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ED can affect intimate relationships and cause low self-esteem in men, as well as in their sexual partners. Smoking, alcohol abuse, and psychological factors, such as depression, stress, and anxiety, may increase the risk for erectile dysfunction. Common treatments for impotence include oral medications (e.g., sildenafil [Viagra®], tadalafil [Cialis®], vardenafil [Levitra®]), sex therapy, self-injections, vacuum devices, and in some cases, surgery. buy Viagra 150mg here real viagra online without prescription The treatment may depend on the cause. For example, if the problem is caused by a hormonal imbalance, medication to treat the underlying endocrine disorder will be prescribed. However, the same treatment may be used for many different causes. Consult your health care provider for appropriate evaluation and management. Footnotes ?1 Abbreviations: PDE, phosphodiesterase; cAMP, adenosine 3?5?-cyclic monophosphate; cGMP, guanosine 3?5?-cyclic monophosphate; GAF, cyclic GMP, adenylyl cyclase, FhlA; CaM, calmodulin; PK, protein kinase; PKA, cAMP-dependent protein kinase; PKG, cGMP-dependent protein kinase; CNS, central nervous system; ANP, atrial natriuretic peptide; NO, nitric oxide; PDP, 9-(6-phenyl-2-oxohex-3-yl)-2-(3,4-dimethoxybenzyl)-purin-6-one; BAY 60-7750, 2-(3,4-dimethoxybenzyl)-7-[(1R)-1-hydroxyethyl]-4-phenylbutyl]-5-methylimidazo[5,1-f] [1,2,4]triazin-4(3H)-one; PI3K, phosphatidylinositol 3-kinase; IGF1, insulin-like growth factor 1; OPC-33450, 6-[3-[3-cyclooctyl-3-[(1R*,2R*)-2-hydroxycyclohexyl]ureido]-propoxy]-2(1H)-quinolinone; UCR, upstream conserved region; CRE, cAMP-responsive element-binding protein; RACK, receptor for activated C-kinase 1; AKAP, A-kinase anchoring proteins; ERK, extracellular signal-regulated kinase; BRL 50481, 3-(N,N-dimethylsulfonamido)-4-methyl-nitrobenzene; PAS, Period, Arnt, and Sim; IBMX, 3-isobutyl-1-methylxanthine; BAY 73-6691, 1-(2-chlorophenyl)-6-[(2R)-3,3,3-trifluoro-2-methylpropyl]-1,5-dihydro-4H-pyrazolo[3,4-d]pyrimidine-4-one. If you opt for using a number of the remedies reviewed in this text, create certain that you're taking them as directed and stick to the prescribed dosage. And above all - get pleasure from better and bigger sexual expertise!