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Because sexual performance is often a big part of a man's self-esteem, experiencing erectile dysfunction (ED) can be devastating not only to a man's sex life, but to his entire sense of being. Men with ED can become uncertain of themselves and avoid intimate situations with their partners; this only increases the pressure and anxiety associated with a condition which is often treatable.
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In the start-and-stop method, you or your partner will stimulate your penis until you feel like you are about to have an orgasm. Then the stimulation stops for about 30 seconds. Once you regain control of your response, stimulation begins again. This process is repeated 3 or 4 times before you allow yourself to have an orgasm.
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"Having an erection does not mean you are being sexual. Being sexual comes from inside your sense of yourself," Shaw says. "You can be sexual, you can feel sexual, you can behave sexually without an erection. A penis is not the only part of a man's body that can be used sexually."
"It's an important message to get out," said Dr. Ira Sharlip, a spokesman for the American Urological Association. "There's an increasing body of knowledge that tells us that erectile dysfunction is a form of cardiovascular disease and often predates the onset of other forms of clinical cardiovascular disease, specifically coronary disease."
A few causes of impotence may be iatrogenic (medically caused). Various antihypertensives (medications intended to control high blood pressure) and some drugs that modify central nervous system response may inhibit erection by denying blood supply or by altering nerve activity. Antidepressants, especially SSRIs, can cause impotence as a side effect. Surgical intervention for a number of different conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. Some studies have shown that male circumcision may result in an increased risk of impotence,   while others have found no such effect,   , and another found the opposite. 
Women who took contraceptives containing desogestrel had a seven times greater risk of developing thrombosis compared to women who aren't on the pill. In contrast, women who took pills containing a progestogen called levonorgestrel had a much lower risk, about four times that of women not taking the pill.
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Attention has recently been focused on the chemical mediators of erection. These include prostaglandin E, acetylcholine, vasoactive intestinal peptide and nitric oxide. The most physiologically important mediator is nitric oxide.2 This substance is released from nerve endings and vascular endothelium and functions by activating guanylate cyclase, which converts guanosine triphosphate to cyclic guanosine monophosphate (cGMP).3 cGMP becomes the secondary messenger that causes smooth muscle relaxation, resulting in venous engorgement and penile tumescence.
Erectile Dysfunction: Where to Start
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Indeed, Downey believes the more matter of fact a woman can be in approaching this conversation, the more likely she is to get through to her man.
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Aging: There are two reasons why older men are more likely to experience erectile dysfunction than younger men. First, older men are more likely to develop diseases (such as heart attacks, angina, strokes, diabetes mellitus, and high blood pressure) that are associated with erectile dysfunction. Second, the aging process alone can cause erectile dysfunction in some men; primarily by decreasing the compliance of the tissues in the corpora cavernosa, although it has been suggested, but not proven, that there is also decreased production of nitric oxide in the nerves that innervate the corporal smooth muscle within the penis.
I went to the New York Times next and found nothing, just as I see now as I write this about 30 minutes after I first went there:
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A new study sheds additional light on how erectile dysfunction (ED) interacts with diabetes. The study is another step in uncovering the link between the two disorders, and may lead to improved efficacy in treatments.
Men Who Smoke Prone to Impotence
Erectile dysfunction and coronary artery disease share many of the same risk factors, including diabetes, smoking, high blood pressure, high cholesterol, obesity, depression, and lack of physical activity.
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There were 99 deaths in this group of patients between October 2001 and December 2002. Heart attack claimed the lives of 27 patients, while heart disease accounted for nine deaths and lung cancer for five deaths. In 21 cases, the cause of death could not be established by the researchers.
In a multi-center, double blind study (18), 520 patients (average age of 54) took either 2mg, 4mg, 5mg, 6mg of apomorphine or a placebo. The number of attempts resulting in an erection firm enough for intercourse was recorded, along with the actual attempts resulting in intercourse.
Vascular reconstructive surgery is performed to improve the blood supply of the penis in attempts to improve a man's ability to get and maintain an erection. Because the procedure is technically difficult, costly and not always effective, it is very rarely performed.
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