Erectile Dysfunction

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Viagra vs Cialis

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Viagra vs Cialis : Background Viagra vs Cialis : Side Effects
Viagra vs Cialis : Mechanism of Action Viagra vs Cialis : Drug Interactions
Viagra vs Cialis : Dosage Viagra vs Cialis : Conclusion
Viagra vs Cialis : Efficacy Viagra vs Cialis : References
Viagra vs Cialis : Duration of Effectiveness

Background

Erectile dysfunction drugs have become a billion dollar industry. Commercials appear on almost every televised sporting event, and men’s magazines are filled with ads to “increase your sexual performance”. Almost everyone is familiar with Viagra, “the little blue pill”. It has been endorsed by celebrities such as NASCAR star Mark Martin, baseball all-star Rafael Palmeiro, and even former Republican presidential candidate Bob Dole. Cialis, another of the dominant erectile dysfunction drugs, has also become a household word. The image of a man and a woman relaxing in separate bathtubs has become as universally recognized as the McDonalds golden arches.

But is there a difference between the erectile dysfunction drugs? Is one safer? More effective? There is no simple answer to these questions. People aren’t all alike, and the treatment that is successful for one man might not be ideal for another. However, it is certainly worthwhile to review the characteristics of each drug. With this knowledge, you and your health care provider should be able to make an informed decision about which drug is right for you.

Mechanism of Action

Viagra (sildenafil) and Cialis (tadalafil) work in a very similar fashion. Both drugs increase the flow of blood into the penis so that when a man is sexually stimulated, he can get and maintain an erection. Viagra and Cialis belong to a class of drugs known as PDE5 inhibitors, which enhance the effect of nitric oxide, a chemical that is normally released during stimulation. Nitric oxide opens and relaxes blood vessels in the penis, thereby increasing inflow and allowing erections to last longer.

It is important to realize that neither drug is an aphrodisiac. You must feel sexually aroused in order for them to cause erections.

Dosage

Viagra is typically prescribed in a dosage of 50 mg, taken as needed approximately 1 hour before sexual activity. Based on effectiveness and toleration, the dose may be increased to a maximum dose of 100 mg or decreased to 25 mg. In most patients, the maximum recommended dosing frequency is once per day. Viagra is best taken on an empty stomach, since its action may be delayed or impaired when taken with food (especially high-fat foods).

Cialis is typically prescribed in a dosage of 10 mg, taken as needed approximately 45 minutes before sexual activity. Based on effectiveness and toleration, the dose may be increased to a maximum dose of 20 mg or decreased to 5 mg. In most patients, the maximum recommended dosing frequency is once per day. Cialis can be taken with or without food.

A low-dose version of Cialis for daily use is also available. The recommended starting dose of Cialis for daily use is 2.5 mg, taken at approximately the same time each day.

Efficacy

Viagra and Cialis have both been shown to be effective in 60-70% of men with erectile dysfunction. Because Viagra has been available the longest (since 1998), there is much more research available. There are also more positive testimonials from consumers. But Cialis (which entered the market 5 years later) seems to have a very similar efficacy profile. The least amount of data is available on the low-dose version of Cialis, although one small study showed that efficacy varied greatly depending on the level of erectile dysfunction (73%-82% efficacy in patients with mild erectile dysfunction, 56%-61% efficacy in men with moderate erectile dysfunction, and 27%-33% efficacy in men with severe erectile dysfunction).

There are very few published head-to-head studies comparing Viagra and Cialis. Most studies have compared the drugs to placebo. In addition, it is difficult to make comparisons across studies, since different studies use different measures of efficacy (e.g. improvement in sexual function versus improvement in sexual satisfaction).

Duration of Effectiveness

The main difference between Viagra and Cialis has to do with duration of effectiveness. Viagra lasts about four to five hours, but with Cialis, the window of opportunity ranges from 24 to 36 hours, which is why it is sometimes called “the weekend drug.” For couples who prize sexual spontaneity, Cialis seems to have a clear competitive edge in this category.

With the low-dose version of Cialis for daily use, there is a steady supply of the drug in the bloodstream. Theoretically, this option makes having sex a possibility without any advance planning at all.

Side Effects

Viagra and Cialis have similar side effects. The most common side effect is a headache, which occurs in about 16% of patients. Other common side effects include nasal congestion, facial flushing, stomach ache, and urinary tract infections. Back pain and muscle aches may occur with Cialis, but rarely with Viagra. In some cases, men taking Viagra and Cialis experience temporary vision problems – mainly a blue tinge to the vision or difficulty in distinguishing the colors blue and green. An extremely rare but very serious side effect associated with both Viagra and Cialis is priapism, an abnormally long and painful erection. If not treated promptly, priapism can lead to erectile dysfunction.

When the drugs are used properly, their side effects tend to be relatively mild. Most disappear after a few hours. However, since Cialis has a longer duration of effectiveness, its side effects tend to last longer, which some men find troubling.

Drug Interactions

Viagra and Cialis should not be taken by men who take medicines or recreational drugs containing nitrates. Like Viagra and Cialis, nitrate drugs cause blood vessels to dilate. The combined effects could cause a dramatic drop in blood pressure, resulting in dizziness, fainting, and sometimes loss of consciousness. Nitrate medicines include nitroglycerin and isosorbide (both used to treat the chest pain associated with angina). Nitrates are also contained in street drugs called “poppers” and in some air fresheners which are inhaled to enhance sexual pleasure.

Cialis should not be taken by men who are on medicines called alpha blockers which are sometimes used to treat prostate problems or high blood pressure. Men who take alpha blockers can use Viagra but must allow at least a six hour gap between taking the alpha blocker and Viagra.

Men taking Cialis may experience an unsafe drop in blood pressure if they drink too much alcohol. The same is true for Viagra, but since Viagra is shorter-acting, this may be less of an issue.
Men who have had a heart attack or stroke within the past 6 months and those with certain medical conditions (e.g., poorly controlled high or low blood pressure, poorly controlled diabetes, liver disease, and unstable angina) that make sexual activity inadvisable should not take Viagra or Cialis. Dosages of the drug should be limited in patients with kidney or liver disorders.

Conclusion

Viagra and Cialis have many more similarities than differences. Both drugs appear to be safe and effective. Cialis lasts longer, allowing greater sexual spontaneity, and can be taken with food. However, the side effects of Cialis can be prolonged and there can be an increased risk for drug interactions. In many cases, insurance coverage and cost may be the deciding factors.

If you are suffering from erectile dysfunction, a complete physical examination by your doctor or healthcare provider is essential. In some cases, erectile dysfunction may be a sign of an underlying medical condition. Your doctor can determine if any other conditions are involved and help you choose the best and safest therapy.

References:

1) Viagra
Source: Drugs.com

2) Cialis
Source: Drugs.com

3) The PDE5 inhibitors: Viagra, Levitra, and Cialis
Source: Patient Education Center, Harvard Medical School

4) Erectile dysfunction: Viagra and other oral medications
Source: Mayo Clinic

5) Comparison of Viagra, Levitra, and Cialis
Source: eMed Expert

6) Erectile Dysfunction: Cialis, Levitra, Staxyn, Stendra, and Viagra to Treat ED
Source: WebMD

Can obesity cause erectile dysfunction?

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Not that long ago, erectile dysfunction (ED) was a taboo subject. It was the topic of crude jokes and was not discussed in polite company. However, since the introduction of Viagra and other similar drugs, the topic of ED has gone mainstream. Commercials appear on almost every televised sporting event, and men’s magazines are filled with ads to “increase your sexual performance”. Celebrities such as NASCAR star Mark Martin, NFL coach Mike Ditka, and even former Republican presidential candidate Bob Dole have provided endorsements for various products. Although many people complain that the television ads are too explicit and are not suitable for family viewing, statistics show that men are now seeking treatment more willingly. Erectile dysfunction drugs have become more than a billion-dollar industry, and for millions of men these drugs have become a godsend.

However, despite the increased awareness of ED, there is still a basic lack of understanding about what causes the disorder and what can be done to prevent it. Many men assume that there is only one treatment option: pills. They are looking for a quick fix rather than a long-term solution. The three dominant drugs –Viagra, Cialis, and Levitra – all work by blocking an enzyme which allows blood to leave the penis, thereby increasing inflow and allowing erections to last longer. Although these drugs are generally very effective, they often have side effects and may stop working after a few years. And of course, pills will not provide complete restoration.
As with most health problems, prevention is best. One of the most preventable causes of ED is obesity. According to the Massachusetts Male Aging Study (http://www.ncbi.nlm.nih.gov/pubmed/8254833 ), 4 out of 5 people who report symptoms of ED are overweight or obese. A body mass index (BMI) in excess of 25 is considered overweight and a BMI in excess of 30 is considered obese. A BMI in excess of 40 is considered extremely obese. (To calculate your own BMI, obtain your height and weight, then use this online calculator: http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm.) A 2003 Harvard study by Bacon et al (http://www.ncbi.nlm.nih.gov/pubmed/12899583 ) noted that men who have a body mass index greater than 28.7 (about 195 pounds for a 5’9″ male) have a 30 percent greater risk of erectile dysfunction than those men with a normal BMI.

WHY DOES OBESITY CAUSE ERECTILE DYSFUNCTION?

In spite of the support that obesity is linked to erectile dysfunction, it is still not well understood how extra belly fat leads to decreased sexual performance. While it was initially thought that most cases of ED among obese men had only psychological roots, now it is believed that numerous physical mechanisms are involved as well.

The most important way that obesity influences a man’s sex life is by decreasing the amount of blood that flows to the penis. An erection occurs when the blood vessels leading to the penis dilate, causing it to fill with blood. The penis must store blood in order to keep an erection. Therefore, the ability of a man to develop and maintain penile erection depends on the health of his vascular system. It is well-accepted that the fatty foods and lack of exercise that cause weight gain can lead to atherosclerosis – the build-up of a waxy plaque on the interior of blood vessels.

When atherosclerosis occurs in the penile artery, the blood flow decreases or gets blocked, diminishing erectile function. Because the arteries in the penis are so small – 1mm to 2mm in diameter – they are affected a lot sooner than those in the heart, which are 3mm to 4mm in diameter. Therefore, ED can often be a warning sign of impending cardiovascular disease.

Another element affecting the health of the vascular system is the endothelium – the thin layer of cells that line the interior surface of all blood vessels. The erection process begins when the endothelium releases nitric oxide, a molecule that signals the surrounding muscles to relax in order for the blood vessels to dilate. (Viagra and similar drugs work by increasing the amount of nitric oxide in the endothelium.) However, when the endothelium is damaged, the endothelium may not release enough nitric oxide to produce or sustain an erection. Obesity, especially excess belly fat, has a damaging effect on vascular endothelium.

* Obesity can also affect erectile dysfunction by lowering testosterone levels. Testosterone is the primary sex hormone in men, and it plays an important role in both libido and sexual function. In a very recent study published in 2013 in _European Journal of Endocrinology _( http://www.ncbi.nlm.nih.gov/pubmed/23425925), low testosterone levels (also known as hypgonadism) were found in 75% of men considered very obese (BMI > 40). The link between obesity and low testosterone levels was found in men at all ages, even in young men and teenagers. The researchers also concluded that the common decrease in testosterone seen in older men is not due to age, but rather to increasing body weight. Another recent study published in 2013 in _Fertility and Sterility_ (http://www.ncbi.nlm.nih.gov/pubmed/23507475) showed that the testosterone decreases in men as they grow older can be reversed with weight loss.

In addition to these biological factors, there are also social and psychological factors associated with obesity. Obese people often have feelings of shame about their bodies and a lower sense of self esteem than their thinner peers. In a society that puts a premium on beauty and thinness, obese people may experience discrimination based on weight, including reduced chances of landing good jobs and decreased likelihood of dating or finding a marriage partner. Teasing and bullying can occur, especially during adolescence. This combination of negative body image and social prejudice could certainly affect the ability of overweight people to have satisfactory sexual relations.

CAN WEIGHT LOSS TURN THINGS AROUND?

Establishing a link between obesity and erectile dysfunction is one thing, but finding a way to improve erectile function is another. However, two recent studies have found that weight loss can indeed improve sexual function for overweight men with ED.

In a follow-up to the Massachusetts Male Aging Study published in _American Journal of Epidemiology_ in 1999 (http://www.ncbi.nlm.nih.gov/pubmed/10731462), Feldman et al found that men who were overweight at baseline were at an increased risk of developing erectile dysfunction. In contrast, men who initiated physical activity in midlife had a 70% reduced risk for erectile dysfunction relative to those who remained sedentary. In quantitative terms, this means that sedentary men may be able to reduce their risk of erectile dysfunction by performing regular physical activity at a level of at least 200 kcal/d, which corresponds to walking briskly for 2 miles.

In a landmark Italian study published in the _Journal of the American Medical Association_ in 2004 (http://jama.jamanetwork.com/article.aspx?articleid=198993), Esposito et al examined the effects of lifestyle changes on erectile dysfunction. This study took a group of 110 men between 35 and 55, who all had some degree of ED. All of the men were obese but otherwise healthy, and were randomly assigned to two equal groups. The first group was given detailed and individualized advice about reducing their total body weight through healthy food choices and by increasing physical activity. The second group just continued their usual care. By the end of the study, the BMI of men in the first group decreased more than the BMI of those in the second. In addition, in the first group there was a 22 percent improvement in erectile dysfunction, and 31 percent of the same men reported being at a level that no longer categorized them as having erectile dysfunction. In contrast, only 6 percent of the men in the second group were no longer considered to have erectile dysfunction. The improvement in erectile dysfunction was associated with improvement of both endothelial function and markers of systemic vascular inflammation.

The findings of this study led Dr. Christopher S. Saigal, a urologist at UCLA, to write an editorial in the same issue of the journal encouraging doctors to consider weight loss and exercise as the initial treatment for obese patients with ED. Saigal comments: “At a time in which obesity has become a public health crisis, this study provides evidence of efficacy for what perhaps should be the first-line treatment for obese patients with ED. This treatment strategy produces many benefits for the patient if it is successful and incurs no untoward risk if it is not.” As the Esposito study shows, even losing as little as 5%-10% of your body weight can lead to major improvements in your health, including blood pressure, cholesterol levels, and insulin sensitivity. And of course, losing weight can also provide an ego boost that carries over into the bedroom. According to Stephen Josephson, Ph.D., a psychologist at New York-Presbyterian Hospital, “People need to feel good about themselves [to] overcome performance anxiety and other things in the sex arena, and sometimes it’s as simple as getting into shape.”

THE BOTTOM LINE

If you are significantly overweight and you want to reduce your risk of ED, you need to make a healthy body weight a top health priority. Weight loss, increased physical activity and proper diet are factors that can protect from ED. Losing as little as 5 to 10 percent of body weight offers meaningful health benefits to people who are obese, even if they never achieve their “ideal” weight, and even if they only begin to lose weight later in life. (National Heart, Lung, and Blood Institute. _Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults_ . 2002)

According to the recently released obesity guidelines for the Obesity Society, American Heart Association, and American College of Cardiology (http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437739.71477.ee), there is no ideal diet for everyone. Doctors need to work with their obese patients to figure out the best plan for them, whether it’s vegetarian, low sodium, a commercial weight loss program, or low-carb. The most effective weight loss programs include 2-3 in-person meetings a month for at least 6 months, and most people should consume at least 500 fewer calories a day to lose weight.

If you are already suffering from ED, a complete physical examination by your doctor or healthcare provider is essential. In some cases, erectile dysfunction may be a sign of an underlying medical condition. Your doctor can determine if any other conditions are involved and help you choose the best and safest therapy. Take your medications as prescribed and follow your doctor’s advice on diet and exercise.

What exactly are you buying

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In the good old days before Big Pharma dragged itself out of the mud, we used to trust the local herbalists. You know the type: a slightly older woman who lived on her own and seemed to have a very friendly cat. When you described the symptoms, she would crack a smile showing missing teeth and spit into her cauldron. Then muttering to herself about whether it was one or two eyes of newt, she would brew something for you and, after you had crossed her palm with silver, off you went to rediscover your health.

Strangely enough, many of these cures were effective. Why? Well there are actually some very effective natural medicines out there in plants, roots, and seeds. Trial and error over generations teaches the observant what works. Then we come to the placebo effect. Many people who believe strongly enough in the “cure” are cured even though the material offered has no medicinal properties. Clinical trials today routinely find about one-third of all those in the control group with chemically inactive capsules, pills and topical creams report significant improvement in their condition. The power of the mind is never to be underestimated.

Of course, one of the problems in our modern age, is the need to tell people the truth about what we put in our mouths. Labeling food is essential if people are to avoid consuming substances causing allergic reactions. It’s the same when it comes to drugs. We want to be certain the product of the research is both effective and safe. That’s why we rely so heavily on the US Food and Drug Administration. There’s just one further difficulty. The FDA does not test “natural” products. All it does is regulate the way in which they are marketed. Distributors are not allowed to claim medicinal results — that would make it a drug and so regulated by the FDA. So distributors either use ambiguous language or make outrageous claims knowing it always takes the FDA months to react.

 

All this is prompted by a “natural’ energy drink claiming it would enhance sexual performance. When such claims first appear, the one or two suckers who buy the product usually arrive on forums to warn others off. Except this drink got the two thumbs up (or three depending on what you are counting). It seemed it really did work. So after time had passed at a glacial pace, a government laboratory tested the drink and discovered why it works. It contains Levitra, also sold as Vardenafil. This is one of the four drugs for the treatment of erectile dysfunction currently licensed by the FDA. Obviously the label did not disclose the presence of this drug. So at every level, the sale of this energy drink was illegal. It never has been a 100% herbal health drink. Moska energy drink is a very expensive way of buying Levitra. Worse, it’s easy to overdose and so cause some very unpleasant side effects. If you suffer from erectile dysfunction, buy the right drug in the usual way. Don’t gamble on natural products which are not regulated by the FDA.

There are many things you can do about ED

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Erectile dysfunction can be caused by millions on reasons. Of course, one of them is the aging barrier. It is hard to get rid of the problem when it seems natural as you grow older. But thanks to medicine we are not suffering as much as we could have been. According to a number of surveys erectile dysfunction can cause depression especially when people seem to see no light at the end of the tunnel.

It is a well-known fact that men need sex as it is extremely important to them. They want to feel good as well as to bring pleasure to their partner. It is a question on confidence as well. When something is not working well enough they shut down and become distant from everyone.

More than 30 million men in USA are struggling to find a way out of erectile dysfunction problem. There is no particular cure for the disease and some men start to lose faith but there is definitely a possibility to improve the situation and make the issue of not being able to erect a temporary one.

Researches have shown that there are a few drugs that are able to perform the “magic” for you. We all know the medication called Viagra. It is quite recognized nowadays. But there are other drugs that could help you to erect and sustain an orgasm. Cialis and Levitra are names of the pills that you can easily rely on. We say this only because we have read thousands of reviews and have taken lots of interviews from people that recommend them and praise them for the passionate nights they experienced.

Statistics show that erectile dysfunction dependent people are very vulnerable and nervous. They come across sudden mood changes and they are more likely to behave abnormally. Levitra and Cialis work the same way that Viagra does. They are the pills that should be only consumed with the doctor’s acknowledgment. Levitra was the second one to appear, while Cialis too a bit longer to manufacture. Some people that happened to try all three types of drugs state that Cialis and Levitra are better than Viagra. They are less addictive and more efficient. This is a matter of choice though as three of them are considered to be trustworthy and qualitative.

Erectile dysfunction problem is not to be taken for granted. As usual, there are plenty of theories around it – some of them true, some of them fake. What is important to remember here is that it is your health and you need to do everything you possibly can to stay content. It is necessary to be happy with who you are and what you do. Men are very sensitive when it comes to sex subject. When they are unable to maintain their sexual intercourse, they become stranded and this finds its reflection in their self-esteem. Let’s not suffer in vain especially since there are good drugs that can help you anytime in any occasion.