As with any medication, tablets should be used with care and on the advice of doctors, and the patient information leaflets which are included in pill packs should be followed.

Related InformationErectile Dysfunction and Blood PressureIt is now common knowledge that there exists a link between blood pressure and erectile dysfunction. Heart Attacks can be fatal whereas erectile dysfunction does not cause any true danger to life.
In this modern age of medicine, someone who is suffering from erectile dysfunction can quite often be treated with oral medication. 50 years old Rasheed was an ill-literate man, he has visited to me for the treatment of panic attacks, delusions and obsessions. The information presented in this web site is not intended as a substitute for medical care.
Unfortunately, this harmony may be jeopardized by the occurrence of erectile disorders, and often lead to separation.
Its precise erudition may add to the comprehension of the physiological phenomenon, comprising libido, erection, copulation, orgasm, and the ejaculation.
Libido is the conscious feeling of the sexual urge, which originates in the brain center through the impulses received by various sense organs.
Accordingly, strong pressure is exerted on the veins that normally drain blood from the penis.
The sperm, along with the secretion of the accessory glands, are discharged into the posterior urethra, between the internal and external sphincter of the bladder. Arterial flow is diminished to flaccid levels, much of the blood from sinusoidal spaces is expelled, and the venous channels are restored (Figure 2). They are abridged by mixed erectile dysfunction, which is composed of a variable mixture of psychogenic and organic factors (Figure 1). This is usually due to physical causes such as endocrinopathies, nervous system disorders, or maldevelopment of the penis and its incompetent veins. With aging, there may occur atheroma of internal iliac arteries and their pudendal branches. Psychogenic erectile dysfunction usually has an acute onset, often related to specific events. The former include atherosclerosis due to smoking, diabetes, low levels of high-density lipoprotein cholesterol, high levels of low-density lipoprotein, and total cholesterol, as well as hypertension. Damage or degeneration of peripheral nerves supplying the corpora may also cause impotence; cauda equina, and the lesions due to prolapsed intervertebral disc and iatrogenic neural injury during abdominoperineal resection of the rectum[20,21,24,28] are some examples. Further, testosterone secreted from Leydig's cell of the testes under the influence of luteinizing hormone affects men's sexuality.[16,17] Thus, the medications such as luteinizing hormone, releasing hormone agonist or stilbestrol, which lower circulating testosterone also cause erectile dysfunction. It is variously considered to be due to an elevation of serum prolactin concentration, sedative effect, anticholinergic effect, decreased dopamine activity, or central effects on the limbic system.[4,7,10] More and more drugs are being added to the list of those which induce erectile dysfunction (Table II).
Hypogonadism due to dysfunction of Leydig's cells, hyperprolactinemia, hyperparathyroidism, anemia, protein malnutrition, zinc deficiency, hypertension, and use of antihypertensive drugs[33] are a few implicated propositions. In order to achieve success in the aforementioned objectives, the patient and his partner need to provide a detailed confidential history.
The latest breakthrough (sildenafil) seems to occupy a place of pride among the current drugs for the purpose.
Yohimbine hydrochloride is an a-adrenoceptor antagonist, which acts both peripherally and centrally; however, it is not highly effective in established organic impotence.
They have also been used in erectile dysfunction, as the presence of dopaminergic pathways in the paraventricular nucleus is important in engendering erectile response.
A central dopamine stimulant has been given with success in patients with functional erectile dysfunction; however, many patients observe nausea and vomiting after its use. This relatively acceptable, noninvasive route of drug delivery has proved to induce similar hemodynamic changes in the corpora cavernosa as have been achieved by intracavernosal injections. Phentolamine (a-adrenoceptor blocker) and papaverine (non-specific phosphodiesterase inhibitor) have been used in the form of intracorporeal injections. They can be simple rods, malleable rods, self-contained hydraulic, multicomponent hydraulic, or articulated prostheses. All UK online doctor and pharmacy services providing prescription-only medicines must be registered by law. Some of them which have a negative impact on erection are stress, age and certain illnesses. Impotence can be caused due to both physical as well as psychological reasons affecting men.
Good erections occur when there is a good blood supply to the penis and the blood vessels are working well.
On the other hand the circulation may be fine, but the signals going from the brain to the blood vessels of the penis via the nervous system may be faulty in some way. When it is not controlled with the right treatment and within the right time period, this illness is known to cause ED in men.
This happens because smoking is known to negatively affect the blood circulation in body and alcohol creates hormonal imbalance and poor sleep quality, which can lead to impotency. When the arteries begin to narrow, this is not restricted to arteries around the heart only, the ones in the pelvic region also get affected and that is why a lot of heart patients suffer from ED.
Often the doctor may prescribe PDE5 inhibitors like sildenafil and ask to refrain from smoking and encourage to adopt a healthy lifestyle. That is why any erection problems should not be ignored and you would be well adviced to consult your GP as soon as you observe any such issues.
But, since the blue pill was the first to arrive on the scene, it is still the most popular oral PDE5 inhibitor and most men start with the blue pill. In this problem, some people don't get erection at all, while other get loose erection and they can't penetrate inside the vagina.
Please talk with your healthcare provider about any information you get from this web site.
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The proper functioning of the sexual apparatus is dependent not only on its nervous and muscular integrity, but also on the endocrinal and psychic factors.
In the event of aroused libido, the brain center sends impulses to the spinal center, which in turn passes them expeditiously to the peripheral nerves of the penis.
After orgasm is reached, the rhythmic contractions of the bulbocavernous and ischiocavernous muscles ejaculate the semen through the penis into the vagina. With advanced techniques of diagnosis of the erectile functions it has been found that more than 75% of patients have organic causes. Further, there is degeneration of the extra-corporeal smooth muscles resulting in venous leakage in the penis. Adrenal androgens, metabolite dehydroepiandrosterone sulfate, show a strong correlation with impotence. To restore confidence, the patient is taught all the consecutive intricacies of the disorder until full rectification of the erectile dysfunction is achieved. The previously used phentolamine, which is an a1-adrenoceptor antagonist, is another safe and effective treatment. Nonorganic impotence responds positively with transbuccal apomorphine, but its use is limited by side effects such as orthostatic hypertension, nausea, vomiting, and persistent yawning. Sildenafil is a selective inhibitor of phosphodiesterase type 5, which results in the increased duration of action of intracorporeal cyclic guanosine monophosphate, that in turn results in the enhancement of normal erectile response (Figure 2). Topical nitroglycerin paste, prostaglandin-E1,[48] and papavarine[49] have been used with variable success (Table III). MUSE (medicated urethral system for erection), a popularly known procedure, consists of insertion of a prostaglandin E1 pellet in the urethra through an applicator.[49] Urethral pain, bleeding, and priapism may be unwanted side effects. Unfortunately, only a few diabetic patients are able to get the treatment sponsored by NHS and the ones that are eligible, receive limited tablets every month.
Another important fact is that it is considered to be very risky to combine alcohol and ED medications in the body and one should be careful to not do something like this. Heart patients are often prescribed nitrate containing medications and they are known to hamper the working of ED medications if taken at the same time. Medications can also be injected directly into the base of the penis to produce short-lived erections in difficult to treat cases. It lasts for a few hours and the effects are noticeable within an hour of taking the tablet if the man is sufficiently aroused. Along with Cialis and Levitra, it is a very effective drug for one of the most troubling conditions men suffer from, erectile dysfunction.
It is the inability to achieve or sustain an erection for satisfactory sexual activity. Some people lose the erection soon, they get full and hard erection during the foreplay but it ends suddenly when they proceed to intercourse. Other systems of the body are complementary and their disorders may ultimately affect this phenomenon, causing erectile dysfunctions. Sympathetic nerves, which act as a motor to the seminal tract, simultaneously close the internal vesicle sphincter, and thus prevent a reflex of semen into the bladder. Priapism or risk of ischemic injury to the intracavernous smooth muscles[5,7,11] are unwarranted side effects. Therefore it is important to control diabetes as soon as possible and with the right medications.
Cialis on the other hand can stay in the system and have the potential to work anytime if the man is aroused during the following 36 hours.
Thus, erection is a complex, involuntary, neuropsychological, hormone mediated vascular event that happens when blood flows rapidly into the penis and becomes trapped in its spongy chamber. An erector muscle of the penis (ischiocavernosus) draws the penis forward and makes it well adapted for penetration of the vagina.
Further, the contraction of detrusor vesicae and the associated inhibition of constrictor vesicae prevent a simultaneous discharge of urine. The psychogenic stimuli to the sacral cord may inhibit reflexogenic erection and subsequently activation of the parasympathetic dilator nerves to the penis. It is for this reason that the medicine is termed the weekend pill and might be better suited for unplanned sex. Erectile dysfunction varies in severity; some men have a total inability to achieve an erection, others have an inconsistent ability to achieve an erection, and still others can sustain only brief erections. An increasing use of drugs, a legacy of civilization, has considerably compounded the problem. Later, the cavernous smooth muscles become less sensitive to the neurotransmitters because of the excessive sympathetic outflow and elevated catecholamine levels.
He told me that his erection is fine with wife, however; he does not get it when he tends to do intercourse with other women.
Therapy for erectile dysfunction, apart from psychosexual counseling, includes medical treatment by alpha adrenoceptor antagonists, dopamine agonists, phosphodiesterase type 5 inhibitors, sublingual apomorphine hydrochloride, or hormone therapy. That medicine acted reversely on him and he has been having nocturnal ejaculation on daily basis. Transdermal or transurethral corporeal drug delivery are other possible treatment modalities. He realized then he has been suffering from sexual weakness and unable to satisfy his wife. I have refused to give him treatment on his request and told him that I can't prepare you for adultery even for it, you would given enough fee.
He went back with dis-hearted and I drowned in a unique feeling of contentment and relaxation.
When he came to know about it he got anger ness and one day he squeezed her throat till death.

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