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2- A More Formal Approach Lay down with your feet flat on the ground and your knees bent. When doing pelvic floor exercises, remember to breathe. Squeeze and count on the exhale. And count and release on the inhale. Alternatively, lie on your side. Sandwich a pillow between your knees. Squeeze your legs together using the same hold and release counts as before.

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Because of the social embarrassment associated with erectile dysfunction, some men may not feel comfortable discussing their symptoms, especially with their regular doctors or with family members.
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The authors would like to acknowledge the University of Gondar for its support and facilitation of the study. The authors also want to thank all the study participants for their collaboration and participation in the study. 1. Gebreyohannes EA, Bhagavathula AS, Gebresillassie BM, Tefera YG, Belachew SA, Erku DA. Recreational use of phosphodiesterase 5 inhibitors and its associated factors among undergraduate male students in an Ethiopian University: a cross-sectional study. World J Mens Health. (2016) 34:186–93. doi: 10.5534/wjmh.2016.34.3.186 2. Guay AT, Perez JB, Jacobson J, Newton RA. Efficacy and safety of sildenafil citrate for treatment of erectile dysfunction in a population with associated organic risk factors. J Androl. (2001) 22:793–7. Erratum in: J Androl. (2002) 23:113. doi: 10.1002/j.1939-4640.2001.tb02582.x 3. Harte CB, Meston CM. Recreational use of erectile dysfunction medications and its adverse effects on erectile function in young healthy men: the mediating role of confidence in erectile ability. J Sex Med. (2012) 9:1852–9. doi: 10.1111/j.1743-6109.2012.02755.x 4. Zusman RM, Morales A, Glasser DB, Osterloh IH. Overall cardiovascular profile of sildenafil citrate. Am J Cardiol. (1999) 83:35C−44C. doi: 10.1016/S0002-9149(99)00046-6 5. Delate T, Simmons VA, Motheral BR. Patterns of use of sildenafil among commercially insured adults in the United States: 1998-2002. Int J Impot Res. (2004) 16:313–8. doi: 10.1038/sj.ijir.3901191 6. Bechara A, Casabé A, De Bonis W, Helien A, Bertolino MV. Recreational use of phosphodiesterase type 5 inhibitors by healthy young men. J Sex Med. (2010) 7:3736–42. doi: 10.1111/j.1743-6109.2010.01965.x 7. Makwana S, Solanki M., Raloti S., Dikshit R. Evaluation of recreational use of aphrodisiac drugs and its consequences: an online questionnaire based study. Int J Res Med. (2013) 1:51–9. 8. Harte CB, Meston CM. Recreational use of erectile dysfunction medications in undergraduate men in the United States: characteristics and associated risk factors. Arch Sex Behav. (2011) 40:597–606. doi: 10.1007/s10508-010-9619-y 9. Schnetzler G, Banks I, Kirby M, Zou KH, Symonds T. Characteristics, behaviors, and attitudes of men bypassing the healthcare system when obtaining phosphodiesterase type 5 inhibitors. J Sex Med. (2010) 7:1237–46. doi: 10.1111/j.1743-6109.2009.01674.x 10. Gebregeorgise DT, Belay YM, Kälvemark Sporrong S. Sildenafil citrate use in Addis Ababa: characteristics of users and pharmacists' dispensing practices. Int J Clin Pharm. (2018) 40:67–73. doi: 10.1007/s11096-017-0558-8 11. Both R. Sex, tension, and pills: young people's use of contemporary reproductive and sexual health technologies in Addis Ababa, Ethiopia (Doctoral dissertation). Anthropology Department, University of Amsterdam, Amsterdam, Netherland (2017). Available online at: https://pure.uva.nl/ws/files/9794196/Thesis_complete_.pdf 12. Both R. A matter of sexual confidence: young men's non-prescription use of Viagra in Addis Ababa, Ethiopia. Cult Health Sex. (2016) 18:495–508. doi: 10.1080/13691058.2015.1101489 13. Cheitlin MD, Hutter AM Jr, Brindis RG, Ganz P, Kaul S, Russell RO Jr, et al. Use of sildenafil (Viagra) in patients with cardiovascular disease. Technology and Practice Executive Committee. Circulation. (1999) 99:168–77. doi: 10.1161/01.CIR.99.1.168 14. Santtila P, Sandnabba NK, Jern P, Varjonen M, Witting K, von der Pahlen B. Recreational use of erectile dysfunction medication may decrease confidence in ability to gain and hold erections in young males. Int J Impot Res. (2007) 19:591–6. doi: 10.1038/sj.ijir.3901584 15. Schiefer J, Sparing R. Transient global amnesia after intake of tadalafil, a PDE-5 inhibitor: a possible association? Int J Impot Res. (2005) 17:383–4. doi: 10.1038/sj.ijir.3901301 16. Pomara G, Morelli G, Menchini-Fabris F, Dinelli N, Campo G, LiGuori G, et al. Epistaxis after PDE-5 inhibitors misuse. Int J Impot Res. (2006) 18:213–4. doi: 10.1038/sj.ijir.3901383 17. Tiryakioglu SK, Tiryakioglu O, Turan T, Kumbay E. Aortic dissection due to sildenafil abuse. Interact Cardiovasc Thorac Surg. (2009) 9:141–3. doi: 10.1510/icvts.2009.205849 18. Nachtnebel A, Stöllberger C, Ehrlich M, Finsterer J. Aortic dissection after sildenafil-induced erection. South Med J. (2006) 99:1151–2. doi: 10.1097/01.smj.0000240732.65859.aa 19. Suleman S, Woliyi A, Woldemichael K, Tushune K, Duchateau L, Degroote A, et al. Pharmaceutical regulatory framework in ethiopia: a critical evaluation of its legal basis and implementation. Ethiop J Health Sci. (2016) 26:259–76. doi: 10.4314/ejhs.v26i3.9 20. Gebretekle GB, Serbessa MK. Exploration of over the counter sales of antibiotics in community pharmacies of Addis Ababa, Ethiopia: pharmacy professionals' perspective. Antimicrob Resist Infect Control. (2016) 5:2. doi: 10.1186/s13756-016-0101-z 21. Jackson G, Montorsi P, Cheitlin MD. Cardiovascular safety of sildenafil citrate (Viagra): an updated perspective. Urology. (2006) 68(3 Suppl):47–60. doi: 10.1016/j.urology.2006.05.047 22. Kloner RA, Jackson G, Emmick JT, Mitchell MI, Bedding A, Warner MR, et al. Interaction between the phosphodiesterase 5 inhibitor, tadalafil and 2 alpha-blockers, doxazosin and tamsulosin in healthy normotensive men. J Urol. (2004) 172(5 Pt 1):1935–40. doi: 10.1097/01.ju.0000142687.75577.e4 23. Ethiopia CC. Summary and Statistical Report of the 2007 Population and Housing Census. Addis Ababa: Federal Democratic Republic of Ethiopia population Census Commission (2008). 24. Ausó E, Gómez-Vicente V, Esquiva G. Visual side effects linked to sildenafil consumption: an update. Biomedicines. (2021) 9:291. doi: 10.3390/biomedicines9030291 25. Gebreslassie M, Feleke A, Melese T. Psychoactive substances use and associated factors among Axum University students, Axum Town, North Ethiopia. BMC Public Health. (2013) 13:693. doi: 10.1186/1471-2458-13-693 26. Lindsey WT, Stewart D, Childress D. Drug interactions between common illicit drugs and prescription therapies. Am J Drug Alcohol Abuse. (2012) 38:334–43. doi: 10.3109/00952990.2011.643997 27. Murtadha M, Raslan MA, Fahmy SF, Sabri NA. Changes in the pharmacokinetics and pharmacodynamics of sildenafil in cigarette and cannabis smokers. Pharmaceutics. (2021) 13:876. doi: 10.3390/pharmaceutics13060876
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Ishii, N., Watanabe, H., Irisawa, C., et al (1989) Intracavernous injection of prostaglandin E1 for the treatment of erectile impotence. Journal of Urology, 141, 323–325.CrossRefGoogle ScholarPubMed
25. Heaton JPW, Lording D, Liu SN, et al. Intracavernosal alprostadil is effective for the treatment of erectile dysfunction in diabetic men. Int J Impot Res. 2001;13(6):317-321.

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Williams, G., Mulcahy, M. J. & Kiely, E. A. (1987) Impotence: treatment by autoinjection of vasoactive drugs. British Medical Journal, 295, 595–596.CrossRefGoogle ScholarPubMed

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    Erection problems (impotence) are very common, particularly in men over 40. It's usually nothing to worry about, but you should see a GP if it keeps happening. It could be the sign of a more serious problem. Causes of erection problems

    Research has found that doing Kegel exercises twice a day can help a man build a strong pelvic floor. The benefits of a strong pelvic floor include maintaining longer and more rigid erections.
    Men worldwide suffer from erectile dysfunction due to physical, psychological or emotional reasons. Many of which are seeking a natural, ED solution with long-term results.

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    A German study found that 69% of men involved in a sleep apnea study also suffered from ED. Disruptions to breathing during sleep affect oxygen levels in the blood, which can cause problems generating an erection. Lack of sleep also disrupts hormone production.

    Compared to aerobic exercise like jumping on a treadmill, performing pelvic floor muscle exercises are super discreet. In fact, the pelvic floor muscles aren't visible — but you'll feel them!
    They work for most men and can be used if medicine is not suitable or does not work.

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    Reduction of “bad” cholesterol (low-density lipoprotein or LDL) levels in the blood, as well as the total level of cholesterolReduction in body weight (obesity is associated with cardiovascular disease) Increase in insulin sensitivity (exercise increases the body’s ability to control glucose levels in the blood)Increase in “good” cholesterol (high-density lipoproteins)
    Some of these products have been found to contain sildenafil (the active ingredient in Viagra) or a substance similar to vardenafil (the active ingredient in Levitra and Staxyn). These products can be dangerous for people who take nitrates to treat chest pain or heart disease.

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    You should not take more than 1 dose in 24 hours. Tadalfil and vardenafil come in tablets of 2.5 mg, 5 mg, 10 mg and 20 mg. Sildenafil comes in tablets of 25 mg, 50 mg and 100 mg.

    Most insurance won’t cover the costs of ED medication, and Medicare doesn’t cover the cost either. So, your available budget is an essential factor to consider. Prescription ED medications vary in price. To provide the best price for the most effective treatment, many companies have various billing cycles, shipping quantities, and dosages you can mix and match.
    Moderate exercise can help reduce a man’s risk of erectile dysfunction (ED) and improve his sexual function. Also, specific exercises can help him to build a strong pelvic floor to enhance his sexual performance.

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The most common reasons to use sildenafil in the present study were to increase erectile sensation and penile rigidity. Similar reasons were reported in a study conducted in Argentina in which a desire to increase penile rigidity, coital frequency, erection duration and to prevent sexual failure were the common reasons for PDE5Is use (6).

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Exercising can be an important part of a healthy lifestyle, and there are specific exercises which are recognised as being conducive to improved sexual health, such as pelvic floor exercises and other routines based on the core muscle group.

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Cialis came off patent in November 2017 allowing other pharmaceutical manufacturers to make a generic version using the same active ingredient called Tadalafil. As with all genuine generic medication, Tadalafil works exactly the same as the branded product but is much cheaper.

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A vacuum constriction device (VCD) is an external pump with a band on it that a man with erectile dysfunction can use to get and maintain an erection.

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