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Tim Roddy, M.D., a urologist in Edmonds, Wash., agrees that the pressure of sitting on a bike seat can cause the problem: "A man can squeeze off some of the vital arteries and nerves necessary for normal sexual functioning by sitting on a hard bicycle seat too long," he says. Erectile Dysfunction (ED or "male impotence") is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis.An erection occurs due to blood entering and being retained in sponge-like bodies within the penis. Monitoring erections that occur during sleep (nocturnal penile tumescence) can help distinguish between erectile dysfunction of psychological and physical causes. If nocturnal erections do not occur, then the cause of erectile dysfunction is likely to be physical rather than psychological, however, tests of nocturnal erections are not completely reliable. Scientists have not standardized the tests and have not determined in whom they should be done. Top of page The case A 46-year-old male presented to our urology clinic 1 year after sustaining an injury to his perineum. He was otherwise healthy, with no underlying medical conditions and led a very active lifestyle. The patient reported no previous traumatic injuries and presented with no other risk factors for erectile dysfunction. The injury occurred when he fell from his surf board and inadvertently speared himself with it. He described having perineal pain immediately after the injury, which continued to the date of his office visit, although with reduced severity. He also described a significant amount of bruising in the area, which subsided over time. His main complaint was that he was only able to obtain a 50–65% erection based on self report. His SEXUAL HEALTH INDEX FOR MEN score was 20. He had sought treatment from several urologists over the previous year for his erectile dysfunction, and had undergone trials of sildenafil 200 mg and tadalafil 20 mg on several occasions without improvement. Cardiovascular Disease If unsuccessful, interferes with other treatments Get plenty of rest and take time to relax. Adjusting medications The answer: it depends. The issue is less actual size than perception of size. Are condoms a good choice? My first-line ED treatment is Viagra. If Viagra doesn't work, I suggest using a vacuum erection device (VED or trying drug injection therapy. A third, highly effective treatment is the surgical implantation of a penile prosthesis. In order to get an idea about how the VED works, I have a patient watch an instructional video in my office. To experience the injectable medication, the man will undergo a test injection in the office that same day. Online viagra sales Return to top By the end of the study, the researchers found no significant differences in vision between the men who took the drugs and those who took the placebo. The findings were published in the April issue of the journal Archives of Ophthalmology. Conditions Associated With Vascular Disease By Randy Dotinga Is it safe for men with heart disease to use sildenafil (Viagra)? Severe renal impairment (CrCl <30 mL/min): Not to exceed 5 mg PO qd prn Buy viagra Canada Vascular Reconstructive Surgery

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