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Physiological oral mucosal melanin hyperpigmentation is very common in Blacks, in general is more frequent in darker-skinned than in lighter-skinned persons regardless of their race/ethnicity, and is most probably caused by genetically determined metabolic hyperactivity of oral melanocytes

Some patients are unaware of the presence of the pigmented macules while others report noting their appearance for weeks to years [26, 29, 32]

However, PDE5is require sexual arousal to work they facilitate an erection in response to arousal but do not create desire or arousal

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