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In some cases, premature and inhibited ejaculation are caused by psychological factors, including a strict religious background that causes the person to view sex as sinful, a lack of attraction for a partner, and past traumatic events. Premature ejaculation, the most common form of sexual dysfunction in men, often is due to nervousness over how well he will perform during sex. Certain drugs, including some antidepressants, may affect ejaculation, as can nerve damage to the spinal cord or back. Total testosterone levels: Blood samples for total testosterone levels should be obtained in the early morning (before 8 a.m.) because of wide fluctuations in the testosterone levels throughout the day. A low total testosterone level suggests hypogonadism. Measurement of bio-available testosterone may be a better measurement than total testosterone, especially in obese men and men with liver disease, but measurement of bio-available testosterone is not widely available. Physical causes: About 8 in 10 cases of ED are due to a physical cause. In most cases due to physical causes (apart from injury or after surgery) the ED tends to develop slowly. So, you may have intermittent or partial ED for a while, which may gradually get worse. If the ED is due to a physical cause, you are likely still to have a normal sex drive (libido) apart from if the cause is due to a hormone problem. In some cases, ED causes poor self-esteem, anxiety, and even depression. These reactions to ED can make the problem worse. This section needs additional citations for verification. (May 2010) Blood hemoglobin A 1c: Abnormally high levels of blood hemoglobin A 1c in patients with diabetes mellitus establish that there is poor control of blood glucose levels. cialis online espaƱa cialis online One of the forms of phosphodiesterase is termed PDE5. The prescription PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally. They work by blocking the action of PDE5, which causes cGMP to degrade. The risk of developing heart attacks or abnormal heart rhythms during sex is low in men with well-controlled hypertension, mild disease of the heart valves, well-controlled heart failure, mild and stable angina (with a favorable treadmill stress test), successful coronary stenting or bypass surgery, and a remote history of heart attack (more than eight weeks previously). Sildenafil can be used safely in men in these low-risk groups. Cialis in the united kingdom cheap viagra online usa buy viagra online no prescription buy viagra online canadian pharmacy viagra online price
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