The role of the endothelium in ED has been noted for a number of years and the overlapping of ED and other conditions, especially coronary heart disease, CVD, affecting endothelial function/dysfunction, is clearly present. The endothelial cell is now known to affect vascular tone and impact the process of atherosclerosis, and impacting ED, CVD and peripheral vascular disease.16
While pills for ED are convenient, some men sustain stronger erections by injecting medication directly into the penis. Drugs approved for this purpose work by widening the blood vessels, causing the penis to become engorged with blood. Another option is inserting a medicated pellet into the urethra. The pellet can trigger an erection within 10 minutes.
I have no idea why your boyfriend's junk is stuck in the junkyard. He's just 25, in the prime of his penis. It's fairly rare for a guy that young to go from instant erection to shy willy. One study found that just 2 percent of men experienced erectile dysfunction before the age of 40. If it's a short-term thing, it could be simple: Maybe he just needs to get more sleep or have fewer drinks.
Did you know that erectile dysfunction precedes coronary artery disease in almost 70 percent of cases.2 The arteries in the penis are smaller than those that cause heart disease symptoms, which means they are likely to be affected by blockages sooner. When the arteries in the penis are blocked, keeping an erection will be difficult regardless of your level of arousal.
Neurologic impotence is suggested by the absence of sensation in the sacral dermatomes when tested by pinprick, or by neurologic abnormalities elsewhere. The bulbocavernosus reflex may be assumed to be present if anal sphincter tone is normal on rectal examination. If there is doubt, the reflex can be tested by pinching the glans penis and assessing sphincter contraction during the rectal examination.
The 1985 National Ambulatory Medical Care Survey indicated that there were about 525,000 visits for erectile dysfunction, accounting for 0.2 percent of all male ambulatory care visits. Estimates of visits per 1,000 population increased from about 1.5 for the age group 25-34 to 15.0 for those age 65 and above. The 1985 National Hospital Discharge Survey estimated that more than 30,000 hospital admissions were for erectile dysfunction.
To start with, ED is NOT in your head. You can’t simply will yourself to get an erection, no matter how much you try. Studies show over 80% of ED cases are caused by a treatable physical disorder. Diseases such as diabetes, high blood pressure, and high cholesterol are common causes. Even a perfectly healthy man can develop ED after a brain or spinal cord injury. ED can be a side effect of certain medications, too.  Read more on our Causes of ED page.
About six months ago, I was talking to another guy (I have a boyfriend) online, and I ended up sending him a topless pic of me. I have been with my man for almost five years, and I feel so guilty and stupid for doing it — not only because I'm dating someone, but also because it's a stupid thing to do anyway. I love my man so much, and I don't know what to do.
There are, as you listen to all of the advertisements, if your erection lasts for more than four hours, there are very, very unusual cases where that can happen. There are very rare cases of visual problems. There are even rarer cases of hearing problems. But with every medication, there always a potential downside. But the absolute contraindication is an unstable medical condition, an unstable cardiovascular condition, being on nitrates.

A device involving a plastic cylinder and pump is used to make blood rush to your penis, enlarging it in a similar way to an instant erection. When you remove the pump, the erection is sustained by slipping a tension ring around the base of the penis. Sounds awful. I don't think you will tell your partner to "please hold on for 20 minutes, I need to put my vacuum pump on to get erect" or "how to get an erection without that magic pump?"
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
Psychotherapy and/or behavioral therapy may be useful for some patients with erectile dysfunction without obvious organic cause, and for their partners. These may also be used as an adjunct to other therapies directed at the treatment of organic erectile dysfunction. Outcome data from such therapy, however, have not been well-documented or quantified, and additional studies along these lines are indicated.

Damage to the autonomic pathways innervating the penis may eliminate "psychogenic" erection initiated by the central nervous system. Lesions of the somatic nervous pathways may impair reflexogenic erections and may interrupt tactile sensation needed to maintain psychogenic erections. Spinal cord lesions may produce varying degrees of erectile failure depending on the location and completeness of the lesions. Not only do traumatic lesions affect erectile ability, but disorders leading to peripheral neuropathy may impair neuronal innervation of the penis or of the sensory afferents. The endocrine system itself, particularly the production of androgens, appears to play a role in regulating sexual interest, and may also play a role in erectile function.


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Willful and capricious – erections are funny things. When you're a young man, they seem to pop up at the most inappropriate moments (and the only thing between you and embarrassment is a carefully placed notebook). As you get older, however, they go the other way, and fail to appear on demand no matter how much you try. The sad thing is, my patients often equate this with a loss of masculinity.
Pills such as Viagra® are the most common ED treatment, but they don’t work for everyone. Some guys find they cause bothersome headaches or persistent stomach troubles. Some have serious side effects such as chest pain and vision or hearing changes. Others don’t respond to the medication at all. And still others don’t like having to wait for the pill to take effect.
The appropriate evaluation of all men with erectile dysfunction should include a medical and detailed sexual history (including practices and techniques), a physical examination, a psycho-social evaluation, and basic laboratory studies. When available, a multidisciplinary approach to this evaluation may be desirable. In selected patients, further physiologic or invasive studies may be indicated. A sensitive sexual history, including expectations and motivations, should be obtained from the patient (and sexual partner whenever possible) in an interview conducted by an interested physician or another specially trained professional. A written patient questionnaire may be helpful but is not a substitute for the interview. The sexual history is needed to accurately define the patient's specific complaint and to distinguish between true erectile dysfunction, changes in sexual desire, and orgasmic or ejaculatory disturbances. The patient should be asked specifically about perceptions of his erectile dysfunction, including the nature of onset, frequency, quality, and duration of erections; the presence of nocturnal or morning erections; and his ability to achieve sexual satisfaction. Psychosocial factors related to erectile dysfunction should be probed, including specific situational circumstances, performance anxiety, the nature of sexual relationships, details of current sexual techniques, expectations, motivation for treatment, and the presence of specific discord in the patient's relationship with his sexual partner. The sexual partner's own expectations and perceptions should also be sought since they may have important bearing on diagnosis and treatment recommendations.
You may already know that lots of hard drugs — like cocaine, heroin, or Oxycontin — can cause sexual problems (though, quite frankly, if you're on cocaine, heroin, or Oxycontin, you have many more pressing concerns to deal with than getting dirrrty). But did you know that sometimes, even pot can inhibit erections? And you thought weed was just a harmless way to enjoy the musical stylings of Pink Floyd. Who knew it could actually mess with one's own pink floyd?
Endocrine evaluation consisting of a morning serum testosterone is generally indicated. Measurement of serum prolactin may be indicated. A low testosterone level merits repeat measurement together with assessment of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin levels. Other tests may be helpful in excluding unrecognized systemic disease and include a complete blood count, urinalysis, creatinine, lipid profile, fasting blood sugar, and thyroid function studies.
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Your erection problems may be putting a strain on your relationship. You may have stopped touching and cuddling your partner, scared that it could lead to sex - and then to disappointment because you cannot get hard. You may have found it has led to regular arguments. At its worst, erection problems can lead to the breakdown of relationships. So it is vitally important to talk things over with your partner.
#2 Physically exhausted. If you’ve been cranking it at the gym, haven’t been sleeping well, or you’ve been working your ass off at your job, getting tangled up with your lover for even more physically demanding activities may not sound ideal. Physical exhaustion has a direct effect on your ability to get aroused. The only fix for this one is to get some rest.

It is estimated that up to 20 million American men frequently suffer from impotence and that it strikes up to half of all men between the ages of 40 and 70. Doctors used to think that most cases of impotence were psychological in origin, but they now recognize that, at least in older men, physical causes may play a primary role in 60% or more of all cases. In men over the age of 60, the leading cause is atherosclerosis, or narrowing of the arteries, which can restrict the flow of blood to the penis. Injury or disease of the connective tissue, such as Peyronie's disease, may prevent the corpora cavernosa from completely expanding. Damage to the nerves of the penis, from certain types of surgery or neurological conditions, such as Parkinson's disease or multiple sclerosis, may also cause impotence. Men with diabetes are especially at risk for impotence because of their high risk of both atherosclerosis and a nerve disease called diabetic neuropathy.
To a significant degree, the public, particularly older men, is conditioned to accept erectile dysfunction as a condition of progressive aging for which little can be done. In addition, there is considerable inaccurate public information regarding sexual function and dysfunction. Often, this is in the form of advertisements in which enticing promises are made, and patients then become even more demoralized when promised benefits fail to materialize. Accurate information on sexual function and the management of dysfunction must be provided to affected men and their partners. They also must be encouraged to seek professional help, and providers must be aware of the embarrassment and/or discouragement that may often be reasons why men with erectile dysfunction avoid seeking appropriate treatment.
You may already know that lots of hard drugs — like cocaine, heroin, or Oxycontin — can cause sexual problems (though, quite frankly, if you're on cocaine, heroin, or Oxycontin, you have many more pressing concerns to deal with than getting dirrrty). But did you know that sometimes, even pot can inhibit erections? And you thought weed was just a harmless way to enjoy the musical stylings of Pink Floyd. Who knew it could actually mess with one's own pink floyd?
Erectile dysfunction (ED) is one of the most common conditions affecting middle-aged and older men. Nearly every primary care physician, internist and geriatrician will be called upon to manage this condition or to make referrals to urologists, endocrinologists and cardiologists who will assist in the treatment of ED. This article will briefly discuss the diagnosis and management of ED. In addition, emerging concepts in ED management will be discussed, such as the use of testosterone to treat ED, the role of the endothelium in men with ED and treating the partner of the man with ED. Finally, future potential therapies for ED will be discussed.
The appropriate evaluation of all men with erectile dysfunction should include a medical and detailed sexual history (including practices and techniques), a physical examination, a psycho-social evaluation, and basic laboratory studies. When available, a multidisciplinary approach to this evaluation may be desirable. In selected patients, further physiologic or invasive studies may be indicated. A sensitive sexual history, including expectations and motivations, should be obtained from the patient (and sexual partner whenever possible) in an interview conducted by an interested physician or another specially trained professional. A written patient questionnaire may be helpful but is not a substitute for the interview. The sexual history is needed to accurately define the patient's specific complaint and to distinguish between true erectile dysfunction, changes in sexual desire, and orgasmic or ejaculatory disturbances. The patient should be asked specifically about perceptions of his erectile dysfunction, including the nature of onset, frequency, quality, and duration of erections; the presence of nocturnal or morning erections; and his ability to achieve sexual satisfaction. Psychosocial factors related to erectile dysfunction should be probed, including specific situational circumstances, performance anxiety, the nature of sexual relationships, details of current sexual techniques, expectations, motivation for treatment, and the presence of specific discord in the patient's relationship with his sexual partner. The sexual partner's own expectations and perceptions should also be sought since they may have important bearing on diagnosis and treatment recommendations.

Nerve or spinal cord damage: Damage to the spinal cord and nerves in the pelvis can cause erectile dysfunction. Nerve damage can be due to disease, trauma, or surgical procedures. Examples include injury to the spinal cord from automobile accidents, injury to the pelvic nerves from prostate surgery for cancer (prostatectomy), and some surgeries for colorectal cancer, radiation to the prostate, surgery for benign prostatic enlargement, multiple sclerosis (a neurological disease with the potential to cause widespread damage to nerves), and long-term diabetes mellitus.


You get to decide what is normal for you. That might include him still experiencing pleasure from you touching his penis even if he’s not hard. Some men can still orgasm without an erection. Or he may prefer not to have any touching while he is dealing with his erection problems. It is okay for you to orgasm even if he doesn’t. Reading about what might bring you pleasure, or considering how you think about sex can make this something enjoyable to explore together.
Remember those cultural messages we discussed earlier, about how men are wild sex aliens from the planet Weenus? Well, men are raised hearing those messages, too, and they can end up screwing with their sexual self-image —for instance, they can lead men to obsess over their own virility, and panic about impressing a new partner, until they've thought their boner into a corner and can't get an erection. Performance anxiety is one of the most common culprits behind lost erections, especially among younger, less experienced men.
When stimulated by the nerves, the spongy tissue arranges itself in such a way that more blood can be stored in the penis. The veins running through the outer sheath of the penis then compress which stops the blood from leaving the penis. As the blood is stopped from flowing out, the penis fills with blood and stretches within the outer casing, giving an erection.
In addition, a man affected by lower testosterone may feel less sexually inclined, less interested in viewing sexual material, and less interested in physical activities. To add to this, a man dealing with less testosterone may also become less assertive, more inclined to stay in, and more likely to seek out medical help for his erectile dysfunction.
Martha K Terris, MD, FACS is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Institute of Ultrasound in Medicine, American Society of Clinical Oncology, American Urological Association, Association of Women Surgeons, New York Academy of Sciences, Society of Government Service Urologists, Society of University Urologists, Society of Urology Chairpersons and Program Directors, and Society of Women in Urology

Vijay Bhat, MD is a board certified internal medicine physician who is passionate about providing quality medical care that’s affordable for patients. He believes that integrating technology and medicine can make healthcare efficient and more accessible. Throughout his training Dr. Bhat was involved with global health initiatives, providing care to underprivileged communities locally and overseas. He’s also been a strong proponent of quality improvement in the medical field. Dr. Bhat graduated with a BS from the University of California Berkeley, and received his medical degree from Stony Brook University in New York. He completed his residency in Internal Medicine at Rutgers Robert Wood Johnson.
It is common for a healthy older man to still want sex and be able to have sex within appropriate limitations. Understanding what is normal in older age is important to avoid frustration and concern. Older men and their partners often value being able to continue sexual activity and there is no age where the man is ‘too old’ to think about getting help with his erection or other sexual problems.
While studies are limited, it has been shown that male sexual dysfunction can also negatively impact the sexual function of female partners. A study comparing the sexual function of women with partners with erectile dysfunction to those without showed that sexual arousal, lubrication, orgasm, satisfaction, pain and total score were significantly lower in those who had partners with erectile dysfunction. Later in that study, a large proportion of the men with erectile dysfunction underwent treatment. Following treatment, sexual arousal, lubrication, orgasm, satisfaction and pain were all significantly increased. It was concluded that female sexual function is impacted by male erection status, which may improve following treatment of male sexual dysfunction.

If you have unstable heart disease of any kind, heart failure or unstable, what we call angina, contraindication to using the medications. All right? So if you’re in an unstable medical state, these medications are not a good idea. Now, there are relative issues. If you may be taking a blood pressure medicine or a medicine for your prostate which dilates your blood vessel a little bit– you know, the typical ones are what we call the alpha blockers– you may have an additive effect from the medication. But for the most part, the medicines are incredibly safe.
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