Ejaculatory incompetence, erectile difficulty, erectile dysfunction, erectile failure, frigidity–female Medtalk The inability to achieve or maintain a penile erection adequate for the successful completion of intercourse, terminating in ejaculation; penile erection is mediated by nitric oxide Epidemiology Prevalence of minimal, moderate, and complete impotence in the Massachusetts Male Aging Study was 52%; age is the most important factor; complete impotence ↑ from 5%–age 40 to 15%–age 70; for an erection to achieve a successful outcome, it requires
Physical examination should include the assessment of male secondary sex characteristics, femoral and lower extremity pulses, and a focused neurologic examination including perianal sensation, anal sphincter tone, and bulbocavernosus reflex. More extensive neurologic tests, including dorsal nerve conduction latencies, evoked potential measurements, and corpora cavernosal electromyography lack normative (control) data and appear at this time to be of limited clinical value. Examination of the genitalia includes evaluation of testis size and consistency, palpation of the shaft of the penis to determine the presence of Peyronie's plaques, and a digital rectal examination of the prostate with assessment of anal sphincter tone.
The lab testing obtained for the evaluation of erectile dysfunction may vary with the information obtained on the health history, physical examination, and recent lab testing. A testosterone level is not necessary in all men; however, a physician will order labs to determine a patient's testosterone level if other signs and symptoms of hypogonadism (low testosterone) such as decreased libido, loss of body hair, muscle loss, breast enlargement, osteoporosis, infertility, and decreased penile/testicular size are present.
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.
The inability to achieve or sustain a sufficiently firm penile erection (tumescence) to allow normal vaginal sexual intercourse. The great majority of cases are not caused by organic disease and most men experience occasional periods of impotence. It is often related to anxiety about performance and is usually readily corrected by simple counselling methods which prescribe sensual massage but forbid coitus. Organic impotence may be caused by DIABETES, MULTIPLE SCLEROSIS, spinal cord disorders and heart disease. Many cases can be helped by the drug SILDENAFIL (Viagra).
None of the ED drugs is safe to take with cardiac drugs called nitrates because it could cause a dangerous drop in blood pressure. Drugs that many men take for urinary symptoms, called alpha blockers, can also lower blood pressure, so take them at least four hours apart from ED drugs. Your doctor may start you on a smaller dose of the ED drug if you already take an alpha blocker, or may recommend the alpha blocker tamsulosin (Flomax), which affects blood pressure less.
But he may have a real problem. Generally, erectile dysfunction is linked to cardiovascular health. If your guy has serious health problems, drinks and smokes too much, or does too many drugs, those conditions may play a role. Obesity, heart disease, prescription medications, and diabetes are just a few of the common risk factors. And then there are the psychological causes: depression, stress, and the million things flashing through his head when he's struggling to get it on.

Most bouts of ED can be explained away by stress, anxiety, or nervousness. If erectile dysfunction becomes frequent, don’t panic, but cover your bases by seeing a doctor to rule out scarier causes like diabetes or prostate cancer. Medications like antidepressants can also cause boner loss. Unless you can’t get it up after a date because you spent the day snorting coke and fucking your ex (in which case figure some shit out before you see other people) this line places the blame on the stress of work and away from your partner. While a woman will usually be understanding, she may fear you can’t get hard because you’re not attracted to her. Ease these anxieties with this line. Even if work was great and you’re having trouble getting it up because of other stress, like a text from an ex or family shit you’re not ready to disclose, I’ll allow a little white lie in this instance.


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Smoking damages blood vessels, inhibiting blood flow throughout the body ... and I mean throughout the body. While studies have found that men with erectile problems only make up 20 percent of the general population, 40 percent of men with erectile problems are smokers. And a 2011 study of a group of male smokers with erectile problems found that 75 percent of them saw those erectile problems disappear after they quit.
Patients receiving penile prostheses should be instructed in the operation of the prosthesis before surgery and again in the postoperative period. The prosthesis usually is not activated until approximately 6 weeks after surgery, so as to allow the edema and pain to subside. The prosthesis is checked in the office before the patient begins to use it.
Psychological causes include depression, stress and anxiety. Men sometimes worry about getting a new sexual partner pregnant so do make sure you mention contraception. If the relationship is relatively new your partner might be nervous about ‘performing’. If they don’t manage to get an erection, this can add to the tension and pressure the next time and further compound the issue.
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.
There are hundreds of medications that have the side effect of ED and/or decreased libido. Examples of drugs implicated as a cause of ED include hydrochlorothiazides and beta-blocking agents. Medications used to treat depression, particularly the SSRIs such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly, Sarafem), fluvoxamine (Luvox, Luvox CR), paroxetine (Paxil, Paxil CR, Pexeva) and sertraline (Zoloft), may also contribute to ED.9 Bupropion (Wellbutrin) which has a predominant effect on blocking the reuptake of dopamine is an antidepressant with lower incidence of ED.10 The side effects of 5ARIs occurring in fewer than 5% of patients can include gynaecomastia, ED, loss of libido and ejaculatory dysfunction.11
A system for inserting a pellet of alprostadil into the urethra is marketed as MUSE. The system uses a pre-filled applicator to deliver the pellet about an inch deep into the urethra at the tip of the penis. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects of the preparation are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness of the penis due to increased blood flow; and minor urethral bleeding or spotting.
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. 
Male/Female Perceptions and Influences. The diagnosis of erectile dysfunction may be understood as the presence of a condition limiting choices for sexual interaction and possibly limiting opportunity for sexual satisfaction. The impact of this condition depends very much on the dynamics of the relationship of the individual and his sexual partner and their expectation of performance. When changes in sexual function are perceived by the individual and his partner as a natural consequence of the aging process, they may modify their sexual behavior to accommodate the condition and maintain sexual satisfaction. Increasingly, men do not perceive erectile dysfunction as a normal part of aging and seek to identify means by which they may return to their previous level and range of sexual activities. Such levels and expectations and desires for future sexual interactions are important aspects of the evaluation of patients presenting with a chief complaint of erectile dysfunction.
So what can you do to help things along a little?  Well, chances are it may sort itself out as you settle in to your relationship. But if it keeps happening and you see a future in the relationship, you need to talk about it, or it will soon become the elephant in the bedroom. Pick a time with no distractions and where nobody can overhear you. Tell them that you care about them and that you don’t need to rush things sexually. This can take the pressure off the need to perform. 
i was one's a man with the problem of weak erection,because of too much masturbation during my young age,until i saw the post of some persons testifying about one Dr Izu,who can cure the problem of weak erection,i also contacted him and he told me all i need to do.that was how i got the treatment,and now am cured permanently.am free again.Any one with such problem can also contact him on +2349038504409 or izujohn9@gmail.com

He can follow the common general physical advice: Sleep well, eat well, exercise, and moderate or abstain from drinking and drugs. He can also visit the doctor to see if there’s any medical reason for his condition (anything from heart disease to diabetes and obesity). Sometimes, impotence is a side effect of prescription drugs. If his anxiety is extreme, it never hurts to see a professional therapist. Whenever there’s even a chance of a medical problem, my advice is always: Why not check with a professional?
Tadalafil shares the common side effects of the PDE5 inhibitors, however, due to its effect on PDE11, another phosphodiesterase located in muscle, tadalafil has been associated with muscle aches. Back pain and muscle aches occur in less than 7% of men taking tadalafil and in most patients will go away without treatment within 48 hours. When treatment was necessary, acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) or naproxen (Aleve) were effective. Rarely do the muscle aches and back pain cause men to stop using tadalafil.
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Some men should not take PDE5 inhibitors. They can cause hypotension (abnormally low blood pressure that can lead to fainting and even shock) when given to patients who are taking nitrates (medications taken for heart disease). Therefore, patients taking nitrates daily should not take any of the PDE5 inhibitors. Nitrates relieve angina (chest pain due to insufficient blood supply to the heart muscle because of narrowing of the coronary arteries); these include nitroglycerine tablets, patches, ointments, sprays, and pastes, as well as isosorbide dinitrate and isosorbide mononitrate. Other nitrates such as amyl nitrate and butyl nitrate also are in some recreational drugs called "poppers."
Most bouts of ED can be explained away by stress, anxiety, or nervousness. If erectile dysfunction becomes frequent, don’t panic, but cover your bases by seeing a doctor to rule out scarier causes like diabetes or prostate cancer. Medications like antidepressants can also cause boner loss. Unless you can’t get it up after a date because you spent the day snorting coke and fucking your ex (in which case figure some shit out before you see other people) this line places the blame on the stress of work and away from your partner. While a woman will usually be understanding, she may fear you can’t get hard because you’re not attracted to her. Ease these anxieties with this line. Even if work was great and you’re having trouble getting it up because of other stress, like a text from an ex or family shit you’re not ready to disclose, I’ll allow a little white lie in this instance.
Erectile dysfunction is clearly a symptom of many conditions, and certain risk factors have been identified, some of which may be amenable to prevention strategies. Diabetes mellitus, hypogonadism in association with a number of endocrinologic conditions, hypertension, vascular disease, high levels of blood cholesterol, low levels of high density lipoprotein, drugs, neurogenic disorders, Peyronie's disease, priapism, depression, alcohol ingestion, lack of sexual knowledge, poor sexual techniques, inadequate interpersonal relationships or their deterioration, and many chronic diseases, especially renal failure and dialysis, have been demonstrated as risk factors. Vascular surgery is also often a risk factor. Age appears to be a strong indirect risk factor in that it is associated with an increased likelihood of direct risk factors. Other factors require more extensive study. Smoking has an adverse effect on erectile function by accentuating the effects of other risk factors such as vascular disease or hypertension. To date, vasectomy has not been associated with an increased risk of erectile dysfunction other than causing an occasional psychological reaction that could then have a psychogenic influence. Accurate risk factor identification and characterization are essential for concerted efforts at prevention of erectile dysfunction.

Maybe your performance issues stem from feelings of discomfort relating to something you've done. Are you having trouble performing because you're feeling uncertain about whether you really love your partner? Or because you feel like you crossed a line in terms of infidelity and now the guilt is tearing you up inside? Maybe your conscience is what's wreaking havoc with your sex.
Stiffy Solution: Luckily, alcohol-induced impotence (also known by the infinitely less classy alias "whiskey d*ck") is a totally temporary condition, one that should clear up as soon as your dude can once again walk a straight line and recite the alphabet backwards. If your dude has consistent erectile problems from consistently drinking too much, however, he should consider cutting down on the sauce, and possibly talking with a doctor.
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 nerves and endothelium of sinusoids and vessels in the penis produce and release transmitters and modulators that control the contractile state of corporal smooth muscles. Although the membrane receptors play an important role, downstream signaling pathways are also important. The RhoA–Rho kinase pathway is involved in the regulation of cavernosal smooth muscle contraction. [12]
Your ability to orgasm is not connected to the prostate gland, although a man who has had a radical prostatectomy will have a dry orgasm with no ejaculation. As long as you have normal skin sensation, you should be able to have an orgasm with the right sexual stimulation. This means that treating your ED will allow you to resume a normal, healthy sex life.
The health care provider will ask about the firmness and duration of erections at different times (e.g., sex with partners, erections after sleep). Discussing sexual dysfunction with a health care provider is very important because many conditions causing it can be successfully treated. If a man has no diseases that cause ED and can have an erection with masturbation or early morning awakening, he likely has ED due to psychological causes.
However, men are affected psychologically when it comes to achieving erections. For instance, if a man is with a woman for the first time, or even before he feels comfortable with her, he may suffer from performance anxiety. In such a situation, his mind and body are both saying yes, but then they become out of sync. The body is then saying yes, but the mind is filled with question. “Will I be able to perform?” “How long will I last?” “Am I big enough to satisfy her?” “Is she looking at that mole on my stomach?” All kinds of questions may be going through a man’s mind upon getting in bed, and these can be distracting, they can lead to self-doubt, and therefore, failure to achieve or maintain an erection.
Prevention of some of the causes that contribute to the development of erectile dysfunction can decrease the chances of developing the problem. For example, if a person decreases their chances of developing diabetes, heart disease, and hypertension, they will decrease their chances of developing erectile dysfunction. Other things like stopping smoking, eating a healthy diet (heart healthy with adequate vitamin intake), and exercising daily may reduce a person's risk.
Ejaculatory incompetence, erectile difficulty, erectile dysfunction, erectile failure, frigidity–female Medtalk The inability to achieve or maintain a penile erection adequate for the successful completion of intercourse, terminating in ejaculation; penile erection is mediated by nitric oxide Epidemiology Prevalence of minimal, moderate, and complete impotence in the Massachusetts Male Aging Study was 52%; age is the most important factor; complete impotence ↑ from 5%–age 40 to 15%–age 70; for an erection to achieve a successful outcome, it requires

early 15c., "physical weakness," also "poverty," from Middle French impotence "weakness," from Latin impotentia "lack of control or power," from impotentem (nominative impotens); see impotent. In reference to a want of (male) sexual potency, from c.1500. The figurative senses of the word in Latin were "violence, fury, unbridled passion." Related: Impotency.

Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject Impulse, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include papaverine, alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).
As a retired police Sgt. Mid 50's I always had a few anxiety or medicine related ED' s but those were women that didn't matter and I always made sure to have a laugh and good time. Now Been with one great women 16 years. Now I'm heavy, drink more than I should, take pain med for chronic pain and watch tv. Anyone here recognize this. how about those recreational drugs I don't do. Before complaining do what I just started. Lose weight, stop reading this and shut off the tv, STOP smoking, go to the Dr. Get blood work done, talk to someone even or especially your better half, talk to and trust your Dr. Trust me, he's heard much worse. Trust that inner voice or gut, it's there for you. And mostly stop saying what about me and my winky, and take care of the other one who loves, cleans, sleeps and whatever else he/she does For u. This won't work for all but I know somehow it will help... AND YOU MIGHT BE DAMN SURPRISED!!!
In prescribing sildenafil, a doctor considers the age, general health status, and other medication(s) the patient is taking. The usual starting dose for most men is 50 mg, however, the doctor may increase or decrease the dose depending on side effects and effectiveness. The maximum recommended dose is 100 mg every 24 hours. However, many men will need 100 mg of sildenafil for optimal effectiveness, and some doctors are recommending 100 mg as the starting dose.
Before delving into the causes and solutions to erectile dysfunction, it’s first important to understand how erections work. The penis is mostly comprised or fibrous tissue that fills with blood upon arousal. This is what causes an erection, and after arousal is finished, blood drains back out into the body and the penis becomes flaccid. Men can have erections for no discernible reason throughout the day, but when sexual stimulation occurs, rather through contact, visual, audible, or mental stimulation, the potential for achieving an erection increases.

It is important that physicians and other health care providers treating patients for chronic conditions periodically inquire into the sexual functioning of their patients and be prepared to offer counsel for those who experience erectile difficulties. Lack of sexual knowledge and anxiety about sexual performance are common contributing factors to erectile dysfunction. Education and reassurance may be helpful in preventing the cascade into serious erectile failure in individuals who experience minor erectile difficulty due to medications or common changes in erectile functioning associated with chronic illnesses or with aging.


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.

What to do: Close your eyes and relax. If you're overly nervous, you may have triggered your sympathetic nervous system, the so-called "fight or flight" reaction your body has in intense situations. This can prevent you from having an erection for between five and 15 minutes. So go back to the foreplay stage. Kiss passionately. Caress. Perform oral sex. Don't rush things. Let your instinct take over. Remember; she's a person, just like you. 

Diabetes is an example of an endocrine disease that can cause a person to experience impotence. Diabetes affects the body’s ability to utilize the hormone insulin. One of the side effects associated with chronic diabetes is nerve damage. This affects penis sensations. Other complications associated with diabetes are impaired blood flow and hormone levels. Both of these factors can contribute to impotence.
Erectile dysfunction is the inability to develop or maintain an erection that is rigid enough to allow penetration of the vagina, and therefore functional sexual intercourse. Generally, the term erectile dysfunction is applied if this occurs frequently (75% of the time) over a significant period if time (several weeks to months). If this is the case, the term impotence may also be used.
Erections are more complicated than you think. Your brain, nerves, heart, blood vessels, and a whole lot of hormones have to work together perfectly or nothing happens. It’s a lot to ask, and sometimes things break down. And while ED happens to most guys at some point in their lives, erectile dysfunction isn’t something you can just ignore and hope it goes away.
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