Question (of a woman of Oregon of 38 years): My fiance', who is 37 years, has hardship maintaining formore of the erection that a minute or two. When we are successful in having copula, he eyacula (and erection of loseshis) with the very small stimulus. It is not safe when this hardship began, because before the meeting the last, it had year not had a sexual partner for 10years. When my fiance' looked for the medical treatment, the urologist picked up blood samples of urineand and more ahead it said to him that he was physically " OK.Heprescribed an antidepressant (Paxil), that fiance' only made vertiginous. What you recommend? How we can find to date to a doctor in our geographic area who well is informed and in this field? Also, there is researchinto what can cause or prevent orgasmo masculine? It seems that erection, orgasmo, and ejaculation is three separated ones, although related, the functions. In our case, no of them seem to work properly.GOLDSTEIN: His fiance' has a common eréctil problem of the quality - incapacity to the eréctil rigidity of maintainthe. Because the problem is constant and hissatisfaction of the affectos with sexual copula he has fulfilled the criteria for having" eréctil dysfunction. The evaluation would consist generally of a history, a physical examinación, and laboratory tests, followed by the education, the modification of the form of life etc, and the initiation of forward edge therapy such citrate of the assildenafil (Viagra). Nevertheless, if his fiance' wishes, because isyoung, he would consider a candidate to one more a more sophisticated test of erectilefunction to gain one better understanding of the nature of thedysfunction and to see if he can be cured of his weakening. He to shouldconsider that he sees an urologist that specializes in this field for the advice moredetailed. Perhaps the call of the American foundation for the urologic diseases in Baltimore can help to locate him to this doctor. Promised you could then be determined for all the sexual editions of the dysfunction such as erection, orgasmo and ejaculation. Question (of a man of Roofing tiles of 53 years): I am in pills of the arterial pressure and of the diabetes and I cannot secure an erection. It is indicated for the eréctil dysfunction of menwith that if so has a physical base for the weakening - alikely panorama. The unique contraindication for the ofsildenafil of the use is the concomitant nitrate use - pill for the treatment of chestpain (angina). If the sildenafil does not work, you could try pelotillas intrauretrales of the emptiness on an attempt of the deviceor, one same-injections or she implants peneal. Question (of a man of California of 59 years): My dysfunction began with diabetes and now he is byPeyronie' complicated additional; s.It has been several years since I could have had normalerection. I have tried the injection in the Drs.I I have occurred Viagra to try. The aid of the pill of Ifthe with the erection still will be a severe return of 90 degrees in the axis of the penis, caused by the weave of the scar (Peyronie& there; #039; s) There is a surgery available to clear the weave of the scar, allowing that the axis remains right - and still responsive to the Viagra? They have said me that there is damage to a side and I will need a graft to complete the weave of the scar of the space I am cleared once. In this time my diabetes controls with pills and diet. I am scared to undergo surgery with a potential for the infection due to diabetes.GOLDSTEIN: Its problem is unfortunately common field and consists of two problems - 1) eréctil dysfunction and 2) peneal curvature of Peyronie' disease of s. The management must be ligature to close the communication with its urologist. In order to handle the impotence specifically, the treatment can first be things initiated of withsimple. The new therapies first-line include the sildenafil or the devices vacuumconstrictive. If these fail, the second line therapies includes the one intrauretrales same-injection or pelotillas. Such center of the treatment as the erection is designed to identify if the eréctil function heightened and wouold improved of the rigidity allow functional sexual copula in spite of the peneal curvature. If so - then ninguÌ  n attnetion needs to be given to the peneal curvature - that would be simpler. If the attention is necessary to correct the peneal curvature, basded in the aforesaid observation, are traditional medical therapies simpler including the procedures of the E.Surgical vitamin to reach to straighten itself peneal includes: 1) suppression of the weave and the replacement of the scar by the graft, 2) " tuck" procedure or 3) the insertion of implants peneal can reach two intentions - peneal rigidity and peneal straightening itself. It is important to discuss all these editions with an urologist. There are important advantages of the announcement of the risks with each treatment. Perhaps the call of the American foundation for the urologic diseases in Baltimore can help to locate him to this doctor. Question (of a man of California of 50 years): In $10 by the tablet, Viagra is expensive. What good reasons can you offer to for*not* that she saves same the cost of a visit of the office and that she simply secures a small source of Mexico? There are the true dangers to this? I feel able of the reading and the understanding drugs of PDR.All to have contraindications to keep. Which are the ones of Viagra? GOLDSTEIN: The citrate of Sildenafil (Viagra) has been approved like insurance and of effective way for the treatment of masculine eréctil dysfunction. If you have compaints constant with eréctil dysfunction, you must see a doctor. Eréctil dysfunction can be caused by the cancer of prostate, the unknown diabetes, the hypertension, the renal lack, the hipogonadismo, the psychological depression, other conditions, aneurysm aortic, disease to sacrolumbar of the disc, the medication use, the etc. The evaluation consists of a history (doctor, sexual, sicosocial), the physical examinación and laboratory tests. If a psychological burden is needed it can be added. The education and the modification of editions or the changes of form of life in the medication can be instituted under well-taken care of of the doctor. If he is appropriate, Viagra can be initiated. There are few contraindications except the concomitant nitrate use. Question (of a woman of California of 32 years): Dr.Goldstein, my partner and I have a wonderful sexual life, nevertheless, we hooked rarely to copula. When we tried to have copula any he loses the erection whereas puts in condón (I have tried many distractions during the process) or he will lose the erection during the penetration. Once in a great one whereas he loses the erection whereas I give oral sex him. When it maintains his erection with the penetration he often orgasmos them very quickly and says that he was too intense and he couldn' control of t he. It is this considered sexual dysfunction? When attempt to discuss it with him (of a way non-threatening, and when we' re having sex) he does not say " the manufacture of a great thing exceeds she does only it worse. Could she be entirely psychological or the combination of problems? GOLDSTEIN: It is difficult to make diagnosis in the patients based on minimalinformation contained in the email. In agreement with the aforesaid one, it sounds that it has eréctil dysfunction (lack to maintain) and premature ejaculation. They can be independent or related sexual phenomena of dysfunction. Encourgage of wouldSTRONGLY I he stops to look for medical aid - we can differentiate generally so great in these cases. Both conditions can very easily be handled. Question (of a man of Florida of 60 years): It was alcoholic assets between the ages of 15 and 51.I has not used any drugs addictive in the nine past years. During the three past years I have used the cream of the testosterone and 25 supplements of magnesium 2x/day DHEA in a failed effort to surpass impotence. In addition, I talk about on the possible threat of the cancer its continuous use. I have three questions: In its opinion, it is my preoccupation by valid cancer? Viagra will be effective in which it has aggravated obvious the adrenal function? Which are their recommendations to treat the impotence due to the alcoholism? GOLDSTEIN: In his opinion, it is my preoccupation by valid cancer? Yes, yes and yes. The prostate cancer is very common - near one in eight men it will develop the prostate cancer and the prostate cancer is a cause of the main death in men its age. One must obtain to analysis of blood of aPSA (specific antigen prostate) each three to six months if isbeing tried by the testosterone. Viagra will be effective in which it has aggravated obvious adrenalfunction? There are several you disorder rare of the adrenal gland - but of ifyou it has one - this is due to handle by a endocrine specialist. Ifimpotence persists in spite of the appropriate treatment of the adrenal condition, later Viagra can be added. Which are their recommendations to treat the impotence due to the alcoholism? The alcoholism can especially cause impotence by a number of mechanisms of psychological and nerve-related damages to the peneal process of the erection. The assumed appropriate advising has been tried, mayinvolve of the medical treatment the use of Viagra

Picture 7: Straight bad the systolic change of the arterial pressure of the arterial pressure of the line basic was measured after the administration of VIAGRA in the same times that those specified for doxazosin previous studies. There were three subjects that had a situation SBP of & lt; 85 mmHg.All three took magnesium from VIAGRA 100, and the three disclosed smooth adverse events at the time of reductions in the SBP positioning, including the vasodilatación and I am annoying. There were four subjects with a diminution of the basic line to place systolic of BP; GT; 30mmHg after magnesium of VIAGRA 100, a subject with a diminution of the basic line to place systolic of BP; GT; placebo of following of 30 mmHg and a subject with a diminution of the basic line to place systolic of BP; GT; 30 mmHg VIAGRA and placebo of following. Whereas there were potentially related no severe adverse events to the disclosed arterial pressure in this study, a subject disclosed vasodilatation moderate after magnesium of 50 VIAGRA and magnesium 100. There were no disclosed episodes of síncope in this study. When the magnesium of 100 VIAGRA oral coadministered with amlodipine, magnesium 5 the magnesium or 10 oral, to the hypertensive patients, the bad additional reduction in the arterial pressure supine 8 era mmHg of systolic and 7 mmHg of diastolic. Warfarin was not demonstrated to any significant interactions with tolbutamide (magnesium 250) or (40 magnesium), that is metabolizado by CYP2C9.VIAGRA (magnesium 50) did not reinforce the increase in the time of the drain caused by aspirin (150 magnesium) .VIAGRA (magnesium 50) did not reinforce the hypotensive effect of the alcohol in healthy volunteers with the bad maximum alcohol indices of blood of 0.In a study of healthy masculine volunteers, sildenafil (magnesium 100) did not affect the farmacinética of stationary state of inhibitors of protease of HIV, saquinavir and ritonavir, that are increase of CYP3A4 substrates,50% in AUC and an increase of 42% in Cmax of bosentan (125 up-to-date Last magnesium B. in RxList: 3/14/2008 of the WARNINGS are a potential for the cardiac risk of sexual activity in patients with preexisting cardiovascular disease there. Therefore, the treatments for eréctil dysfunction, including VIAGRA, are not due to use generally in the men for those who the sexual activity is inadvisable due to underlying his status.VIAGRA cardiovascular has systemic vasodilator characteristics that gave rise to transitory diminutions of the supine arterial pressure in healthy volunteers (hoped that the diminution maximum bad of 8.While this normally was of little consequence in the majority of the patients, before prescribing VIAGRA, the doctors must consider carefully if their patients with underlying cardiovascular disease could on the contrary be affected by such vasodilator effects, especially jointly with sexual activity. The patients with the following underlying conditions can be particularly sensible to the actions of the vasodilators including VIAGRA - those with the left ventricular obstruction of the exit (e.There is no clinical data controlled on the security or effectiveness of VIAGRA in the following groups; if it is prescribed, this is due to do with the precaution. Patients who have had an infarct of the myocardium, a movement, or a dangerous arrhythmia for the life within the 6 past months; Patients with the reclinación hypotension ( of BP; lt; 90/50) or hypertension ( of BP; GT; 170/110); Patients with the cardiac lack or the disease of the coronary artery that causes unstable angina; Patients with pigmentous of the retinitis (a minority of these retinal patients has you disorder genetic of fosfodiesterasas). The majors of 4 hours and priapism prolonged (majors of 6 hours of the erection of the painful erections in the duration) have been disclosed infrequently since the approval of the market of VIAGRA in case of erection that persists more of length of 4 hours, the patient must look for immediate medical aid. If priapism does not treat immediately, the peneal weave damage and the permanent loss of power could be. The concomitant administration of ritonavir of protease inhibitor substantially increases concentrations of the serum of the sildenafil (increase of eleven times in AUC). If VIAGRA prescribes the patients who take ritonavir, the precaution must be used. The data of the subjects set out at the systemic high levels of sildenafil are limited. The diminished arterial pressure, síncope, and the prolonged erection was disclosed in some exhibited healthy volunteers to the high doses of the sildenafil (magnesium 200-800). In order to diminish the occasion of adverse events in the patients who take ritonavir, a diminution of the dosage of the sildenafil is recommended (it sees the DRUG INTERACTIONS, the REACTIONS and ADVERSE DOSAGE AND the ADMINISTRATION). The evaluation of GeneralThe of the PRECAUTIONS of eréctil dysfunction must include a determination of potential underlying causes and the identification of the appropriate treatment that follows medical a burden complete. Before prescribing VIAGRA, it is important to observe the following one: The precaution when type 5 of fosfodiesterasa inhibiting (PDE5) sews administers with inhibitors alpha-blockers.PDE5, including VIAGRA is advised, and the agents of blockade alpha-adrenérgicos are both vasodilators with the arterial pressure that lowers effects. When the vasodilators are used in the combination, an effect additive on the arterial pressure can be advance. In some patients, the concomitant use of these classes of two drugs can arterial tension loss (it sees the DRUG INTERACTIONS) that perceivably takes to symptomatic hypotension (e.Consideration is due to give the following one: - The patients must be stable in therapy of the alpha-mold before initiating an inhibitor PDE5. The patients who only demonstrate to instability haemodynamics in therapy of the alpha-mold are in the increasing risk of symptomatic hypotension with the concomitant use of inhibitors PDE5. - In those patients who are stable in therapy of the alpha-mold, inhibitors PDE5 must be initiated in the lowest dose. - In those patients already to take an optimized dose from an inhibitor PDE5, therapy of the alpha-mold is due to initiate in the lowest dose. The increase gradually in dose of the alpha-mold can be associated to the additional loss of the arterial pressure when taking an inhibitor PDE5. - The security of the combined use of inhibitors PDE5 and the alpha-molds can be affected by other variables, including the exhaustion of intravascular volume and other drugs of anti-hypertensive. Viagra has systemic vasodilator characteristics and can increase the pressure arterial that lowers the effect of other medications of anti-hypertensive. They included to the multiple medication patients of antihypertensive in the revolving clinical tests for VIAGRA.In a separated study of the drug interaction, when amlodipine, magnesium 5 magnesium or 10, and VIAGRA, magnesium 100 were administered oral concomitant to the additional reduction of the arterial pressure of hypertensive means of 7 the 8 patients of mmHg of systolic and mmHg of diastolic were observed (it sees the DRUG INTERACTIONS). The VIAGRA security is not known in patients with you disorder of the drain and the patients with peptic ulceration active .VIAGRA must be used with the precaution in patients with the anatomical deformation of the penis (as she forms angular, cavernosal fibrosis or Peyronie' disease of s), or in the patients who have conditions that can predispose them to priapism (as anemia of sickle cell, mieloma multiple, or leukemia). The security and the effectiveness of combinations of VIAGRA with other treatments for eréctil dysfunction have not studied. Therefore, the use of such combinations is not recommended. In human beings, VIAGRA does not have ninguÌ  n effect on time that it bleeds when it is only taken or with aspirin. The Ines studies vitro with plaquetas human indicate that the sildenafil reinforces the effect antiaggregatory of the nitroprusiato of sodium (donor of nitric oxide). The combination of heparina and VIAGRA had an effect additive on time that it bled in the anaesthetised rabbit, but this interaction has not studied in human beings. The information for PatientsPhysicians must discuss with the patients the contraindication of VIAGRA with the regular and intermittent use of organic nitrates. The doctors must advise to the patients of the potential so that VIAGRA increases the pressure arterial that lowers the effect of alpha-molds and medications of anti-hypertensive. The concomitant administration of VIAGRA and a alpha-mold can take to symptomatic hypotension in some patients. Therefore, when VIAGRA sews administers with the alpha-molds, the patients must be stable in therapy of the alpha-mold before initiating the VIAGRA treatment and VIAGRA is due to initiate in the lowest dose. The doctors must discuss with patients potential the cardiac risk of sexual activity in patients with preexisting cardiovascular factors of risk. The doctors must advise to patients to stop the use of all the inhibitors PDE5, including VIAGRA, and look for the medical attention in case of sudden loss of vision in or ambo eyes. Such event can be a sample of previous ischaemic optical neuropathy non-arteri