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De gemiddelde prijs van Viagra is erg verschillend. U kunt namelijk verschillende verpakkingen kopen.
Kiest u voor 12 Viagrapillen van 100 milligram, dan kost het ongeveer €13,- per pil.
12 Viagrapillen van 50 milligram kosten echter gemiddeld €12,- per pil.
Dit is dus inhoudelijk een verschil van 50% per pil, maar de prijs verschilt nog geen 10%.

Hier is een tabel met de gemiddelde prijzen van Viagra:

Gem. Prijs per pil

Prijs viagra, prijzen viagra, viagra prijzen

Prijs Viagra

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Viagra prijs

Viagra prijs

Viagra prijs. het belangrijkste wanneer je zoekt op het internet, je wil weten wat zoiets kan kosten. De prijs van de officiГ«le Viagra is relatief hoog, maar hier krijg je kwaliteit voor terug. Voor ongeveer 75 euro heb je vier tabletten. Je kunt ook pillen vinden van een paar euro, maar dit zijn in vele gevallen nep.

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Een echte Viagra pil kost circa 10 tot 25 euro per stuk. De daadwerkelijke prijs voor een tablet hangt af van de dosering. Je kunt kiezen voor tabletten van 25, 50 en 100 mg. Grotere verpakking zijn daarnaast in verhouding voordeliger. Als je deze erectiepil wilt proberen kun je eerst een kleine dosering en een paar tabletten proberen. Indien het bevalt kun je voor een grotere verpakking kiezen en mocht het nodig zijn ook een hogere dosering. Je vraagt je misschien ook af: waarom zijn Viagra pillen veel duurdere dan de neppe pillen? Bij het fabriceren van de officiГ«le pillen worden duurdere grondstoffen gebruikt. De tabletten dienen te voldoen aan allerlei eisen en worden streng gecontroleerd door diverse instanties. Je betaalt dus wat meer, maar krijg hier wel kwaliteit voor terug.

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Aangezien de officiГ«le pillen wellicht best duur zijn is het verleidelijk om te kijken naar namaak pillen. Deze zijn goedkoper, maar gevaarlijk. Bij de productie van de goedkope pillen worden vaak goedkope grondstoffen gebruikt en dat is het gevaarlijke aan deze namaak pillen. Je weet als gebruiker niet welke grondstoffen zijn gebruikt. De stoffen die worden gebruikt zijn vervuild en je kunt hier ziek van worden. De pillen die als namaak te boek staan worden ook niet gecontroleerd en zijn daardoor ook illegaal. We raden je aan om nimmer namaak pillen te gebruiken, want de gevolgen voor je gezondheid kunnen in negatieve zin behoorlijk groot zijn.

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Goede Viagra is niet goedkoop, maar je krijgt dan wel goede kwaliteit. Er zijn echter veel namaak tabletten verkrijgbaar. Deze zijn spotgoedkoop, maar we raden je aan om deze niet te kopen. Deze pillen kunnen gevaarlijk zijn voor je gezondheid en kunnen allerlei nadelige bijwerkingen hebben. Via onze website kun je voordelig de officiële viagra kopen.

Echte viagra kopen, is het duur?
Voor vier tabletten van 25 mg betaal je tussen de 74 en 79 euro. Dit is afhankelijk van de aanbieder. Via onze website kun je deze Viagra van Pfizer kopen voor € 73,70. Voor 64 tabletten van 100 milligram betaal je tussen 1040 en 1079 euro. De reden dat echte Viagra duurder is komt omdat hier kwalitatieve grondstoffen voor worden gebruikt. Bij nep-Viagra worden goedkope grondstoffen gebruikt. Deze bevatten vaak veel bacteriën en bovendien kunnen de grondstoffen gevaarlijk zijn. Als je deze Viagra koopt kun je zelfs behoorlijk ziek worden.

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Als je online gaat zoeken naar Viagra kom je op websites terecht waar je voor een paar euro Viagra kunt komen. Het betreft hier nep-Viagra. Let hier dus op goed. Als je deze Viagra voor een paar euro kunt kopen is dat wellicht verleidelijk, maar pas op. Deze illegale erectiepillen zijn zelfs gevaarlijk, want ze zijn niet gecontroleerd op veiligheid, kwaliteit of werkzaamheid. Soms wordt dit wel op websites beweerd, maar is dit op geen enkel feit gebaseerd. Via onze website kun je veilige Viagra pillen kopen. Deze zijn verantwoord te bestellen. Een ander mogelijk is het bestellen van erectiepillen via een arts of apotheek. Het voordeel is dat je het via onze website snel kunt bestellen, zodat je de Viagra pillen snel in bezit hebt.

Hoe echte Viagra herkennen?

Een Viagra tablet is te herkennen aan de kenmerkende kleur blauw. Daarnaast is de diamantvorm, die afgerond is, kenmerkend. Op het tablet is ook Pfizer (merknaam) gedrukt en daarnaast de dosering. Deze officiële tabletten zijn verkrijgbaar in een doses van 25, 50 en 100 milligram. De nep erectiepillen lijken op de echte pillen, dus het verschil is soms niet goed zichtbaar. Waar je wel op kunt letten is waar je de Viagra haalt. Als je deze bij een erkend verkooppunt koopt, dan weet je zeker dat je goede Viagra koopt. Via ons kun je in elk geval de officiële Viagra van Pfizer bestellen.

Wat is Viagra?

Alhoewel velen Viagra kennen als een erectiemiddel om een erectie bij mannen in stand te houden heeft Viagra (sildenafil) ook een ontspannende werking. Het ontspant de spieren en verhoogt de bloedtoevoer naar bepaalde gebieden van het lichaam. Viagra wordt gebruikt om erectiestoornissen (impotentie) bij mannen te behandelen. Een ander merk van sildenafil is Revatio, die wordt gebruikt bij pulmonale arteriële hypertensie en verbeterd de inspanningscapaciteit bij mannen en vrouwen.

Belangrijke informatie over Viagra:

Je mag geen Viagra gebruiken als je allergisch bent voor sildenafil.Neem geen Viagra als je ook gebruik maakt van een drug of medicament voor nitraat pijn op de borst of hartproblemen. Dit omvat nitroglycerine, isosorbidedinitraat, en isosorbidemononitraat. Nitraten worden ook gevonden in sommige recreatieve drugs zoals amyl nitraat of nitriet ("poppers"). Het nemen van Viagra met een nitraat geneesmiddel kan een plotselinge en ernstige daling van de bloeddruk veroorzaken.

Stop met het gebruik van dit geneesmiddel als je plotseling zicht verliest, zoek dan direct medische hulp op. Om ervoor te zorgen dat Viagra veilig is voor je, vertel altijd aan je arts over de andere medische aandoeningen, in het bijzonder:

  1. Hartziekte of hartritmestoornissen, coronaire hartziekte
  2. Een recente geschiedenis (in de afgelopen 6 maanden) van een hartaanval, beroerte of congestief hartfalen.
  3. Hoge of lage bloeddruk.
  4. Lever- of nierziekte.
  5. Een bloedcel stoornis zoals sikkelcelanemie, multiple myeloom, of leukemie.
  6. Een bloeden stoornis zoals hemofilie.
  7. Een maagzweer
  8. Retinitis pigmentosa (een erfelijke aandoening van het oog)
  9. Een fysieke misvorming van de penis (zoals de ziekte van Peyronie).

Viagra kan bloedtoevoer naar de oogzenuw van het oogverminderen, waardoor plotseling gezichtsverlies optreedt. Dit heeft plaatsgevonden in een klein aantal mensen die Viagra gebruikt heeft, van wie de meesten ook hart-en vaatziekten, diabetes, hoge bloeddruk, hoog cholesterolgehalte, of bepaalde reeds bestaande oogproblemen hadden en met degenen die roken of zijn meer dan 50 jaar oud zijn. Het is niet duidelijk of Viagrade werkelijke oorzaak van gezichtsverlies is

Viagra en Zwangerschap

Deze medicatie is naar verwachting niet schadelijk voor een ongeboren baby. Gebruik Viagra niet zonder jouw arts te vertellen dat je zwanger bent of van plan bent zwanger te worden tijdens de behandeling.Het is niet bekend of sildenafil overgaat in de moedermelk of als het een zogende baby kan schaden. Vertel altijd aan je arts dat je borstvoeding geeft aan de baby.

Als je aan deze regels en richtlijnen houd, dan kun je Viagra gebruiken voor plezier en daar ook echt plezier mee hebben.

Het gebruik van Viagra

De lichtblauwe erectiepil is voor veel mannen een heus wonderpil. In de jaren negentig kwam Viagra op de markt. Het bleek een groot succes, want mannen bij wie de hartstocht leek verdwenen, presteerden plotseling weer in bed. Op 27 maart 1998 liet het Amerikaanse FDA de eerste pil tegen een erectie stoornis toe. Een half jaar later volgde de Europese Unie en was de pil ook in Nederland verkrijgbaar. Impotente mannen waren na jaren van bedrust ineens weer in staat om te presteren. Het middel tegen een erectiestoornis werd een doorslaand succes. Er zijn vele miljoenen mannen succesvol met Viagra behandeld.

Er waren overigens eerder al alternatieven om iets te doen tegen een erectiestoornis. Zo kon je met een spuitje een middel in de penis injecteren, of een minipilletje in je plasbuis doen. De vacuümpomp was daarnaast een optie. Maar deze alternatieven waren niet zo handig. Een vrijpartij moest je onderbreken om jezelf een prik te geven of om de pomp ter hand te nemen. Erg onpraktisch. De huisarts had daarnaast weinig te bieden en stelde veel patiënten met een erectie stoornis gerust. Er werd gezegd dat erectieproblemen op later leeftijd niet vreemd zijn. Dat is natuurlijk ook zo, maar als oudere man hoef je hier natuurlijk geen genoegen mee te nemen. Je hebt natuurlijk recht op kwaliteit van leven. Je bent niet de enige, want veel mannen die actief in het leven staan, welvarend zijn en veel reizen willen ook op het gebied van seks plezier beleven. Dat is mogelijk dankzij Viagra.

Waar op letten bij het Viagra kopen?

Als je op kopen Viagra zoekt kun je naar veel verschillende websites gaan. Kijk wel goed of je op een betrouwbare website iets koopt, want er zijn ook veel namaak artikelen in omloop. Deze wil je natuurlijk niet kopen, want hier kun je niks mee. Eventueel kun je kijken naar ervaringen van andere mensen, alvorens je Viagra koopt. Je hoeft overigens niet louter Viagra te kopen, want er zijn ook alternatieven zoals cialis en sildenafil. Deze alternatieven zorgen voor hetzelfde effect: het krijgen van een erectie. Als je van plan bent om sildenafil te kopen kun je dit eventueel ook eerst met je huisarts overleggen. Hetzelfde geldt voor cialis.

Heb je hartklachten of andere fysieke ongemakken? Dan is het gebruik van Viagra niet direct aan te raden. Overleg eerst met je huisarts en bespreek of het verstandig is om dit wonderpilletje te gebruiken. Als de huisarts het vanwege medische redenen afraadt, kun je deze ook het best niet gebruiken.

Het succes van Viagra

Het oplossen van een erectie stoornis is mogelijk dankzij Viagra. Mannen die viagra gebruiken voelen zich vaak als herboren. Viagra staat internationaal bekend als een goedwerkend medicijn. De meeste gebruikers krijgen namelijk weer een erectie. Het gaat hierbij om 80 tot 90 procent van de mannen. Dat is natuurlijk ook een fantastisch percentage. En dit verklaart dus ook direct het succes.

Je hoeft je ook absoluut niet te schamen voor een erectie stoornis, want massa’s mannen hebben hier mee te kampen. Na de introductie van de Viagra pil meldden veel mannen zich bij de huisarts. Ze kwamen uit alle gaten en hoeken. Toen werd ook duidelijk hoe veel mannen te maken hadden met een erectie stoornis. Het beeld van 'mannen kunnen altijd seks hebben' brokkelde in de jaren na de introductie van de Viagra pil langzaam maar zeker af. Het probleem is daarvoor lang onzichtbaar geweest. Seksproblemen zijn vandaag de dag een stuk gewoner, waar men vroeger geheimzinnig deed over een erectie stoornis, hoor je tegenwoordig zelfs grappen. Hierdoor is het ook bespreekbaar geworden.

Viagra kopen

Zoals gezegd hoef je je absoluut niet te schamen als je een erectie stoornis hebt. Je kunt dus naar een huisarts gaan en op doktersrecept Viagra verkrijgen. Vind je dit toch een lastige drempel? Online zijn er ook websites te vinden waar je vrijwel anoniem Viagra kunt kopen. Let uiteraard wel goed op, want er wordt ook veel namaak-Viagra aangeboden. Bij kopen Viagra is het dus belangrijk om ook de website in kwestie goed te checken. Zo weet je zeker dat je bij een goede website dit product koopt.

Introductie van Viagra

In de tijd dat er nog geen Viagra beschikbaar was, hield de huisarts bij impotentie de boot liever af. Een patiënt kon als één van de weinige opties kiezen voor een psychologische benadering. Zo waren er therapiegesprekken mogelijk, met daarnaast oefeningen voor thuis. De Viagra-pil betekende een revolutie. Fabrikant Pfizer pakte de introductie van de pil in 1998 slim aan. Het bedrijf organiseerde bijscholingscursussen voor huisartsen. Honderden artsen namen deel en dit verklaart voor een deel het doorslaande succes van het lichtblauw pilletje.

Overige producten

Naast het blauwe wonderpilletje zijn er nog andere mogelijkheden. Zo kun je bij diverse websites ook kijken naar sildenafil. Dankzij sildenafil worden bloedvaten verwijdt en dit bevordert de erectie aanzienlijk. Een andere mogelijkheid is overigens cialis. Ook dit is online verkrijgbaar.

Viagrakopen.biz – www.viagrakopen.biz verkoopt noch levert genoemde producten en biedt deze ook niet (namens apotheken) aan. Viagrakopen.biz verstrekt slechts productinformatie en prijzen van derden (o.a. (online) apotheken). Productinformatie is slechts afkomstig van openbare bronnen, dokters, apotheken en/of bijsluiters en bevat nimmer een (eigen) mening, opinie of advies van Viagrakopen.biz zelf.

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Werking Viagra

Viagra bestaat al sinds 1998 en is oorspronkelijk door het bedrijf Pfizer op de markt gebracht. Inmiddels hebben meer dan 27 miljoen mensen gebruik gemaakt van dit blauwe pilletje om daarmee weer een ferme erectie te krijgen. Viagra is in werkelijk Sildenafil, een middel dat de erectie bij mannen stimuleert.

Al in 1996 werd dit middel gepatenteerd, maar het duurde nog tot 1998 totdat het ook daadwerkelijk als erectiemiddel op de Amerikaanse markt werd toegelaten. Zoals iedereen inmiddels ongetwijfeld weet werd het middel een enorm succes. Jaarlijks wordt er meer dan 1 miljard dollar aan Viagra omgezet. Het wereldwijde patent op Sildenafil verloopt in de periode van 2011 – 2013.

De werking van Viagra

Een erectie ontstaat doordat de bloedvaatjes in de penis zich ontspannen, waardoor deze zich met bloed vullen. Bij erectiestoornissen worden de bloedvaatjes niet gevuld met bloed. Viagra zorgt er vervolgens voor dat de bloedvaatjes zich bij opwinding wel weer met bloed kunnen vullen en je volle erectie weer ten hemel prijkt als nooit tevoren.

Aanloop tot de werking van viagra

Voor de beste werking dien je het pilletje ongeveer één uur voor dat je seksuele activiteiten hebt in te nemen. Vrijwel altijd begint het binnen 30 tot 60 minuten na inname al te werken. Bij medische proeven is gebleken dat bij de meeste mannen de erectie na gemiddeld 25 minuten na inname voldoende was om seks te bedrijven. Dit is natuurlijk sterk afhankelijk van de persoon die het gebruikt en van de persoonlijke omstandigheden. Bij de ene werkt het sneller dan bij de ander, maar ook als je bijvoorbeeld zwaar getafeld hebt of veel alcohol hebt gedronken zal het in de praktijk ietsje langer duren voordat je jongeheer zich meldt. Het is daarom ook aan te bevelen om het drinken van alcohol te vermijden of in ieder geval sterk te beperken voordat je Viagra inneemt. Alcohol kan er zelfs voor zorgen dat het effect helemaal teniet wordt gedaan. Neem ook nooit meer in dan de voorgeschreven dosering per dag. Mocht het zo zijn dat het gebruik van Viagra niet het gewenste resultaat geeft, overleg dat dan met je arts en ga niet zelf aan het experimenteren.

Werkt Viagra bij iedereen?

Viagra werkt ook niet bij iedereen even goed. Het werkt in ieder geval wel goed bij 4 op de 5 mannen. Tevens schijnt het vaak zo te zijn dat het de eerste keer ook niet het volledige gewenste resultaat geeft. Hierbij spelen ook stress en faalangst een hele grote rol bij het achterwege blijven van een erectie, net als bij mannen die geen Viagra gebruiken.

Hoeveel Viagra mag je innemen?

Allereerst moet worden gezegd dat Viagra alleen beschikbaar is op doktersvoorschrift, omdat het een medicijn is. Aangezien vele mannen met erectieproblemen of zelfs impotentie kampen wordt het heel vaak voorgeschreven. Ken of herken je dit probleem, wacht dan niet langer en ga er mee naar je huisarts. Die zal er echt niet raar van opkijken.

Dosering viagra

Viagra is verkrijgbaar in doseringen van 25mg, 50mg en 100mg. Meestal wordt de eerste keer een dosis van 50mg gebruikt. Indien nodig kun je daarna, in overleg met je huisarts, de dosis verhogen of verlagen. Neem altijd een volledige pil in, want het actieve deel in de pil is niet overal even goed verspreidt door het gehele tabletje. Neem je toch een halve pil, dan kan het dus zijn dat je net dat gedeelte gebruikt waar geen of heel weinig actieve delen inzitten en de werking nihil is

extra functie Viagra

Naast de functie als erectiemiddel heeft Sildenafil nog een positieve bijwerking. Het blijkt namelijk ook de bloeddruk van de longcirculatie omlaag te brengen. Een verhoogde bloeddruk van de longcirculatie is levensbedreigend en tot voor kort niet behandelbaar. Dat is nu dus verleden tijd.

Voordelen viagra

Lees hier over de voordelen van viagra ten opzichte de andere werkende erectiepillen cialis en Levitra

Viagra bijwerkingen

Zoals vrijwel alle medicijnen kan Viagra bijwerkingen geven. Hieronder leest u meer over de mogelijke bijwerkingen van Viagra en welke factoren invloed hebben op bijwerkingen.

Welke bijwerkingen heeft Viagra?

De meest voorkomende bijwerkingen bij het gebruik van Viagra zijn:

  • hoofdpijn
  • blozen

Minder vaak gemelde bijwerkingen zijn:

  • duizeligheid
  • braken
  • spierpijn
  • verstopte neus
  • bonkende hartslag
  • ontregelde spijsvertering
  • effecten op het gezichtsvermogen

De bijwerkingen zijn vaak mild van aard en verdwijnen in de loop van de tijd. Vertrouwt u het niet of ervaart u andere verschijnselen dan in de bijsluiter staan, neem dan contact op met de arts. Dit geldt ook als u een langdurige en pijnlijke erectie heeft die meer dan 4 uur aanhoudt.

Allergische reactie

Het is mogelijk dat u allergisch bent voor de werkzame stoffen in Viagra. Dit merkt u aan zwelling van oogleden, gezicht, lippen of keel of moeilijke ademhaling. Stop direct met het gebruik van het middel en raadpleeg de arts.

Versterking van bijwerkingen

Het wordt aangeraden om Viagra niet meer dan eenmaal daags te gebruiken. Wanneer u het meer dan 1 keer per dag slikt, kan dit de Viagra bijwerkingen versterken. Ook bij een te hoge dosering kunt u last krijgen van meer bijwerkingen. Geef dit aan bij de arts, zodat de dosering eventueel verlaagd kan worden. Gebruik nooit meer tabletten dan is voorgeschreven. Dit vergroot ook de kans op bijwerkingen. Zolang u zich houdt aan de instructies van de arts, zal de kans op bijwerkingen minimaal zijn.

Niet gebruiken bij:

Viagra wordt afgeraden aan patiГ«nten die geneesmiddelen slikken die nitraat bevatten. Deze combinatie kan de bloeddruk gevaarlijk verlagen. Gebruik de erectiepil ook niet wanneer u geneesmiddelen gebruikt die stikstofmonoxide afgeven. Daarnaast wordt gebruik afgeraden aan patiГ«nten met hartproblemen of die onlangs een beroerte hebben gehad. Geeft altijd aan welke medicijnen u gebruikt voor eventuele andere aandoeningen, zodat u veilig het middel kunt gebruiken.

Lees voor het gebruik van Viagra altijd de bijsluiter

De bijsluiter is toegevoegd aan de Viagra verpakking, maar u kunt deze ook vinden op onze website. Wij raden u aan om voor het gebruik de bijsluiter aandachtig door te lezen. Wanneer u in een ontspannen gemoedstoestand bent zal dit het effect van Viagra ten goede komen en kunt u een goede seksuele beleving bereiken. De meeste gebruikers ervaren weinig tot geen Viagra bijwerkingen bij het gebruik van het middel. Het is een populaire erectiepil die van vele mannen het seksleven heeft verbeterd.

Let op: bovenstaande informatie is slechts beknopt en onvolledig. De informatie is afkomstig van openbare bronnen, dokters, apotheken en/of bijsluiters en bevat nimmer een (eigen) mening, opinie of advies van Dokteronline.com. Voor gedetailleerde informatie over eventueel genoemde producten en bijwerkingen verwijzen wij u naar de desbetreffende bijsluiter.

Wat is de werking van Viagra?

Viagra werkt op basis van sildenafil. Deze stof beГЇnvloedt de aanmaak van een bepaald enzym dat het erectieproces hindert. Een erectie ontstaat als het lichaam meer bloed de penis laat instromen en er tegelijkertijd minder bloed laat uitstromen. Het enzym fosfodiesterase remt dit doorbloedingsproces waardoor een erectie niet op gang komt of te snel weer verdwijnt. De werking van Viagra is erop gericht om het fosfodiesterase-enzym tijdelijk uit te schakelen zodat het erectievermogen in de penis wordt hersteld.

Werking Viagra per toeval ontdekt

Het effect van Viagra op de erectie is per toeval ontdekt. Het middel werd oorspronkelijk door fabrikant Pfizer ontwikkeld tegen angina pectoris: een drukkend gevoel op de borst. Tijdens de klinische tests bleek dat er sprake was van een stimulerende werking op de erectie. Sindsdien is deze fosfodiesteraseremmer een van de populairste en meest voorgeschreven medicijnen bij erectiestoornissen (impotentie).

Fabels over de werking van Viagra

Er doen een hoop indianenverhalen de ronde over Viagra. Zo zou het middel pas na een uur werken en zou men na het innemen urenlang rondlopen met een erectie. Deze geruchten zijn nergens op gebaseerd. Een pilletje alleen is niet genoeg om een erectie te krijgen. Hiervoor is ook seksuele opwinding nodig. Gemiddeld werkt Viagra zo’n 25 minuten nadat het is ingenomen. Slikt u de erectiepil na een zware maaltijd, dan kan het iets langer duren voordat u het effect merkt.

Gebruik van Viagra

Viagra is een van de meest voorgeschreven erectiemiddelen. Het voordeel van Viagra is dat het gemakkelijk in gebruik is. Door het ongeveer een half uur voor de seksuele activiteit in te nemen, bent u in staat om tijdens het liefdesspel een volledige erectie te krijgen. Deze houdt lang genoeg aan om bevredigende geslachtsgemeenschap te hebben. Om vervelende bijwerkingen te voorkomen, mag het middel eenmaal per dag en maximaal driemaal per week gebruikt worden. In de bijsluiter leest u meer over het gebruik van Viagra.

Viagra en sildenafil

Viagra is over de hele wereld bekend geworden als het blauwe pilletje van de firma Pfizer. De werkzame stof sildenafil is echter sinds kort ook als generiek geneesmiddel verkrijgbaar bij samenwerkende apotheken. Helaas zijn er veel dubieuze webwinkels waar nep-Viagra wordt verkocht. Het is dus zaak om altijd goed op te letten bij de aanschaf van dit erectiemiddel. Bij apotheken die met Dokteronline.com samenwerken kunt u veilig de echte Viagra, sildenafil of andere erectiemiddelen kopen.

Viagra werking geschikt voor iedereen?

Viagra beГЇnvloedt de bloedsomloop: het zorgt er onder andere voor dat de bloedvaten in de penis zich beter kunnen verwijden. Dit effect kan echter ook merkbaar zijn op andere plaatsen in het lichaam. In sommige gevallen is deze erectiepil daarom niet geschikt, bijvoorbeeld bij mannen die lijden aan bepaalde hart- en vaatziekten.

Makkelijk, veilig en discreet Viagra bestellen bij de met Dokteronline.com samenwerkende apotheken

Dankzij de werking van Viagra krijgt uw seksleven weer glans. Dit erectiemiddel wordt al jarenlang door veel mannen naar tevredenheid gebruikt. Bij de samenwerkende apotheken bestelt u Viagra nadat u desgewenst in contact bent gebracht met een samenwerkende arts voor een online consult. Deze controleert uw medische gegevens en schrijft een recept uit. U heeft daardoor geen recept van uw eigen huisarts nodig. Viagra bestellen is op deze manier dan ook gemakkelijk, veilig en discreet. Bovendien zorgt de apotheek ervoor dat u de bestelling snel krijgt thuisgestuurd.

Let op: bovenstaande informatie is slechts beknopt en onvolledig. De informatie is afkomstig van openbare bronnen, dokters, apotheken en/of bijsluiters en bevat nimmer een (eigen) mening, opinie of advies van Dokteronline.com. Voor gedetailleerde informatie over eventueel genoemde producten en bijwerkingen verwijzen wij u naar de desbetreffende bijsluiter.

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Reduzierte sexuelle Funktion im produktiven Alter ist für viele Männer als eine Katastrophe. Und es ist klar, warum die Spezialisten von Pfizer, die das Medikament Viagra erstellt haben, bekamen den Nobelpreis. Pharmazeutische Entwicklung auf der Basis von Sildenafil Citrat (medizinische Name des Wirkstoffs von Viagra), der ursprünglich für die Behandlung von verschiedenen Herzerkrankungen hergestellt wurde, besitzt in der Medizin die gleiche Stufe wie Penicillin und Röntgenstrahlen. Viagra ist bis heute einer der effektivsten Wege zur Behandlung der erektilen Dysfunktion.

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Generikum ist ein Medikament, das enthält den gleichen Wirkstoff wie das Medikament des Entwicklers. Nach dem Patentabschluß sind die Pharmaunternehmen berechtigt, ähnliche Medikamente weltweit herstellen. Bevor die Medikamente in den Verkauf gehen, werden die Analoga durch die Phase der Studie getestet. Nach diesen Studien, bekommen die Analoga ein Zertifikat für die Einhaltung den ursprünglichen Medikamenten. Das heißt, die pharmakologischen Eigenschaften von Viagra Generika sind nicht anders als von Original, aber sie sind viel billiger, da die Kosten für Tests, für Entwicklung der Formel und Werbung nicht mehr benötigt sind.

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Viagra kaufen online fast immer ohne Versandkosten. Viagra werden als das klassische Mittel unter den Potenzmitteln bezeichnet. Heute immer mehr Männer versuchen in Deutschland Viagra kaufen. Viagra wird von dem amerikanischen Pharmahersteller Pfizer herausgegeben. Pfizer ist einem der weltweit bekannten und größten Pharmahersteller. Viagra wurde in den 90er als das Mittel zur Behandlung der Angina entwickelt. Und nur während der Forschungen wurde es herausstellt, dass Viagra bei der erektilen Dysfunktion helfen kann. Das Pharmaunternehmen Pfizer führte Viagra im Jahr 1998 inEuropa und änderte das Sexualleben in vielen Familien rund der Welt. Viagra ist das populärste Mittel im Vergleich zu anderen Potenzmitteln. Heute Viagra rezeptfrei kaufen über 35 Millionen Männer in mehr als 120 Länder der Erde. Die blauen Viagra Pillen heute sind das Symbol für eine neu gewonnene männliche Gewissheit. Jeder kann online Viagra kaufen.

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Heute haben immer mehr Männer die Potenzprobleme, die viele Faktoren verursacht können. Und wenn Mann verstehen, dass seiner Penis schlaff ist, vertraut er nur auf Wirkung von Viagra oder anderen Potenzpillen. Dank der verlässlichen Wirkung von Viagra, kann Mann eine starke und dauerhafte Erektion fühlen. Wie funktioniert die männliche Körper und wie wirkt Viagra? Wenn Mann in einem Erregunszustand versetzt, bilden die Penis Nervenzellen Stickoxid (NO). Das Stickoxid verursacht die Entspannung der Gefäßwände im Penis und Blut einfließen kann. In Folge dessen wird Penis hart. Das körpereigene Enzym Phosphodiesterase 5 (PDE-5) steuert die Rückbildung der Erektion. Und der Wirkstoff von Viagra und vielen anderen Potenzmitteln beeinflusst diese Stelle in der Wirkungskette.

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Der enthaltende in den Viagra Piĺlen Wirkstoff Sildenafil hemmt das Enzym Phosphodiesterase 5 (PDE-5), das für den Abbau der Erektion verantwortlich ist. Mit anderen Worten, Bei der sexuellen Erregung hilft Viagra die Gefäße im Penis zu erweitern und das Blut kann leicht in den männlichen Penis fließen. Viagra hilft jeden Mann wieder der kraftvolle und gute Liebhaber zu sein. Die Wirkung von Viagra tritt in der Regel 30 bis 60 Minuten nach der Einnahme ein. Viagra hat eine dauerhafte Wirkung (ca. 4-6 Stunden) und in diesem Zeitraum können Sie ohne Probleme viel Male Sex machen. Selbstverständlich, hängt die Dauer der Erektion vom Umlauf des Blutes in den Schwellkörpern des Glieds ab. Die Erektion endet mit dem Samenerguss (Orgasmus).

Wir alle haben Гјber die Wikipedia gehГ¶rt, und entsprechend Wikipedia ” Sildenafil ist ein Arzneistoff aus der Gruppe der PDE-5-Hemmer, einer Gruppe gefäßerweiternder (vasodilatierender) Substanzen. GroГџe Bekanntheit erlangte er als Wirkstoff des 1998 von dem US-amerikanischen Unternehmen Pfizer unter dem Namen Viagra auf den Markt gebrachten Arzneimittels zur Behandlung der erektilen Dysfunktion (ErektionsstГ¶rung) beim Mann.” Mehr Informationen Гјber Sildenafil kГ¶nnen Sie hier lesen.

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Impotenz ist die volksmundige Bezeichnung der Erkrankung Erektile Dysfunktion und betrifft die fehlende Fähigkeit zur Erektion. Impotenz ist eine der am häufigsten anzutreffenden Erkrankungen bei Männern und wird häufig nur als Sexualstörung gesehen. Von Impotenz betroffene Männer weisen häufig unterschiedliche Ausmaße der Erektilen Dysfunktion auf und leiden oft zusätzlich zur fehlenden Erektion auch an anderen Erkrankungen, für die eine Potenzstörung das erste Anzeichen sein kann.

Grundlegendes zum Thema Impotenz

Grundlegend wird zwischen zwei Arten der Ursachen der Erektilen Dysfunktion unterschieden: den physischen und den psychischen Faktoren, die die Erektion betreffen. Eine Unterscheidung kann dabei sein, dass Männer, die nachts Erektionen haben, in der Regel an psychisch bedingter Impotenz leiden. Die häufigsten Ursachen für fehlende Erektion können Stress und übermäßiger Leistungsdruck sowohl am Arbeitsplatz als auch im Bett sein. Bei den meisten betroffenen Männern sind die Ursachen körperlich bedingt. Nach aktuellen Schätzungen leiden besonders Männer über 40 Jahre überdurchschnittlich häufig an Impotenz, nach Schätzungen mehr als 50%. Körperliche Ursachen für die Erektile Dysfunktion können zum Beispiel Herz-Kreislauf Beschwerden, zu hoher oder zu niedriger Blutdruck, Diabetes, Operationen oder zu starker Alkoholkonsum sein.

Formen der Impotenz

Die Formen der Impotenz und der Erektilen Dysfunktion können unterschiedlich ausfallen. Einen kleinen Überblick über die Arten von Impotenz bietet Ihnen die folgende Zusammenfassung:

Impotentia coeundi bezeichnet mit Impotenz die ungenügende Erekiton, den Geschlechtsverkehr befriedigend ausüben zu können, sei es durch mangelnde Härte zur Penetration oder die Unfähigkeit, die Erektion für einen zufriedenstellenden Geschlechtsverkehr aufrecht zu erhalten.

Diese Variante der Impotenz betrifft nicht die männliche Erektion, sondern Frauen und wird auch mit Sterilität bezeichet. Es ist die Unfähigkeit, eine Eizelle für die Befruchtung durch männliche Samenzellen verfügbar zu machen.

Impotentia concupiscentiae hat einige Begriffe im Volksmund. Es ist der fehlende Drang zur sexuellen Betätigung, der nicht direkt von der Erektilen Dysfunktion ausgelöst werden.

Impotentia satisfacionis
Hiermit wird die Erektionsstörung bezeichnet, bei der es mit Erektion aber ohne Orgasmsus zur Ejakulation kommt.

Ursachen fГјr Impotenz

Die Ursachen für Impotenz (Erektile Dysfunktion ) können unterschiedlich sein und sowohl psychisch aber auch körperlich bedingt sein. Besonders im jungen Alter sind Männer eher von psychischen Ursachen der Impotenz betroffen, während im zunehmenden Alter meist die physischen Ursachen eine größere Rolle spielen. Es zeigt sich, dass bei 80% der Männer, die an der Erektilen Dysfunktion leiden, körperliche Umstände die Ursache sind. Die psychologischen Ursachen der Erektilen Dysfunktion bedürfen eines Gesprächs mit dem Facharzt und können durch eine richtige Therapie behandelt werden. Liegt als Ursache für die Erektile Dysfunktion eine körperliche Beschaffenheit vor, werden häufig Potenzmittel zur Behandlung empfohlen. Zusammen mit dem passenden Potenzmittel hilft gegen Impotenz eine ausgewogene Ernährung und ausreichend körperliche Betätigung, wie z.B. regelmäßiger Sport. Durch die Stärkung des Kreislaufs und der Muskulatur können körperliche Ursachen langfristig beseitigt werden und somit die Wirkung der Potenzmittel verbessert oder gar überflüssig gemacht werden, um eine ausreichende Erektion zu erreichen.

Die Impotenz wird durch die PDE5 Hemmer solange aufgehoben, solange sich der Wirkstoff im Kreislauf des Patienten befindet. Sollte der Reiz von außen oder die sexuelle Stimulation nachlassen, geht auch die Erektion wieder zurück. Das PDE5 kann damit wieder das zyklische Guanosinmonophosphat (cGMP) spalten und dadurch das Blut aus den Penismuskeln wieder abfließen. Die Inhibition von PDE5 hilft damit Männern, die Impotenz aufzuheben und körperlich bedingte Erektionsfähigkeit zu erreichen.

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During clinical studies of people who took Levitra with Flomax, there was a noticeable drop in blood pressure, but it did not cause any symptoms of low blood pressure, such as lightheadedness, dizziness, or fainting. If your healthcare provider thinks that it is safe for you to take Flomax and Levitra together, he or she may recommend that you take the lowest dose of Levitra to make sure that there is no significant drop in blood pressure.

Combining Levitra and Flomax: An Overview

Flomax ® (tamsulosin hydrochloride) is a prescription medication that is used to treat an enlarged prostate (also known as benign prostatic hyperplasia, benign prostatic hypertrophy, or BPH ). It is part of a group of medications called alpha blockers.

Levitra ® (vardenafil ) is a prescription medication that is used to treat erectile dysfunction (also referred to as ED or impotence ). It is part of a group of medications called phosphodiesterase-5 inhibitors, or PDE-5 inhibitors for short. Other medications in this group include tadalafil (Cialis ®. Adcirca ® ), sildenafil (Viagra ®. Revatio ® ), avanafil (Stendra ™), and another vardenafil medication (Staxyn ™).

In some cases, it can be dangerous to combine alpha blockers with phosphodiesterase inhibitors because it can cause a dangerous drop in blood pressure. This can result in lightheadedness, dizziness, or fainting.

Can I Combine Levitra and Flomax?

Based on the results of clinical studies, Flomax does not seem to interact significantly with Levitra or other similar medications. Studies have shown that other alpha blockers can cause dangerously low blood pressure if taken with Levitra or similar medications. However, in studies that focused on people who took Levitra with Flomax, this problem was not seen to the same extent.

One study published in the November 2004 edition of Urology tested the effects of taking Levitra with Flomax in people who had been taking Flomax for a least one month. While there was a noticeable drop in blood pressure, it did not cause any symptoms of low blood pressure.

If your healthcare provider believes that combining Levitra with Flomax is safe for your situation, he or she will probably recommend you take the lowest dose of Levitra (Levitra 5 mg). He or she will also make sure that you have been taking Flomax for a long enough period of time to know how it affects you. If Flomax is newly prescribed, your healthcare provider will also prescribe the lowest dose available to make sure that there is no significant drop in blood pressure when combined with Levitra.

Taking flomax and viagra

It is advised for you to be stable on Flomas before starting Viagra. If you have been on Flomax for a few weeks and wish to start on Viagra. start on the lowest dose (25 mg).

i’m taking flomax and proscar because of an enlarged prostate. i now suffer from erectile dysfunction. any way of getting back my sexual potency while working on keeping my prostate from enlarging?

Have been taking flomax for about 1 1/2 years but then increasing trouble ejaculating and then eventually maintaining erection. Added viagra to try and solve this problem. Went off flomax 6 weeks ago. Now gaining and maintaining erections and completing intercourse is better but recent ultrasound showed 200ml of 400ml not emptying from bladder after voiding. Increased bladder pain again and often feels like I need to void but not able to. Had cystoscopy intitially which indicated nothing.

should I take Flomax BEFORE taking Cipro? I’ve heard taking Flomax and hour or 2 before will soften the prostate and allow the antibiotic to better penetrate the prostate? Does it matter if I take them in the morning or evening, or is the rule just be consistent? Thanks again.

I did not associate it with flomax until recently. Is it harmful if I stop taking the flomax and is this the cause of my retro? This discussion is related to <a href=’/posts/show/226027′>Retrograde Ejaculation from Flomax. permanent or not?</a>.

I have also experimented while taking flow max I have also tried taking Viagra and other times Cialas. Would taking both Flowmax and Cialas or Viagra be causing the retrograde. I didnt like it and after the sex I did not feel satisfied. I have read that Flowmax could cause RE. Would stopping Flowmax correct the RE or is it that once damaged it stays damaged? Any input would be appreciated. Thanks in advance, flowmax stop the RE? any input would be appreciated. Thanks in advance.

The only problem is if you are on Viagra therapy you cannot take Flomax because of the interactions. You can stop the Viagra but then taking Flomax will be of no use if you are not able to acheive an erection without Viagra.

which i did for about a month, however, this resulted in erectile dysfunction, so i stopped taking finasteride, after which the ED has gone. can u suggest other medication for mildly enlarged prostate. I am 63, male, under the following medication every day 1)amias 8mg every night for high bp 2)finasteride 1mg every night for baldness 3)statin 20mg for high cholesterol about 210 please advise. This discussion is related to <a href=’http://www.medhelp.

My testosterone level is 80 without help so I take 200 mg testosterone shots every two weeks. Viagra and Levitra do not work however Cialis helps somewhat. I cannot ejaculate since the operation and that makes my E.D. problem worse. He also told me that the Avodart would inhibit the effects of the testosterone so I am not taking the Avodart. My question is there a medical device or sex toy that could apply pressure to the prostrate that would allow ejaculation?

i had sex twice and everything was ok, and after the third time the problems began. my partner and i had hard sex and my penis hurt a bit when she was on top of me. i urinated a few minutes after ejaculating and blood came out along with a very big blood clot at the end. i had sexual intercourse about 7 or 8 times before seeing a doctor. the same occurred except for 2 times, in which no blood appeared.

I had been being treated for enlarged prostate and was on Flomax. That Saturday morning I woke up and nothing would come out. So at the Hospital they tried to put a cath in 3 times, wouldnt go. Then urologist came in and found that I had a stricture and he used these sharp long straws and with the help of morphine, was able to punch out a hole big enough to get cath in and urine to start flowing. I kept the cath in for 2 weeks. after it was taken out, I had perfect flow but with blood in it.

and i actually joined this site because i wanted to send you a message. I typed a long message and no reply.

Like for example, I just chatting with this one guy about his penis always stinging during urination (std free) and come to find out he finally tells me he’s been taking this testosterone booster product and wonder if that could be the problem. I told him absolutely because the body needs a certain amount of testosterone (you shouldn’t overdo it) So,now it has me wondering about you. Are you putting anything funny into your body that could be affecting your prostate, your groin area, etc?

In the case that this is due to some circulation problems amongst most of us, from my research I recommend you all to start taking Omega-3 fish oils and L’arginine ethyl ester (helps increase and improve blood flow) on a daily basis. Further look into Ginko Biloba, but I’m unsure about the effectiveness of this. Also wrap a hot towel around your penis once a day.

Many have been put on beta blockers like Flomax as well to ensure that the prostate is relaxed and therefore makes urination more efficient. Using this medication does what it is supposed to do but also relaxes the sphyncter. As Dr. Singh mentioned there are meds that can be tried but they all have their side effects. These meds also do not have the same effects on every person. So the medications might work OK on one person when the next person is not at all effected.

or Centrum? I just started taking a multivitamin and when I stopped for a few days it subsided, but I started taking it again and conicidentally felt feeling again, could be my imagination. That phantom ringing sounds like a good possibility, what website did you read that on? Since I went to doctor, I don’t know if there is anything else to do at this point, I’ll keep you posted and watch for your updates.

I have taken Doxycline 100mg capsules for 10 days and I am currently taking Ciprofloxacin 500mg for 10 days and still no improvement. This is very fustrating. doesnt seem like there are many links out there to this specific type of problem. This is the first link that actually explains what I am going through. PLEASE let me know if you find anymore information on this. Or if anybody can help.

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With aluminum wheels, Reg. $3800, now $1899. With Can Viagra Be Taken With Tamsulosinaero whheelset, Reg. $5125, now $2499! The critically acclaimed Litespeed C1 is fullr arrayed with features including an adjustable aero seatpost, optional internal Di2 gear cable routing, and race-ready Ultegra 6700 components. Loaded with Aerologic features and fully Shimano Di2 compatible, the super modulus carbon C1 converts our wind-tunnel qualified data-set into an easy real-world Can Viagra Be Taken With Tamsulosin.

Manufacturer link: Litespeed
The Can Viagra Be Taken With Tamsulosin 2016 Litespeed T3 uses an ovalized 3/2.5 titanium top tube in place of the 6/4 titanium tube from the T1-SL, and a simplier bottom bracket design but is otherwise nearly identical to the T1-SL frame with almost 90% of the $4000 T1-SL frame’s performance but for $1100 less! New for 2016: the T3 now includes hex-bolt-attached removable head-tube cable guides (just remove them for conversion to Di2), and ovalized chain and seat stays for leaf-spring like shock absorption, as well as both disc brake and rim brake compatible design! Of course like all Litespeed titanium frames, the T3 is fully hand-crafted in the USA and comes with a lifetime warranty. Can Viagra Be Taken With Tamsulosin: Get $350 OFF any of our Adrenaline Bikes build kits with the purchase of the frame and for the $2,999 MSRP price, AND get a FREE $420 MSRP full carbon tapered fork with either a frame-alone or bike purchase!

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Read Road Bike Action magazine’s review of this bike:

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FREE: 48-contiguous US state shipping on Ritchey frames and bikes! (Regular $110.)

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WAS $5990, NOW $2995!

The 30th Anniversary R240 Disc LE comes equipped with full Ultegra groupset, Vision Team 30 Disc wheels, and Lynskey Pro Road Carbon #3 Disc fork. Each frame has a hand brushed finish, and 30th Anniversary etching.

The Lynskey R240 Disc is one of our most popular frames for club rides or racing. The added stopping power of disc brakes combined with curved seat stays, chain stays and English threaded BB remain the structural foundation of the R240.

Manufacturer link: Bianchi
Now in gloss Celeste finish for 2017! Now $500 off any of our normal build kit prices with an Infinito CV frameset purchased at the $3,199 MSRP! Use the ‘choose bike or frame’ pull-down menu below to see the discounted kit prices. Using NASA viscoelastic Countervail technology, Bianchi has developed a carbon layup that can immediately reduce vibration in the frameset. With this revolutionary material the Infinito is propelled in to a new realm of endurance, comfort, and performance.

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Read Road Bike Action magazine’s review of this bike:

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İlacın prospektüsünde zaten kullanım konusu son derece detaylı olarak işlenmekte ve yapılması gerekenler ile yapılmaması gerekenler maddeler halinde sıralanmaktadır. Levitra satın almak isteyen kişilerin bilmeleri gereken önemli bir konuda kesinlikle Levitra’nın afrodizyak etkisi bulunmadığı için ilacın kendi kendine etki göstermeyeceğidir. Yani ilaç tek başına etki göstermemekte olup kişinin cinsel yönden uyarılması ile etki göstermeye başlamaktadır.

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Viagra Vs. Levitra

Call it getting a rise out of the competition. In its first month of sales, Levitra, the new erectile dysfunction treatment from Bayer and GlaxoSmithKline. managed to grab a 50% share of prescriptions in newly diagnosed patients. Sounds impressive, but analysis by Bernstein Research of data from health information provider IMS Health reveals another side to these figures. Viagra maker Pfizer still has well more than 95% of total prescriptions for impotence.

Worse, Bernstein pharmaceuticals analyst

Richard Evans Richard Evans

sees U.S. sales of only $425 million each annually for Levitra and another erectile dysfunction drug, Cialis, being developed by Eli Lilly and ICOS. Cialis is expected to go on the market early next year. Viagra, which now has U.S. sales of $1 billion, will, by Evans’ reckoning, drop by nearly half. The new drugs will merely cannibalize the existing market.

Not everyone is so bearish.

Myron Murdock Myron Murdock

medical director of hisandherhealth.com and a doctor who has conducted clinical trials with all three drugs, thinks the flood of direct-to-consumer ads will get men into their doctor’s office. All three drugs work by inhibiting the same enzyme, but he sees significant advantages to the new entrants. Levitra is a more potent molecule, and it seems to work faster and on a full stomach. (Expect more studies from Pfizer, showing that Viagra works fast and with food, to keep up.) He says Levitra also clearly works better in hard-to-treat cases, such as men whose impotence is caused by diabetes.

Cialis, on the other hand, clearly works for 36 hours or more, making it an ideal choice for men who are very sexually active, Murdock says. He still gives Viagra the edge in treating female sexual dysfunction, a yet-unapproved but potentially lucrative use. Pfizer is five years ahead of the competition in that area. Murdock also notes another advantage for Levitra. Viagra patients have been ordering high-dose pills and splitting them, because all doses come at the same cost. Levitra, a small, hard orange pill, is much more difficult to cut, so at least it won’t have to deal with sales reduced by pill splitting.

Cialis vs. Levitra vs. Viagra: How Each Stacks Up

Three of a kind?

Cialis, Levitra, and Viagra are oral medications used to treat erectile dysfunction (ED). You may also know them by their generic names, tadalafil (Cialis), vardenafil (Levitra), and sildenafil (Viagra).

About 30 million men occasionally have a problem with getting or keeping an erection, according to the Urology Care Foundation. When ED becomes a problem, many men turn to oral ED medications. These drugs often help. Cialis, Levitra, and Viagra each work in similar ways. But there are also some differences, such as when you take them, how long they work, and what their side effects are.

Drug features

Cialis. Levitra. and Viagra are all in a class of drugs called PDE-5 inhibitors. These drugs work by blocking an enzyme called phosphodiesterase type 5. They also boost a chemical in your body called nitric oxide. This action encourages the muscles in your penis to relax. Relaxed muscles allow blood to flow freely so that when you’re aroused, you can get an erection. It also helps you maintain the erection long enough to have sex.

Levitra and Viagra stay in your bloodstream for about four to six hours. Cialis remains in your bloodstream for 17 to 18 hours or longer. The length of time a drug stays in your system may be important if you’re taking other medications.

Here are more basics on each of these drugs:

Be sure to take this drug exactly as your doctor tells you to. If you have questions or concerns, talk with your doctor.

Cost, availability, and insurance

Cialis, Levitra, and Viagra are usually stocked at most pharmacies. All three of these drugs cost about the same amount. In general, most health insurance companies won’t cover their costs. But if you have certain medical conditions, your health plan may pay for the drug with prior authorization.

Side effects

The side effects of these medications are similar. Most men have only mild side effects.

The chart below compares the side effects of these drugs.

Tell your doctor if you have any side effects that linger and don’t go away on their own. If you have an erection that lasts longer than four hours, call your doctor right away.

Drug interactions

Each drug comes with the chance of drug interactions. Since PDE-5 inhibitors work on the body in similar ways, Cialis, Levitra, and Viagra come with similar interactions.

If you have an erection that lasts longer than four hours, call your doctor right away.

All three of these drugs interact with nitrates. They also all interact with blood pressure drugs such as alpha-blockers. For Cialis, these also include the drugs bendrofluazine, enalapril. and metoprolol. For Viagra, these also include the blood pressure drug amlodipine .

Viagra also interacts with the drug ritonavir .

Cialis can also interact with alcohol. Drinking alcohol with Cialis can cause low blood pressure when you stand up from a sitting or lying position. This may result in dizziness or a headache. To learn more, read more about the effects of mixing Cialis and alcohol.

Levitra and Viagra do not seem to cause low blood pressure when taken with alcohol. However, alcohol may interfere with your ability to get an erection, even while you’re taking any of these drugs.

Outlook

If you have ED, talk to your doctor about Cialis, Levitra, and Viagra. Tell your doctor if you take other over-the-counter or prescription drugs or supplements. Be sure to mention all other health conditions you have.

Each of these three popular drugs has been shown to help men with ED when they’re used correctly. All three drugs have good results, but it may take a little time and patience to get it right. If one drug doesn’t work or produces unpleasant side effects, you can try another drug. It may also take some trial and error to find the dosage that works best for you. And if you’re not sure that drug treatment is right for you, you can give these natural treatments for erectile dysfunction a try.

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Boston University Medical Campus
Sexual Medicine

Choosing the Right Pill to Treat ED

Ricardo Munarriz, MD

The most common sexual dysfunctions in men include lack of interest, premature ejaculation and erectile dysfunction. The latter affects 52% of men between the ages of 40 and 70, including mild, moderate and complete forms of ED.

Organic or physical causes for sexual dysfunction in men include vascular, hormonal and neurologic factors. Concerning vascular causes, the risk factors for atherosclerosis (including smoking, high blood pressure, diabetes (diabetics do not respond well to pills like sildenafil (Viagra)) and high cholesterol are ALSO risk factors for erectile dysfunction. Since a straddle injury or use of a narrow saddle can obstruct and impair arteries to the penis, bicycle riding is also considered a risk factor for erectile dysfunction.

Little attention has been paid to endocrine factors. Testosterone modulates desire, arousal and orgasmic function. Concerning the orgasmic response, testosterone modulates the integrity of genital sensory receptors. Concerning the arousal response, decreased testosterone blood levels can influence the efficacy of sildenafil (Viagra). If the sildenafil response is not reliably improving erection, the physician should first check if the patient is taking the pill correctly. The physician should also check the patient’s testosterone level. One investigator in Italy gave testosterone to patients with low testosterone who did not respond to sildenafil (Viagra). When daily testosterone was given, subsequent sildenafil (Viagra) use resulted in IIEF (the International Index of Erectile Function questionnaire used to determine erectile function) scores improving significantly.

Other risk factors for erectile dysfunction include neurologic problems (multiple sclerosis, stroke), depression and medications for treating diabetes, hypertension, heart disease and depression.

There are many oral therapies for erectile dysfunction, but the only approved medication in the US is the PDE 5 enzyme inhibitor sildenafil (Viagra). Unapproved therapies, some of which are available in the US and some elsewhere, some of which have data to prove efficacy and some not, include tadalafil (Cialis), vardenafil (Levitra), yohimbine, phentolamine, trazodone, apomorphine and neutraceuticals. PDE5 inhibitors act to relax penile erectile tissues with sexual stimulation thus enhancing your ability to get an erection. Sildenafil (Viagra) is effective for all sorts of erectile dysfunction in 69% of people. Why is there a need for another pill? In some cases the erection is not hard enough, sometimes sildenafil (Viagra) just doesn’t work.

Structurally vardenafil (Levitra) is similar to sildenafil, while tadalafil (Cialis) is very different. Vardenafil (Levitra) is almost 10 times more biochemically potent than sildenafil, therefore a lower dose is needed to facilitate the penile erection, potentially resulting in less side effects. Selectivity is the ability of the drug to attach to the specific enzyme PDE 5 found in penile tissues. Vardenafil (Levitra) is more selective than sildenafil and tadalafil (Cialis) to PDE5, which again means a lower dose is needed with potentially less side effects. Tadalafil is very specific for PDE5 and is also very specific for the enzyme PDE11. Unfortunately, we don’t know much about PDE11, which is found in the heart, in the pituitary gland in the brain and in the testicles. Pharmacokinetics, half-life, is how long the medication stay s in the blood. Sildenafil (Viagra) has a half-life of 4 hours and vardenafil (Levitra) has a half-life of 4-6 hours while tadalafil (Cialis) has a half-life of 17.5 hours. This means that vardenafil (Levitra) should act longer than sildenafil (Viagra) but the clinical significance is not known. Tadalafil (Cialis) has the longest half-life and allows you to take the medication and not relate the sexual activity to the immediate use of the medication. The drawback is if you need nitrates after using tadalafil (Cialis), this medication lasts a long time in your blood stream and may place you at a higher risk. Younger people might do well treated with tadalafil, (Cialis) while older people with other health issues might be better off using sildenafil (Viagra) or vardenafil (Levitra) but more data are needed. The side effects of vardenafil (Levitra) are potentially less than sildenafil (Viagra), but more data are needed. In a recent study on men with erectile dysfunction and diabetes, vardenafil (Levitra) improved their erectile dysfunction. Tadalafil (Cialis) is as effective as sildenafil (Viagra), and vardenafil (Levitra) with similar side effects except for back pain that occurs occasionally with tadalafil, probably because of the long half-life.

Many people stop taking drugs because they are experiencing side effects, they no longer have a partner, or they are worried about safety. Sexual activity is not a major contributor to the risk of a heart attack. Sexual activity, with or without sildenafil (Viagra) increases the chance of an MI during sexual activity by only 0.1%. If pills fail, there are vacuum devices, Muse, injections, bypass surgery and implants.

The patient making a presentation has had penile bypass surgery. In addition he takes testosterone and sildenafil as needed. This is a classic example of why people with ED need complete care: a psychological exam, history and physical exam, and diagnostic studies with long term follow-up care. Patients with ED should not just be prescribed sildenafil (Viagra) and then be lost to follow-up.

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He escuchado, en boca de pacientes o en grupos de adolescentes, y leído en distintos medios, sobre un uso frívolo o recreativo del Viagra entre jóvenes, en “boliches”,”raves” o “discos”, combinado con alcohol, sustancias como la cocaína, el éxtasis o el “poper”.

Con el alcohol no hay una verdadera contraindicación sino una prevención: las bebidas alcohólicas tienden a bajar la presión arterial y eso puede verse potenciado por el uso conjunto con este medicamento. O sea que tomar sildenafil estando alcoholizado, parecerá muy divertido, fashion, o a la mode, pero puede presentar complicaciones.

El “poper”, que se inhala, es básicamente nitrito de amilo (el famoso “lanzaperfume” de antaño) que por sí mismo puede marear y producir hipotensión con desmayos. El Viagra está contraindicado con los nitritos y nitratos (medicamentos que se usan como vasodilatadores coronarios), por lo tanto, les cuento, queridos jóvenes, que con el uso conjunto con el “poper”, CORREN SERIOS RIESGOS para su salud, y no es sólo una declaración “careta”, no es sólo una prevención ética, sino con criterio de evitar desmayos, lipotimias y estados de shocks.

El Viagra habría que usarlo con precaución con el cisapride, la cimetidina, la eritromicina y antibióticos macrólidos (eritromicina, claritromicina), con astemizol y algunos antimicóticos (ketoconazol, itraconazol), inhibidores de la proteasa (usados contra el HIV), algunos antidepresivos (fluvoxamina y nefazodone) por lo que en pacientes polimedicados siempre hay que tener precauciones, pero esto no es privativo del sildenafil sino de todos los fármacos: hoy en Medicina se da mucha importancia a las interacciones medicamentosas, incluso con hierbas como el antidepresivo hipérico o la yohimbina y hasta con el jugo de pomelo que inhibe un citocromo del hígado, por lo que toda prescripción tiene que estar en mano de los médicos.

Con el uso conjunto de cocaína, éxtasis o anfetaminas –ya aisladamente se corren riesgos puesto que esas drogas son neurotóxicas o cardiotóxicas- y el Viagra, me parece un verdadero uso descabellado de un fármaco, efectivo y seguro cuando es de venta bajo receta por indicación médica.

Creo que muchos jóvenes han caído bajo las redes de la ansiedad por el rendimiento, por “no poder fallar estando borrachos o falopeados” (palabras textuales de un paciente) lo que los lleva a tomar posiciones peligrosas para su salud.

Otra cosa con la que quisiera alertar a la población en general es uno de los mitos que dice que “con el Viagra no hay necesidad de hacer estudios complementarios ni consultas médicas”. Esto es totalmente falso. En absoluto excluye, para el diagnóstico de la disfunción eréctil (impotencia) -de acuerdo al criterio del médico, al cuadro clínico y psicológico- el pedido de análisis de sangre ni los estudios específicos o los que amerite cada caso según existan o no factores de riesgo cardiovascular: ergometrías, radiografías de tórax (en fumadores crónicos, p. ej.), estudios prostáticos, controles de presión arterial (puedo asegurar que he detectado hipertensión arterial, diabetes, o colesterol alto, problemas hormonales o cardíacos en pacientes que ni sabían que los padecían o en otros que, habiendo tenido registros previos, se hacían los desentendidos) y exámenes clínicos. Puedo decir que, muchas veces la disfunción eréctil, es un predictor, un marcador de otra patología de base (que muchos casos puede ser también una depresión). En algunos cuadros psicológicos se pueden hacer tests. Estos cuidados no son por el uso del Viagra sino porque es hacer mala medicina prescribir sólo por el síntoma y descuidar los desajustes que muchos pacientes con impotencia padecen.

Es importante corregir los factores de riesgo para mejorar la calidad de vida tanto como para que el sildenafil sea más efectivo, como lo demostramos en un trabajo presentado en el congreso de Psiquiatría de Chicago 2000: en aquellos pacientes que no tenían ningún factor de riesgo cardiovascular (hipertensión arterial, diabetes, sedentarismo, obesidad, tabaquismo, alcoholismo y abuso de sustancias, lípidos altos en la sangre) la respuesta era casi del 100%, en aquellos que tenían 1 factor de riesgo la respuesta al sildenafil descendía al 85.7% y en los que tenían 2 ó más bajaba al 78.9%, lo que aconseja la reducción de los mismos por ambos motivos: mejora de la calidad de vida y de la respuesta erectiva con el sildenafil. No me canso de repetir que muchos pacientes que se acercaron al consultorio procurando el uso del Viagra pudieron, posteriormente, hacerse cargo del descuido en que habían caído: son aquellos grandes fumadores o bebedores, con vida sedentaria y estrés, con diabetes y colesterol fuera de control, con síntomas circulatorios que, aunque parezca extraño, jamás hubieran consultado por esas situaciones pero sí por la impotencia: luego en las consultas sexológicas pudieron rever la situación.

Cuando se consulta a un médico –y puede ser en un Hospital o en un Centro de salud, o en una Obra Social- creo que se está actuando correctamente: cuidar a los pacientes es también cuidarse, como no lo es cuando se vende un remedio (incluso psicofármacos) sin la prescripción médica.

El Viagra (citrato de sildenafil) es un medicamento para una condición médica como la disfunción sexual eréctil -que también pueden padecer jóvenes-, que cambió la historia de la Farmacología, la Sexología y la Medicina, marcando un camino (que ahora continuarán nuevos fármacos como el tadalafilo o el vardenafil) del cual no se volverá: el hecho de conocer el mecanismo íntimo de la erección y la acción específica del fármaco en el lugar específico, augura a los varones que no descuiden otros factores indispensables del erotismo -que no pasa sólo por las pastillas ni por sus partes genitales o por el falo erecto- una larga y satisfactoria vida sexual.

* DR. ADRIÁN SAPETTI, médico psiquiatra, psicoterapeuta, sexólogo clínico, Presidente de la Sociedad Argentina de Sexualidad Humana, autor del libro “El sexo y el varón de hoy”; director del Centro Médico Sexológico. Bs. As. Argentina.

Nota del editor: como lectura complementaria se aconsejan los artículos alojados en la sección El Viagra .

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100mg Viagra Equals Cialis

100mg Viagra Equals Cialis in Snow Hill, Maryland is small town living at its best. Nestled on the south banks of the Pocomoke River Snow Hill is a place where people know each other. From the people who call it home to the business owners and those in city government, we have built a community where life is gentle, fun, and prosperous. Home to a quaint downtown retail area and a broad spectrum of recreational activities, 100mg Viagra Equals Cialis is the perfect place to spend a relaxing weekend or a lifetime.

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Drug Interactions With Panax Ginseng

Diabetes medications, "blood-thinning" medicines, and medications that are metabolized by enzymes in the liver may cause drug interactions with Panax ginseng. These interactions can make certain drugs more toxic and increase your risk of bleeding or low blood sugar. Since so many medications can cause Panax ginseng drug interactions, you should check with your healthcare provider before combining any drugs with ginseng supplements.

Drug Interactions With Panax Ginseng: An Overview

Even though Panax ginseng is a natural product, it can potentially interact with several medications. In fact, Panax ginseng may cause significant interactions with many medications, too many to list in this article. Most drug interactions with Panax ginseng fall into the following categories:

  • Interactions that can cause excessive bleeding
  • Interactions with diabetes medications
  • Interactions that affect the way liver enzymes metabolize other drugs
  • Other miscellaneous drug interactions.

This article specifically refers to Panax ginseng (also known as Asian ginseng, Chinese ginseng, and Korean ginseng). This type of ginseng should not be confused with American ginseng or Siberian ginseng, which are entirely different herbs.

Panax Ginseng Interactions and Bleeding

Theoretically, Panax ginseng could decrease the ability of blood platelets to stick together. While this may be a beneficial action in many situations, it can also increase the risk of bleeding. It is not clear if this is a significant problem in humans.

Until more information is available, it should be assumed that combining Panax ginseng with medications that increase the risk of bleeding could lead to dangerous problems, such as internal bleeding. Some of the "blood-thinning" medicines that may lead to Panax ginseng drug interactions include:

    • Alteplase (Activase ® )
    • Reteplase (Retavase ® )
    • Streptokinase (Streptase ® )
    • Tenecteplase (TNKase ® )

Do not combine Panax ginseng with any such medications without your healthcare provider’s approval and supervision. There have been reports that Panax ginseng could actually make warfarin less effective (which is the opposite of what would be expected), increasing the risk of blood clots.

Due to the unpredictability of interactions between Panax ginseng and "blood-thinning" medications, your healthcare provider may recommend against combining them at all or may recommend increased monitoring to detect any problems.

Viagra and ginseng

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There does not seem to be many side effects to most herbs, I did get some high blood pressure from Viagra but now since being on mostly herbs I feel and get some real good hardons, and the morning woods are good, I even get woken in the night with some real boners and never had that before.

OK for me, I was given Viagra here in Greece when a was told all that I had was anxiety, its great when your told that, without any examination, and then given Viagra without any tests of any kind, all this I found out later of line, and after this decided that I then needed to find my own way out of ED if I could, the one thing if you start looking is DHEA comes up a lot of the time, so did research into it and asked on a couple of forums for info, for or against.

Said nothing was wrong maybe it was stress..he tried Viagra and Cialis. and haven’t really worked. I love him with all my heart and got married thinking sex isn’t everything..he makes me happy in any other aspect of our relationship but now I started feeling completely unattractive. don’t even want to initiate sex because I know I will be dissapointed..I go to the restroom to cry mostly every time after we try having sex because I feel so frustrated.

for about 6 yrs, now, i’ve had a very hard time getting an erection and keeping it for a while. if i’m able to get hard, premature ejaculation is sure to come. no pun intended. it’s very embarrassing for me. because of this problem, my wife hasn’t had an orgasm in a very long time. i’m researching the many different pills. i’m very surprised at how expensive they are. does anyone have suggestions on which one works the best for the best price?

1) Ginseng Ginseng is one of the bestselling herbs in the United States. In much of Asia, ginseng is prized as a revitalizer for the whole body, partly due to the human-like shape of the root. For more information about ginseng, read the Ginseng Fact Sheet. 2) Horny Goat Weed According to folklore, horny goat weed’s reputed aphrodisiac qualities were discovered when a Chinese goat herder noticed increased sexual activity in his flock[ after they ingested the weed.

There does not seem to be many side effects to most herbs, I did get some high blood pressure from Viagra but now since being on mostly herbs I feel and get some real good hardons, and the morning woods are good, I even get woken in the night with some real boners and never had that before.

I My GP brushed everything off as just being caused by anxiety or stress which I know is not true since I have been depressed and very stressed before and was very revved up sexually. Have also been very moody and irritable lately; now this problem only makes things worse. I have been on well know libido killer anti-depressants in the past like Paxil, but I quit taking it over two years ago. Also have been fully weened off Depakote since September.

acupuncture ginkgo biloba horny goat weed yohimbe Korean red ginseng and L-arginine However, there is little in the way of hard scientific evidence to suggest that these are any more effective than a placebo, and some may even pose a significant risk of harmful side effects. They should therefore not be approached without first consulting a healthcare professional.

We are in a long distance relationship, he is in london and I’m in Manchester so that doesn’t help. I can’t stop thinking about moving on and finding someone else at the moment, it’s on my mind a lot! I am 23 and just don’t know what to do anymore. Part of me feels though that breaking up with someone over this is shallow. but I don’t feel close to him. Sometimes I feel like we’re just close friends. He says he loves me but I am not so sure anymore.

Consume very little Alcohol and start an exercise program that starts to get those pounds off. Supplements like the Ginseng Berry and Mulberry Leaf are proven to help people who are T2, but without the other lifestyle changes forget it. In the short term check out the root vegetable called MACA, it’s available in capsules at your local health food store, that will put more lead in the pencil for now.

Do i need to stop the pill? It will go back to normal once i stop it or i need to take meds like viagra or ginseng. Any advice?

1) Ginseng It was first discovered by the Chinese and has been used as a libido enhancers for thousands of years. Ginseng is one of the bestselling herbs in the United States. In much of Asia, ginseng is prized as a revitalizer for the whole body, partly due to the human-like shape of the root. 2) L- Arginine: This is not a herb but an amino acid and it helps increase the production of nitric oxide which helps you achieve rock hard or firmer erections. It is also called the Nature’s Viagra.

Hi, I have the same problem as you. I’m 44, diabetic and bp problems as well. I’ve been declining in that area for a long time, also. I’m not able to have intercouse with my g/f either because of this. I’m able to make her orgasm other ways, but she hasn’t been able to make me yet. I tried viagra & cialis a few times, and they helped some, but not what i was hoping for. Maybe they will be what you need. I’m not sure what else to do also.

I got prescribed cozaar because I found out that diuretics also caused impotence in men. This still didnt change much. At this point viagra was not working fully, and even when I got erect it felt less full and smaller. I went to a urologist who took me off the testosterone for 2 months, and then ran some tests, and testosterone levels came back normal. He also tested for venemous leaks and said the blood flow was fine, just 1 point or so below normal.

we want to try to have children so we would like some answers. he went to a dr. visit and got prescribed viagra. it seems to help but it’s expensive and should this be happening at the age of 41.

I have had Rx for Viagra and the various clones, and also just got a penis pump a couple of months ago. Neither works at all. I have high blood pressure (125/60 -140/70 with an occasional spike to 150/65), and am on Metformin for diabetes (ranges anywhere from 70 to 130 average through out the day). I have run out of ideas on what to do and my wife is getting aggravated, although luckily with her menopause, her libido has been mostly low so that helps. Any suggestions?

I am on effexorfor anixiety and took1 Viagra and it did not work. now what? I don’t even masturbate anymore becasue it takes too long or it never happens. My testosterone is at a good level. I have lost ALL interest in Sex. My partner is not happy.

OK for I was given Viagra here in Greece when a was told all that I had was anxiety, its great when your told that, without any examination, and then given Viagra without any tests of any kind, all this I found out later of line, and after this decided that I then needed to find my own way out of ED if I could, the one thing if you start looking is DHEA comes up a lot of the time, so did research into it and asked on a couple of forums for info, for or against.

OK for me, I was given Viagra here in Greece when a was told all that I had was anxiety, its great when your told that, without any examination, and then given Viagra without any tests of any kind, all this I found out later of line, and after this decided that I then needed to find my own way out of ED if I could, the one thing if you start looking is DHEA comes up a lot of the time, so did research into it and asked on a couple of forums for info, for or against.

OK for me, I was given Viagra here in Greece when a was told all that I had was anxiety, its great when your told that, without any examination, and then given Viagra without any tests of any kind, all this I found out later of line, and after this decided that I then needed to find my own way out of ED if I could, the one thing if you start looking is DHEA comes up a lot of the time, so did research into it and asked on a couple of forums for info, for or against.

I’ve tried herbal supplements such as l-argenine, ginseng. and ginko but all have done nothing. I welcome all questions, comments and suggestions! I’d appreciate any help!

There does not seem to be many side effects to most herbs, I did get some high blood pressure from Viagra. but now since being on mostly herbs I feel and get some real good erections, and the morning woods are good, I even get woken in the night with some real boners and never had that before.

OK for I was given Viagra here in Greece when a was told all that I had was anxiety, its great when your told that, without any examination, and then given Viagra without any tests of any kind, all this I found out later of line, and after this decided that I then needed to find my own way out of ED if I could, the one thing if you start looking is DHEA comes up a lot of the time, so did research into it and asked on a couple of forums for info, for or against.

I have since decided to take various suppliments since December like ginko, ginseng. L-arginine and now the testosterone boosting suppliment Tribex. I also tried Viagra So far nothing has really helped however just started the Tribex. If anyone can help point me in the right direction in identifying the problem and remedying this, it would be greatly appreciated. I really don’t have any clue as to what has happened to the old horny me except the testosterone issue.

OK for I was given Viagra here in Greece when a was told all that I had was anxiety, its great when your told that, without any examination, and then given Viagra without any tests of any kind, all this I found out later of line, and after this decided that I then needed to find my own way out of ED if I could, the one thing if you start looking is DHEA comes up a lot of the time, so did research into it and asked on a couple of forums for info, for or against.

There does not seem to be many side effects to most herbs, I did get some high blood pressure from Viagra but now since being on mostly herbs I feel and get some real good hardons, and the morning woods are good, I even get woken in the night with some real boners and never had that before.

There does not seem to be many side effects to most herbs, I did get some high blood pressure from Viagra but now since being on mostly herbs I feel and get some real good hardons, and the morning woods are good, I even get woken in the night with some real boners and never had that before.

OK for I was given Viagra here in Greece when a was told all that I had was anxiety, its great when your told that, without any examination, and then given Viagra without any tests of any kind, all this I found out later of line, and after this decided that I then needed to find my own way out of ED if I could, the one thing if you start looking is DHEA comes up a lot of the time, so did research into it and asked on a couple of forums for info, for or against.

There does not seem to be many side effects to most herbs, I did get some high blood pressure from Viagra but now since being on mostly herbs I feel and get some real good hardons, and the morning woods are good, I even get woken in the night with some real boners and never had that before.

Sex Boosters

Menstuff® has information on Sex Boosters.

Natural Sex Boosters: Can You Rev Up Your Libido?
Some swear a supplement or two can get sexual desire sizzling again — but what do the studies show?

Got bedroom troubles? Waning sexual desire or erection problems are very common. Maybe you’ve been tempted to try ginseng, gingko, and similar supplements. There’s no lack of products out there.

What are these supplements? Do they live up to their promises? Are there any studies showing they work? Do they have bad side effects? Are they worth the cash? Is a romantic bath for two a better solution?

Getting Sex Supplement Advice

For advice on women’s supplements, we turned to Hilda Hutcherson, MD, clinical professor of obstetrics and gynecology at Columbia University Medical Center, and author of the book Sex and Pleasure: A Woman’s Guide to Getting the Sex You Want and Need and Deserve.

The supplements are generally harmless, she tells WebMD. She has found that herbal oils and supplements do seem to help some women having trouble with sexual desire and vaginal dryness. Yet she always advises talking to your doctor before taking any supplements — as some have dangerous side effects.

We also spoke with Christopher Saigal, MD, assistant professor of urology at UCLA School of Medicine, about men’s supplements — mostly for erectile dysfunction (ED). He’s got an open mind about supplements that mimic Viagra, but he’s also got definite opinions.

If you’re buying an off-the-shelf supplement, the quality is worth questioning, Saigal says. “There is so much fraud in this industry,” Saigal tells WebMD. “Go to a site that evaluates the contents, like Consumerlab.com. One evaluation of ginseng showed that half the brands had contaminants like pesticides. So buyer beware. Look for high-quality products.”

Sexual Desire, Supplements…and the Science

Ginseng: There are two kinds of ginseng — Siberian ginseng, which is typically used as an aphrodisiac, and red Korean ginseng, which is used in Chinese traditional medicine and is better studied, explains Saigal.

“Ginseng, like a lot of herbs, is thought to work by helping the body make more nitric oxide — as does Viagra,” he says. “A couple of good studies showed some effect from ginseng, so people can look at this as an alternative to Viagra. But it’s not going to be as effective as Viagra or Levitra or Cialis.”

Ginseng appears to help women, too, says Hutcherson. “Ginseng gives people energy, and you need energy and endurance for sex, right?”

Black Cohosh: In the past, black cohosh has been used to treat arthritis and muscle pain. Today, it is marketed to treat hot flashes, night sweats, vaginal dryness, premenstrual syndrome, and other menopausal symptoms.

“Black cohosh has estrogen-like properties, and increases blood flow to the pelvis — which increases arousal and response to sexual stimulation,” Hutcherson says. “More blood flow means more lubrication, and that’s good for sex.” The National Institutes of Health (NIH) is funding studies of black cohosh as a treatment for menopausal symptoms.

Some swear a supplement or two can get sexual desire sizzling again — but what do the studies show?(continued)

Chasteberry (Vitex): Chasteberry is native to the Mediterranean region and western Asia — and is approved in Germany for premenstrual and menstrual problems. It is said to increase sexual desire by boosting the hormone progesterone and the brain chemical dopamine.

Chasteberry also decreases the brain chemical prolactin that interferes with sexual desire. “It works for some patients,” Hutcherson says.

L-Arginine (Arginine): Arginine is an amino acid the body needs for many functions, like boosting immunity. The body also uses arginine to produce nitric oxide — an effect similar to Viagra. Arginine has been found to improve blood flow to the penis.

One study showed improvements when L-arginine, glutamate, and yohimbine were combined. (Yohimbine is FDA approved as a drug therapy for ED, so how much of the effect was due to arginine is unknown.) Another study showed “significant improvement in sexual function” when L-arginine and pycnogenol were combined — but not when L-arginine was used alone.

Arginine is generally safe, although there may be drug interactions — especially with high blood pressure drugs. In addition, men taking Cialis, Levitra, or Viagra – or nitroglycerin (nitrates) for chest pain (angina) — should be cautious as combining them with L-arginine can cause a potentially serious drop in blood pressure.

“It’s something to try. And if it works for those arteries, it could also help the heart arteries, too. Men with heart disease might benefit most from taking arginine,” says Saigal.

Gingko: Gingko has been used in traditional Chinese medicine for thousands of years. Gingko leaf extract is used today to boost mental power, treat asthma, fatigue, and sexual dysfunction. Some studies show that gingko enhances the effects of nitric oxide — which allows better blood flow to the penis.

“Gingko is one of those herbs that’s pretty popular,” says Saigal. “The thing is, there’s no great data on it.” Gingko is thought to help with sexual dysfunction related to antidepressant use, he notes. “One study showed that gingko made no difference; the other showed some slight difference. There may be a large placebo effect, but there have been anecdotal reports that it helps some people.”

Yohimbe: Yohimbe is derived from bark of the yohimbe tree, native to Africa — and traditionally used as an aphrodisiac. In current times, “this extract has been shown to be moderately effective in treating ED,” says Saigal. “It may perhaps increase erections and libido, because it has some effect on the brain.

Some studies indicate that yohimbe may help ED in men taking antidepressants, although research in this area is limited. Caution: Some yohimbe bark extracts may not contain significant amounts of yohimbine, so they may not have these effects. “There’s a buyer-beware issue,” Saigal adds. “A lot of supplements use names that sound like yohimbe but are basically worthless. Look at the content label. Make sure it’s from the yohimbe tree.” Also, look for the name of the active ingredient — yohimbine or yohimbine hydrochloride.

Maca: Maca is a vegetable native to Peru — and is traditionally used as an aphrodisiac, says Saigal. “There have been rat studies, but studies to support its use are very limited,” he adds. “But because it’s a vegetable, maca won’t hurt you.”

Pycnogenol: Pycnogenol is an extract of the bark from French maritime pine. It is believed that pycnogenol helps protect blood vessels and boost production of nitric oxide — similar to L-arginine, yohimbe, gingko, and ginseng.

“Some studies show that taking L-arginine and pycnogenol together boosts nitric oxide production,” says Saigal. “Those weren’t randomized trials [compared to placebo], but there was an effect. So there’s some effect in combining the two.”

ArginMax: If female patients are interested in herbs, Hutcherson guides them to ArginMax (a combination of Panax ginseng, L-arginine, ginkgo biloba, damiana, multivitamins and minerals).

Two large clinical studies found that ArginMax improved sexual function in menopausal and other women with low sexual desire, Hutcherson explains.

Zestra for Women: Zestra, a blend of botanical oils and extracts, is designed to increase female sexual desire, arousal, pleasure, and satisfaction when applied to the female genitalia, says Hutcherson. Zestra’s ingredients include: borage seed oil, evening primrose oil, angelica extract, coleus extract, vitamin C, and vitamin E.

In a preliminary study, Zestra was shown to increase sexual sensation, arousal, pleasure, and satisfaction in “normal women” and women with arousal problems. Zestra also helped with sexual side effects related to antidepressants.

“You rub it on your clitoris, which is supposed to increase blood flow,” Hutcherson explains. But “I don’t know whether it’s the Zestra that works or because they’re rubbing the clitoris.”

The NIH is launching a clinical study comparing Zestra to placebo in women with a variety of sexual dysfunctions, including problems with interest, desire, arousal, and orgasm.

Vitamin E: Vitamin E oil — when applied to the vagina — helps improve lubrication. “It is very effective,” Hutcherson says.

Cautionary Notes About DHEA Supplements

DHEA (dehydroepiandrosterone) is a natural hormone that is converted into male and female sex hormones in the body. DHEA is sold as an antiaging supplement that improves energy, strength, and muscle, plus it increases immunity and burns fat.

However, the NIH says, “there is no conclusive evidence that DHEA supplements do any of these things,” and “there is little scientific evidence to support the use of DHEA as a ‘rejuvenating’ hormone.”

Long-term effects of DHEA supplements have not been studied — but there are “early signs that these supplements, even when taken briefly, may have detrimental effects on the body, including liver damage.”

Even if DHEA does rev your libido, it won’t help erections, Saigal says. “If the goal is a better erection, getting more testosterone won’t help. I advise using a pharmaceutical instead. I would say, start with [Viagra, Cialis, or Levitra] first — especially since we don’t know the long-term effects of DHEA.”

Keeping Your Libido Healthy

Pills aren’t the only answer. If flagging sexual desire is the problem, “find something that adds spice,” Hutcherson says. “Find something interesting that stimulates your mind, since the brain is the largest sex organ.”

Her libido-boosting suggestions:

  • Sleep in the bedroom. Have sex anywhere else — the den, kitchen, or laundry room.
  • Seize the moment wherever, whenever, it hits.
  • Buy something new. New lingerie definitely qualifies.
  • Send hot sizzling notes to each other during the day.
  • Buy a sex toy. Read an erotic novel together. Watch an erotic video.

“There are so many things, you can never run out of ideas,” Hutcherson says. “What helps most — the best aphrodisiac — is going on a field trip to an adult store together. Try different things, touch, giggle, have a good time. You find you can’t wait to get home to try them.”

Protecting Your Sexual Desire

To keep your libido in prime form, you’ve got to walk, jog — do some kind of aerobic exercise daily. Maybe it doesn’t sound sexy, but a two-mile walk every day keeps the blood flowing, Saigal says.

Losing weight (if you’re obese) and eating a low-fat diet also helps restore sexual function, he adds. “You’ll feel better about yourself, and your partner will be more interested in you. You’ll also help your heart.” And that’s very sexy.
Source: By Jeanie Lerche Davis, www.webmd.com/diet/vitamins-supplements-8/natural-sex-boosters-can-you-rev-up-your-libido?ecd=wnl_sxr_071908&spon=912345_0

State Comparisons
States Implementing Laws that Provide Immunity from Prostitution Charges for Minor Victims

Since the development of state protective response laws is an emerging area fraught with implementation challenges, many state statutory responses have been built on earlier models, with each state identifying an approach that works for that state and adapting it to its unique policy and resource landscape. Within the range of state responses, four general categories of protective system responses have emerged10:

1. Immunity without referral – provides immunity from prostitution-related charges to direct juvenile sex trafficking victims away from a punitive response but does not statutorily direct them into an alternative system or specialized response for access to services.

2. Immunity with referral – provides immunity from prostitution-related charges and directs juvenile sex trafficking victims to an alternative system or specialized response for access to services.

3. Law enforcement referral to a protective system response – does not make minors immune from prostitution charges but directs or allows law enforcement to refer minors suspected of prostitution offenses to child welfare or other system-based services instead of arrest.

4. Diversion process – does not make minors immune from prostitution charges but allows or requires juvenile sex trafficking victims to be directed into a diversion program through which victims can access specialized services and avoid a delinquency adjudication.

States that do not fit into these statutory categories may still be implementing components of a JuST Response. Based on existing research and knowledge gained from the experiences of states that have been implementing protective response laws, three basic elements have emerged as critical to a complete juvenile sex trafficking (“JuST”) response: statutory protective provisions, multidisciplinary interagency state system protocols, and access to an array of funded service options. Georgia and Maryland for example each have protocols for connecting youth to services or avoiding a punitive response. No doubt there are other non-punitive service responses beyond these statutory categories that have not yet been explored or developed.

To explore the methods and challenges of deploying protective responses that integrate the critical elements of statutes, systems and services, the JuST Response Mapping Report merges Shared Hope’s research and policy analysis to provide a national overview of existing state juvenile sex trafficking responses and an in-depth analysis of responses in example states that represent each of the four statutory frameworks most commonly found under existing state laws. While this report goes beyond those frameworks and explores the implementation of system responses and access to services, there are two reasons for organizing state JuST responses according to their statutory frameworks:

(1) The state’s statutory framework is a prerequisite to statewide change: By mandating a fundamental shift in how the state views juvenile sex trafficking victims—from criminals to victims of exploitation—the statutory framework can survive shifts in power that informal policies and executive-led initiatives are less likely to survive. The stability provided by a framework of law makes it less difficult to commit resources and energy to the hard work of implementing a protective rather than a punitive response.

(2) Since four approaches to enacting a statutory framework implementing this paradigm shift have arisen over the past several years, comparing implementation of these responses allows for a more structured analysis, i.e. comparing one state’s immunity response with another state’s immunity response provides a more accurate reflection of how similar laws can play out very differently depending on each state’s policy and resource landscape. Comparing immunity with diversion, for example, illustrates how the different laws play out, but comparing immunity with immunity illustrates how the different approaches to implementation play out.

It should be noted that the division by statutory category is meant to help guide the reader through a comparison of approaches and is not meant to minimize the concurrent importance of system protocols and available services. In addition, a state’s political climate, resources and advocate personalities invariably influences the implementation of its protective response for juvenile sex trafficked victim. Comparing the implementation of immunity laws in Tennessee and Minnesota provides an excellent narrative of these differences. For instance, Minnesota has one of the best funded state governments in the country11 while Tennessee is more resource limited. While their statutes are similar in terms of providing immunity to minors, implementation of their laws has been very different.12

Two approaches to protecting victims that are not included here are an affirmative defense for sex trafficking victims or definitional changes intended to direct victims to an alternative system process, such as the person or child in need of services (PINS or CHINS). These approaches do not amount to a protective response in most cases because these laws—while important in helping to lay a foundation for such —lack a procedure to affirmatively direct minors out of the punitive system response and into services and/or place the burden on the victim to seek protection and services.

This report is a first step in ongoing research and is not inclusive of all promising state protective responses since over half of the states in the country have enacted some form of protective response law. For example, the responses of states such as Georgia13 that have developed strong agency or community protocols in lieu of supportive statutes are not covered herein.

10 See “State Law Survey: Protective System Responses to Child Sex Trafficking Victims.” Sharedhope.org. Shared Hope International, 2014. http://sharedhope.org/wp-content/uploads/2014/12/Shared-Hope-State-law-survey_Protective-System-Responses_through-8.1.141.pdf. Accessed on February 24, 2015. This chart reflects See State Law Survey Chart – Protective Responses, reflecting legislation enacted as of 8/1/14. While most state responses fall into one of these categories, some state responses blend more than one approach, for example Delaware provides a diversion process and also requires law enforcement to report commercially sexually exploited youth to child welfare in order to connect youth with services.

11 Kiernan, John S. “ States Most and Least Dependent on the Federal Government.”,WalletHub. Evolution Finance, Inc. 2014. http://wallethub. com/edu/states-most-least-dependent-on-the-federal-government/2700/. Accessed February 24, 2015.

12 These approaches are further explored in the following chapters,

13 The Georgia Care Connection, recently established by the Governor’s Office for Children and Families, identifies commercially sexually exploited children and links them to services without subjecting them to arrest. The Georgia Care Connection office serves as the single point of entry and care coordination entity for these commercially sexually exploited girls, ages 11-17. Learn more at www.georgiacareconnection.com/

States Implementing Laws that Provide Immunity from Prostitution Charges for Minor Victims
By ensuring that all juvenile sex trafficking victims are directed away from a punitive court process that can re-traumatize victims and reinforce mistrust of the system, immunity from delinquency charges for prostitution and status offenses related to juvenile sex trafficking is a critical component of a protective response. However, enacting an immunity statute does not come without challenges. A common concern raised by advocates in states that have passed immunity laws is that youth may still be charged with status offenses that mask the intent to arrest victims for prostitution. This is especially prevalent in areas where law enforcement feel there is a lack of safe placement alternatives or a particularly high risk of re-exploitation. States that enact immunity laws in the absence of a statutory procedure to ensure youth receive a specialized service response may face a situation where child serving agencies are unable to adequately respond to a trafficking situation, leaving exploited youth with limited service options. First line responders such as law enforcement and social workers are thus faced with the heart wrenching decision to return a victim to a situation where there is risk of re-exploitation.

Even in states that have passed immunity laws that mandate law enforcement referral of juvenile sex trafficking victims to child serving agencies, factors such as lack of training or implementable protocols within child serving agencies or a lack of appropriately equipped service providers may still leave victims vulnerable to re-traumatization and exploitation. At the JuST Response Congressional Briefing, panelists from two states, Minnesota and Tennessee, discussed their strategies for enacting immunity statutes as the core of their state’s protective response. Despite the similarity in their laws, which both lack a statutory procedure that specifically mandates a child welfare or alternative system response, the challenges and successes encountered in implementing their laws vary greatly. In Tennessee, immunity laws were enacted prior to identifying funding procedures and protocols to connect youth to services. This progressive law codified thestatus of juvenile sex trafficking as victims of trafficking and created a sense of urgency that has motivated state agencies to come to the table to create a state-wide protocol for identifying and responding to juvenile sex trafficking victims. In Minnesota, amendments to the state delinquency laws established a three-year deadline for the legislature to fund service protocols for responding to juvenile sex trafficking victims before the law establishing immunity for minors became effective. As a result, Minnesota’s No Wrong Door14 campaign was able to secure government funding to establish a comprehensive, multidisciplinary plan to ensure communities across the state have the knowledge to identify and the skills and resources to serve juvenile sex trafficking victims.

Another approach to immunity laws is represented by Illinois and Kentucky, both of which combined immunity with a mandatory referral to child welfare for services. While Illinois enacted its law much earlier, enabling Kentucky to build upon Illinois’ model, similar challenges to implementation have arisen in both states. Such challenges, though similar, provide important learning as solutions are shaped by the policy and resource landscape peculiar to each state.

14 Minnesota Department of Public Safety Office of Justice Programs. No Wrong Door: A Comprehensive Approach to Safe Harbor for Minnesota’s Sexually Exploited Youth. 2013. dps.mn.gov/divisions/ojp/forms-documents/Documents/!2012%20Safe%20Harbor%20 Report%20%28FINAL%29.pdf Accessed on February 24, 2015.

Oregon – State law establishes a protective response for DMST victims through existing systems1 – no

Type of protective system response: Immunity without referral to alternative system / Immunity with referral to alternative system No immunity, law enforcement referral to protective system / No immunity, diversion n/a
Source: sharedhope.org/wp-content/uploads/2015/09/JuST-Response-Mapping-Report-Final-web.pdf

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