i heard that some anti hypertensive agents may cause erectile dysfunction,is this true

Yes, it is true. Ask your doctor if you can skip once a week. My male friend does this (with his doctor is blessing) and is good to go by evening. No spontaneity - but that is better than no sex!

None of them are that great for erection . but aging itself causes ED and cannot be reversed. Welcome to life.

A great movie to watch that will be very helpful!
http://video.google.com/videoplay?docid=8271947477140788534&q=men%27s+health&hl=en


Original Article:http://mayoclinic.com/health/erectile-dysfunction/DS00162

Erectile dysfunction
Introduction
Erectile dysfunction (ED) affects the lives of many middle-aged men & their partners to one degree or another. The term erectile dysfunction covers a range of disorders, but usually refers to the inability to obtain an adequate erection for satisfactory sexual activity.
Although erectile dysfunction, formerly called impotence, is more common in men older than 65, it can occur at any age. An occasional episode of erectile dysfunction happens to most men & is normal. As men age, it is also normal to experience changes in erectile function. Erections may take longer to develop, may not be as rigid or may require more direct stimulation to be achieved. Men may also notice that orgasms r less intense, the volume of ejaculate is reduced & recovery time increases between erections.
When erectile dysfunction proves to be a pattern or a persistent problem, it can interfere with a man is self-image as well as his & his partner is sexual life. Erectile dysfunction may also be a sign of a physical or emotional problem that requires treatment.
Erectile dysfunction was once a taboo subject, but more men r seeking help. Doctors r gaining a better understanding of what causes erectile dysfunction & r finding new & better treatments.
Signs & symptoms
Patterns of erectile dysfunction include:
·Occasional inability to obtain a full erection
·Inability to maintain an erection throughout intercourse
·Complete inability to achieve an erection
Causes

CLICK TO ENLARGE
Male reproductive system

The penis contains two cylindrical, sponge-like structures that run along its length, parallel to the tube that carries semen & urine (urethra). When a man becomes sexually aroused, nerve impulses cause the blood flow to the cylinders to increase about seven times the normal amount. This sudden influx of blood expands the sponge-like structures & produces an erection by straightening & stiffening the penis. Continued sexual arousal or excitation maintains the higher rate of blood flow, keeping the erection firm. After ejaculation, or when the sexual excitation passes, the excess blood drains out of the spongy tissue, & the penis returns to its nonerect size & shape.
Specific steps take place to produce & sustain an erection:
·Arousal. The first step is sexual arousal, which men obtain from the senses of sight, touch, hearing & smell, & from thoughts.
·Nervous system response. The brain communicates the sexual excitation to the body is nervous system, which activates increased blood flow to the penis.
·Blood vessel response. A relaxing action occurs in the blood vessels that supply the penis, allowing more blood to flow into the shafts that produce the erection.
If something affects any of these factors or the delicate balance among them, erectile dysfunction can result.
Nonphysical causes
Nonphysical causes may account for impotence. They may include:
·Psychological problems. The most common nonphysical causes r stress, anxiety & fatigue. Impotence is also an occasional side effect of psychological problems such as depression.
·Negative feelings. Feelings that u express toward ur sexual partner — or that r expressed by ur sexual partner — such as resentment, hostility or lack of interest also can be a factor in erectile dysfunction.
Physical causes
Physical causes account for many cases of erectile dysfunction & may include:
·Nerve damage from longstanding diabetes (diabetic neuropathy)
·Cardiovascular disorders affecting the blood supply to the pelvis
·Certain prescription medications
·Operations for cancer of the prostate
·Fractures that injure the spinal cord
·Multiple sclerosis
·Hormonal disorders
·Alcoholism & other forms of drug abuse
In fact, erectile dysfunction may be one of the first signs of an underlying medical problem.
The physical & nonphysical causes of erectile dysfunction commonly interact. For instance, a minor physical problem that slows sexual response may cause anxiety about attaining an erection. Then the anxiety can worsen ur erectile dysfunction.
Risk factors
A wide variety of physical & emotional risk factors can contribute to erectile dysfunction. They include:
·Physical diseases & disorders. Chronic diseases of the lungs, liver, kidneys, heart, nerves, arteries or veins can lead to impotence. So can endocrine system disorders, particularly diabetes. The accumulation of deposits (plaques) in ur arteries (atherosclerosis) also can prevent adequate blood from entering the penis. And in some men, erectile dysfunction may be caused by low levels of the hormone testosterone (male hypogonadism).
·Surgery or trauma. Damage to the nerves that control erections can cause erectile dysfunction. It may result from an injury to the pelvic area or spinal cord. Surgery to treat bladder, rectal or prostate cancer also can result in erectile dysfunction. Prolonged bicycle riding also can cause a temporary problem.
·Medications. A wide range of drugs — including antidepressants, antihistamines & medications to treat high blood pressure, pain & prostate cancer — can cause erectile dysfunction by interfering with nerve impulses or blood flow to the penis. Tranquilizers & sleeping aids also may pose a problem.
·Substance abuse. Chronic use of alcohol, marijuana or other drugs often causes erectile dysfunction & decreased sexual drive. Excessive tobacco use also can damage penile arteries.
·Stress, anxiety or depression. Psychological conditions also contribute to some cases of erectile dysfunction.
When to seek medical advice
It is normal to experience erectile dysfunction on occasion. But if erectile dysfunction lasts longer than two months or is a recurring problem, see ur doctor for a physical exam or for a referral to a doctor who specializes in erectile problems. Your own doctor or a specialist can help u determine the underlying cause or causes of erectile dysfunction & then help u find the right type of treatment.
Although u might view erectile dysfunction as a personal or embarrassing problem, it is important to seek treatment. In many cases, erectile dysfunction can be successfully treated. Also, see ur doctor if the therapy or medication prescribed to treat erectile dysfunction is not working for you. Do not try to combine medications or therapies on ur own or deviate from prescribed doses.
Screening & diagnosis
Your doctor will want to ask questions about how & when ur condition developed, the medications u take & any other physical conditions u may have. Your doctor will also want to discuss recent physical or emotional changes.
If ur doctor suspects that physical causes r involved, he or she will likely want to take blood tests to check ur level of male hormones & for other potential medical problems, such as diabetes. Your doctor may also want to try eliminating or replacing certain prescription drugs you're taking one at a time to see whether any r responsible for erectile dysfunction.
More specialized tests may include:
·Ultrasonography. This test can determine the adequacy of arterial circulation in ur genital organs. Ultrasonography involves using a wand-like device (transducer) held over the blood vessels that supply the penis. The transducer emits sound waves that pass through body tissues & reflect back, producing an image to let ur doctor see if ur blood flow is impaired. The test often is done before & after injection of medication to see if there is an improvement in blood flow.
·Neurologic evaluation. Your doctor usually assesses possible nerve damage by conducting a physical examination to test for normal touch sensation in ur genital area.
·Cavernosometry & cavernosography. Cavernosometry is a test that measures penile vascular pressure. Cavernosography involves injecting a dye into ur blood vessels to permit ur doctor to view any possible abnormalities in blood flow into & out of ur penis.
If ur doctor suspects that mainly nonphysical causes r to blame, he or she may ask whether u obtain erections during masturbation, with a partner or while u sleep. Most men experience many erections, without remembering them, during sleep. A simple test that involves wrapping a special perforated tape around ur penis before going to sleep can confirm whether u have nocturnal erections. If the tape is separated in the morning, ur penis was erect at some time during the night. Tests of this type confirm that there is not a physical abnormality causing erectile dysfunction, & that the cause is likely psychological.
Treatment
A wide variety of options exist for treating erectile dysfunction. They include everything from medications & simple mechanical devices to surgery & psychological counseling. The cause & severity of ur condition r important factors in determining the best treatment or combination of treatments for you. You & ur doctor may also want to consider how much money you're willing to spend & the personal preferences of u & ur partner. If erectile dysfunction is the result of a medical condition, the cost of treatment may be covered by insurance.
Oral medications
Oral medications available to treat ED include:
·Sildenafil (Viagra)
·Tadalafil (Cialis)
·Vardenafil (Levitra)
The Food & Drug Administration (FDA) approved Viagra in 1998, & it became the first oral medication for erectile dysfunction on the market. Since then, Levitra & Cialis have been approved, providing more options for oral therapy.
Viagra, Levitra & Cialis work in much the same way. Chemically known as phosphodiesterase inhibitors, these drugs enhance the effects of nitric oxide, a chemical messenger that relaxes smooth muscles in the penis. This increases the amount of blood & allows a natural sequence to occur — an erection in response to sexual stimulation. These medications do not automatically produce an erection. Instead they allow an erection to occur after physical & psychological stimulation. Many men experience improvement in erectile function after taking these medications regardless of the cause of their impotence.
These medications share many similarities, but they have differences as well. They vary in dosage, duration of effectiveness & possible side effects. Other distinctions — for example, which drug is best for certain types of men — r not yet known. No study has directly compared these three medications.
Not all men benefit
Although these medications can help many people, not all men can or should take them to treat erectile dysfunction. If you've had a heart attack, stroke or life-threatening heart rhythm during the last six months, do not take these medications. If you've been told that sexual activity could trigger a cardiac event, discuss other options with ur doctor. In addition, do not take Viagra, Levitra or Cialis with nitrate medications, such as the heart drugs nitroglycerin (Nitro-Bid, others), isosorbide mononitrate (Imdur) & isosorbide dinitrate (Isordil). The combination of these medications, which work to widen (dilate) blood vessels, can cause dizziness, low blood pressure, & circulation & heart problems.
Do not expect these medications to fix ur impotence immediately. Dosages may need adjusting. Or u may need to alter when u take the medication. Before taking any medication, make sure to discuss with ur doctor its potential benefits & side effects.
Prostaglandin E (alprostadil)
Two treatments involve using a drug called alprostadil (al-PROS-tuh-dil). Alprostadil is a synthetic version of the hormone prostaglandin E. The hormone helps relax smooth muscle tissue in the penis, which enhances the blood flow needed for an erection. There r two ways to use alprostadil:
·Needle-injection therapy. With this method, u use a fine needle to inject alprostadil (Caverject, Edex) into the base or side of ur penis. This generally produces an erection in five to 20 minutes that lasts about an hour. Because the injection goes directly into the spongy cylinders that fill with blood, alprostadil is an effective treatment for many men. And because the needle used is so fine, pain from the injection site is usually minor. Other side effects may include bleeding from the injection, prolonged erection & formation of fibrous tissue at the injection site. The cost per injection can be expensive. Injecting a mixture of alprostadil & other prescribed drugs may be a less expensive & more effective option. These other drugs may include papaverine & phentolamine (Regitine).
·Self-administered intraurethral therapy. This method is trade name is Medicated Urethral System for Erection (MUSE). It involves using a disposable applicator to insert a tiny suppository, about half the size of a grain of rice, into the tip of ur penis. The suppository, placed about two inches into ur urethra, is absorbed by erectile tissue in ur penis, increasing the blood flow that causes an erection. Although needles r not involved, u may still find this method painful or uncomfortable. Side effects may include pain, minor bleeding in the urethra, dizziness & formation of fibrous tissue.
Hormone replacement therapy
For the small number of men who have testosterone deficiency, testosterone replacement therapy may be an option.
Vacuum devices
This treatment involves the use of an external vacuum & one or more rubber bands (tension rings). To begin u place a hollow plastic tube, available by prescription, over ur penis. You then use a hand pump to create a vacuum in the tube & pull blood into the penis. Once u achieve an adequate erection, u slip a tension ring around the base of ur penis to maintain the erection. You then remove the vacuum device. The erection typically lasts long enough for a couple to have adequate sexual relations. You remove the tension ring after intercourse.
Vascular surgery
This treatment is usually reserved for men whose blood flow has been blocked by an injury to the penis or pelvic area. Surgery may also be used to correct erectile dysfunction caused by vascular blockages. The goal of this treatment is to correct a blockage of blood flow to the penis so that erections can occur naturally. But the long-term success of this surgery is unclear.
Penile implants
This treatment involves surgically placing a device into the two sides of the penis, allowing erection to occur as often & for as long as desired. These implants consist of either an inflatable device or semirigid rods made from silicone or polyurethane. This treatment is often expensive & is usually not recommended until other methods have been considered or tried first. As with any surgery, there is a small risk of complications such as infection.
Psychological counseling
If stress, anxiety or depression is the cause of ur erectile dysfunction, ur doctor may suggest that you, or u & ur partner, visit a psychologist or psychiatrist with experience in treating sexual problems.
Prevention
Although most men experience episodes of erectile dysfunction from time to time, u can take these steps to decrease the likelihood of occurrences:
·Limit or avoid the use of alcohol & other similar drugs.
·Stop smoking.
·Exercise regularly.
·Reduce stress.
·Get enough sleep.
·Deal with anxiety or depression.
·See ur doctor for regular checkups & medical screening tests.
Coping skills
Whether the cause is physical factors or psychological factors or a combination of both, erectile dysfunction can become a source of mental & emotional stress for a man — & his partner. If u experience erectile dysfunction only on occasion, try not to assume that u have a permanent problem or to expect it to happen again during ur next sexual encounter. Do not view one episode of erectile dysfunction as a lasting comment on ur health, virility or masculinity.
In addition, if u experience occasional or persistent erectile dysfunction, remember ur sexual partner. Your partner may see ur inability to have an erection as a sign of diminished sexual desire. Your reassurance that this is not the case can be helpful in this situation.
To appropriately treat erectile dysfunction & strengthen ur relationship with ur partner, try to communicate openly & honestly about ur condition. Couples may also want to seek counseling to confront any concerns they may have about erectile dysfunction & to learn how to discuss their feelings. Try to maintain this communication throughout the diagnosis & treatment process. In fact, treatment is often more successful if couples work together as a team.



By Mayo Clinic Staff
Jan 18, 2006
© 1998-2006 Mayo Foundation for Medical Education & Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. ''Mayo,'' ''Mayo Clinic,'' ''MayoClinic.com,'' ''Mayo Clinic Health Information,'' ''Reliable information for a healthier life'' & the triple-shield Mayo logo r trademarks of Mayo Foundation for Medical Education & Research.

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