Sexual desire disorders or decreased libido can be caused by a decrease in normal estrogen (in women) or testosterone (in both men and women) production. Other causes may be aging, fatigue, pregnancy, medications (such as the SSRIs) or psychiatric conditions, such as depression and anxiety. Erections can change over time, sometimes stronger or weaker than other times. When men are in their teens they often have little control over their erections and obtain erections when not in a sexual situation. For most men this stops in their late teens to early twenties. As men get older, erections may not always be obtained when they want one. Almost every man has the occasional time when their erection is less strong than they would like but sometimes it becomes a problem. Erectile dysfunction, also called impotence, means that a man's penis doesn't get hard enough to have intercourse. The man cannot get or maintain an erection. This condition affects approximately 30 million men in the United States. Erectile dysfunction is not the same as premature ejaculation, the inability to ejaculate (retarded ejaculation) or infertility.) Psychological issues such as depression, anxiety, guilt or fear can sometimes cause sexual problems. At one time, these factors were thought to be the major cause of erectile dysfunction. Doctors now know that physical factors are present in most men with erectile dysfunction. However, embarrassment or "performance anxiety" can make a physical problem worse. Erectile dysfunction caused only by psychological causes is found most commonly in young men. Sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) drugs can cause minor side effects such as flushing and headache, but they have been shown to be safe in most men, including those with heart disease. However, these drugs can interact with other medications and cause dangerously low blood pressure. In particular, they should never be taken with nitroglycerin or other nitrate medications commonly used to treat heart disease. Men with enlarged prostates who take alpha-blocker drugs such tamsulosin (Flomax) or doxazosin (Cardura) should probably avoid PDE5 drugs.
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