There are three new treatments available. The first to be marketed was Viagra (or sildenafil), followed by Cialis (tadalafil) and then by Levitra (vardenafil). Your doctor or specialist will discuss with you which of these oral treatments he or she thinks would suit you. They all belong to a group of drugs called PDE5 inhibitors, which are in tablet form. Viagra is a blue diamond, Cialis is a yellow almond shape and Levitra is orange and round.

How the drugs work

They are not aphrodisiacs and do not increase sexual desire. For them to be effective, you need sexual stimulation (foreplay) as well, as they will not give you an erection spontaneously (taking a tablet and waiting for something to happen just doesn't work).

There is no point in a man without erectile dysfunction taking a tablet if he can get an erection anyway. It is unnecessary and makes little difference. The drugs work by relaxing the blood vessels in the penis, allowing blood to flow into it, causing an erection. They also make other blood vessels dilate and you may get a flush or a headache. These are usually not bad and are temporary. They shouldn't stop you continuing to have sex. You can also get a stuffy nose or indigestion, which usually goes with regular dosing over time or if the dose is lessened.

Dosage

Viagra is in 3 strengths - 25, 50 and 100 mgs, Levitra in 5, 10 and 20mg and Cialis in 10 and 20 mgs. Many doctors start treatment by prescribing the maximum dose, although some may start on a lower dose They usually work in a minimum of 30 minutes but many men find it better to wait longer to have sex if possible. Don't forget that you need sexual stimulation - foreplay - as well as sexual desire to get an erection. Once you have taken one of the tablets (don't go above the maximum recommended dose - you simply increases the side effects and not the efficacy), Viagra and Levitra will continue to have an effect for 4 -6 hours (although many men claim also to have a'good erection the next morning), and Cialis can have an effect up to 48 hours, useful if things don't work out for you immediately. Don't have more than one a day.

With all three tablets, too much alcohol or a heavy meal can interfere with getting an erection, so if you want success, cut down on alcohol and don't have a big meal before sex. If you don't get much of a result after takingthe highest dose on 6 different occasions, ask to try one of the others. as sometimes this works. Find out how a tablet works on you and what side effects it has, if any, before you drive. as you may get a bit light headed.

When it is not sensible to take one or other of the tablets

•You should not take one of these treatments for impotence if you are taking a drug containing nitrates. These include inhalers for angina. or tablets for blood pressure such as Suscard, Sustac, an isosorbide (check the label of your tablets) or if you go clubbing, using poppers. If you feel that you would like to try a PDE5 inhibitor and you are taking a nitrate for another reason, talk to your doctor and ask to be changed to another type of blood pressure tablet (which should not really be a problem unless you have severe angina). The reason is that the combination of a nitrate and a PDE5 inhibitor can lower the blood pressure catastrophically, with serious results.
• If you are a "heart patient" check with your consultant.
• You shouldn't take two different PDES inhibitors at the same time.
• They should not be taken by women as their safety in women hasn't been tested.
• If any of these tablets do not help you to get an erection, or your erection does not last long enough for you to enjoy your chosen sexual activity, you should tell your doctor, who will be able to help. There are other effective treatment options available and you can find what they are from your doctor or the Sexual Health Alliance helpline in your country.

Warning! Do not buy drugs for impotence off the internet.

A recent report shows that 62%1 of all drugs bought via the internet are fake. Make sure you have a genuine prescription after a check-up by your doctor and send it to a pharmacy with a verifiable address.
European Alliance for access to safe medicines (www.eaasm.eu)

About ESHA
The European Sexual Health Alliance (ESHA) is an umbrella organisation for patient support groups across Europe. The main role of this patient focused organization is to assist patients suffering from sexual dysfunction. to inform them about the solutions available as well as to provide awareness and understanding of the condition to their partners, media and other interested parties.

ESHA's purpose is to help every couple affected by sexual dysfunction to communicate openly about their sexual concerns in order to find a solution that improves the patient's sexual function and the couple's quality of life.