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.

A lot of guys don’t want to admit it, but not being able to get or keep an erection happens more often than you’d think. Guys usually have trouble getting or keeping an erection when they’re nervous, scared or worried about something. They might be worried about how they’ll “perform,” or they could be feeling guilty about having sex. They might be afraid of getting a sexually transmitted disease (STD), or, if they are with a girl, getting their partner pregnant. Drugs (including some anti-depressants) and alcohol can also prevent you from getting and/or maintaining an erection.
Conditions associated with reduced nerve and endothelium function (eg, aging, hypertension, smoking, hypercholesterolemia, and diabetes) alter the balance between contraction and relaxation factors (see Pathophysiology). These conditions cause circulatory and structural changes in penile tissues, resulting in arterial insufficiency and defective smooth muscle relaxation. In some patients, sexual dysfunction may be the presenting symptom of these disorders.

Erectile dysfunction can occur as a side effect of medication taken for another health condition. Common culprits are high blood pressure meds, antidepressants, some diuretics, beta-blockers, heart medication, cholesterol meds, antipsychotic drugs, hormone drugs, corticosteroids, chemotherapy, and medication for male pattern baldness, among others.
Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor's OK. Medications for erectile dysfunction do not work in all men and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:
Thanks for your question, Frightened Turtle! To help answer it, we spoke with Dr. Darius Paduch, urologist and male sexual medicine specialist at New York Presbyterian/Weill Cornell Medical Center, and sex therapist Jenni Skyler, Ph.D., director of The Intimacy Institute for sex and relationship therapy in Boulder, Colorado. Here's what they had to say:
In order to establish whether normal erections are occurring overnight (nocturnal erections), the doctor may organise nocturnal penile tumescence (NPT) testing. This involves wearing a monitor overnight in your own home. The data from this monitor is then assessed to analyse how often erections occurred, how long they lasted, and how rigid and large the penis was during the erections. If NPT testing is normal, the cause of erectile dysfunction is usually psychological. If not, further testing of the blood flow in the genital area may be required to see if there is blockage or leakage. The doctor may also organise a blood test of levels of hormones such as testosterone, prolactin and thyroid stimulating hormone to see if these are contributing to the erectile dysfunction.

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Another potential new treatment consists of penile low-intensity shock wave lithotripsy. This consists of 1500 shocks twice a week for 3–6 weeks. The purpose is to stimulate neovascularisation to the corporal bodies with improvement in penile blood flow and endothelial function. The use of low-intensity shock wave lithotripsy may convert PDE5 inhibitor non-responders to responders.47
In other cases, men who habitually use alcohol or other drugs may experience similar results. Alcohol is a depressant to the central nervous system. This means that a little bit might be able to lighten the mood, but too much can basically shut down all communication between the brain and the penis. When this happens, no amount of will or stimulation will result in an erection. Other drugs can also affect the body’s ability to achieve an erection, including heroin and MDMA, otherwise known as ecstasy.
My name is John and i am happy today,because it has been a long time since i have this problem of weak erection and premature ejaculation,hope was lost because i cant even penetrate or erect,and a man that those not erect is not a man,but now i erect and i can now have sex any time any day,i was cured by a Doctor OLUMBA,so if you want to be strong and erect again you can contact him @ Email.drolumbaayi@gmail.com or call him @ +2347068002488.
It is necessary to identify the causes of worry and try to remove these. They could include concern about personal relationships, work, family problems, health or even sexual “performance” with a new or old partner. It is often said that the brain is the biggest sex organ of them all – if it is too busy with other things, it will not be involved in arousal and the erection that follows.
To reach the largest audience, communications strategies should include informative and accurate newspaper and magazine articles, radio and television programs, as well as special educational programs in senior centers. Resources for accurate information regarding diagnosis and treatment options also should include doctors' offices, unions, fraternal and service groups, voluntary health organizations, State and local health departments, and appropriate advocacy groups. Additionally, since sex education courses in schools uniformly address erectile function, the concept of erectile dysfunction can easily be communicated in these forums as well.
As blood flows into the penis, the corpora cavernosa swell, and this swelling compresses the veins (blood vessels that drain the blood out of the penis) against the tunica albuginea. Compression of the veins prevents blood from leaving the penis. This creates a hard erection. When the amount of cGMP decreases by the action of a chemical called phosphodiesterase type 5 (PDE5), the muscles in the penis tighten, and the blood flow into the penis decreases. With less blood coming into the penis, the veins are not compressed, allowing blood to drain out of the penis, and the erection goes down.
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.
Several pathways have been described to explain how information travels from the hypothalamus to the sacral autonomic centers. One pathway travels from the dorsomedial hypothalamus through the dorsal and central gray matter, descends to the locus ceruleus, and projects ventrally in the mesencephalic reticular formation. Input from the brain is conveyed through the dorsal spinal columns to the thoracolumbar and sacral autonomic nuclei.
Treatment. prostatitis or another acute infection affecting the genitalia can cause temporary impotence that clears up in response to antibiotics. The smooth muscle relaxant sildenafil (viagra) was introduced in 1998 as a treatment for organic impotence. Administration of testosterone may be indicated if low levels of this hormone are found in a blood sample. If impotence is organic and does not respond to other therapies, a penile prosthesis can be implanted; this is usually done surgically by a urologist. Other therapies include the use of vacuum tumescence devices and penile injection of pharmacologic agents that cause dilation.
Infection is a concern after placement of a prosthesis and is a reported complication in 8%-20% of men undergoing placement of a penile prosthesis. If a prosthesis becomes infected (redness, pain, and swelling of the penis and sometimes purulent drainage are signs of infection), the prosthesis must be removed. Depending on the timing and severity of the infection and your surgeon's preference, the area can be irrigated extensively with antibiotic solutions and a new prosthesis placed at the same time or removal of the infected prosthesis and an attempt to place a new prosthesis made at a later time when the infection is totally cleared.

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. 
Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualized by infusing a mixture of saline and x-ray contrast medium and performing a cavernosogram.[20] In Digital Subtraction Angiography (DSA), the images are acquired digitally.
ED means no erections from masturbation. According to the American Urological Association, ED is “the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.” Huh? That’s absurdly vague. If you define “an erection” as what you see in porn, and “satisfactory sexual performance” as porn sex—instant, hard-as-rock erections that last forever with climaxes always on cue—then just about every guy has ED. What is ED, really? For practical purposes, it means that a man who’s sober (no alcohol or other erection-impairing drugs) cannot raise even a semi-firm erection after extended masturbation.

The patient and partner must be well informed about all therapeutic options including their effectiveness, possible complications, and costs. As a general rule, the least invasive or dangerous procedures should be tried first. Psychotherapy and behavioral treatments and sexual counseling alone or in conjunction with other treatments may be used in all patients with erectile dysfunction who are willing to use this form of treatment. In patients in whom psychogenic erectile dysfunction is suspected, sexual counseling should be offered first. Invasive therapy should not be the primary treatment of choice. If history, physical, and screening endocrine evaluations are normal and nonpsychogenic erectile dysfunction is suspected, either vacuum devices or intracavernosal injection therapy can be offered after discussion with the patient and his partner. These latter two therapies may also be useful when combined with psychotherapy in those with psychogenic erectile dysfunction in whom psychotherapy alone has failed. Since further diagnostic testing does not reliably establish specific diagnoses or predict outcomes of therapy, vacuum devices or intracavernosal injections often are applied to a broad spectrum of etiologies of male erectile dysfunction.
Psychosexual counselling, or sex therapy, is an appropriate recommendation especially for men who are experiencing discord with their partner especially if the conflict is related to the man’s ED. Counselling usually consists of 5–20 sessions with counsellor. It is our recommendation that referral doctors treating men with ED make a referral to a psychotherapist or sex therapist who is certified by AASECT (American Association of Sexuality Educators, Counselors and Therapists) of certified sexuality educator.43
#9 Smokers hell. Bad stimulants such as smoking cigarettes may be having a negative impact on more than just your lungs. That’s right, smoking may lead to a lazy penis. One study shows that 40% of men that suffer from erectile dysfunction are smokers. The good news is that 75% of men reported erectile issues disappear after quitting smoking. What better motivation to quit smoking than having amazing sex? [Read: How to keep an erection up for longer in 20 ways]
My name is John and i am happy today,because it has been a long time since i have this problem of weak erection and premature ejaculation,hope was lost because i cant even penetrate or erect,and a man that those not erect is not a man,but now i erect and i can now have sex any time any day,i was cured by a Doctor OLUMBA,so if you want to be strong and erect again you can contact him @ Email.drolumbaayi@gmail.com or call him @ +2347068002488.
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 drugs are worth trying, but don’t expect miracles. Everyone has heard of Viagra, but Cialis is actually more popular because it’s effective longer—24 to 36 hours instead of three to five. Erection drugs improve erections in around two-thirds of men. They don’t work for about one-third. When they work, they do not produce porn-star erections. Over time, many men need larger doses. But as dosage increases, side effects become more likely, notably, headache and nasal congestion. Finally, the drugs have no effect on arousal, so men may raise erections but don't feel particularly interested in sex. Many men feel disappointed with the drugs. Fewer than half refill their prescriptions.

Although women tend to become more around by psychological stimuli, such as fantasies or romance novels, men tend to be more visual creatures, meaning they need to be able to actually see the object of arousal. Obviously, no two people are alike, so this is not a blanket statement, but scientific study after study over the years has shown this to be the norm.


Just as certain meds can make it difficult for men to have an orgasm, some can keep the flagpole from even getting raised in the first place. Anti-depressant medications like Prozac and Zoloft, anti-anxiety pills like Valium, high blood pressure medicine like Diuril, and even over-the-counter cold medicines like Sudafed and anti-heartburn pills like Zantac can inhibit erections.
If you’re no longer having intercourse, you don’t need erections. Most men assume that erections are necessary for sex. No. Couples can have great sex without them. Intercourse becomes problematic for older couples. Men have erection issues and post-menopausal women develop vaginal dryness and atrophy that can make intercourse uncomfortable (or worse) even with lubricants. Many older couples jettison intercourse in favor of mutual massage, oral sex, and sex toys—and still enjoy hot sex.
The vacuum device creates a vacuum to pull blood into the penis. Unlike a normal erection, the inflow of blood does not continue once the individual removes the vacuum device. The rubber band placed at the base of the penis constricts the penis to prevent the blood from leaving the penis. As there is no inflow or outflow of blood when the rubber band is in place, it is uncommon for the tip of the penis (the glans) to appear a little blue and the penis to be cooler. Once intercourse is completed, the individual removes the rubber band and the blood drains out of the penis.
Uncooperative boners might be related to low testosterone, which could be caused by anything from being overweight or stressed to having a chronic health condition, says Paduch. And in men who have taken anabolic steroids, it's not uncommon for them to end up suppressing their natural testosterone production. If you abuse it over a long period of time, you can really mess with your natural testosterone levels, as well as your fertility and erectile function, he says.
My boyfriend, 25, can't get hard anymore!! He WANTS to have sex, but he just won't get hard, when just about a month ago he would get hard just by looking at me. We have been together for six months, and I'm starting to think he might be bored of me or that I'm the problem. He says it's not me at all. Our relationship is great, but I don't know what to do. Please help!!
Usually there will not be a specific treatment that will lead to the improvement of erectile dysfunction. However, there are treatments that will allow erections to happen and can be used to allow sexual activity to take place. There are three main types of treatments: non-invasive treatments such as tablet medicines and external devices (e.g. vacuum device); penile injections; or for men who have not had success with other treatments, surgery may be an option.
This statement is more than five years old and is provided solely for historical purposes. Due to the cumulative nature of medical research, new knowledge has inevitably accumulated in this subject area in the time since the statement was initially prepared. Thus some of the material is likely to be out of date, and at worst simply wrong. For reliable, current information on this and other health topics, we recommend consulting the National Institutes of Health's MedlinePlus http://www.nlm.nih.gov/medlineplus/.

When sexually stimulated there is a release of a chemical, nitric oxide (NO) in the blood vessels of the corpus cavernosum. The NO stimulates the production of a compound called cGMP, which causes relaxation of the smooth muscle in the blood vessels supplying the corpus cavernosum. PDE 5 is an enzyme that breaks down cGMP. By inhibiting the breakdown of cGMP by PDE5, these medications allow cGMP to build up in the penis. cGMP causes muscles in the corpora cavernosa of the penis to relax. When the muscle is relaxed, more blood can flow into the penis and fill the spaces in the penis. As the penis fills with blood, the veins in the penis are compressed, and this results a hard erection. When the effect on PDE5 decreases, the cGMP levels go down and the muscle in the penis contracts, causing less blood to flow into the penis and allowing the veins to open up and drain blood out of the penis.
Among the phenomena in the ageing man are a decrease in erectile function and testosterone levels. Add to these, increased risk for CVD, muscle wasting, decrease in bone density and libido, with all of these factors having an interplay with testosterone metabolism.33 Androgens play a key role in maintaining erectile function through four main mechanisms. Androgen deprivation has been shown to result in impairment of NO synthase release, altered PDE5 expression and activity, impaired cavernosal nerve function, and contribution to veno-occlusive disease in the penis.34 The role of testosterone replacement therapy (TRT) as a potential to improve erectile function in the man with ED remains an issue for patient and physicians who are comfortable treating androgen deficiency which include primary care physicians and specialists. Androgens are known to have a significant impact on the function of the smooth musculature within the corpus spongiosum.35
The observation that TRT enhances the efficacy of PDE5 inhibitors in hypogonadal men taking these therapies with suboptimal response to the PDE5 inhibitors alone has been reported.33 In addition, investigators have demonstrated that TRT in hypogonadal men can improve erectile function even without the benefit of PDE5 inhibitors.33 In addition, guidelines for managing ED in hypogonadal men by the European Association of Urology recommend controlling the man to a eugonadal state prior to initiation of PDE5 inhibitor therapy.36 Testosterone measurement consists of a serum specimen which should be ideally obtained in the morning because of the normal diurnal variation of testosterone which is at its peak in the morning. Since TRT is relatively safe, and men can potentially see an improvement in erectile function, it seems prudent to consider this issue when presented with a patient suffering from ED.

Years ago, the standard treatment for impotence was an implantable penile prosthesis or long-term psychotherapy. Although physical causes are now more readily diagnosed and treated, individual or marital counseling is still an effective treatment for impotence when emotional factors play a role. Fortunately, other approaches are now available to treat the physical causes of impotence.
Causes contributing to erectile dysfunction can be broadly classified into two categories: organic and psychologic. In reality, while the majority of patients with erectile dysfunction are thought to demonstrate an organic component, psychological aspects of self-confidence, anxiety, and partner communication and conflict are often important contributing factors.
That means that as an adult, you need to activate the opposing parasympathetic system through sexually exciting visuals, thoughts and touches to get an erection going. But this nerve transmission is disrupted if you're stressed, anxious or distracted. The latter because you simply don't develop enough total stimulation of your genitals to get an erection, and the former because stress and anxiety all increase adrenaline – a key transmitter in the inhibiting sympathetic nervous system. They quite literally sabotage your erection.
Although erectile dysfunction increases progressively with age, it is not an inevitable consequence of aging. Knowledge of the risk factors can guide prevention strategies. Specific antihypertensive, antidepressant, and antipsychotic drugs can be chosen to lessen the risk of erectile failure. Published lists of prescription drugs that may impair erectile functioning often are based on reports implicating a drug without systematic study. Such studies are needed to confirm the validity of these suggested associations. In the individual patient, the physician can modify the regimen in an effort to resolve the erectile problem.

“Cardiovascular exercise and weight resistance exercises increase a man’s testosterone, which helps ward off ED,” Gittens says. The problem is, your testosterone levels drop as you age. Your levels now as a 25-year-old will drop about 50 percent by the time you're 75, according to data from the Reviews of Urology. To keep your levels high, check out this testosterone-boosting workout.


Stanley A Brosman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Advancement of Science, American Association for Cancer Research, American College of Surgeons, American Medical Association, American Urological Association, Society for Basic Urologic Research, Society of Surgical Oncology, Society of Urologic Oncology, Western Section of the American Urological Association, Association of Clinical Research Professionals, American Society of Clinical Oncology, International Society of Urology, International Society of Urological Pathology


Obviously, there are worse problems than a guy saying "I love you" too often, but if it's a problem, it sounds like the two of you need to have a long conversation. You need to understand why he likes to say it so much: Is it because he's insecure or hoping to comfort you or just breathlessly in love? (Or some combination of the three?) And he needs to understand how it makes you feel. So, if it really bothers you, tell him why.
Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus.
Erection dissatisfaction can actually enhance lovemaking. The dark cloud of erection changes has a silver lining. Young couples often have problems because young men become aroused faster than young women. Young men are often all finished before young women have even started to get aroused. Post-50 erection changes slow men’s arousal process so their erotic pace more closely matches women’s. A slower pace allows plenty time for kissing, cuddling, and whole-body massage, all essential to most women’s enjoyment of sex. Seen in this light, for many older couples, erection dissatisfaction can be a gift.

In some cases, ED can be a warning sign of more serious disease. One study suggests ED is a strong predictor of heart attack, stroke, and death from cardiovascular disease. The researchers say all men diagnosed with ED should be evaluated for cardiovascular disease. This does not mean every man with ED will develop heart disease, or that every man with heart disease has ED, but patients should be aware of the link.
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