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Re found to be low, then replacement therapy with testosterone is possible. In most other circumstances, a trial with a medicine that helps men obtain and keep an erection is the next step. However, these medicine are only available on the NHS for people with specific medical conditions such as diabetes, multiple sclerosis and Parkinson's disease, or men who have had major pelvic surgery, spinal injury or who have kidney failure. A private consultation and prescription may be required for other men. There are now three different brands of tablets known as phosphodiesterase type-5 (PDTE5) inhibitors. The two newer drugs tadalafil (Cialis) and vardenafil (Levitra) work in a similar way to sildenafil (Viagra), the first drug of this type, but take effect more quickly. Men taking nitrate drugs (eg glyceryl trinitrate) for angina must not use PDTE5 inhibitors at the same time as it can dangerously lower the blood pressure. A fourth drug, apomorphine (Uprima), comes as a tablet to be dissolved under the tongue. It brings about an erection in about 20 minutes. For all four medicines, sexual foreplay is needed to start the arousal process. The ability to have erections can last for several hours or with tadalafil and vardenafil for up to 24 hours. Side-effects with these treatments tend to be minor and include headaches, nausea, indigestion and a stuffy nose. However they are prescription-only drugs, that are not suitable for everyone. There have been rare but serious complications. The cost varies, depending on the dose, from about £4-£6 per tablet. In more severe case

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Sm. Pelvic Trauma: Injuries caused by accidents Impotence causes, particularly accidents associated with bicycle riding Impotence causes, water sports Impotence causes, gymnastics and horseback riding Impotence causes, can cause impotence. Prescription Drugs: Many prescription drugs Impotence causes, especially blood pressure or anti-depressant medication Impotence causes, can cause impotence Impotence causes, as well as some over-the-counter medications. Psychological: Depression Impotence causes, anxiety Impotence causes, problems with self-esteem Impotence causes, anger Impotence causes, fear Impotence causes, and other mental conditions may lead to impotence. Vascular Disease: Vascular diseases such as hardening of the arteries Impotence causes, or heart disease Impotence causes, can lead to reduced blood flow Impotence causes, thereby impairing the ability of the penis to become sufficiently engorged to maintain an erection. Treatments Intra Urethral Pellets: The patient uses an applicator to insert a small pellet of medication into t/r/n