Incidence :
around 52 % of adult males between 40 – 70 years old have some sort of ED .

Mechanism of erection :
Anatomy :
- the erectile tissue is composed ot 2 cylinders named corpora cavernosa , each corpus   cavernous is covered by an elastic fibrous tissue sheath known as the tunica albuginea ( TA . ) .
- Each corpus cavernous is lined by blood sinusoids and a cavernosal artery runs in the middle of               each corpus .
- The venous drainage of the corpora cavernousa is formed of small venules which anastomose                together to form emissary veins which run between the bi – layered tunica albuginea .

Physiology of erection :
On sexual stimulation the nerve endings of the penis secrete a neurotransmitter known as nitric oxide ( NO ) which stimulate the release of cyclic guanine monophosphate ( Cgmp ) which promotes relaxation of the sinusoidal walls and increase of blood flow within the sinusoids together with trapping of the emissary veins in between the stretched tunica albuginea leading to a rigid erection .

Causes of erectile dysfunction ( ED ) :
A – Psychogenic causes ( which are really very important even if the biological status of the man is good still psychogenic causes controls everything there ) :
1 – loss of self esteem .
2 – honey moon ED .
3 – Sympathetic overflow ( fear ) .

B – Arteriogenic causes :
1 – Arteriosclerosis .
2 – Arterial injury ( pelvic trauma ) .
3 – Le Riche syndrome .

C- Venogenic causes :
1 – venous leakage .
2 – incompetent venous valves .

D – Hormonal causes :
1 – hyperprolactinemia .
2 – hypogonadism .

E – systemic diseases :
1 – Diabetes mellitus .
2 – Parkinsonism .
3 – Collagen diseases .

F – Drug induced :
1 – Diuretics .
2 – H2 blockers .
3 – Antipsychotic .
4 – Smoking ( yes smoking is recently proved that it has a rule in causing male erectile      dysfunction ( ED . ) and stopping smoking is a major way in the treatment options during the course of treatment ) .
5 – iatrogenic trauma of nerves ( cavernous nerves).
6 – Hyper tension ( HTN).
7 – Others .

For more information on Diagnosis of male erectile dysfunction

How does it work?

The active ingredient that is found in Cialis is Tadalafil. Cialis works by allowing the chemical nitric oxide to relax the smooth muscles in the penis; this increases the blood flow in the penis causing erection. Also, it allows the penis to stay hard for longer period of times.

Dose:

The dose for this medication is either 10 mg if taken before sexual activity, or 2.5 mg daily regardless sexual activity time.

Side effects:

Most of the side effects appeared after taking Cialis are very mild and don’t last for long. Most common side effects are:

• Headache.
• Flushing.
• Indigestion.
• Runny nose.
• Muscle aches or Back pains.
• Very rare it would decrease blood flow to the retina causing sudden vision loss.
• Drinking alcohol while taking Cialis can exaggerate the side effects.

Contraindications:

1. Cialis is contraindicated to be taken with drugs containing nitrates such as Nitroglycerine as it may produce low blood pressure.
2. Also if the patient experienced any allergic reaction for the drug, he should stop it immediately. Also it is rare to develop an allergic reaction but if any of these symptoms developed after taking Cialis then you should contact your doctor, these symptoms include:

Skin rash.

Swelling in the throat leading to difficulty in breathing.

Swelling in the lips and tongue.

Difficulty in swallowing liquid and food.

Patients suffering from liver diseases should be aware to adjust their dose and the liver is the primary site for this drug metabolism.

General Information:
Cialis helps in increasing the blood flow to the various parts of the body by relaxing the arteries. On arousal, the drug comes into action at the penile arteries, thereby increasing the blood flow in this region and therefore leading to the enlargement of the penis. Cialis by the name of Adcirca is used for treatment of pulmonary arterial hypertension in men and women and also to increase the capacity of exercise in both men and women. There are many other potential uses of Cialis that doctors prescribe based on different problems of the arteries and in combination with other drugs to increase the effectiveness of the other drugs.

Scientific Information:
The active ingredient in Cialis is Tadalafil, which belongs to a class of drugs also known in the scientific terms as PDE-5 inhibitors. There is no use going into the scientific details here, as it probably wont make sense for the general user, but PDE-5 inhibitors stop the degradation of phosphodiesterase type-5 enzyme on cyclic guanosine monophosphate. Phosphodiesterase type-5 enzyme is found in smooth muscles of the penis and other areas. Hence when this enzyme action is stopped, the smooth muscles relax, which increases the blood flow in the penis, only after sexual arousal. The action of tadalafil is specific in the fact that it is only specific to the phosphodiesterase enzyme found in the penis, which is the type-5, hence the action of tadalafil is more specific in this region than in other parts of the body and helps in reducing male impotency.

Usage information:
Cialis can be used by men who may or may not prefer from impotence problems, above the age group of 25. In concentrations of 5mg, Cialis can be used without prescription. The action is fast and within 30 minutes of consumption, the drug comes into effect and give a strong erection along with the ability to stay in action for a longer period than usual. Above 20mg, Cialis needs to be only taken on prescription and never by people in their 20’s. This drug is designed only for people with serious erectile dysfunction.