Caution: There is a higher rate of heart disease in men who have problems with maintaining an erection. All men with ED -- particularly older men who are more likely to have physical causes as opposed to psychological causes -- need a medical evaluation, detailed cardiac assessment, blood pressure measurement, lipid profile and blood sugar tests, as well as lifestyle advice regarding weight management, diet improvement, smoking cessation, reduction of alcohol use, sleep quality improvement, and exercise. See diet for suggestions. If you have erectile dysfunction, make sure to have a full medical evaluation before starting therapy, whether with an herbal product or a drug. Some herbs are very potent and have a tendency to accelerate heart rate or increase blood pressure which may not be well tolerated by those who have cardiac or cardiovascular problems. Even though herbs are safer than prescription medications, they do have side effects in high doses.

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Dr. Sahelian and his research staff have tested various doses and extracts of dozens of herbs from a number or raw material suppliers to determine the ideal dosage and combination for optimal aphrodisiac properties with the fewest side effects. After years of trial and error, a special proprietary blend with 15 herbal extracts from the best raw material suppliers has been created which works within hours. The exact dosages and potencies of this UNIQUE aphrodisiac blend is a close kept secret only known to the doctor and his research staff.

Find out more details about Passion Rx, and to buy sex herbs such as Tribulus, Muira Puama, Tongkat Ali, and Horny Goat weed

The potent herbal extracts in Passion Rx include ashwagandha herb, catuaba herb, cnidium, herba cistanches, horny goat weed herb, maca herb, muira puama, Passion flower, Tongkat Ali (Eurygold and LJ100), Tribulus terrestris extract and Yohimbe herb. A Passion Rx version without yohimbe bark is also available. I am not convinced that l arginine, by itself, is an effective treatment for erectile dysfunction.

Understanding the causes
Erectile dysfunction can be classified simply under two headings. Psychological: that is, mental; or Organic: that is, due to some form of physical or medical problem. Organic ED becomes more common as men get older. Psychological causes are more likely in those below the age of 30.

Psychological causes
The causes of psychological erectile dysfunction are numerous, and it is difficult to list them all, but most often this condition is related to depression, performance anxiety, marital stress or relationship problems, marital boredom, life crisis, financial difficulties, religious repression, or some type of mental illness. Improving ED in these cases may require addressing the underlying causes.

Organic causes
There are four major causes of organic erectile dysfunction: Vascular, Neural, Hormonal, and Drug-induced. The cause of ED determines the treatment approach. Diabetes mellitus, hypertension, and tobacco abuse are the three most common causes in men older than 50 years of age.

Vascular causes involving poor blood flow
Alterations in the flow of blood to and from the penis are thought to be a common cause. For instance, medical conditions such as atherosclerosis (hardening of the arteries), high cholesterol, hypertension, or diabetes reduce blood flow to the penis and genital organs thus leading to difficulty with erection or genital swelling.  Erectile dysfunction could be an early indication of oxidative stress and vascular dysfunction. Patients with cardiovascular disease and patients with diabetes represent the largest group of patients with ED. Lowering cholesterol through diet, supplements, or medicines improves this condition.
   Metabolic syndrome can increase inflammatory markers in blood and negatively influence endothelial function resulting in poor vasodilation and a higher incidence of erectile dysfunction.
   Additional factors that can impede blood flow include penile injury and surgery in the pelvic and abdominal area.
   Heavy smoking is an important risk factor for ED in men and quitting smoking, over time, improves this condition. Stopping cigarette smoking leads to improved penile tumescence and rigidity.
  Chronic periodontitis is characterized with inflammation of the gingival tissues, which causes endothelial dysfunction in different organs. There seems to be an association of chronic periodontitis with ED.

Neural causes
Nerve damage from disorders such as multiple sclerosis, Parkinson’s disease, diabetes, and stroke affect the brain’s ability to respond to sexual stimulation and cause erectile dysfunction. In women, abdominal or pelvic operations can occasionally lead to nerve damage. ED is common in men undergoing surgical treatment for prostate enlargement or cancer.

Hormonal causes
Low levels of androgens, such as testosterone, are sometimes a component of erectile dysfunction. Testosterone levels decline about 1 percent each year in men, which may contribute to erectile dysfunction with aging. Testosterone also declines with age in women leading to a decrease in female libido. Replacement of androgens can sometimes be helpful in those with age related erectile dysfunction. Testosterone is available by prescription only. An over the counter hormones, such as DHEA, converts into testosterone and thus has a positive influence on erectile dysfunction. Pregnenolone is another over the counter hormone that may increase testosterone levels and thus improve erectile dysfunction. Many herbal aphrodisiacs also have a positive influence on erectile dysfunction. Routine hormone blood studies for erectile dysfunction evaluation are not needed during the initial evaluation but perhaps later if treatment modalities are not successful. Prominent diseases of the endocrine system, such as diabetes mellitus, hypogonadism, and hyperprolactinemia, may cause erectile dysfunction. Sometimes erectile dysfunction treatment with hormones such as DHEA or testosterone can be effective.

Drug or Medication-induced ED is quite common, even some herbs and supplements can be a cause
Drugs that interfere with erectile function include antihistamines used for allergy treatment, some anti-hypertensives used for high blood pressure, SSRIs (like Prozac, Zoloft, Paxil and others), sedatives (such as Zanax, Valium, prescription sleeping pills, and others), narcotic pain medications such as codeine and morphine, and beta-blockers. SSRIs - treatment for depression - cause ED mostly due to their effect on serotonin metabolism. Serotonin has an inhibitory effect on erectile function and sexuality. Beta blockers such as propranolol, atenolol, and others, are some of the most common medications that cause erectile dysfunction. DHT blockers such as Avodart and Proscar, Propecia, are also known to cause ED. The generic names are dutasteride and finasteride.
   Surprisingly, NSAIDs such as ibuprofen and naproxen also cause erectile dysfunction. Regardless of the reason for taking them, painkillers classified as non-steroidal anti-inflammatory drugs (NSAIDs) apparently increase the likelihood that middle-aged and elderly men will develop erection difficulties.

I am a sufferer of ED caused from Propecia drug. I live in Cyprus, many young men can reach finasteride from local pharmacy without a doctor's prescription. I'm 30 years old and had a very good sexual life strong erections and good sex drive all my life until I took Propecia for two months. My prolactin level increased from normal ranges 3-15 to 35. MRI showed no pituitary tumor.

Natural herbs and supplements as cause
Certain dietary supplements, such as 5-HTP that converts into serotonin, and the herb kava, can, if used frequently, reduce sex drive, urge, and sensation.

Medical diseases and metabolic disorder
Certain medical conditions cause erectile dysfunction or reduce libido, performance, or enjoyment. These include hypertension, diabetes, high cholesterol, cardiovascular disease, obesity, peripheral vascular disease, neurologic disorders, and insomnia. In diabetic men with ED, the severity of their sexual performance problem increases as control of blood sugar levels worsens.
   Sitting on a bicycle too long. Men who log several thousand miles a year on their mountain bikes suffer scrotal damage that could reduce their fertility or cause erectile dysfunction.
   Have you heard of the metabolic syndrome or Syndrome X? Symptoms of metabolic syndrome include a large waistline, high blood pressure, raised insulin levels, excess body weight and abnormal cholesterol levels. If someone has three or more symptoms they have the syndrome and a higher risk of suffering from life-threatening illnesses. Patients with metabolic syndrome have an increased prevalence of erectile dysfunction.
   Insomnia is a common cause.
       
Cardiac Patients and heart disease
Erectile dysfunction is common in cardiac patients and shares the same risk factors - smoking, hypertension, hyperlipidemia and diabetes mellitus. Sexual activity is not unduly stressful to the heart and, providing patients are properly assessed using established guidelines, sexual intercourse can be enjoyed without increased risk. ED in asymptomatic patients may be a marker of silent vascular disease or increased vascular risk factors and should alert the physician to the need for cardiac risk screening.
   Physical fitness positively influences sexual desire and performance. Moderate exercise may help boost sexual function in men with heart failure.

Diabetes
Diabetic men are much likely to develop ED as non-diabetic men. The cause is multifactorial, but most commonly reflects endothelial dysfunction and autonomic neuropathy. Diabetes and vascular disease may be a marker for silent occlusive arterial disease. Treatment is effective in the majority and all options should be considered, beginning with the much preferred oral phosphodiesterase type 5 inhibitors (sildenafil, tadalafil, vardenafil).
    
Review of Cialis, Levitra, Viagra and erectile dysfunction pills
Viagra (sildenafil), approved by the FDA in 1998, has been the most popular medicine for the treatment of ED. Viagra works very well in dilating blood vessels in the genital region leading to an erection or increased blood flow to the vaginal tissues, however it does little to directly increase libido or sexual arousal. The effect of Viagra is often noticed within an hour after taking a pill of 50 or 100 mg, and ease of erection may last up to 12 hours. Side effects of Viagra include headache, flushes, nasal congestion or runny nose, malaise, nausea, changes in blood pressure, irregular heart beats, visual disturbances including rare cases of blindness, and chest pain. Viagra may cause stickiness of blood platelets. Trimetazidine, a drug that prevents heart-related chest pain, is a better choice than "nitrate" drugs, such as Nitro-DUR and Isordil, for men with heart disease who are taking Viagra (sildenafil) for erectile dysfunction treatment. There have been concerns about dangerously low blood pressure when Viagra is combined with nitrates, the authors explain, yet many men with heart disease are currently seeking treatment for erectile dysfunction.
   I personally find natural sex boosters quite effective and preferable to pharmaceutical erectile dysfunction drugs.

Drugs to treat erectile dysfunction need stronger warnings on their packaging about the risk of blindness, U.S. consumer group Public Citizen said in 2005, in a petition filed with health regulators. The U.S. Food and Drug Administration should "immediately add a black box warning regarding the risks of drug-induced blindness for the three phosphodiesterase 5 (PDE5) inhibitors that are prescribed for the treatment of erectile dysfunction," Public Citizen's Health Research Group wrote. Pfizer Inc.'s pulmonary hypertension drug Revatio, which has the same active ingredient as its impotence drug Viagra, should also carry a similar black box warning. Earlier drugmakers agreed to put information on their impotence drug labels about the possible vision loss, called non-arteritic anterior ischemic optic neuropathy. Viagra, Cialis, sold by Eli Lily & Co. and Icos Corp., and Levitra, sold by GlaxoSmithKline , Bayer AG and Schering-Plough Corp., now carry the new labels, which say the condition "has been reported rarely."