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Estrogens increase the liver s ability to manufacture clotting factors. However, studies have shown that some heavy MDMA users experience problems that are long lasting, including confusion, depression, and problems with memory and attention. This might make you lose some of your erection, expanding the time it requires to climax. Bisoprolol increases effects of sildenafil by additive vasodilation. However, the addition of sildenafil to bosentan therapy did not result in any improvement in exercise capacity.