There are treatments available to help you to get and maintain an erection. In addition, making healthy changes to your lifestyle could help with impotence. Switching to a healthier balanced diet, taking more exercise and cutting down on or giving up alcohol and cigarettes could help you to see an improvement in sexual function. If you think that the problem may be related to stress or anxiety, counselling can also help.
The primary nerve fibers to the penis are from the dorsal nerve of the penis, a branch of the pudendal nerve. The cavernosal nerves are a part of the autonomic nervous system and incorporate both sympathetic and parasympathetic fibers. They travel posterolaterally along the prostate and enter the corpora cavernosa and corpus spongiosum to regulate blood flow during erection and detumescence. The dorsal somatic nerves are also branches of the pudendal nerves. They are primarily responsible for penile sensation. [10]
It's unlikely. Testosterone levels fall as you get older but they have to fall really low to cause erectile problems. Thus assessment for erectile dysfunction includes a testosterone blood test but only replacement if it is very low. Giving someone more testosterone than their body would have made, even at a young age, can cause blood clots due to blood thickening and even reversible infertility. So don't be tempted with homespun remedies.
Relationship problems can make it difficult for you to get or stay hard when you’re attempting to have sex with the person you’re in a relationship with. However, if you have this problem and you’re in a relationship that doesn’t mean your relationship is necessarily the reason. There are lots of other reasons you might not be able to get or stay hard (see above).
Half of all men between the ages of 40 and 70 will experience erectile dysfunction. While the problem doesn't cause heart disease, the two often occur together – study after study has shown that men with ED are dramatically more likely to develop heart disease and have a heart attack or stroke. One German study from 2010 found men with erectile dysfunction are twice as likely to die within the next two years as those without, prompting some experts to call the phenomenon "the canary in the trousers".
Associated morbidity may include various other male sexual dysfunctions, such as premature (early) ejaculation and male hypoactive sexual desire disorder. The NHSLS found that 28.5% of men aged 18-59 years reported premature ejaculation, and 15.8% lacked sexual interest during the past year. An additional 17% reported anxiety about sexual performance, and 8.1% had a lack of pleasure in sex. [51]
Yes, the vacuum device is effective. In fact, with use of the vacuum device, 88% of men will have an erection that is satisfactory for completion of sexual activity. The vacuum device may be the only therapy that is effective after the removal of a penile prosthesis. Patients also use vacuum devices as part of penile rehabilitation after radical prostatectomy to help preserve the tissue of the penis and prevent scarring within the penis and loss of penile length. Its use, however, is limited by the mechanical nature of it and the time taken to pump the device and apply the band. Sex partners may complain of the penis being cool to touch.
Recently, the US Food and Drug Administration (FDA) has issued a safety announcement regarding TRT. In part it reads ‘The benefit and safety of these medications have not been established. We are also requiring these manufacturers to add information to the labeling about a possible increased risk of heart attacks and strokes in patients taking testosterone.’37
ED is defined as the inability to achieve a full erection or the inability to maintain an erection adequate for sexual intimacy. Other types of sexual dysfunction such as premature ejaculation and low libido may occur; however, the most common and disruptive problem in men is ED. Although most men will experience periodic episodes of ED, these episodes tend to become more frequent with advancing age.
Look, ED can have many causes. Most of the time, it’s physiological. But there are also lots of psychological reasons why someone may experience ED. Treating ED isn’t all about medication. Dealing with some of these psychological issues can help you battle ED, too. I’m talking about depression, anxiety, loss of desire, sense of inadequacy, guilt, fatigue, anger, relationship dysfunction. Working through these types of psychological challenges can help you achieve the happy, healthy manhood you deserve.
JP graduated from University of California, Davis with a degree in Human Development. Prior to Lemonaid, JP worked in worker’s compensation case management, ensuring patients avoided permanent disability and adhered to medication guidelines to prevent medication overdose. She also spent time volunteering at pediatric occupational therapy clinics helping differently-abled children. She has a strong interest in mental health advocacy and believes that no matter the circumstance, everyone deserves the best quality of life possible. She joined the Lemonaid mission because she strongly supports the idea that healthcare should be both affordable and easily accessible to everyone. Outside of work, she enjoys DIY projects, anything crafty, live music and spending time with her dogs!
In some cases, nocturnal penile tumescence testing is performed to find out whether the man has erections while asleep. Healthy men usually have about four or five erections throughout the night. The man applies a device to the penis called a Rigiscan before going to bed at night, and the device can determine whether he has had erections. (If a man is able to have normal erections at night, this suggests a psychological cause for his impotence.)

The Prostate Cancer Prevention Trial was a landmark study by Thompson et al that prospectively assessed the time to developing CVD after the diagnosis of ED. There were 4247 men with no ED at study entry; 2420 developed incident ED (defined as the first report of ED of any grade) over 5 years. Those men that developed ED had a 1.45-fold higher probability of experiencing a CV event compared with men who did not develop ED.27


I always made sure to satisfy my woman first, from the start of our marriage. When I started having issues with ED a few years ago, I talked to her about it and asked for her to be understanding and also that I needed a lot of the things sexually that she had not really given me much of, regardless of how much pampering or pleasing I did for her. She agreed, but never really stepped it up despite me talking to her about it every few weeks trying to salvage my own interest in sex. I had chased her constantly for over 10 years, then after the psychological effects of ED took their toll and she never really followed through helping me, my sex drive just tanked. I stopped chasing her, then after a little while she slowly started wanting it enough to initiate. Even then, she still wants the same sex as before, without the things I want being a regular part of it. My sex drive is still very low, and I still make an effort, but I can tell that my interest in sex is just deteriorating every time I have an ED episode and feel my desires being neglected. Each time, it just makes me less interested in continuing to try "serve" her because she does not return the favor much. The idea of spending so much effort doing "other stuff" while my wants and desires are barely recognized makes sex sound as exciting as mowing the yard to me now days.
The first step in treating the patient with ED is to take a thorough sexual, medical, and psychosocial history. Questionnaires are available to assist clinicians in obtaining important patient data. (See Presentation.) Successful treatment of sexual dysfunction has been demonstrated to improve sexual intimacy and satisfaction, improve sexual aspects of quality of life, improve overall quality of life, and relieve symptoms of depression. (See Treatment.)
ED usually has a multifactorial etiology. Organic, physiologic, endocrine, and psychogenic factors are involved in the ability to obtain and maintain erections. In general, ED is divided into 2 broad categories, organic and psychogenic. Although most ED was once attributed to psychological factors, pure psychogenic ED is in fact uncommon; however, many men with organic etiologies may also have an associated psychogenic component.
In fact, one common reason many younger men visit their doctor is to get erectile dysfunction medication. Often, men with erectile dysfunction suffer with diabetes or heart disease, or may be sedentary or obese, but they don’t realize the impact of these health conditions on sexual function. Along with erectile dysfunction treatment, the doctor may recommend managing the illness, being more physically active, or losing weight.

As with most other organ system in the human body, changes and loss of function is normal consequence of the ageing process. This is also true of the endocrine system, specifically the levels of testosterone production from the Leydig cells of the testicle. Accompanying the decrease in testosterone is a decrease in erections which also has a component in decrease in the blood supply to the penis making erection not as frequent and not as rigid compared with a young man’s erectile function. Although these changes are in itself not life threatening, they can impact a man’s relationship with his partner, and also ED may be a harbinger of other undiagnosed conditions such as coronary artery disease (CAD), hypercholesterolaemia or diabetes mellitus.6
What’s important to take away from this is that, because erections can occur throughout the day for no reason, erectile dysfunction can be difficult to diagnose. Some men achieve erections for no reason, yet when provided with stimuli, they aren’t able to. Some men, on the other hand, only get aroused when directly stimulated. This means that healthcare professionals need to take into account many variables prior to diagnosing and treating erectile dysfunction.
For many men, stopping smoking is an erectile dysfunction remedy, particularly when ED is the result of vascular disease, which occurs when blood supply to the penis becomes restricted because of blockage or narrowing of the arteries. Smoking and even smokeless tobacco can also cause the narrowing of important blood vessels and have the same negative impact. 
Conditions that may be associated with ED include diabetes, [25, 26, 27] hypertension, [28] , and CAD, as well as neurologic disorders, endocrinopathies, benign prostatic hyperplasia, [29] , sleep apnea [30] , COPD, [31] and depression (see Table 1 below). [32, 33, 34, 35] In fact, almost any disease may affect erectile function by altering the nervous, vascular, or hormonal systems. Various diseases may produce changes in the smooth muscle tissue of the corpora cavernosa or influence the patient’s psychological mood and behavior.
I always made sure to satisfy my woman first, from the start of our marriage. When I started having issues with ED a few years ago, I talked to her about it and asked for her to be understanding and also that I needed a lot of the things sexually that she had not really given me much of, regardless of how much pampering or pleasing I did for her. She agreed, but never really stepped it up despite me talking to her about it every few weeks trying to salvage my own interest in sex. I had chased her constantly for over 10 years, then after the psychological effects of ED took their toll and she never really followed through helping me, my sex drive just tanked. I stopped chasing her, then after a little while she slowly started wanting it enough to initiate. Even then, she still wants the same sex as before, without the things I want being a regular part of it. My sex drive is still very low, and I still make an effort, but I can tell that my interest in sex is just deteriorating every time I have an ED episode and feel my desires being neglected. Each time, it just makes me less interested in continuing to try "serve" her because she does not return the favor much. The idea of spending so much effort doing "other stuff" while my wants and desires are barely recognized makes sex sound as exciting as mowing the yard to me now days.
Prostate cancer isn’t considered a cause of ED on its own, but radiation treatments, hormone therapy, and surgery to remove the entire prostate gland can lead to difficulty in getting or keeping an erection. Sometimes erectile dysfunction related to prostate cancer treatment is only temporary, but many guys experience ongoing difficulties that need to be addressed by other means.
There are also alternative treatments, such as using a penis pump or a penile injection. Penis pumps work by creating a vacuum and thereby causing more blood to flow to your penis. Penile injections need to be used shortly before intercourse. They contain a medication which widens your blood vessels. A doctor’s prescription is needed for the injections.
Aging: There are two reasons why older men are more likely to experience erectile dysfunction than younger men. First, older men are more likely to develop diseases (such as heart attacks, angina, cardiovascular disease, strokes, diabetes mellitus, and high blood pressure) that are associated with erectile dysfunction. Second, the aging process alone can cause erectile dysfunction in some men by causing changes in the muscle and tissue within the penis.

Occasional successful sexual function and early morning erections do not preclude the possibility of endocrine dysfunction. Since abnormally low levels of testosterone frequently are the primary cause of impotence, it is recommended that determination of the blood level of testosterone be an integral part of the total evaluation of the impotent patient.
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The recommended starting dose of vardenafil is 10 mg taken orally approximately one hour before sexual activity. A doctor may adjust the dose higher or lower depending on efficacy and side effects. The maximum recommended dose is 20 mg, and the maximum recommended dosing frequency is no more than once per day. Patients can take vardenafil with or without food. As with sildenafil, for vardenafil to be effective, sexual stimulation must occur.
First realize that this is normal, and just because it happened once does not mean it will happen again (but freaking out about it could make it happen again). Then Skyler tells people to completely ditch the idea that sex is a goal-oriented act with orgasm being the big finish. Instead, take a pleasure-oriented mentality where various sex acts are done because they feel good — not because it's part of series of steps to get you to climax. This helps take away some of the anxiety, because when you're not so focused on the performance, it's not that big of a deal if there's a little bit of stage fright, she says. There's plenty of other things you can do while hanging out with a non-erect penis!
In one study, 9.6% reported ‘occasional’ erectile dysfunction, 8.9% reported erectile dysfunction occurring ‘often’, and 18.6% reported erectile dysfunction occurring ‘all the time’. Of these, only 11.6% had received treatment.In another study, only 14.1% of men reported that they had received treatment, despite experiencing erectile dysfunction for longer than 12 months.

Patients with both ED and cardiovascular disease who receive treatment with an oral PDE5 inhibitor require education regarding what to do if anginal episodes develop while the drug is in their system. Such education includes stressing the importance of alerting emergency care providers to the presence of the drug so that nitrate treatment is avoided.


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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