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Sikiric described the program in a 2006 review in Inflammopharmacology

[6] [10] You should arrange a GP appointment if you experience: Persistent difficulty achieving or maintaining erections sufficient for sexual activity Sudden onset of erectile problems, especially if accompanied by other symptoms Reduced libido or changes in sexual desire Pain during erection or intercourse Concerns about fertility or reproductive health Psychological distress related to sexual function Your GP will conduct a thorough assessment including medical history, medication review, and examination

It is also influenced by how much folate (the bodys form of folic acid) there is, kidney function, and genetic factors