What is Kamagra? And Is It Safe?

Importantly, taking an OTC drug that contains sildenafil at the same time as a drug that contains nitrates, such as one for heart disease, can cause a dangerous drop in blood pressure. For non prescription products, read the label or package ingredients carefully. Taking https://gezondheidswinkel24.com/kopen-xarelto-generiek-zonder-voorschrift/ too much sildenafil can cause unpleasant side effects. Anti Doping Agency prohibits the use of DHEA in sports and notes that the substance falls under the category of anabolic agents on the World Anti Doping Agency Prohibited List. Other than as required by applicable law, Sanofi does not undertake any obligation to update or revise any forward looking information or statements. TrustSEAL VerifiedVerified Exporter. If you’re taking Cialis and use antacids to treat heartburn, the antacids may decrease the level of Cialis that your body absorbs. However, there’s no evidence that Viagra caused these bleeding problems. However, you should be careful and responsible for what you do to gain maximal response and avoid intolerable adverse effects. Brush the inside and chewing sur. ” Iconic themes in Cialis ads include couples side by side in matching bathtubs and the slogan “When the moment is right, will you be ready. There was no evidence of favourable clinical effect of the combination in the population studied.

1 48 of 165 results for “lovegra 100mg tablet for female” Sort by: Featured Price: Low to High Price: High to Low Avg Customer Review Newest Arrivals Best Sellers Sort by:Featured Go

The side effects may vary depending upon the condition being treated. So if the penis wasn’t able to become fully erect before taking Cialis, it may appear larger after taking Cialis. Osphenia is an estrogen agonist/antagonist that binds to estrogen receptors to activate certain pathways like vaginal tissue and block others. A higher score on the IIEF meant that erectile function was better, so ED symptoms improved. Online Doctor 020 7989 9888Mon Fri: 9am 5pmSat: 9am 1pmContact us. It also analyzed reviews to verify trustworthiness. One user recounted how, after years of struggle, following the “Sig” on his script allowed him to regain intimacy with his partner instantly. Unlock members only prices. Sold under the brand name Addyi, Flibanserin claims to increase sexual arousal by altering the chemicals in the brain.

Pills for erectile dysfunction: Why a pill is not always the answer

Sildenafil may cause an unwanted erection that is persistent, painful, and that may occur without sexual arousal. Private blood pressure check service. They may increase your dosage or recommend that you try a different medication. Packaging of vardenafil sold in the U. “Maybe they have a history of trauma. Learn about dosage, side effects, and more. Some ED drugs can have unpleasant side effects, like headaches, that cause discomfort. If they do not go away or get worse, speak with your doctor. You can also talk to them about side effects. View Pharmacy Profile. Men with BPH usually have difficulty urinating, a decreased flow of urination, hesitation at the beginning of urination, and a need to get up at night to urinate. ” Nitrates are used to treat chest pain angina. Your health and safety should always be the top priority. Vardenafil is used to treat erectile dysfunction impotence; inability to get or keep an erection in men. Erectile dysfunction can be debilitating because it can affect your ability to be intimate. 12 brilliant bridesmaid gift ideas for all budgets. Check with a healthcare professional before trying the natural alternatives above, as each may cause interactions with medications. This price is usually much higher than the production cost. You likely will not need to consider how long the pill is effective because if taken regularly, you may not experience any ED symptoms. The FDA describes two placebo controlled trials that have shown statistically significant increases in sexual desire and arousal among females who used Vyleesi. One of the downsides to penis pumps is their cost, although you only have to pay it once and they’re reusable. No, Viagra does not cure ED but can temporarily alleviate symptoms. Patients should be advised not to use Priligy in combination with recreational drugs. The following list looks at some common natural remedies that people use for ED. If you have a private prescription for tadalafil, read the information that comes with your medicine carefully.

Sildenafil: Best for Immediate Results

6 g/kg, hypotension was not observed and dizziness occurred with similar frequency to alcohol alone. Now, this doesn’t mean that it’s not possible to enhance your sexual performance or treat issues like erectile dysfunction or premature ejaculation. What to know about dental implants. If you take more than your prescribed dose, like taking 2 doses in 1 day, this can increase the risk of side effects and potentially dangerous complications, including permanent damage to your penis. The women who took Viagra reported better results than those who took a placebo. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Bigger packs and sizes. 23% of men in the dapoxetine 60 mg groups no statistical analysis presented. These drugs include. Brian Cole is a nationally acclaimed orthopedic surgeon, specializing in sports medicine for the knee, shoulder and elbow. Medicines in this group include avanafil Stendra, sildenafil Viagra, Revatio, and others, tadalafil Cialis and others, and vardenafil Levitra, Staxyn.

What is Lovegra?

They say they can do things like. As a result, the risk of overdosing is rather minimal. Here’s what you need to know about Viagra, including how it works, what to expect after taking it, how to tell if your partner is using it. Pharmacy and Therapeutics: “Flibanserin Addyi. Also, do not stop taking this medicine without checking first with your doctor. Menopause and HRT treatment. Dr Fox prices are 25%–50% lower than other UK online clinics. Erectile dysfunction, commonly referred to as ED, is a condition that affects millions of men worldwide. Viagra alternatives range from medical options like Cialis and Levitra to natural methods like acupuncture and even therapy. You can get vardenafil online, if prescribed, from RedBox Rx. Super Vilitra pills provide a complete treatment for adult men with both ED and PE when taken one to three hours before planned sexual activity. FDA Roundup: June 13, 2023. Further study is needed on how concomitant PE and ED affect treatment of the other condition. You can, however, take Viagra while using a penis pump. Pregnant women must consult doctor before using this medication. Exploring semaglutide as a diabetes treatment option.

Vardenafil generic Levitra

If you are a Mayo Clinic patient, this could include protected health information. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias. Serotonin is a natural hormone in our bodies which is responsible for many activities, including helping to regulate our mood and wellbeing. This medication also helps the erection to last longer by inhibiting the action of a naturally occurring chemical which can prematurely return the erection to its normal state. But you should try to take your dose at the same time every day. All authors reviewed the manuscript. In addition, a high percentage of patients responded to both sildenafil and placebo in Study I 47% and in the first part of Study II when VSS started 2 h after dosing 42%. Save up to half price. In fact, sometimes these drugs may cause symptoms of erectile dysfunction ED, which Viagra is used to treat. Pharmacokinetic and covariate parameters from the final population model.

Condition Spotlight

Support and Charity Fundraising. It may take a few attempts to find the best pill for you. Adobe Acrobat is required to read PDFs. A female with low sexual arousal resulting from antidepressant medication should talk with their doctor about other depression treatment options, such as bupropion Wellbutrin, Zyban or mirtazapine Remeron. Takes effect in: 1 2 hours. Psychological factors that may contribute to premature ejaculation include. © 2024 Harvard Health Publishing® of The President and Fellows of Harvard College. There are, however, a few FDA approved medications to treat low sexual desire in women. They just make you more likely to feel in the mood. 4, with the highest scores for a decrease in barriers to treatment 5. Learn more about link terms and conditions. There is no clear evidence that Kamagra works for women, but the manufacturer of Kamagra does offer an alternative for women called Lovegra. This list contains examples of serious side effects that can occur with Cialis and Viagra when taken individually. This date is typically 1 year from the date they dispensed the medication. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. ED is a condition in which you can’t get or maintain an erection. Other tablet treatments for erectile dysfunction are all PDE5 inhibitors. Any other dosage of Viagra i. Although Cialis doesn’t change the size of the penis, the drug can increase the ability to have an erection. Examples of nitrate drugs that should not be taken with Viagra include. 22 This could be why Promescent states that VitaFLUX may be able to help you recover more quickly from injury or exhaustion. Psychological factors that could contribute to or cause ED include depression, anxiety and stress. Sildenafil metabolism is principally mediated by the cytochrome P450 CYP isoforms 3A4 major route and 2C9 minor route. Such an event may be a sign of non arteritic anterior ischemic optic neuropathy NAION, a cause of decreased vision including possible permanent loss of vision, that has been reported rarely post marketing in temporal association with the use of all PDE5 inhibitors.

UNCOMMON

A range of options to fit your needs. Reduced dose recommended when 50mg starting dose is highly effective. The corresponding change in supine diastolic blood pressure was 5. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. They’re effective for the majority of men who take them, but they can be unsafe when taken too frequently or in doses higher than those approved by the FDA. Skin and subcutaneous tissue disorders. If you have regular, unplanned sex, a once daily tablet may be best suited to your lifestyle. The expert panel comprised four urologists, one of whom chaired the meeting, a cardiologist, a pharmacist, and the speaker was a clinical pharmacologist. The plasma concentration of M1 is approximately 26% that of the parent compound. VIAGRA does not protect against sexually transmitted diseases, including HIV. An erection’s rigidity. Visit digestive health advice. US residents can call 1 800 222 1222. If a dosage works well but causes bothersome side effects, your doctor may suggest a lower dosage. However, there is a substantial disparity between the incidence of PE in epidemiological studies which rely upon patient self reporting of PE or inconsistent and poorly validated definitions of PE , and that suggested by community based stopwatch studies of the IELT, the time interval between penetration and ejaculation which forms the basis of the ISSM definition of lifelong PE. 2 Paroxetine appears to be particularly effective at improving IELT; in one study, paroxetine 20–40 mg per day over a 6 week period was found to increase median IELT by 9. You can take your dose at any time of day. Org, to learn more about what this latest pharmaceutical option means for women. In study subjects whose blood pressure was not controlled, the reduction was greater, although this reduction was not associated with hypotensive symptoms in the majority of subjects. Order by the 2:00 PM weekday cut off time for guaranteed delivery by 1:00 PM the next business day. Affordable, efficient, and hassle free process from start to finish. Sildenafil compound UK 92,480 was synthesized by a group of pharmaceutical chemists led by Simon Campbell working at Pfizer’s Sandwich, Kent, research facility in England. Age is a factor that can cause or make ED more likely. The presence of other medical problems may affect the use of this medicine.

We provide you with authentic, trustworthy and revelant information

LEVITRA is a prescription medicine taken by mouth for the treatment of erectile dysfunction ED in men. Morning after pill emergency hormonal contraception. Effect of Cordyceps militaris supplementation on sperm production, sperm motility and hormones in Sprague Dawley rats. 5 mg and 20 mg a day or as needed. If you experiencechest pain, dizziness, or nausea during sex, seek immediate medical help. Research indicates that 1 in 3 Irish men have experienced difficulty in achieving an erection, 1 in 5 indicated they experience ED regularly. There are a number of treatments you can consider. Customers like the taste of the herbal supplement. The Journal of Sexual Medicine, 162, 223–234. An action plan to fight unhealthy inflammation. Experiencing relationship issues, starting or losing a job, and even moving to a new home can all contribute to ED symptoms. The perfect Christmas stocking fillers. If you are taking tadalafil to treat both ED and BPH, take it as directed by your doctor, usually once a day. 94, suggesting that sildenafil increased the duration of rigidity by three to fourfold, compared with placebo. Please note that all PharmacyChecker accredited online pharmacies tier 1 and non tier 1 meet the same high standards as identified in the PharmacyChecker Verification Program. Our services are provided by one of our four medical groups. These side effects may vary depending on the form of vardenafil prescribed. A standard checkup may beat a paid online consultation. The dose can be increased to one 60mg tablet, as required, providing the 30mg dose has been well tolerated no significant side effects are experienced. VIAGRA, REVATIO, and CARDURA are registered trademarks of Viatris Specialty LLC, a Viatris Company. Reply HELP for help and STOP to cancel. In most cases, there is insufficient research to suggest that OTC ED pills can benefit sexual function. Addyi was the first HSDD drug to receive FDA approval.

Can too much masturbation cause Erectile Dysfunction?

It should not be used with the recreational drugs, amyl nitrate and butyl nitrate, also known as poppers. This will also give you access to better savings and more options. Alcohol, Drugs and Smoking Interactions: The interactions of Sildenafil with smoking are unknown. You’ll also need to check with your insurance provider, as it may only cover one or the other. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them. Com is a registered service mark of PharmacyChecker. These events have been chosen for inclusion either due to their seriousness, reporting frequency, lack of clear alternative causation, or a combination of these factors. Integrative Medicine Fourth Edition, 592 599. Preliminary recommendations of the American Psychiatric Association’s Diagnostic and Statistical Manual V DSM V Committee suggest a DSM V definition which parallels the definition recently adopted by the International Society for Sexual Medicine. Though rare, some people have reported permanent vision loss. To get information on different conditions and tips for improving your health, subscribe to any of Healthline’s newsletters. Studies show that as men age, erections become less turgid stiff and the force and volume of ejaculation decrease. See medicine expiry dates for further information. Visit mobility and daily living aids. Several clinical studies have evaluated the safety and efficacy of tadalafil dosed once daily in patients with ED. They’ll help determine what’s causing the increase in blood pressure and the best way to treat it. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. Com is the exclusive platform where we provide medicines at the lowest prices, ranging from $5. However, talking to your doctor about any risks or side effects is important before taking it. One of our doctors will review your order and prescribe a treatment if suitable. This medication can be used to treat pulmonary hypertension PH that happens in the arteries of your lungs pulmonary arterial hypertension or PH that happens due to a blood clot in your lungs.

Minor 7

Viagra can cause mild or serious side effects. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to estimate their frequency or establish a causal relationship to drug exposure. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product. The best pill to maintain an erection are FDA approved PDE5 inhibitors, such as Viagra, Cialis, and their generic versions. Igor Kirillov: Notorious mouthpiece and man behind Russia’s chemical weapons. First class service every time and always arrives on time. Use of Cialis® and Chewtadzy® tablet is not indicated for use in the pediatric population. In most cases doctors write the prescriptions and pharmacies dispense the tablets. CIALIS may still be effective up to 36 hours after taking the tablet. The maximum recommended dosing frequency is once per day. Please expect up to 4 to 6 weeks for reimbursement. Please enable Strictly Necessary Cookies first so that we can save your preferences. Our 6 top picks for hair straighteners. A fat that contains a carbon carbon double bond, or a fat containing unsaturated fatty acids, such a fatty acid has double or triple covalent bonds and is thus able to add more atoms. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco. 10 of the best self care gifts to help wellbeing. However, researchers noticed that patients who took part in the trial had increased libido. Tadalafil is also used in both men and women to treat the symptoms of pulmonary arterial hypertension to improve your ability to exercise.

Is Your Medication Making You Tired?

You may also know them by their generic names: sildenafil Viagra and tadalafil Cialis. The amount of sildenafil in your body will drop by 50% every 3 5 hours, meaning it should be completely out of your system within a day. Vardenafil usually begins to work within 60 minutes after taking the medication. Recycle your electricals. You can also ask your doctor whether you could benefit from vitamin supplements. To achieve the best outcome, the female partner should be included as fully as possible in the treatment and counseling sessions. It’s one of the most recognized and marketed ED treatments worldwide. Apply on checkout page, when there is a product in the cart. However, in men with ED, this process is disrupted, often due to underlying health conditions such as diabetes, heart disease, or nerve damage. Thanks to the wide choice of tablets available, deciding which is the best ED medication for you can be difficult. “There are more factors at play in female sexual desire. In the second study, fasted patients received four treatments and underwent four assessments. Excellent product, very effective within a few days of starting taking it. The New Zealand example of reduced counterfeit packages following reclassification was discussed and considered to be potentially applicable in Germany. Older research has shown that propionyl L carnitine and L carnitine also enhance the effects of sildenafil Viagra. Before sharing sensitive information, make sure you’re on a federal government site. Contact your healthcare provider if you think you are having a side effect of a medicine. The Agenda for will be available in June 2019. 00 for ten to thirty 10mg tablets , generic alternatives now offer significant savings. It can be taken with or without food. Always check with your healthcare provider. Painful, Prolonged Erection Priapism. Keep out of reach of children and pets. Low Blood Pressure Hypotension. This medicine should come with a patient information leaflet.

Adcirca, Alyq, Tadliq

Viagra is usually the first ED medication prescribed, Tesfu says. If you feel faint or dizzy, lie down. L arginine in 1,500 to 5,000 milligrams mg can be effective in treating mild to moderate ED. 5g 1,500mg of L citrulline appears to be a safe and effective alternative treatment for mild to moderate erectile dysfunction. Here are the biggest pros of seeing a virtual doctor. Mild and transient differences in colour discrimination blue/green were detected in some subjects using the Farnsworth Munsell 100 hue test at 1 hour following a 100 mg dose, with no effects evident after 2 hours post dose. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. 3% at end of study for those who received dapoxetine 60 mg, compared with 35. Since DHEA is readily available as a supplement, the premise is that people who take it do so for the long term.

INDICATION

Patients should be monitored for potential drug interactions, such as reduced efficacy, increased side effects, and decreased therapeutic efficacy. Besides, medications may be a causal factor in which 25% of cases of ED are caused by either prescription or over the counter medications. But you should try to take your dose at the same time every day. Sorry, gentlemen, a four hour erection isn’t all it’s cracked up to be. Psychological factors include. The extracts found in HerSolution Pills have been standardized to deliver a high concentration of those bioactive compounds. Registered: 1 month, 3 weeks ago. Com is the exclusive platform where we provide medicines at the lowest prices, ranging from $5. We offer Stendra from $236 a month four tablets of 100mg. Although rare, Cialis may also increase your blood pressure. Talk to your doctor before trying a sexual enhancement supplement. However, the Food and Drug Administration FDA has approved the drugs to treat different conditions. You’ll get the finest effects if you take Levitra tablets 30–60 minutes before engaging in sexual activity. Online procurement offers convenience and discretion. As may be expected, discontinuations due to treatment emergent adverse events in the studies described here were reportedly more frequent with dapoxetine than with placebo, and more frequent with dapoxetine 60 mg than with 30 mg. You can take it with or without food. Still, more clinical trials are needed to support these findings. You can also get Tadalafil Daily, an ED pill that you take every day so you’re always prepared for sex, which comes in two dosages: 2. Been using it for a number of years and am more than satisfied. Ques : Can I take Kamagra Gold 100 MG Tablet in my 20s. Most men who experience sexual arousal after taking this med can achieve and maintain an erection hard enough for sex. 5 points would indicate a possibly better treatment effect. Are the exact same and others are not. View Pharmacy Profile. Therapy can help you communicate better with your partner, work through performance anxiety or relationship problems, and build self esteem. Examples of blood pressure medications include. A kitchen timer can work, too. 50mg is the most popular dosage of Viagra, and is effective for most men who try it. For example, patients with HIV associated PAH who are being treated with ritonavir may have an impaired ability to metabolize tadalafil and should be started on the 20 mg tadalafil dose.

+91 5565659220

This will be given as a 2. This article discusses how long Viagra lasts, what it is for, and alternative methods of treating erectile dysfunction. Possible serious side effects include low blood pressure, dizziness and fainting. Information given here is based on the salt content of the medicine. Opticians terms and conditions. Stop taking tadalafil and get emergency help right away if you have any of the following symptoms of priapism. Doctors will only be able to prescribe the drug after counselling patients about potential side effects, including low blood pressure, nausea and fainting. For benign prostatic hyperplasia, tadalafil relaxes the muscles of the bladder and prostate, making it easier to urinate and reducing symptoms. The NIDDK would like to thank:Tom Lue, M. Some herbs that are effective in treating ED in animals may not have been tested in humans and could cause unexpected side effects. In some patients, concomitant use of these two drug classes can lower blood pressure significantly leading to symptomatic hypotension for example, fainting. You should try to take your dose at about the same time each day. Sexual problems may be due to trouble with arousal, a lack of desire or both. The active ingredient in Priligy, dapoxetine, is an SSRI Selective Serotonin Reuptake Inhibitor. This service operates in the United Kingdom only.

The sponsor retains responsibility for the content and holds the copyright to their material

Some studies found that Viagra can help people with PE to delay ejaculation longer than they could without treatment. For Cialis to be effective in this condition, sexual stimulation is required. Paediatric population. His son Jesse expanded the business to become a modern retailer and the biggest chemist in Britain. “Clearly we need more than just one medication — women need to have an array of choices that meets their specific medical needs,” says Terry O’Neill of the National Organization for Women. Never take more than one pill within 24 hours and do not combine it with other ED medicines. The Patient Information Leaflet PIL is the leaflet included in the pack with a medicine and must be read before taking the medicine. If you’re prescribed Addyi, you no longer have to avoid alcohol completely. It’s important to note that neither drug makes sex better. Effect of zinc on testosterone levels and sexual function of postmenopausal women: a randomized controlled trial. The guidelines recommend that pharmacological treatment options include ‘on demand’ dapoxetine and daily use of a longer acting SSRI such as citalopram, fluoxetine or paroxetine off label use or daily use of clomipramine off label use. These drugs are called alpha blockers. “I think it’s great that we’re finally doing research into medications for women and sexual desire,” she says. Here’s some detail on certain side effects this drug may cause. Side effects associated with sildenafil were generally mild to moderate, the most common being headache, flushing, nausea, stuffy nose, and visual disturbances. The sildenafil tablets offered by us are widely used for treating erection dysfunction in men by inhibiting CGMP specific phosphodiesterase type 5. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them. When you take Viagra, the active ingredient, sildenafil, relaxes the smooth muscles in the penis blood vessels, increasing blood flow which causes an erection. View Pharmacy Profile. If you need financial support to pay for Viagra, or if you need help understanding your insurance coverage, help is available. “It’s not just that I want to look good, I want to FEEL GOOD. The active chemical in Viagra, sildenafil citrate, is still used under the name Revatio to treat pulmonary arterial hypertension or elevated blood pressure in the arteries that carry blood from your heart to your lungs. In fact, many men who experience nasal congestion, stomach pain, nausea and diarrhoea with other drugs find that Cialis doesn’t give them these symptoms. Tadalafil enhances blood flow to the penis during sexual stimulation and encourages erection in the penis following such stimulation since it is a phosphodiesterase type 5 PDE 5 inhibitor.

For Clinics

Laser caps for hair loss. When hypertension occurs in the lungs, the heart must work harder to pump enough blood through the lungs. Although betel nut may boost libido, it’s not recommended for anyone because it is highly addictive. Available pharmacodynamic/toxicological data in animals have shown excretion of tadalafil in milk. Quando sono in giro con le donne normalmente ci vuole un po’ per erigere. Tadalafil Brand name: Cialis is a popular generic medication prescribed for the treatment of erectile dysfunction. For full details, see the package leaflet. This topical medication is a second line treatment for ED, which means a healthcare professional may prescribe it if a person cannot tolerate oral medication or in combination with more traditional tablets like Viagra. Appropriate studies have not been performed on the relationship of age to the effects of sildenafil in children younger than 1 year of age. One study explored the effects of sildenafil citrate the active ingredient in Viagra on the uterine and clitoral arterial blood flow in postmenopausal women. There are many different causes of ED, including. Who should not take Cialis. 51 as brand name Cialis, per GoodRx. Stop taking Priligy and see your doctor straight away if. Viagra can help stimulate blood flow to the penis and help people with the condition maintain an erection. Memorial Sloan Kettering Cancer Center. The best pill to maintain an erection are FDA approved PDE5 inhibitors, such as Viagra, Cialis, and their generic versions. As it’s unlicensed and unregulated, users can’t be sure exactly what they’re taking. Two such organizations are. The strength of these tablets generally ranges from 2. Consult doctors online from the comfort of your home for free. It is of utmost importance to acknowledge that this medication may not be suitable for every individual, as certain persons with specific medical conditions or those concurrently undergoing treatment with other pharmaceutical agents may encounter contraindications preventing its safe and effective use. Immediately telephone your doctor, or the Poisons Information Centre telephone in Australia 13 11 26, in New Zealand 0800 POISON or 0800 764 766, or go to the accident and emergency department at your nearest hospital, if you think you or anyone else may have taken too much Levitra. Most of these men had known heart problems before taking this medicine. Here’s what you need to know about the dangers of recreational Viagra use. While some struggle to become sufficiently lubricated for sex or feel a lack of sexual desire, others find they’re unable to achieve orgasm or feel pain during intercourse.