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What is Erectile Dysfunction?

Writtent by Janna Mustafina, MSN, FNP-C

Dec 2nd, 2020

According to Urology Care Foundation about 30 million of American men occasionally experiencing a problem with getting and/or keeping an erection.  Erectile dysfunction, commonly called ED, can be caused by either or both factors: physiologic and  psychological. Physiologic factors are those that affect or impair the blood flow to the penis. Those factors can be diabetes, high blood pressure, smoking and/or alcohol abuse, high cholesterol, obesity, low testosterone, and normal aging process. Psychological factors are also called mental factors that can impair an ability to have an erection. Those mental factors include depression, anxiety, general stress, and sex-phobia.

The evaluation for erectile dysfunction starts with learning your relationship harmony. Is this a new relationship or established? In a new relationship the erectile dysfunction can be a result of multiple psychological factors. We always recommend males to give themselves at least 1-2 months to build a trustful relationship with a new sexual partner before they decide they need help for their performance. It is very important to be comfortable with the new partner, to have a relaxed mind during intimacy for the best erection and sexual functionality.  In case of already established relationship when men complain that over the years their erection is not as strong as used to, commonly, it is more related to physiologic factors.

At eCareNow we help treat Erectile Dysfunction with a class of drugs called PDE5 inhibitors. Viagra, Cialis, Levitra, and Stendra are PDE5 inhibitors. How do they help with an erection? They block the PDE5 enzyme which plays role in smooth muscle contraction and relaxation. Blocking PDE5 enzyme increases blood flow to certain areas of the body due to the relaxation of the blood vessels. The most common and affordable drugs for erectile dysfunction are Sildenafil (Viagra) and Tadalafil (Cialis).

What is the difference between Viagra and Cialis?


The main difference between these two drugs is the time of drug presence in your body. Tadalafil can stay in the system for up to 36 hours while Sildenafil is up to 8-10 hours.

Therefore, taking a very small dose of Tadalafil (2.5mg or 5mg) once a day helps establish a steady, constant dose in the body. Another difference is that Tadalafil can be taken after meals vs Sildenafil should be taken on an empty stomach for better effect. Lastly, Sildenafil starts working faster vs. Tadalafil may take an 2hrs  before it kicks in. 

What are the side effects of generic Viagra or Cialis?


The side effects of either Sildenafil or Tadalafil are the same and include

  • headache,

  • nausea,

  • stuffy nose,

  • flushing,

  • indigestion,


but there can be some other rare side effects and/or drug interactions.

Who should NOT take Sildenafil, Tadalafil, or other medications from  PED5i category? 

  •  Males who take Nitrate-contained medications such as Isosorbide Mononitrate (ImDur), Isosorbide Dinitrate (ISMO), Nitrostat, Nitoglycerin (in any form pills, patches, creams). These medications taken with PED5i can cause a life-thretening hypotension. 

  •  Males who use illicit drugs such as cocaine, methaphetamine, etc. The combination of cocaine with PDE5i can cause life and health threatening emergencies including priapism, stroke, cardiac arrest, and serotonin syndrome.

  •  Males with stable or unstable angina; past MI (less than 8 weeks ago), uncontrolled high blood pressure; with past medical history of advanced congestive heart failure, stroke, or transient ischemic attack; males who have chest pain or shortness of breath with sex or other physical activities; males who have unexplained sudden hearing or vision loss; males with an active Peyronie’s disease, recent history of penile fracture, or history of pirapism; males with severe kidney or liver disease; males with peripheral arterial disease. 

  • Males with sickle cell anemia, leukemia, myeloma, blood clotting disorders (should be evaluated for ED treatment in person). 

Who are at risk for Erectile Dysfunction?

Sometimes erectile dysfunction can be a normal part of aging process. It happens more often in older men.


The risk factors include:

• Chronic health conditions:  heart and blood vessel disease, obesity, diabetes, high blood pressure, low testosterone levels, metabolic syndrome, and lung, liver, or kidney disease.
• Certain medications: antidepressants, antihistamines, tranquilizers, sleeping pills, treatments for prostate cancer
• Trauma or surgery to the nerves that are involved with erections
• Consuming alcohol
• Substance abuse (street drugs)
• Cigarette smoking
• Certain psychological conditions: stress, depression, anxiety

How to prevent Erectile Dysfunction?

Stay healthy, maintain regular physical activity, and try to prevent the risk factors above.

The articles above serves for informative purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

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