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What causes erectile dysfunction

An erection needs two things to work together: a signal from the brain that starts arousal, and enough blood flowing into the penis to hold it. ED happens when either side falls short.

Most of the time the cause is physical: blood vessels that do not relax as easily, often linked to high blood pressure, diabetes, high cholesterol, smoking, weight or age. Stress, poor sleep, alcohol and some medications play a part too. Because the blood vessels involved are small, ED can be an early sign of heart or circulation problems, which is one reason a provider reviews your health history before prescribing.

How prescription ED medicine works

Sildenafil, tadalafil and vardenafil belong to a group called PDE5 inhibitors. They relax the blood vessels in the penis so more blood can flow in when you are aroused. They do not cause an erection on their own; arousal is still needed.

Apomorphine works differently. It acts on dopamine receptors in the brain that are involved in arousal, the signal side rather than the blood-flow side. Quattro combines all four in one dose: three for blood flow, one for the arousal signal.

Sildenafil vs. tadalafil vs. vardenafil

All three work the same way. The difference is mostly timing:

• Sildenafil: the best known. Taken about an hour before sex, it works for a few hours, and a heavy meal can slow it down when taken as a pill.
• Tadalafil: the longest window, up to 36 hours, which means less planning around timing.
• Vardenafil: similar to sildenafil in timing, and some men respond to it better.

Why under the tongue

A tablet you swallow has to pass through the stomach before it is absorbed, which is why food can delay it. A dose held under the tongue is absorbed through the lining of the mouth instead, so a meal does not hold it up. Quattro is taken this way: one small dose, held under the tongue until it dissolves.

Who should not take ED medication

Your provider screens for these before anything is prescribed. Do not take ED medication if you:

• Take nitrates for chest pain (such as nitroglycerin or isosorbide), or use nitrite "poppers"
• Take riociguat for pulmonary hypertension
• Have had a recent heart attack or stroke, or have been told sex is not safe for your heart
• Have very low blood pressure or severe liver or kidney disease

Side effects

The most common are headache, flushing, indigestion, a stuffy nose, nausea and dizziness, and they usually fade within hours. Get emergency care for an erection that lasts more than 4 hours, or for sudden changes in vision or hearing. Tell your provider about every medication you take, including blood pressure medicines and alpha blockers.

How everslim works, and what it costs

You answer a short online assessment about your health and what you have tried before. A licensed US provider reviews it and decides whether treatment is right for you and at what dose. If you are prescribed, a licensed US pharmacy prepares your doses and ships them in a plain box, usually in 2 to 4 days. No insurance and no waiting room.

Quattro starts at $4.67 a dose on the 20-dose pack with the 3-month plan. 5, 10 and 20 dose packs are available month to month. You are only charged if a provider prescribes, and you can cancel any time.

Is everslim legit?

everslim is operated by Divineslim, doing business as EverSlim, a US telehealth company. Prescriptions are written by independent, state-licensed US providers and filled by licensed US pharmacies, and the site is LegitScript certified, which you can verify from the seal at the bottom of this page.

We are not connected to everslim.co.uk, a separate UK weight-loss clinic with a similar name. Reviews of that company are not about us.