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Most times, the discolorations are caused by extrinsic stains, which affect the enamel only, and are therefore not corrected by brushing or flossing. PDE5i, like Cialis , block this enzyme leading to higher levels of cGMP and improving the ability to obtain and maintain an erection. Nilotinib will increase the level or effect of sildenafil by affecting hepatic intestinal enzyme CYP3A4 metabolism. If a hormonal condition is causing erectile dysfunction, you may be referred to an endocrinologist.