Surgery to repair arteries (penile arterial reconstructive surgery) can reduce impotence caused by obstructions that block the flow of blood to the penis. The best candidates for such surgery are young men with discrete blockage of an artery because of a physical injury to the pubic area or a fracture of the pelvis. The procedure is less successful in older men with widespread blockage of arteries.
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.

It is essential to discuss erectile dysfunction with your doctor, so any serious underlying causes can be excluded and treatment options can be discussed. Many men are embarrassed discussing this issue with their doctor, or even their partner. Open communication with your doctor, and in your relationship, is important for effectively managing this common problem.
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.
Let’s admit that not “talking about anything that could possibly be uncomfortable” is a sure-fire recipe for total disaster. Maybe you’re exaggerating, but if he can’t deal with anything even slightly difficult, then that is a bigger problem than pillow talk. Think about how exactly it would affect everything else in your relationship. He can’t choose not to deal. When good things are happening, it’s a shame he can’t say "I love you0". But when hard things happen, he can’t just say: "Um, pass."
The causes of erectile dysfunction include aging, high blood pressure, diabetes mellitus, cigarette smoking, atherosclerosis (hardening of the arteries), depression, nerve or spinal cord damage, medication side effects, alcoholism or other substance (drug) abuse, pelvic surgery including radical prostatectomy, pelvic radiation, penile/perineal/pelvic trauma such as pelvic fracture, Peyronie's disease (a disorder that causes curvature of the penis and sometimes painful erections), and low testosterone levels.
Effective treatment for erectile dysfunction is available, and for most men will allow the return to a fulfilling sex life. The side effects of the treatment for erectile dysfunction vary depending on the treatment that is used. Some may interrupt the spontaneity of sexual activity. For example, PDE-5 inhibitors typically need to be taken one hour before sex. Side effects may include headaches, indigestion, vasodilation, diarrhoea and blue tinge to vision. Other treatments such as penile injections may cause pain at the injection site, or an erection that will not go down. Treatment options need to be carefully discussed with your doctor to determine which one is best suited to you.

Impotence can have emotional causes but most often it is due to a physical problem. The physical causes of impotence include diseases (such as diabetes and hypertension), injuries (such as from prostate surgery), side-effects of drugs (such as the protease inhibitors used in HIV therapy), and disorders (such as atherosclerosis) that impair blood flow in the penis. Impotence is treatable in all age groups. Treatments include psychotherapy, vacuum devices, surgery and, most often today, drug therapy.
The most common inflatable prosthesis is the three-piece penile prosthesis. It is composed of paired cylinders, which doctors surgically insert inside the penis. Patients can expand the cylinders using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and pump, which doctors also surgically implant. The reservoir is usually in the pelvis. A doctor places the pump in the scrotum. By pressing on the pump, sterile fluid transfers from the reservoir into the cylinders in the penis. An erection is produced primarily by expansion of the width of the penis, however, one model can increase in length a small amount also. Lock-out valves in the tubing prevent the fluid from leaving the cylinder until a release valve is pressed. By pressing the relief valve and gently squeezing the penis, the fluid within the cylinders transfers back into the reservoir.
Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both cases, an intact neural system is required for a successful and complete erection. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems.[17] Spinal cord injury causes sexual dysfunction including ED. Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also be caused by prolonged exposure to bright light.
Your question reminds me of this brilliant Louis CK bit from his special Hilarious, in which he talks about a guy who said his appetizer was amazing. "Really? You were amazed by a basket of chicken wings? What if Jesus comes down from the sky and makes love to you all night long and leaves the new living lord in your belly? What are you going to call that? You used amazing on a basket of chicken wings! You've limited yourself verbally to a shit life."
#7 You’re way too distracted. It’s not exactly sexy to try and screw while your newborn/parents/relatives/friends are perched in the next room. If you’re distracted by a loud TV, knocks at the door, or your phone going off while you’re trying to go down on your partner, it’s going to make it an aggravating sexual experience. Not exactly ideal grounds for getting an erection.
For the past few months I’ve been dating a lovely man but our relationship is at risk because he can’t get it up. He says he fancies me and always seems turned on. Sometimes he gets hard - but when we try for sex he loses his erection. On the few occasions he has got hard, he doesn’t orgasm. I’ve always been a very sexual person and would like a lot of sex. We’re hardly having any. I find it difficult to orgasm even if he tries other things because I keep thinking. Why can’t he have proper sex with me?
Many common medications for treating hypertension, depression, and high blood lipids (high cholesterol) can contribute to erectile dysfunction (see above). Treatment of hypertension is an example. There are many different types (classes) of medications for high blood pressure; these include beta-blockers, calcium channel blockers, diuretics (medications that increase urine volume), angiotensin converting enzyme inhibitors (ACE inhibitors), and angiotensin receptor blockers (ARBs). Patients may use these medications alone or in combination to control blood pressure. Some of these medications can cause troubles with erections. For example, Inderal (a beta-blocker) and hydrochlorothiazide (a diuretic) cause erectile dysfunction, while calcium channel blockers and ACE inhibitors do not seem to affect erectile function. On the other hand, other medications (such as angiotensin receptor blockers [ARB] including losartan [Cozaar] and valsartan [Diovan]) may actually help with erections. Therefore, if possible, you may benefit from changing your medications, but this requires approval by your prescribing health care provider.
A rigid or nearly rigid erectile response to intracavernous injection of pharmacologic test doses of a vasodilating agent (see below) indicates adequate arterial and veno-occlusive function. This suggests that the patient may be a suitable candidate for a trial of penile injection therapy. Genital stimulation may be of use in increasing the erectile response in this setting. This diagnostic technique also may be used to differentiate a vascular from a primarily neuropathic or psychogenic etiology. Patients who have an inadequate response to intracavernous pharmacologic injection may be candidates for further vascular testing. It should be recognized, however, that failure to respond adequately may not indicate vascular insufficiency but can be caused by patient anxiety or discomfort. The number of patients who may benefit from more extensive vascular testing is small, but includes young men with a history of significant perineal or pelvic trauma, who may have anatomic arterial blockage (either alone or with neurologic deficit) to account for erectile dysfunction.
This inflatable penile prosthesis has 3 major components. The 2 cylinders are placed within the corpora cavernosa, a reservoir is placed beneath the rectus muscle, and the pump is placed in the scrotum. When the pump is squeezed, fluid from the reservoir is transferred into the 2 cylinders, producing a firm erection. The deflation mechanism is also located on the pump and differs by manufacturer.
Defined as experiencing difficulty having an erection at least 50 percent of the time, about 30 million men in the U.S. suffer from erectile dysfunction (ED), according to the National Institutes of Health. So, if odds are pretty good you’ll experience a failure to launch at some point in your life, take solace in this finding from the University of Adelaide: You can reverse ED by focusing on lifestyle factors, not just popping a blue pill.

Sildenafil is available as oral tablets at doses of 25 mg, 50 mg, and 100 mg. Patients should take sildenafil approximately one hour before sexual activity. In some men, the onset of action of the drug may be as early as 11-20 minutes. It's best for men to take sildenafil on an empty stomach for best results since absorption and effectiveness of sildenafil can be diminished if it is taken shortly after a meal, particularly a meal that is high in fat. Sildenafil and the other PDE5 inhibitors don't cause an immediate erection. Sexual stimulation is necessary for these medications to work.
This penile tumescence monitor is placed at the base and near the corona of the penis. It is connected to a monitor that records a continuous graph depicting the force and duration of erections that occur during sleep. The monitor is strapped to the leg. The nocturnal penile tumescence test is conducted on several nights to obtain an accurate indication of erections that normally occur during the alpha phase of sleep.
NO is produced by the enzyme NO synthase (NOS). [13] NOS plays many roles, ranging from homeostasis to immune system regulation. To date, 3 subtypes have been identified: nNOS, iNOS, and eNOS, which are produced by the genes NOS1, NOS2, and NOS3, respectively. This nomenclature is derived from the sources of the original isolates: neuronal tissue (nNOS), immunoactivated macrophage cell lines (iNOS), and vascular endothelium (eNOS). The subtypes are not, however, limited to the tissues from which they were first isolated.

If you're regularly having trouble getting or maintaining erection and it's not situation specific (for instance, this happens whether you're with a partner or alone or watching porn or whatever), it could be a tip-off to a physiological problem. Diabetes, high cholesterol, high blood pressure, and cardiovascular issues can all present with erectile problems, says Paduch. That's because basically anything affecting your nerves or blood flow can impact your boners.


Vardenafil and tadalafil belong to the same group of chemical compounds as sildenafil, namely phos-phodiesterase type 5 (PDE-5) inhibitors. Some men cannot benefit from sildenafil or the two newer PDE-5 inhibitors because they have low levels of nitric oxide. British investigators reported in late 2002 that three different types of compounds are being studied as possible medications for men with low levels of nitric oxide. They are Rho-kinase inhibitors, soluble guanylate cyclase activators, and nitric oxide-releasing PDE-5 inhibitors.
Accurate statistics are lacking on how many men are affected by the condition because it is often underreported, but it is estimated that about half of men over 40 in Canada have frequent problems achieving or maintaining an erection. The number of men suffering from erectile dysfunction increases with age, but it is not considered a normal part of aging. The majority of cases can be successfully treated.
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.
I'm a college guy who has only had sex a handful of times, and I've noticed a bit of a reccurring issue. During any foreplay and all that good stuff, I have a nice big erection, but as soon as I'm about to stick it in, the erection disappears like a frightened turtle. Then once the 30 seconds of embarrassing made-up explanations concludes, the erection is back.
Whenever I am prescribing a medication to a patient, I’m always asking myself, what can the patient do before requiring the medication? What changes do they have to make in order to reduce the amount of medication or preclude their even needing it? So a good candidate is somebody who has an understanding of a healthy lifestyle, about physical activity, about sleep, about nutrition, alcohol, smoking. So patients, individuals, have to do their share before they’re a candidate for anything. All right?
In diabetics, impotence that develops acutely in the setting of hyperglycemia and poor metabolic control is usually reversible. This is not true of the slowly progressive impotence of long-standing diabetes that is a manifestation of autonomic neuropathy. Intracavernosal self-injection of vasoactive drugs such as papaverine, which relaxes arteriolar smooth muscle is a promising new approach to treatment that is particularly suited for diabetic patients whose erectile dysfunction is on a neuropathic basis. It also has been used with success in spinal cord patients.
Along the same vein as stress, relationship troubles may also be at the root of some men’s erectile problems. Not trusting your partner, fears of birth control failure, or just genuinely not being emotionally attached to a partner could make it hard for a man to have an erection, The Huffington Post reported. Talking about issues within a relationship can help to resolve this problem.
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. 
One thing you need to know.  When you are experiencing anxiety, you get a stress response.  You can read more about this here.  A stress response is what you automatically feel, say, if a fight broke out near you.  Your body gets ready to protect itself.  During a stress response, blood is diverted away from less important areas to help your heart beat faster.

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 laboratory results should be discussed with the patient and, if possible, with his sexual partner. This educational process allows a review of the basic aspects of the anatomy and physiology of the sexual response and an explanation of the possible etiology and associated risk factors (eg, smoking and the use of various medications). Treatment options and their benefits and risks should be discussed. This type of dialogue allows the patient and physician to cooperate in developing an optimal management strategy.
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:
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Since you’re the talker, this is an argument that you’re going to have to win. Really let him know that you feel insecure and unloved when he doesn’t say “I love you.” Tell him it makes you worry about how he really feels when he doesn’t say anything. Tell him that it hurts you that he won’t step the slightest bit out of his comfort zone to say three words that would make you feel so much better. Let him know this doesn’t mean he has to suddenly get all lovey-dovey and give you a cheesy nickname and lay on the sugar so sweet your teeth rot, you adorable little honeybee — because then you might both puke. (I just threw up a little in my mouth myself while typing that.) But that’s not what you’re asking. Let him know you just want an “I love you” now and then. That’s not unreasonable. He doesn’t have to go overboard and you may not get the constant affirmation you prefer — but you can both compromise.
Everyone knows that regular exercise is good for the body and the mind, and in many cases, exercise can be good for relieving stress and helping men’s bodies produce more testosterone. In some cases, however, exercise can be detrimental. This is the case in cycling as long and regular rides can cause the nerves in the perineum to be compacted, leading to a loss of feeling in the penis and/or testicles. Over time, this nerve compaction and damage may lead to either erectile dysfunction or ejaculatory dysfunction.
While erectile dysfunction can occur at any age, the risk of developing erectile dysfunction increases with age. According to the Massachusetts Male Aging Study, the prevalence of erectile dysfunction was 52% in men 40-70 years of age. The prevalence of complete erectile dysfunction increases from 5% at 40 years of age to 15% among men 70 years of age and older.
Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley dropped his trousers and demonstrated to a shocked Urodynamics Society audience his papaverine-induced erection.[32] The drug Brindley injected into his penis was a non-specific vasodilator, an alpha-blocking agent, and the mechanism of action was clearly corporal smooth muscle relaxation. The effect that Brindley discovered established the fundamentals for the later development of specific, safe, and orally effective drug therapies.[33][better source needed][34][better source needed]
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

For example, many men with diabetes mellitus may develop erectile dysfunction during their young and middle adult years. Physicians, diabetes educators, and patients and their families are sometimes unaware of this potential complication. Whatever the causal factors, discomfort of patients and health care providers in discussing sexual issues becomes a barrier to pursuing treatment.
Constriction of the trabecular smooth muscle and helicine arteries induced by sympathetic innervation makes the penis flaccid, with blood pressure in the cavernosal sinuses of the penis near venous pressure. Acetylcholine is thought to decrease sympathetic tone. This may be important in a permissive sense for adequate trabecular smooth muscle relaxation and consequent effective action of other mediators in achieving sufficient inflow of blood into the lacunar spaces. When the trabecular smooth muscle relaxes and helicine arteries dilate in response to parasympathetic stimulation and decreased sympathetic tone, increased blood flow fills the cavernous spaces, increasing the pressure within these spaces so that the penis becomes erect. As the venules are compressed against the tunica albuginea, penile pressure approaches arterial pressure, causing rigidity. Once this state is achieved, arterial inflow is reduced to a level that matches venous outflow.
#6 It’s performance anxiety. Many men suffer from performance anxiety, and that’s another reason you can’t get hard. Simply put, you’re too nervous to get your dick up. And that’s okay, it happens! This is likely to happen if you haven’t had sex in a while or if you’re starting up with a new partner. Sex is supposed to be fun, but worrying over your prowess between the sheets can make sex the exact opposite of what’s it’s supposed to be. [Read: 13 ways to overcome sexual anxiety and perform]
Sildenafil is available as oral tablets at doses of 25 mg, 50 mg, and 100 mg. Patients should take sildenafil approximately one hour before sexual activity. In some men, the onset of action of the drug may be as early as 11-20 minutes. It's best for men to take sildenafil on an empty stomach for best results since absorption and effectiveness of sildenafil can be diminished if it is taken shortly after a meal, particularly a meal that is high in fat. Sildenafil and the other PDE5 inhibitors don't cause an immediate erection. Sexual stimulation is necessary for these medications to work.
Ingredients: water, helianthus (sunflower) seed oil, glycine soya (soy) bean oil, stearic acid, sodium bicarbonate, citric acid, methyl salicylate, cetearyl alcohol, aloe barbadensis leaf juice, camellia sinensis (green tea) leaf extract, l-arginine, panax ginseng extract, muira puama extract, lamium album (white nettle) extract, serenoa serrulata (saw palmetto) fruit extract, lepidium meyenii (maca) root extract, erthroxylum catauba extract, rosmarinus officinallis (rosemary) leaf extract, citrus grandis (grapefruit) seed extract, lecithin, methylparaben, propylparaben, tocopheryl acetate (vitamin E), ascorbyl palmitate (vitamin C), zinc oxide, methyl nicotinate, xanthum gum, fragrance.

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.

My fiancé and I have been together for four years, and while we've had our ups and downs, we're in a good place now and looking forward to our life together. Throughout our relationship, we've made some bad financial decisions. Since I'm the one with the credit cards (his credit is awful), I'm the one that's more affected. We're trying to dig ourselves out of this hole, and he does pay a good portion of the bills, but I recently found out he didn't pay even close to the amount he could have. Meanwhile, I'm basically spending my full paycheck trying to pay off my debts. When I asked about it, he said he didn't just want to "throw all of his money toward it," but that's exactly what I'm doing. Am I wrong to ask him to contribute more? He doesn't spend frivolously or anything, but I feel that we should focus on outstanding balances before trying to save money.


I think that a very powerful argument to young men who want to perform at the highest level is to point out the destructive nature of what they’re doing. If they’re having 18 drinks per week, if they’re having three, four, five drinks at any one time, they’re going to guarantee that their erections are not going to be at the highest level. I can’t tell you the number of men who come in saying, they went out, they had a date, they had a big dinner– which, by the way, is also not a great thing for erections, because all the blood is now going to your gut instead of to the genital area. And how important lifestyle changes are to improving your performance, as well, if not better, than the medications. So make certain that you exercise modestly, not excessively. Make certain that you have a smaller meal on an evening or a day that you want to have a sexual encounter, because you want the blood to go, once again, to the penile area and not to your gut. And really, the whole idea of stress– if you’re stressed out, if you’re worried about a lot of things, if you’re distracted, you can’t initiate that psychic stimulus to your spinal cord and then ultimately to your penis. So stress management is incredibly important.
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