Question (of a woman of Oregon of 38 years): My fiance', who is 37 years, has hardship maintaining formore of the erection that a minute or two. When we are successful in having copula, he eyacula (and erection of loseshis) with the very small stimulus. It is not safe when this hardship began, because before the meeting the last, it had year not had a sexual partner for 10years. When my fiance' looked for the medical treatment, the urologist picked up blood samples of urineand and more ahead it said to him that he was physically " OK.Heprescribed an antidepressant (Paxil), that fiance' only made vertiginous. What you recommend? How we can find to date to a doctor in our geographic area who well is informed and in this field? Also, there is researchinto what can cause or prevent orgasmo masculine? It seems that erection, orgasmo, and ejaculation is three separated ones, although related, the functions. In our case, no of them seem to work properly.GOLDSTEIN: His fiance' has a common eréctil problem of the quality - incapacity to the eréctil rigidity of maintainthe. Because the problem is constant and hissatisfaction of the affectos with sexual copula he has fulfilled the criteria for having" eréctil dysfunction. The evaluation would consist generally of a history, a physical examinación, and laboratory tests, followed by the education, the modification of the form of life etc, and the initiation of forward edge therapy such citrate of the assildenafil (Viagra). Nevertheless, if his fiance' wishes, because isyoung, he would consider a candidate to one more a more sophisticated test of erectilefunction to gain one better understanding of the nature of thedysfunction and to see if he can be cured of his weakening. He to shouldconsider that he sees an urologist that specializes in this field for the advice moredetailed. Perhaps the call of the American foundation for the urologic diseases in Baltimore can help to locate him to this doctor. Promised you could then be determined for all the sexual editions of the dysfunction such as erection, orgasmo and ejaculation. Question (of a man of Roofing tiles of 53 years): I am in pills of the arterial pressure and of the diabetes and I cannot secure an erection. It is indicated for the eréctil dysfunction of menwith that if so has a physical base for the weakening - alikely panorama. The unique contraindication for the ofsildenafil of the use is the concomitant nitrate use - pill for the treatment of chestpain (angina). If the sildenafil does not work, you could try pelotillas intrauretrales of the emptiness on an attempt of the deviceor, one same-injections or she implants peneal. Question (of a man of California of 59 years): My dysfunction began with diabetes and now he is byPeyronie' complicated additional; s.It has been several years since I could have had normalerection. I have tried the injection in the Drs.I I have occurred Viagra to try. The aid of the pill of Ifthe with the erection still will be a severe return of 90 degrees in the axis of the penis, caused by the weave of the scar (Peyronie& there; #039; s) There is a surgery available to clear the weave of the scar, allowing that the axis remains right - and still responsive to the Viagra? They have said me that there is damage to a side and I will need a graft to complete the weave of the scar of the space I am cleared once. In this time my diabetes controls with pills and diet. I am scared to undergo surgery with a potential for the infection due to diabetes.GOLDSTEIN: Its problem is unfortunately common field and consists of two problems - 1) eréctil dysfunction and 2) peneal curvature of Peyronie' disease of s. The management must be ligature to close the communication with its urologist. In order to handle the impotence specifically, the treatment can first be things initiated of withsimple. The new therapies first-line include the sildenafil or the devices vacuumconstrictive. If these fail, the second line therapies includes the one intrauretrales same-injection or pelotillas. Such center of the treatment as the erection is designed to identify if the eréctil function heightened and wouold improved of the rigidity allow functional sexual copula in spite of the peneal curvature. If so - then ninguÌ  n attnetion needs to be given to the peneal curvature - that would be simpler. If the attention is necessary to correct the peneal curvature, basded in the aforesaid observation, are traditional medical therapies simpler including the procedures of the E.Surgical vitamin to reach to straighten itself peneal includes: 1) suppression of the weave and the replacement of the scar by the graft, 2) " tuck" procedure or 3) the insertion of implants peneal can reach two intentions - peneal rigidity and peneal straightening itself. It is important to discuss all these editions with an urologist. There are important advantages of the announcement of the risks with each treatment. Perhaps the call of the American foundation for the urologic diseases in Baltimore can help to locate him to this doctor. Question (of a man of California of 50 years): In $10 by the tablet, Viagra is expensive. What good reasons can you offer to for*not* that she saves same the cost of a visit of the office and that she simply secures a small source of Mexico? There are the true dangers to this? I feel able of the reading and the understanding drugs of PDR.All to have contraindications to keep. Which are the ones of Viagra? GOLDSTEIN: The citrate of Sildenafil (Viagra) has been approved like insurance and of effective way for the treatment of masculine eréctil dysfunction. If you have compaints constant with eréctil dysfunction, you must see a doctor. Eréctil dysfunction can be caused by the cancer of prostate, the unknown diabetes, the hypertension, the renal lack, the hipogonadismo, the psychological depression, other conditions, aneurysm aortic, disease to sacrolumbar of the disc, the medication use, the etc. The evaluation consists of a history (doctor, sexual, sicosocial), the physical examinación and laboratory tests. If a psychological burden is needed it can be added. The education and the modification of editions or the changes of form of life in the medication can be instituted under well-taken care of of the doctor. If he is appropriate, Viagra can be initiated. There are few contraindications except the concomitant nitrate use. Question (of a woman of California of 32 years): Dr.Goldstein, my partner and I have a wonderful sexual life, nevertheless, we hooked rarely to copula. When we tried to have copula any he loses the erection whereas puts in condón (I have tried many distractions during the process) or he will lose the erection during the penetration. Once in a great one whereas he loses the erection whereas I give oral sex him. When it maintains his erection with the penetration he often orgasmos them very quickly and says that he was too intense and he couldn' control of t he. It is this considered sexual dysfunction? When attempt to discuss it with him (of a way non-threatening, and when we' re having sex) he does not say " the manufacture of a great thing exceeds she does only it worse. Could she be entirely psychological or the combination of problems? GOLDSTEIN: It is difficult to make diagnosis in the patients based on minimalinformation contained in the email. In agreement with the aforesaid one, it sounds that it has eréctil dysfunction (lack to maintain) and premature ejaculation. They can be independent or related sexual phenomena of dysfunction. Encourgage of wouldSTRONGLY I he stops to look for medical aid - we can differentiate generally so great in these cases. Both conditions can very easily be handled. Question (of a man of Florida of 60 years): It was alcoholic assets between the ages of 15 and 51.I has not used any drugs addictive in the nine past years. During the three past years I have used the cream of the testosterone and 25 supplements of magnesium 2x/day DHEA in a failed effort to surpass impotence. In addition, I talk about on the possible threat of the cancer its continuous use. I have three questions: In its opinion, it is my preoccupation by valid cancer? Viagra will be effective in which it has aggravated obvious the adrenal function? Which are their recommendations to treat the impotence due to the alcoholism? GOLDSTEIN: In his opinion, it is my preoccupation by valid cancer? Yes, yes and yes. The prostate cancer is very common - near one in eight men it will develop the prostate cancer and the prostate cancer is a cause of the main death in men its age. One must obtain to analysis of blood of aPSA (specific antigen prostate) each three to six months if isbeing tried by the testosterone. Viagra will be effective in which it has aggravated obvious adrenalfunction? There are several you disorder rare of the adrenal gland - but of ifyou it has one - this is due to handle by a endocrine specialist. Ifimpotence persists in spite of the appropriate treatment of the adrenal condition, later Viagra can be added. Which are their recommendations to treat the impotence due to the alcoholism? The alcoholism can especially cause impotence by a number of mechanisms of psychological and nerve-related damages to the peneal process of the erection. The assumed appropriate advising has been tried, mayinvolve of the medical treatment the use of Viagra

For the new patients, brief a medical file and physical examinación are required before the beginning of the VIAGRA therapy. It is very important that you inform to us on other drugs that you are taking or begins to take whereas in the VIAGRA therapy. The honorarium for the initial medical evaluation, including his first doses of VIAGRA test, is $ 40 0.From ignited there, the cost is $15 by the tablet with a minimum of 5 tablets by repuesio. The established patients who are medically stable can receive their repuesios by mail. Our goal is to maintain its isolation, health, and security whereas you are in the VIAGRA therapy.