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But they can cause ED or make it worse. Avoid illegal drugs, and consider limiting the amount of alcohol you drink. Smoking and smokeless tobacco can cause narrowing of blood vessels all over the body, including those that supply blood to the penis. Talk to your provider about quitting. Having ED can make you feel bad about yourself. This can make it even more difficult to seek treatment and enjoy sexual activity. ED can be a troubling issue for couples because it can be difficult for you or your partner to discuss the problem with each other.

Couples who do not openly talk to each other are more likely to have problems with sexual intimacy. If you have trouble communicating, counseling can be very helpful for you and your partner. Finding a way for both of you to express your feelings and desires, and then work on the issues together, can make a big difference. They cause erections only when you are sexually aroused. Other ED medicines include drugs that are injected into the penis and tablets that can be inserted into the opening of the urethra.

Your provider will teach you how to use these treatments if they are prescribed. If you have heart disease, talk with your provider before using these medicines. Men who take nitrates for heart disease should not take ED medicines. None of these remedies have been proven effective for treating ED. Talk to your provider to see if any of these treatments are right for you. Treatment options other than medicines are available if medicines do not work for you.

Talk to your provider about these treatments. If this problem is not treated, you may suffer lasting damage to your penis. Never go to sleep with an erection. Evaluation and management of erectile dysfunction. Campbell-Walsh-Wein Urology. Philadelphia, PA: Elsevier; chap Rutherford's Vascular Surgery and Endovascular Therapy. Your doctor is the best person to advise you on whether tramadol is the right medicine for you, how much you need and how long to take it for. If you take tramadol you may become dependent on this medicine if you take it regularly, even if you take it exactly as prescribed and for a short time only.

Your doctor will monitor how you use tramadol to reduce your risk of harm, including through misuse, abuse and addiction. You can also develop tolerance when you take tramadol. This means that you may need to take larger amounts of the opioid to get the same effect. As the dosage increases, so does the risk of side effects.

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