Erectile Dysfunction or Premature Ejaculation Treatment

  • 2019-2020 18 million American males suffer from ED
  • 1 in 3 men will experience ED by age 50.
  • Most ED Patients are over the age of 40.
  • Erectile dysfunction will happen to 33% of men by age 50.
  • Erectile dysfunction will happen to 42% of men by age 60.
  • 44% of all men suffering from ED is experiencing this problem because of a health defect.
  • Cialis medication lasts the longest—24 to 36 hours.
  • The amount of ED cases is expected to reach 322 million men globally by the year 2025.
  • According to NIH– The prevalence of mild to moderate erectile dysfunction of 52% in men in the USA aged 40–70 years was related to underlying conditions such as high blood pressure, diabetes, obesity, and neurological problems.

What is erectile dysfunction (ED)?

Erectile Dysfunction (ED) is the inability to get or maintain an erection suitable for satisfying sex. In short, ED occurs when there is not enough blood flow into the penis and too much blood flow out. The Lack of blood flow happens in part by an enzyme called PDE5. The goal of our treatment is to increase blood flow into the penis helping you get and maintain an erection.


Before ED was ED, the term impotence was first reported in 1948 by researchers from the University of Indiana where they addressed the occurrence of sexual dysfunction in the general population. They surveyed 12,000 males who self-reported ED – at the time, 1% in men were under 19 years of age, 3% of men under 45 years, 7% younger than 55 years and 25% showed signs by age 75. In a follow up study in 1979, a similar survey revealed over 5000 men (42%) admitted to erectile dysfunction. Reference

What causes erectile dysfunction (ED)?

An erection is a sequence of events where the brain sends signals throughout the body triggering psychological and physical actions to send blood flow to the penis. If any one of those triggers are off, you have ED. Erectile dysfunction causes by a number of medical conditions or psychological issues.

Performance anxiety, depression, schizophrenia, other psychological disorders.

Remember back when you were younger and just the thought of sex gave you an erection thinking about sex. Negative thoughts in general can prevent an erection from popping up.

Erectile dysfunction is generally considered to be primarily mental and less physical if erections continue during sleep or when men wake up with morning wood. Depression, anxiety, or other problems can affect both erections and sex drive. Outside factors like issues at home or work certainly impact your thoughts. One of the more common phycological roadblocks for men both young and old is performance anxiety.

Performance anxiety is a complex topic that may be as simple a worry how you look or a more intense situation when worrying about premature ejaculation. Some men worry about pleasing their partner. Others may worry about being a novice in the bedroom. All of these phycological issues can be addressed and reversed.

Physical issues may be tougher to identify on your own, but they can show themselves in your daily life or in the bedroom.

Frequent or worsening ED may be a sign of more serious conditions commonly found in men like:

  • Cardiovascular disease, stroke, diabetes, obesity, or high blood pressure. ED may also be a sign of hormone imbalance and low testosterone, which are both bothersome, but treatable conditions.
  • Neurological Causes: Multiple sclerosis, Parkinson’s disease, Spinal cord and nerve injuries may lead to loss of nerve signals from the brain to the penis.
  • Certain medications account for 25% of all cases of ED. High blood pressure medications and some antidepressants some and painkillers may be to blame. It’s important to list all mediations when you are filling out our providers diagnostic and medical history online surveys.
  • Surgery around the groin may impact nerves and blood flow to the penis causing ED.
  • In extreme cause, penile abnormalities may surface after an accident like a fall or hard impact to the groin.
  • Obesity and excess fat is linked to ED and more common in men with high blood pressure and diabetes.
  • High cholesterol in the blood can damage the blood vessels impacting blood flow to the penis causing ED. 
  • ED is 64% more common in men with sleep apnea. Studies show that the sleep disruption may be related to low blood oxygen levels while men sleep. ED caused by sleep apnea can be treated and reserved with a CPAP or other treatment devices to improve sexual function. Snoring is a telling sign that you may have sleep apnea.

What Are the signs and symptoms of ED?

ED may start with softer or less frequent erections. Some men may experience erections that don’t last long enough for satisfying sex while other men are unable to get an erection at all. Aside from these noticeable experiences, a common sign of ED is the lack of morning erections.

If you’re unable to have satisfying sex for any of these reasons, you may have ED. If you’re experiencing low sex drive or premature ejaculation, those may not be corrected by ED treatment but we can go over those conditions during your evaluation.

Like many things that decrease with age, erections are one of those conditions on the list to look after for men. While it is normal for life to get in the way of sex, it’s important to be aware when stress, financial constraints, or relationship issues can decrease your desire for sex and impact your erections.

Unhappy sex life or loss of intimacy with partners can lead to anxiety and depression.

What causes a weak erection?

To sum up the above, erection problems can have many causes.

  • Physical or psychological problems disrupt communication between the brain and penis as detailed above.
  • Other health problems, such as diabetes, high blood pressure, anxiety, stress, and depression impact the trigger portion of the erection sequence.
  • Side effects of certain medicines.
  • Drinking too much alcohol or smoking.
  • Surgery below the waist, such for prostate cancer, can impact erections.

Does erectile dysfunction last forever?

Depending on the cause, erectile dysfunction can be “cured” meaning an improved for good or avoided without the need for ED medication, surgery, injections, or implants. With the right diagnosis, support, and treatment, it’s possible for ED to go away without the need for ED mediation. Men should not have issues spontaneously getting an erection.

At what age does ED start?

There is no specific age where ED starts hindering men, but there is plenty of data showing that problems start showing themselves over 50 years old. According to several studies, the curve increases to 26% in age group 50 to 59 years and 40% in men age 60 to 69 years.

Men in their 20s and 30s are usually in their sexual peak with no issues in the bedroom; however, some men under the age of 40 can certainly experience ED. The numbers show it. The numbers of younger men experiencing ED has grown over the last decade. While most younger men may have psychogenic symptoms, physical issues can hinder a healthy erection.  Reference, Reference

Erectile dysfunction in fit and healthy young men: psychological or pathological?

Sexual dysfunction in the United States: prevalence and predictors

Erectile Dysfunction in Young Men

One patient out of four with newly diagnosed erectile dysfunction is a young man


What are treatment options for erectile dysfunction (ED)?

The standard and most effective treatment for ED is oral PDE-5 inhibitors but, on average, 30-35% of men do not see positive outcomes from the oral medication. Intracavernosal injections are proven secondary options for men who experience ED.

The body is supposed to releases nitric oxide (NO) when its sexually stimulation sets in but when experiencing ED, that mechanism does not fire off.

Oral ED medication helps increase the effects of nitric oxide (NO) to assist men who have trouble getting or keeping an erection.

The medication stops the enzyme called phosphodiesterase-5 (PDE-5) from hindering the levels of cGMP, the chemical to makes the penis hard.

ED mediation helps relax the muscles in the penis allowing blood to flow in and become erect. Reference, Reference

What is sildenafil?

Sildenafil citrate has been the de facto medication to treat erectile dysfunction for many years. Sildenafil is the generic form of name brand Viagra. This ED mediation is part of the oral PDE-5 inhibitors family. If someone says they are on Viagra, there is a high probability that they are simply on generic sildenafil.

Generic Viagra® should be taken without food 30 minutes to an hour before sex and its effects last up to 6-8 hours.

What is tadalafil?

Tadalafil is active ingredient in name brand Cialis®. Tadalafil is the generic form. This ED of medication works similar to sildenafil but Tadalafil stays active in the body for 36 hours (commonly called “the weekend pill.” This ED mediation is part of the oral PDE-5 inhibitors family and is also used to treat benign prostatic hyperplasia.

Is sildenafil the same as tadalafil?

Sildenafil has been around the longest and cheaper than tadalafil for several reasons. Sildenafil works well for occasional sex and “when the time is right.”  It begins to work after 30 minutes must be taken on an empty stomach.

Tadalafil is more expensive because it’s provides more flexibility for spontaneous erection lasting 36 hours. It’s better for men that want to be prepared. Flexibility is nice when you’re going out on a date or hitting the town. It can be taken with or without a meal.

Many men alternate between sildenafil and tadalafil, depending on the occasion.

Vardenafil and Avnafil are other PDE-5 inhibitors to treat ED. These two generics can be found under their brand names: Levitra, Staxyn, and Stendra. Each medication has the same goal in mind, but they provide varies levels of potency and advantages. It’s good to have options if standard medications do not improve your symptoms.

Vardenafil is more expensive than sildenafil, because it is 10 times more potent and has shown to result in less side effects.

What are some alternatives to Oral ED Medication?

Intracavernosal injections (penile self-injection) include prescription TriMix or BiMix medicines that men self-inject directly into the penis.

Most men begin injection therapy with Trimix, which is a mixture of 3 ingredients: alprostadil, phentolamine, and papaverine. These ingredients work by relaxing the smooth muscle and opening the blood vessels in your penis, causing an erection.

TriMix therapy is recognized as a viable treatment for erectile dysfunction by the American Urological Society and has a 90% success rate.

TriMix is standard and effective treatment, especially for those patients who have not had positive results, or experience moderate to severe side effects from oral PDE-5 inhibitors, (sildenafil, tadalafil, etc). Reference

How to start ED treatment?

Our Board-Certified Providers will evaluate your symptoms you report through our online forms and medical history then setup a telehealth video chat to diagnose your symptoms. If they determine that a prescription is necessary, they will call a script into your local pharmacy or we will mail the ED prescription directly to you.

What should I tell my Provider?

The online forms will prompt you to answer all of the questions needed to determine if you are experiencing ED. However, it is important to disclose any problems with your heart, liver, kidneys, vision disorders, bleeding disorders, or penile deformities.

Our Providers have designed the forms based on the latest guidelines issued by the regulating medical boards.

American Urological Association Guidelines

European Association or Urology Guidelines

Mayo Clinic’s: The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

Is prescribing ED medication online safe?

Yes, our Board-Certified Providers review your symptoms and medical history to determine the best treatment option. If there is a diagnosis of erectile dysfunction, they may prescribe one of the PDE-5 inhibitors to treat ED (Sildenafil, Tadalafil, Vardenafil or injectables). Providers can call in a script to your local pharmacy or we can mail your prescription directly to you. We only use FDA 503B Registered and PCAB Accredited Pharmacy’s to source any medication. All medications are manufactured by pharmaceutical companies that are regulated by the FDA.


What is the First Pass Metabolism?

First Pass Metabolism is a phenomenon that occur in our body when we’re digesting medication while it absorbs through our blood stream and liver before taking effect. In turn, we are able to reap the benefits much faster!  Source 

The Many Benefits of Tadalafil:

While treating Erectile Dysfunction with Tadalafil (Generic Cialis) is common place, there are many other incredible benefits as well.

It’s been known to help with:

  • Enlarged Prostate – (BPH: benign prostatic hyperplasia)
  • Pulmonary Hypertension: Tadalafil has been shown to treat high blood pressure in the lungs as the active ingredient reduces blood flow in certain areas of the body allowing blood to flow freely.
  • Diabetes: Erectile dysfunction is one of the most common complications of diabetes and also one of the most underdiagnosed. Source
  • Depression & Stress: Tadalafil simply improves Quality of Life. Source
  • Memory Function

Common side effects of ED Medication:

The most common side effects of ED medication may lead to headache, flushing, stuffy nose, upset stomach, indigestion.

More Serious side effects that are rare include an erection that will not resolve even after 3–4 hours (priapism), hearing loss, which can be sudden, and vision loss in one or both eyes. For more information about side effects, see sildenafil side effects below.

ED mediations should never be used with nitrates, such as nitroglycerin, because they reduce low blood pressure. Alpha blockers, such as alfuzosin, terazosin, or tamsulosin, can cause the same effect of low blood pressure when taken with ED mediations. Any antihypertensives (medications to lower blood pressure) in combination with ED mediations can also interact, causing low blood pressure.

ED medications may interact with similar medications like bosentan, cimetidine, conivaptan, imatinib, isoniazid, antidepressants, antibiotics, antifungals, drugs to treat high blood pressure or a prostate disorder, heart or blood pressure medications, hepatitis C medications, or HIV/AIDS medicines. Reference, Reference

In a 2003 survey of 31,742 men from across the U.S. ages 53 to 90 were polled to understand how age and other common aging factors affect rates of erectile dysfunction in the male population. The findings showed the following results for those who experience ED:

Moderate or severe ED issues were reported by 12% in men younger than 59, 22% in men 60-69 years old, and 30% of the men over 69 years old.

Problems increased with age. The report shows men over 50 years old had more severe ED issues due to inactive lifestyle, obesity, and other medical conditions or medications.

How often should I use Tadalafil?

The tablets will dissolve sublingually in about 4-5 minutes and goes into effect in about an hour.

The tablets can be stored at room temperature and are good for 180 days from the date made.

Tadalafil (Generic for Cialis) dissolvable tablets are now available to the public and 50% cheaper than name brand Cialis. The benefits of Tadalafil typically last about 36 hours and equally as effective as name brand. This is great news, gentleman! Higher doses of Cialis can cost almost $2000 for 30 tablets….

(Pronounced tə-DAL-ə-fil)

The reason we prescribe these dissolvable tablets is to skip what is called – First Pass Metabolism.

By skipping First Pass Metabolism you get a quicker and more effective response to the medication.

We prescribe Tadalafil Dissolvable Tablets online.

Our Board Certified Providers will review all of the above with you. If you are currently on high blood pressure medication, you may not be eligible for treatment.

Why are there so many benefits (what’s in Tadalafil (Generic Cialis)?

Tadalafil and sildenafil are classified as “PDE-5 Inhibitors” (phosphodiesterase type 5 inhibitor), which relax muscles and increase blood flow to specific areas of the body.

Here is an extreme example to help you understand increased blood flow.

When should I use Tadalafil?

Low-dose tadalafil can be taken on a daily basis giving you more control of the action between the sheets… formally, more spontaneity.

Our generic does of Viagra lasts for around four hours.