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In the late 1990s, the launch of the drug Viagra revolutionized treatment of impotence. The drugs Levitra and Cialis followed. All three medications enhance the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow. Cigarette smoking: Cigarette smoking aggravates atherosclerosis and thereby increases the risk for erectile dysfunction. For more information, please read the Smoking and Quitting Smoking article. Erectile dysfunction, also known as impotence, has many causes and a growing body of treatments. According to the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), erectile dysfunction "can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections." The condition affects as many as 30 million American men at some point in their lives. generic viagra here buy viagra without prescription online Nonpharmacologic options may be offered as second-line treatment in lieu of intraurethral or intracavernosal injection for patients who do not respond to or cannot tolerate oral therapy. Vacuum erection devices increase corporal blood flow, and a constrictor ring is then used to retain this blood within the penis. Satisfaction is variable (27%74%), and this technique can cause discomfort and bruising of the penis.63 Surgical options exist for patients with erectile dysfunction. Penile arterial bypass surgery is appropriate in only a select group of patients (men under 35 years of age who have no generalized vascular disease and in whom an isolated injury has obstructed blood flow). Penile implants are available for patients who have not responded to more conservative treatment. This procedure is invasive, irreversible and subject to complications such as infection, erosion and mechanical failure. There is, however, a high rate of patient and partner satisfaction.63 best price cialis best buy cialis buy

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