Cialis is phosphodiesterase-5 inhibitors that helps treat erectile dysfunction in men. Through sexual stimulation, Cialis will relax the blood vessels in the penis in order to increase the blood flow into the penis. It will result in an improved erection for men. Erection will not happen out of the blue like often happens with Viagra (for example) – Erection will occur during sexual intercourse or with some sort of sexual stimulation. Cialis increases the Natural process of erections.

How does Cialis (tadalafil) work?

Similar to Viagra, Cialis will block the phosphodiesterase-5 enzyme to help widening and relaxing the penis muscles to ensure a greater flow of blood in the penis for easier and faster erection.

How well does cialis (tadalafil) work?

Cialis is used to treat men with ED problem. 10 to 20mg dosages are the approved dosages for using Cialis per 24 hours. Similar to Viagra, Cialis should be taken prior to sexual behavior since sexual stimulation is required, and can be taken with or without the consumption of food.

Clinical Data Overview

There are 60 different studies with 4,000 men that were conducted in order to test the efficacy and safety for Cialis. Among 1,112 men participating in the studies for primary efficacy of different ED problems, 81 percents reported a positive response for improved and faster erection while using Cialis compared to the men using other stimulators.

The most frequently reported side effects of Cialis are nasal congestion, upset stomach, headache, muscle ache, and dizziness. However, the more severely reported problems come from people who are using any type of medication which contains Nitrates. Indeed anyone that suffers from heart problem is not advised to use Cialis.

Remember, Cialis is only prescribed to each individual based upon his/here medical conditions. Furthermore, any Nitrates contained drug or Nitroglycerin should not be taken together with Cialis. Uses of Nitrate contained drugs could result in some severe and serious side effects such as severe blood pressure drop, server dizziness, and/or even stroke. Contact your medical experts, or your doctor, for better details on how to use Cialis while taking under consideration your personal health conditions.

What is the normal Cialis (tadalafil) dose?

10 to 20 mg of Cialis per 24 hours had been administered among most men in the clinical test for Cialis.

Are there any side effects with Cialis (tadalafil)?

Muscle pain, upset stomach after a meal, headache, and back pain are the most commonly reported side effect from Cialis. The severity of the side effects from Cialis is depended upon the doses.

Cialis is a prescription medication for erectile dysfunction (ED). It’s important to note that only the intake of Cialis is not going to help ED, as sexual stimulation is also an important component of getting an erection. It’s a drug that needs to be taken before sexual activity commences. Mexican Pharmacy Cialis intake increases the blood flow to the penis when the man is sexually aroused. The penis returns to its original state post sexual intercourse. Mexican pharmacy online

Working of Cialis

Cialis, with its active ingredient tadalafil, belongs to a family of medications known as phosphodiesterase-5 inhibitors (PDE-5 inhibitors). PDE-5 is blocked by tadalafil. PDE-5 is an enzyme that is released after sexual intercourse and returns the penis to its flaccid state. By blocking its action, tadalafil ensures that the penis muscles stay relaxed and the inflow of blood into the penis continues unhampered for a longer time. This ensures a hard penis with a prolonged erection.

A complex series of events need to occur for an erection to take place. Due to sexual arousal, many bodily chemicals are released, and amongst these chemicals, cyclic GMP holds prime importance. It helps relax penile muscles and also increases the blood flow to the penis. Cyclic GMP is broken down, immediately after ejaculation or on the removal of sexual stimulation, by the action of PDE – 5. Due to the intake of Cialis, tadalafil works towards inhibiting PDE-5 so that the cyclic GMP does not break down and remains intact for a longer duration.

Cialis – Suitability

Men who suffer from the inability to get or maintain an erection can take Cialis. This is of course, if they are prescribed this medication by their doctor. Men with mild, moderate and severe ED are prescribed this medication. Those who want their penis to maintain a longer-lasting erection so as to get complete satisfaction during sexual intercourse are suitable candidates for Cialis. Clinical studies conducted on men, have proven that a Cialis dosage improves erection in men. The study was conducted on men who suffered from erectile dysfunction as a result of various psychological or physical factors.

Cialis, as an ED drug is also preferred by men who are looking at a fast action option. The effect of Cialis is seen in as little as 30 minutes. Also men who are looking for a long lasting option also choose to go with Cialis. The 36 hour Cialis helps men stay prepared for as many 36 hours. This does not mean that they remain erect for that many hours. They are just in a state of readiness. All they require is a bit of sexual stimulation and they are ready to go.

Cialis – Who is it not for?

Genuine Cialis is a great drug and has a very good safety profile. But like all drugs, it also comes with its share of precautionary measures and side effects. There is some important information about Cialis that you must know and which will help you use it correctly. The intake of Cialis could lead to a drop in your blood pressure. This can leave you feeling faint or you could also suffer from bouts of dizziness. If you are taking any medications called ‘nitrates’, it’s important not to take Cialis. If you are not sure whether your medications have ‘nitrates’ in them, you can ask your doctor or for that matter also your pharmacist.

Even if you are on some alpha-blockers, you must avoid Cialis. Also, there might be a case, wherein, you might be allergic to some of the ingredients contained in the medication. In such cases, it’s important that you don’t take this drug. Also, apprise your doctor of your detailed medical history and current intake of medications so that your doctor can make sure that you do not suffer from side effects as a result of Cialis intake.

You must take Cialis in the required dosage, as prescribed by the doctor. Don’t go overboard in your intake, thinking that the more Cialis you take, the longer-lasting will be the erections. Also, be aware of the various side effects of Cialis, so that you know just what you are getting into.

Medications are available that can substantially delay ejaculation. The familiar 5-PDE inhibitors (Viagra, Levitra and Cialis) that are commonly used for erectile dysfunction, may have a role in the treatment of P.E. in men with acquired P.E. secondary to erectile dysfunction.

Anti-depressants of the S.S.R.I. class (selective serotonin reuptake inhibitors) have been clearly demonstrated to delay ejaculation. These medications can have undesirable side effects such as decreased libido, sleepiness, insomnia, headache, nausea and dry mouth. You are generally started on a low dose for two weeks with an increase in dose if necessary for the next two weeks. Once an effective dosage is achieved, you can use the medication on a situational basis, 3-4 hours prior to sexual intercourse.

The most commonly used medications are:

• Anafranil (Clomipramine): 25-50mg
• Paxil (Paroxetine): 20-40mg
• Zoloft (Sertraline): 25-100mg
• Prozac (Fluoxetine): 5-60mg

A new medication, Dapoxetine (30/60mg), is currently in investigational trials.

Insofar as most cases of P.E. have an underlying psychological basis, it may be beneficial to seek the aid of a sexual therapist who can help manage the problem with counseling sessions. This can be done in conjunction with some of the aforementioned techniques in order to bring about a quicker resolution.

One method of attempting to prolong the time prior to ejaculation is to  employ mental diversionary tactics—that is, filling your mind with thoughts  other than ejaculating in order to prevent doing so. Baseball, work, counting  backwards, etc., are examples of such thoughts. Unfortunately, these “deerotization”  techniques are rarely effective and diminish the pleasure of  sexual activity and intimacy.

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A more successful means of preventing P.E. is the stop-start method  originated by Dr. Semans. This technique requires you to develop an  enhanced awareness of the feelings and sensations surrounding the time  leading up to ejaculation; by achieving such familiarity, you can learn to  accurately predict when ejaculation will occur and how to gain control before  the “point of no return.” Recognizing imminent ejaculation and responding  by slowing the pace of pelvic thrusting as well as varying the angle and  depth of vaginal penetration may allow time for the feeling to dissipate. If  slowing the tempo is not sufficient to prevent the occurrence of premature  ejaculation, you may need to stop thrusting completely while maintaining  penetration in order for the urgency to go away. Once the sensation to  ejaculate subsides, pelvic thrusting may be resumed.

Another option is the squeeze technique originated by Masters and Johnson.  As ejaculation approaches, the penis is withdrawn from the vagina and  the head of the penis is squeezed until the feeling of ejaculation passes,  after which intercourse is resumed. The male or his partner may apply the  squeeze.

Decreasing penile sensitivity can be helpful in the management of P.E. There are various means of accomplishing this, including the use of extra  thick condoms, topical creams that desensitize the penis, and increasing  the frequency of ejaculation, since P.E. tends to be more pronounced after  prolonged periods of sexual abstinence. By masturbating prior to engaging  in sexual intercourse, the ejaculatory latency period can be increased.

Local anesthetics including
Lidocaine (2.5%) or Lidocaine and Prilocaine (EMLA  cream) applied 20-30 minutes prior to intercourse will diminish the sensitivity of  the penis.

Premature ejaculation (P.E.) is defined as ejaculation with minimal sexual stimulation and climax occurring before, upon, or shortly after vaginal penetration, prior to a person’s desire to do so, over which the sufferer has little voluntary control. P.E. typically causes the sufferer and partner extreme bother and distress.

This is a very common male sexual dysfunction, occurring in up to 30% of the male population, and affecting men of all ages, ethnicities, and socio-economic groups. P.E. can be devastating, causing embarrassment, frustration and loss of self-confidence for males, and negatively affecting their relationships with their partners. The basis of P.E. can be psychological and/or biological – with guilt, fear, and performance anxiety, but also genetics and certain medical disorders playing possible roles in its occurrence.

P.E. may be classified as either primary (lifelong) or secondary (acquired). Primary P.E. applies to men who have had the problem since becoming sexually active and is thought to have a strong biological component. Psychological or situational stressors may contribute to secondary P.E., but it is also associated with erectile dysfunction, prostatitis and urethritis.

Our society’s cultural emphasis on ejaculation as the focal point of sexual intercourse tends to exacerbate the performance anxiety that can initiate the problem. The occurrence of P.E. has social and psychological consequences that tend to perpetuate the problem as fear of and mental preoccupation with P.E. can actually induce the unwanted ejaculation, creating an unfortunate vicious cycle. But males experiencing P.E. need to know that various types of help are available and that there is no need to suffer in silence. Treatments are varied, consisting of behavior modification techniques, physical and pharmacological interventions, and sexual counseling.

Peripheral Nerve Injury Peripheral nerve injury is another important cause of ED, especially in patients undergoing prostatectomy. Other causes of peripheral nerve injury include bicycle riding and acute pelvic trauma. Several authors have reported genital numbness and increased the incidence of ED among cyclists. The pathophysiological basis for ED in cyclists is thought to be neurogenic as well as vasculogenic.

A recent systematic review of the literature found that the reported incidence of ED after radical prostatectomy with nerve sparing technique varies widely due to methodology. 50% and 34% for bilateral and unilateral nervesparing surgery, respectively.

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Nerve-sparing techniques are based on the seminal study by Walsh and Donkers in which they identified the path of the nerves to the corpus cavernosa.
They identified the branches of the pelvic plexus traveling through the urogenital diaphragm adjacent to the prostatic capsule and then adjacent to and through the wall of the membranous urethra. Not surprisingly, they found that men with tumors that did not invade the prostatic capsule and were amenable to salvage of this structure had reduced rates of ED.

Recovery and improvement in erectile function after radical prostatectomy has been reported to continue up to and beyond 2 years postoperation, perhaps indicating healing of injured nerves.
Loss of erectile function is also related to anatomical changes in the penis, specifically fibrosis of the penis due to prolonged lack of tumescence. In animal models, histological changes occurring after nerve injury are prevented by regular pharmacologically induced erections.

Psychogenic Risk The number of cases of ED attributed purely to psychogenic etiology have greatly declined in the past several decades. Younger men who complain of ED are more likely to have a psychogenic component than older men. Psychogenic ED is generally classified into generalized and situational pathologies and further subclassified.

This classification scheme has been criticized as it fails to account for advances in neurobiology that have linked certain psychiatric illnesses with neurochemical and neurohormonal derangement. Depression Depression and ED are often comorbid conditions. Several epidemiologic studies report men with ED are more likely to report depression, and that this association is independent of associated comorbidities, demographic factors and medications. In a study of men diagnosed with Major Depressive Disorder but not yet treated, almost half had trouble sustaining an erection and reported decreased sexual desire

Spinal Cord Injury The nature of ED caused by spinal cord injury (SCI) is dependent on the acuity and location of the injury. Estimates of the preservation of erectile function vary widely, and are as high as 95% for reflexogenic erection.

Erections in men with SCI are characterized as reflexogenic when the stimulus is tactile or psychogenic when visual, auditory, or memory serve as the stimulus. Since erections are the result of parasympathetic output to the penis arising from S2 to S4, reflexogenic erection is maintained in suprasacral injuries or those not involving the lower motor neurons (LMN).

Cerebrovascular Accidents Cerebrovascular accidents (CVA) are another important cause of sexual dysfunction and, specifically, ED. As with other neurological diseases, the pathophysiology of ED in these patients is multifactorial and related to the physical, psychological, and social consequences of stroke. Sexual complaints in stroke patients include the loss of libido, frequency of sexual intercourse, ED, and sexual satisfaction.

These complaints are most attributable to interpersonal variables, such as the inability to discuss sexuality with a spouse or changed attitude toward sex, but the fear of impotence is a significant variable. Erectile dysfunction increases from 36% prestroke to 76% poststroke, and is associated with the degree of depression poststroke.

In a study that specifically assessed ED in stroke patients, approximately half of stroke patients reported ED.

A more important finding in this study was that preexisting diabetes, hypercholesterolemia, obesity, and smoking increased the prevalence of ED after stroke. The neurogenic component of ED in stroke patients is complex due to the various central structures involved in erectile physiology and the complexity of stroke distributions. Only one study to date has attempted to associate lesions on MRI with sexual dysfunction. Erectile dysfunction was only weakly associated with lesions involving the right pons.

While the specific nature of neurological insults that determine ED in stroke patients is yet to be determined, it is evident that psychosocial factors are an important determinant of sexual dysfunction after stroke.

Neurogenic Factors The proportion of ED that is currently attributed to pathophysiology of the neurological system is likely underestimated. In the central nervous system, the amygdala, medial preoptic area (MPOA) and periventricular nucleus (PVN) of the hypothalamus, and the hippocampus are all involved libido and erection.

Parkinson’s Disease and Alzheimer’s Disease The prevalence of ED in men with Parkinson’s disease (PD) exceeds that of age-matched controls.

The pathophysiology of ED in patients with PD is multifactorial, as PD is characterized by significant psychiatric comorbidities and dysautonomia in addition to the destruction of dopaminergic cells in the substantia nigra.

The specific pathophysiology of ED in Alzheimer’s disease has not been elucidated but appears to be independent of concomitant risk factors such as age. Multiple Sclerosis One case-controlled study found ED to occur five times more often in men with Multiple Sclerosis (MS) compared to those with other chronic diseases. Over 50% of men with MS report either one or more of altered genital sensation, decreased libido, decreased intensity of orgasm, and increased time for arousal. Epilepsy Epileptic men also have an increased prevalence, with 15–57% experiencing ED.

Temporal lobe epilepsy, specifically, may exert its effects on erectile function through a derangement in the hypothalamic–pituitary axis (HPA). More pronounced in times of epileptic discharge, this derangement results in hypogonadotropic hypogonadism and hyperprolactinemia.

Chronic Obstructive Pulmonary Disease There is a clear association between respiratory diseases and ED independent of comorbid conditions, such as peripheral vascular disease or coronary artery disease. Chronic obstructive pulmonary disease (COPD) is a common chronic disease in men. Dyspnea and hypoxemia diminish a patient’s functional capacity and can lead to ED. The prevalence of ED in patients with respiratory disease has been reported as high as 75%.

Several investigators have demonstrated that as pulmonary function tests (i.e., FEV1, FRC, PaO2) worsen, so does a man’s erectile function. Pathophysiology of ED in patients with COPD is multifactorial. Disruption of the hypothalamic– pituitary–gonadal axis has been reported in patients with COPD.

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Reversal of hypoxemia with long-term oxygen has been shown to be effective in improving impotence. Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is also a common chronic disease. It has been reported in as many as 10% of men over 40 years old. Recurrent intermittent hypoxemia and transient increases in sympathetic tone during apneic episodes result in an increased risk of daytime somnolence, hypertension, and ischemic cardiovascular events. Erectile dysfunction has also been found to be associated with OSA.

This association appears to be strongest in the most severe cases of OSA. Causes for ED in these patients include hypoxemiadriven neural damage, microvascular endothelial damage from increased sympathetic tone and hypertension, low gonadotropin secretion, and psychosocial abnormalities, including daytime somnolence and depressed mood

A cohort of nearly 30,000 men evaluated through a screening questionnaire reaffirmed the previous concepts – patients with ED are more likely to suffer from cardiovascular disease. But the study also suggested that it is important to take into account the degree of ED. Authors stated that the greater the severity of ED, the greater the risk of presence of a medical comorbidity in the patient. Degree of ED severity can therefore be used as a prognostic marker for overall health risk, particularly cardiovascular disease risk.

Specific degrees of ischemic coronary disease and their association with ED in male patients were researched in a group of men with an average age of 56. These men underwent coronary angiography for the purpose of documentationof the specificextent of coronary disease in order to compare this with sexual function.

Sexual function was evaluated using an extensive questionnaire focused on sexual desire, erectile function, and ejaculation. A statistically significant correlation was made between ED and the number of coronary vessels involved. Those patients with one-vessel coronary disease were much more likely to achieve erection than those with two- or three-vessel disease.

It is well understood that only a small fraction of men with ED seek treatment. With the positive correlation between ED and cardiovascular risk, this underreporting by male patients to their healthcare providers should be taken seriously. Perhaps all men over a particular age should be screened for the presence of ED, much like the current recommendations for prostate cancer screening. If ED is present, it could be argued that these men should then undergo investigation for underlying subclinical cardiovascular disease. Endothelial dysfunction appears to be the link between the two disease entities. Increased awareness of the association between ED and cardiac disease should lead general practitioners to inquire as to the presence of ED symptoms in their male patients.

An important issue in patients with cardiac risk and ED is the safety of ED treatment. Topics including the risk of sexual activity eliciting a cardiac event and risk of drug interactions were addressed in an algorithm developed by the First Princeton Consensus Panel. They designated patients to low, intermediate, or high risk for the treatment of ED and participation in sexual activity. They support lifestyle interventions in patients with ED, including weight loss and increased physical activity