iStock_000020577754XSmallMen who suffer with impotence (erectile dysfunction or erection problems) have frequent difficulties with getting or keeping an erection sufficient to have satisfying sex.
The man is often unable to penetrate their partner or keep their erection to allow enjoyable sex. This is a common problem. Around 40 % of all men over the age of 40 years have some difficulties with getting and keeping their erections. The problem becomes more prevalent in older men. It is thought that about 1/5 men between 50 and 54 years and half of men between 70 and 74 years have erection problems.
90% of men do not seek impotence treatments. This is remarkable because the impotence treatments available are highly effective in many cases when they are used appropriately.

Why do men get impotence?

The strength of erections reduces with age. This, coupled with anything which reduces the circulation, and possibly a contribution from stress reduces erections. Once a man becomes concerned about his performance, it can lead to a vicious cycle.
Most men with reduced erections are not generally unwell, although as a group these men tend to be generally less fit than they could be. Many have no health problems at all apart from their erectile dysfunction
Both psychological and physical considerations can cause a man to have impotence. In all cases a reduced blood flow to the penis causes an insufficient erection.
Physical factors are present in three quarters of cases. The following things can cause or contribute to impotence; diabetes, alcohol and drug abuse, smoking, high cholesterol, stroke, low blood flow to the penis or too much leakage of blood from the penis, nerve damage, hormone imbalance.
Psychological factors that contribute to the cause of impotence include; an unhappy relationship, stress and anxiety and depression. Men with impotence often suffer from the fear of failure. Men who have suffered from impotence in the past worry about their performance, and this removes the pleasure of feeling sexually excited. This in itself contributes to their impotence.

ED and alcohol and smoking: Men who smoke and men who drink get ED more than others. Alcohol in excess reduces hormone levels, the quality of sleep, and overall vigour. Smoking affects the circulation and reduces blood flow.
It is also worth mentioning that men who drink and take ED drug treatments at the same time take risks they should not.

ED and diabetes: Diabetes has an effect on the circulation and on the nervous system. Poorly controlled longstanding diabetes is often associated with ED. Some diabetics qualify for ED treatment on the NHS, but this is rationed to a few tablets a month and then only to selected patients. Good control of diabetes tends to reduce the likelihood of developing impotence.

ED and heart diseases: Heart diseases are nearly always the result of narrowing or blocking of the arteries supplying blood to the heart. The narrowing of the arteries is normally not restricted to heart. The blood vessels to the pelvis and penis are often also narrowed. Heart attack and ED are often found in the same person.
Men who have heart disease are sometimes prescribed nitrate tablets. Nitrates interact with the most commonly prescribed ED drugs and they cannot be taken at the same time. However, men who have recovered from heart attacks and are capable of fairly vigorous exercises and are not taking nitrates can still benefit from ED medication.

You should always tell your regular doctor if you are having problems with erections.
Doctors sometimes think of ED as a signal condition; an early warning of possible problems with circulation. This is one reason all men with ED should tell their doctors about it. This is particularly important if symptoms develop over a period of weeks or months, or even suddenly, without an emotional event to set them off. Erectile dysfunction can be a complication of previous operations or a side effect of medicines.
Once the GP is told, tests may be arranged. In the end, depending on what is found, GPs are quite likely to advise nothing more than maintaining a healthy lifestyle and avoiding cigarettes. GPs may recommend regular or occasional ED treatments and nothing more.

Erectile Dysfunction (Impotence) treatments

The majority of men with ED are treated with tablets. And the majority of these are prescribed one of the very well known PDE5 inhibitors; Viagra, Cialis or Levitra. These tablets are usually the most effective treatment for impotence from most causes.
The description PDE5 inhibitor is given to drugs which slow down the action of an enzyme, phosphodiesterase. This enzyme plays a part in producing erections.
Where ED is situational and associated with emotional and personal stresses and concerns, counselling can be effective. ED drugs are sometimes used as an adjunct to counselling until problems resolve.

How to choose an ED drug for yourself?
ViagraCialis and Levitra all work in a similar way. They are generally remarkably effective. Historically, most men take Viagra; it was the first of it’s type on the market and is the most familiar. It works within an hour or so, sometimes less, and last for a few hours. Levitra works for longer and Cialis, with duration of action of up to 36 hours, last the longest of all. Cialis might be a better choice for a man planning a romantic weekend. Viagra might be more suitable for a man going on a date. The choice is personal and depends on things such and previous experience, cost and convenience.
Viagra, the chemical name of which is Sildenafil, and the other PDE5 inhibitors, are a bit of a magic bullet for impotence. They are rare amongst drugs in as much as they work almost exclusively where they are needed in the body and when they are needed, with very few side effects in most men who take them.
Viagra, Cialis and Levitra all work in the same way. They increase the blood flow to the penis during sexual arousal. If there is no arousal the drug action is not triggered. There is no automatic erection. The erection occurs when it is needed.
These drugs increase the amount of a chemical in the penis which produces erections. They increase the blood flow.