What is Erectile Dysfunction ?


Erectile dysfunction(ED) the persistent inability to attain or maintain penile erection sufficient for sexual intercourse, affects millions of men to various degrees.




How common is Erectile Dysfunction?


Most men have odd times when they cannot get an erection. For example, you may not get an erection so easily if you are tired, stressed, distracted, or have drunk too much alcohol. For most men it is only temporary, and an erection occurs most times when you are sexually aroused.


However, some men have persistent, or recurring,ED. It can occur at any age, but becomes more common with increasing age. About half of men between the age of 40 and 70 have ED. About 7 in 10 men aged 70 and above have ED.




Openly Discussing Erectile Dysfunction is The Only Way


Good sex is a sensual and indeed a spiritual experience; it rejuvenates your mind and body and increases your self-confidence. But sometimes sexual problems can make your life and your partners life turbulent and unstable. Today million of people across the globe are suffering with erectile dysfunction.
Formerly called impotence, erectile dysfunction was once a taboo subject. It was considered a psychological issue or a natural consequence of growing older. These attitudes have changed in recent years. It's now known that erectile dysfunction is more often caused by physical problems than by psychological ones, and that many men have normal erections into their 80s.
An occasional episode of erectile dysfunction happens to most men and is normal. As men age, it's also normal to experience changes in erectile function. Erections may take longer to develop, may not be as rigid or may require more direct stimulation to be achieved. Men may also notice that orgasms are less intense, the volume of ejaculate is reduced and recovery time increases between erections.




Erectile Dysfunction is an under-estimated problem


Some people have trouble speaking with their doctors about sex. But if you have ED, you should tell your doctor. ED can be a sign of health problems. It may mean your blood vessels are clogged. It may mean you have nerve damage from diabetes. If you don't see your doctor, these problems will go untreated.
Your doctor can offer several new treatments for ED. For many men, the answer is as simple as taking a pill. Getting more exercise, losing weight or stopping smoking may also help.




Erectile Dysfunction is Not an Inevitable part of Aging


Erectile dysfunction doesn't have to be a part of getting older. It's true that as you get older, you may need more stimulation (such as stroking and touching) to get an erection. You might also need more time between erections. But older men should still be able to get an erection and enjoy sex. Such problems contribute to loss of confidence and inadequacy.
Erectile dysfunction occurs in 5% of all males above 40 years of age and this percentage increases with advancing age. When erectile dysfunction proves to be a pattern or a persistent problem, it can interfere with a man's self-image as well as his and his partner's sexual life.
Erectile dysfunction may also be a sign of a physical or emotional problem that requires treatment. In the past, patients have underreported this problem because of embarrassment and the belief that little could be done to alleviate it. The availability and marketing of new therapies for erectile dysfunction have greatly increased public awareness of this problem. The word "impotence" may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm. An estimated 30 million American men have some degree of erectile dysfunction..


Talk to your Doctor about Erectile Dysfunction


Although it can be embarrassing to talk with your doctor about sexual issues, seeking help for erectile dysfunction can be worth the effort. Erectile dysfunction treatments ranging from medications to surgery can help restore sexual function for most men. Sometimes erectile dysfunction is caused by an underlying condition such as heart disease. So it's important to take erectile trouble seriously because it can be a sign of a more serious health problem.
If erectile dysfunction is more than a temporary, short-term problem, see your doctor. Your own doctor, or a doctor specializing in erectile dysfunction, can help you determine the underlying cause or causes of erectile dysfunction and then help you find the right type of treatment.
Minor abnormalities of the penis during erection are common. They usually aren't serious and don't require evaluation or treatment. However, an abnormality severe enough to interfere with sexual activity (erectile dysfunction) should be evaluated.
Although you might view erectile dysfunction as a personal or embarrassing problem, it's important to seek treatment.
In most cases, erectile dysfunction can be successfully treated. 


Also, see your doctor if the therapy or medication prescribed to treat erectile dysfunction isn't working for you. Don't try to combine medications or therapies on your own or make changes from prescribed doses.
Some people can talk with their doctors about sex. Others feel that sex is private. They do not want to share details with anyone. But if you have problems getting or keeping an erection, you have good reasons to talk to a doctor: your health and your quality of life.


Erectile Dysfunction is a  Growing Problem


Erectile dysfunction, or ED, can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining ED and estimating its incidence difficult. Estimates range in the tens of millions of men worldwide. The increase happened gradually, The availability of treatments such as vacuum devices and injectable drugs and the acceptability of  discussing erectile function has also contributed to the increase in the number of men diagnosed with this condition. The introduction of Viagra for treatment of Erectile Dysfunction in 1998 put the spotlight on what was originally a secretive diagnosis.
ED may have an identifiable physical cause or there may be no identifiable physical cause. The incidence increases with age: About 5 percent of 40-year-old men and 20% percent of 65-year-old men experience ED. But it is not an inevitable part of aging.
Normal erection depends on healthy nerves, blood vessels, muscles, and fibrous tissues, as well as on adequate blood levels of certain hormones, such as testosterone. Damage, injury, or malfunction in any of these areas can lead to erectile dysfunction. A number of physical factors such as disease or surgery, as well as psychological factors, can also cause erectile dysfunction. In the past it was believed that most cases of erectile dysfunction were due to psychological causes. But now we know that in most cases, especially in older men a physical cause can be identified.


Sexual Anatomy and Erectile Dysfunction


The penis consists of two parallel cylinders of erectile tissue, the corpora cavernosa, and a smaller, single ventrally placed cylinder, the corpus spongiosum, which surrounds the urethra and distally forms the glans penis. The corpora cavernosa are composed of a meshwork of interconnected cavernosal spaces lined by vascular endothelium. They share an incomplete septum that allows them to function as a single unit.


Blood flow is provided primarily by the cavernosal branches of the internal pudendal artery. Each branch divides into numerous terminal branches that open directly into the cavernous spaces. Venous drainage of the erectile bodies occurs via postcavernous venules that coalesce to form large emissary veins that pierce the tunica albuginea before draining into the deep dorsal vein.
Autonomic and somatic nerves innervate the penis. Parasympathetic nerve fibers originate from sacral segments of the spinal cord, while sympathetic nerves originate from lower thoracic and upper lumbar segments. Somatic sensory and motor fibers enter and leave the sacral cord and innervate the penis and the perineum via the pudendal nerve.


How does  erection and ejaculation occur?


Touch, sights, sounds, erotic memories, fantasies etc, cause sexual excitement.
These stimuli increase signal output from a part of the brain called the para-ventricular nucleus.
These signals then pass through special autonomic nerves in the spinal cord, the pelvic nerves and the cavernous nerves that run along the prostate gland to reach the corpora cavernosa and the arteries that supply them with blood.
In response to these signals, the muscle fibres in the corpora relax, allowing blood to fill the spaces between them.
Muscle fibres in the arteries that supply the penis also relax, and there is an eight-fold increase in blood flow to the penis. The increased blood flow expands the corpora, then stretches the surrounding sheath (the tunica).
As the tunica stretches, it blocks off the veins that take blood away from the corpora cavernosa. This traps blood within the penis, the pressure becomes very high and the penis becomes erect.
During an erection pressure in the penis is at least twice the pressure of blood in the main circulation. This is possible because the muscles of the pelvic floor contract around the base of the corpora cavernosa.
At orgasm, the signalling from the brain changes dramatically. There is a sudden increase in noradrenaline production from nerves in the genitalia. This seems to both trigger orgasm and contract the muscle fibres in the corpora cavernosa and their supplying arteries.
The pressure within the corpora drops, which also relaxes the tunica and so allows blood to flow out of the penis.
Hormones, blood vessels, nerves, and muscles must all work together to make an erection. Your brain starts an erection by sending nerve signals to the penis when it senses sexual stimulation. Touching may cause this arousal. Another trigger may be something you see or hear. It may be a sexual thought or dream.
The penis contains two chambers called the corpora cavernosa, which run the length of the organ . A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa.
Erection begins with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection is reversed.An erection occurs when blood is pumped into the penis and stays there, making it hard.             It   generally   happens  because  a  guy  is  thinking about sex,  or because his penis is being stimulated..
The result is that signals go down the nerves that lead from his spinal cord to his genitals. They tell the blood vessels which supply the penis to open up. Blood flows in and the organ 'blows up' like a balloon. A valve mechanism near the base of the penis keeps the blood from flowing out again - a least, until sex is over.


As you can see, getting an erection is a complex process. It's awfully easy for various factors to interfere with it - for instance, worry, tiredness, too much alcohol or in later life, narrowing of the blood vessels.


Nicotine is now known to narrow those vital blood vessels - which is why ED is much commoner in smokers.
But often, there is nothing physically wrong with men who develop ED.


The pressure from the expanding penis compresses the veins (blood vessels that drain the blood out of the penis) in the tunica albuginea, helping to trap the blood in the corpora cavernosa, thereby sustaining erection.
Erection is reversed when cGMP levels in the corpora cavernosa fall, causing the smooth muscles of the corpora cavernosa to contract, stopping the inflow of blood and opening veins that drain blood away from the penis. The levels of the cGMP in the corpora cavernosa fall because it is destroyed by an enzyme called phosphodiesterase type 5 (PDE5)


Why does ED occur?


ED is very common, and it occurs for a variety of reasons and at different ages.


Young men:
In younger males, the most frequent cause is anxiety - particularly nervousness about having sex, about causing a pregnancy, or about using a condom. A lot of men in this age group complain that they 'can't get on with a condom' because as soon as they try to put it on, they lose their 'stiffy'.


Middle aged men:
Common causes in this age group are overwork, stress, guilt and bereavement (ED often happens when a widowed man tries to form a new sexual relationship). A few cases are due to diabetes.
Older men:
In this group of men, ED gets commoner with increasing age.             
Nonetheless, 70 per cent of all 70-year-olds are sexually potent.


It is now clear that in a very high proportion of cases, the problem is due to deterioration in the blood vessels that carry blood into the penis.             


Research which was carried out in 2007 suggests that in addition there may often be deterioration in the arteries of the brain or the heart.


Heart Attacks and Erectile Dysfunction


In October 2008, leading sex expert Dr Geoffrey Hackett said in the British Medical Journal, 'Erectile dysfunction is the manifestation of vascular disease in smaller arteries, and can give a two to three year early warning of heart attack.'


Therefore older men with ED should take care to protect themselves against strokes and heart attacks - for example by keeping their blood pressure and cholesterol down.
You may be surprised to see that we have not listed 'lack of hormones' as a common cause of ED. In fact, lack of male hormone is pretty rare. However, it can occur particularly after severe injuries to the testicles, or to the base of the brain.


If you are tempted to go to one of the many private clinics that make a habit of diagnosing 'male hormone deficiency', and then charging huge sums of money for testosterone treatment, I suggest you think twice!


Risk factors for Erectile Dysfunction


A variety of risk factors can contribute to erectile dysfunction. They include:
Getting older.


As many as 80 percent of men 75 and older have erectile dysfunction. Many men begin to notice changes in sexual function as they get older. Erections may take longer to develop, may not be as rigid or may take more direct touch to the penis to occur. But erectile dysfunction isn't an inevitable consequence of normal aging. Erectile dysfunction often occurs in older men mainly because they're more likely to have underlying health conditions or take medications that interfere with erectile function.
Having a chronic health condition.


Diseases of the lungs, liver, kidneys, heart, nerves, arteries or veins can lead to erectile dysfunction. So can endocrine system disorders, particularly diabetes. The accumulation of deposits (plaques) in your arteries (atherosclerosis) also can prevent adequate blood from entering your penis. And in some men, erectile dysfunction may be caused by low levels of testosterone (male hypogonadism).


Taking certain medications. A wide range of drugs - including antidepressants, antihistamines and medications to treat high blood pressure, pain and prostate cancer - can cause erectile dysfunction by interfering with nerve impulses or blood flow to the penis. Tranquilizers and sleeping aids also can pose a problem. Certain surgeries or injuries. Damage to the nerves that control erections can cause erectile dysfunction. This damage can occur if you injure your pelvic area or spinal cord. Surgery to treat bladder, rectal or prostate cancer can increase your risk of erectile dysfunction.


Substance abuse. Chronic use of alcohol, marijuana or other drugs often causes erectile dysfunction and decreased sexual drive. Stress, anxiety or depression. Other psychological conditions also contribute to some cases of erectile dysfunction.
Smoking.


Smoking is a sure-fire way to kill your sex life. After all, who wants a smoked weiner? Tobacco smoke damages the arteries and veins to your penis.


Obesity.


Men who are obese are much more likely to have erectile dysfunction than are men at a normal weight. Not to mention the visual turn-off of shako-jello!


Metabolic syndrome.


A descriptive term for the unholy combination of belly fat, unhealthy cholesterol and triglyceride levels, high blood pressure, and insulin resistance.


Prolonged bicycling.


Prolonged pressure from a bicycle seat has been shown to compress nerves and blood flow to the penis, leading to temporary erectile dysfunction and penile numbness. Similar problems can occur from prolonged horse-riding.


Classification of Erectile Dysfunction


There are different levels of erectile dysfunction:


A total inability to achieve erection
The occasional ability to achieve erection
An inability to maintain erections
The ability to achieve erection, but inability to control ejaculation
Erectile dysfunction is divided into two etiologic categories: psychogenic and organic.


Most causes of erectile dysfunction were once considered to be psychogenic, but current evidence suggests that up to 80 percent of cases have an organic cause. Organic causes are subdivided into vasculogenic, neurogenic and hormonal etiologies.


Vasculogenic etiologies represent the largest group, with arterial or inflow disorders being the most common. Abnormalities of venous outflow (corporeal veno-occlusive mechanism) are much less common. Regardless of the primary etiology, a psychologic component frequently coexists.


The severity of erectile dysfunction is often described as mild, moderate or complete, although these terms have not been precisely defined. Erectile ability is just one aspect of normal male sexual function.




Male Sexual Response Cycle


The male sexual response cycle consists of four major phases:


(1) desire
(2) arousal (erectile ability),
(3) orgasm 
(4) relaxation.


Disorders and dysfunction may occur in one or more of these phases, and the clinician evaluating sexual function problems must clarify which phase is primarily responsible for the patient's symptoms.
Psychological problems, neurological problems, abnormalities in blood flow, damage to the genital organs, hormonal imbalance, and the use of drugs or medications - all can interfere with any of the four stages of normal sexual function.


Erectile dysfunction occurs when one or more of these factors persistently interfere with the ability to achieve and maintain an erection sufficient to complete sexual intercourse.


Erectile dysfunction is often called impotence. Some experts object to the term "impotence" because of its negative implications and lack of precise meaning.


The term "erectile dysfunction" is now used. Erectile dysfunction is defined as the inability to achieve or maintain an erection as part of the overall multifaceted process of sexual function. This definition deemphasizes intercourse as the essential or only aspect of sexual life and gives equal importance to other aspects of male sexual behavior.


At some time in their life, all men experience erectile problems. But for 30 million men in the United States, erectile dysfunction is a chronic, persistent problem.  Fewer than 5 percent of men with erectile dysfunction seek treatment for this condition.


Medical Conditions that Cause Erectile Dysfunction


The following conditions can cause erectile dysfunction
Diabetes.


High levels of blood sugar associated with diabetes can damage small blood vessels and nerves throughout the body, including those in and around the penis. Diabetes damages the nerve function and blood supply necessary to produce an erection. About 60 percent of men with diabetes develop erectile dysfunction.


Erectile dysfunction tends to develop 10-15 years earlier in diabetic men than among nondiabetic men.


The increased risk of erectile dysfunction among men with diabetes mellitus may be due to the earlier onset and greater severity of the hardening of the blood vessels and thereby reduces the delivery of blood to the penis.


When insufficient blood is delivered to the penis, it is not possible to achieve an erection.


Diabetes mellitus also causes erectile dysfunction by damaging both sensory and autonomic nerves, a condition called diabetic neuropathy.


Smoking cigarettes


This increases the risk of erectile dysfunction in diabetes. In addition to atherosclerosis and/or neuropathy causing ED in diabetes, many diabetic men develop muscle disease and as a consequence the muscles  in the corpora cavernosa do not work properly and this also leads to erectile dysfunction.


Atherosclerotic disease.


Atherosclerosis, which causes hardening and narrowing of the arteries, increases with age. Over time it can reduce blood flow to the penis and lead to erectile dysfunction. It accounts for most cases in men over 60 years of age.


Leaking veins.


When veins in the penis are not compressed during an erection, a vein can leak, leading to erectile dysfunction. A leak can be the result of injury, disease, or damage to the veins of the penis.


Neurological injuries or disorders.


Spinal cord and brain injuries, including stroke can cause erectile dysfunction when they interrupt the transfer of nerve impulses from the brain to the penis. Other neurological disorders, such as multiple sclerosis, Parkinson's disease, and Alzheimer's disease, may also result in erectile dysfunction.
Drugs.


There are hundreds of prescription medications that can contribute to erectile dysfunction. This includes blood pressure medications and psychiatric medications. Illegal drugs such as heroin and cocaine also can cause erectile dysfunction.


Hormonal imbalances.


Hormonal disorders are a relatively rare cause for erectile dysfunction.  Testosterone deficiency can lead to loss of sexual desire. Some types of tumors inside the head can cause high levels of a hormone called prolactin which in turn can lead to a drop in testosterone levels. Kidney and liver disease also cause hormonal disturbances.


Peyronie's disease.


Peyronie's disease causes inflammation of the penis with consequent scarring. The scarring produces a curvature of the penis causes erections to be painful.


Pelvic surgery.


With surgery of the colon, prostate, or bladder, the nerves to the penis may be damaged. These nerves can be permanently damaged in men who have undergone radiation therapy for prostate or bladder cancer. These nerves influence the firmness of the penis during erection.
Surgeons do try to spare nerve function during these procedures, with the hope that any sexual function problem will be temporary.
Usually it takes a year for erections to return. Even the return of partial erections is a hopeful sign that full recovery may occur.


Pelvic injury.


A minor injury to the pelvic area, including a fall or blow to the hip while participating in sports, or a very long bike ride, can sometimes numb the nerves around the penis and block their normal functioning.
A day of rest is usually enough time for the nerves to recuperate.
Psychological causes.


Even though most cases of erectile dysfunction are the result of physical factors, psychological factors should not be overlooked. The most common psychological cause of erectile dysfunction is performance anxiety, a man's fear that he will not be able to perform sexually. Anxiety may lead to an initial failure, which increases the anxiety, resulting in a cycle that leads to future failures to achieve an erection.
Stress, tension, depression, worry, guilt, and anger can also inhibit sexual performance. These psychological factors may occur secondary to and possibly as a result of the physical causes. They may magnify the impact of erectile dysfunction resulting from physical causes.






Premature Ejaculation


Many cases of sexual dissatisfaction are related to problems in the control of ejaculation or in the loss of sexual desire unrelated to achieving or maintaining an erection.


Premature ejaculation is ejaculation that occurs too early, usually before, upon, or shortly after penetration. This condition, also called rapid ejaculation, is the most common sexual dysfunction.


As many as 30 percent to 40 percent of men may have this problem. Even when rapid ejaculation is not defined by a man as a problem, it limits the sexual satisfaction of his partner.


Premature ejaculation is common among young males who fear having their sexual activities discovered or making their partner pregnant. Some young men find the sheer experience of touching a naked woman so overwhelming that they may ejaculate even before they can undress. In most men, ejaculatory control increases with sexual experience. Anxiety about sexual performance is a big factor in premature ejaculation.




Premature ejaculation can be the cause or symptom of a troubled marriage.  Lack of intimacy eventually creeps in. The humiliation of repeated premature ejaculation drives the man away from the woman eventually, no matter how accepting she is.  Some men try to prevent it from happening by using negative mental imagery such as images of pain or religious events. The fear of premature ejaculation can be even more dangerous than the premature ejaculation itself.


There is no agreed-upon amount of time that has to pass before an ejaculation is no longer considered premature. Some experts have used the number of thrusts and the partner's achievement of orgasm as criteria. As you yourself realize, 'premature' is what your partner considers as premature, not what your doctor quotes from a medical book.




No one is sure what causes premature ejaculation. Following in the new social trend of re-defining what is normal, some claim that this is not abnormal. Some experts like to point out that fast ejaculation is common in the animal world. But everyone agrees that what works for roosters is not necessarily ideal for humans. An underlying psychological cause should be considered for these men. In some cases inflammation of the prostate gland or a nervous system disorder may be involved.
Three different approaches are used to treat premature ejaculation. Counseling by a psychologist, psychiatrist, or sex therapist may be recommended by your doctor.




Success rates of counseling are difficult to evaluate, since therapists use a variety of methods to measure success. The second approach to treating premature ejaculation is behavior modification. A popular technique is the "stop-start" exercise.


The man receives sexual stimulation for a short period of time. He is allowed to have an erection but stimulation is stopped before he ejaculates. Then we wait till the erection subsides. This exercise is repeated numerous times. It is supposed to increase the amount of time that a man can maintain his erection without ejaculating. It is a somewhat frustrating exercise that needs the patience of a saint to make it work.




The third and most recently introduced treatment method is medication. Low doses of some antidepressants seem to produce a delay in the ejaculation response. While the potential benefits of these medications may be significant, there are some concerns that treatment may be offered without first evaluating the man's health history  and actual need for the medication.




Retarded Ejaculation


Retarded ejaculation is the inability to have an orgasm even with prolonged erection. An irrational fear of vaginal penetration or high anxiety provoked by the possibility of ejaculating in the presence of another person may cause this. This may be caused by blood pressure medications, tranquilizers, and antidepressants, as well as diabetes.  Behavioural modification therapy has been used by some doctors to treat this.


Retrograde Ejaculation


Retrograde ejaculation is a condition in which semen travels up the urethra toward the bladder instead of through the penis. This condition is seen with some spinal cord injuries, after removal of the prostate gland, or after bladder surgery. It does not have any negative effects on the man's health.


Loss of Desire / Libido


Loss of libido is a decrease in sex drive that occurs in both men and women. Nearly half of those seeking sex therapy have low libido. Most often, this common condition develops after years of normal sexual desire and activity. It may be caused by boredom, stress, depression, conflict with a partner, or changes in hormone levels. Often it is related to the increased use of medications, particularly in middle age.




A loss of libido may occur as a consequence of erectile dysfunction or it may precede erectile dysfunction. There is no "normal" amount of sexual drive or desire. Having less sexual desire than your partner does not indicate that you have a problem, only that there is a difference in how much sex each of you wants.




If loss of libido has become a problem in your relationship, it is important to seek a physician's help to rule out medical causes.


If psychological factors are involved, sex education, counseling, or behavioral therapy may help you and your partner communicate better and achieve a more intimate sexual relationship.




Decreased Orgasmic Intensity


Decreased orgasmic intensity is another symptom in men who have problems with sexual function. It is not quite the same as loss of libido because the man still has the same level of sexual desire, but he experiences the loss of or diminished sensation of pleasure usually associated with ejaculation.




Those who lose the sensation may lose interest in sex altogether. Others may become anxious, which often leads to erectile dysfunction.




The intensity of orgasm depends on many factors, including the setting in which sexual activity occurs, feelings toward the partner, the amount of fantasy and foreplay, the partner's physical response to stimulation, and the amount of time that has passed since the previous orgasm.
Partners who communicate during sex, including verbal communication about their deeper fantasies are able to achieve better orgasms. However this is not always possible since there is an invisible wall between most couples that prevents this kind of communication. This is especially a problem in cultures such as America and the Middle East.


Men with diabetes or with a neurological condition such as multiple sclerosis often experience decreased orgasmic intensity. With age, some loss of orgasmic intensity is normal.


Effects of Erectile Dysfunction


Erectile dysfunction, regardless of the cause, leads both sexual partners to experience a range of feelings and intense emotions, including a sense of hopelessness and low self-esteem. These feelings can reinforce a man's performance anxiety and create a cycle of repeated failures and increasingly negative feelings.


To overcome these feelings, both partners have to acknowledge the problem and communicate openly and honestly with each other. Because sexual performance is linked so strongly to a man's self-esteem, erectile dysfunction can be devastating not only to his sex life but also to his sense of self. Men with erectile dysfunction often develop feelings of inadequacy, embarrassment, or guilt, and may consider themselves unattractive to their partner.


The psychological effects of erectile dysfunction can invade other areas of a man's life as well, such as social interactions and job performance.
It is important for a man with erectile dysfunction to overcome the reluctance to talk with his partner and physician to determine effective treatment strategies.


Typically, the ED develops quite suddenly if it is a symptom of a mental health problem. The ED may resolve when your mental state improves. For example, if your anxiety or depression eases. However, some people become even more anxious or depressed when they develop ED. They do not realise it is a reaction to their mental health problem. This can make matters worse and lead to a 'vicious circle' of worsening anxiety and persisting ED.


As a rule, a psychological cause is more likely for the ED than a physical cause if there are times when you can get a good erection, even though most of the time you cannot. (For example, if you can get an erection by masturbating, or wake up in the morning with an erection.)




How is ED diagnosed?




Medical and sexual histories help define the degree and nature of ED. A medical history can disclose diseases that lead to ED, while a simple recounting of sexual activity might distinguish among problems with sexual desire, erection, ejaculation, or orgasm.


Using certain prescription or illegal drugs can suggest a chemical cause, since drug effects account for 25 percent of ED cases. Cutting back on or substituting certain medications can often alleviate the problem.




The history should include the frequency and duration of symptoms, the presence or absence of morning erections and the quality of the relationship with the sexual partner. The sudden onset of erectile dysfunction in association with normal morning erections or a poor relationship suggests psychogenic impotence.




A detailed medical history may reveal that the disorder is due to a chronic disease such as atherosclerosis, hypertension or diabetes mellitus. Inquiry about decreased libido and symptoms of hypothyroidism or hyperthyroidism may reveal a reversible cause




Because as many as 25 percent of cases of erectile dysfunction are due to medication side effects the patient's drug therapy should be reviewed. Common pharmacologic causes of this disorder include antihypertensive drugs, most notably the centrally acting agents, beta blockers and diuretics. Antipsychotic and antidepressant drugs are also frequently implicated. Other drugs that can cause erectile dysfunction include spironolactone (Aldactone), cimetidine (Tagamet) and finasteride (Proscar).


Excessive alcohol intake, heroin use and cigarette smoking are also known causes
A thorough history is the most important factor in the evaluation of the patient with erectile dysfunction. The initial step is to identify the patient's concern with his sexual function. Several studies have indicated that patients and providers are reluctant to address sexual topics. Physicians cite not knowing what questions to ask or how to ask them, feeling uncomfortable with the topic, awkwardness with sex language and fears of insulting the patient as reasons for their reluctance. However, evidence suggests that the vast majority of patients believe sexual function is an appropriate topic to be raised by their physician and are relieved when these topics are addressed
Sexual function can often be incorporated in the discussion when reviewing the effects of a patient's chronic medical problems or medication use. An effective technique in this setting is to ask "inform-then-probe" type questions. First, provide information about conditions that are commonly associated with sexual dysfunction, then follow with a question about the individual's concerns. For example, you could say "Many men (insert a condition that affects the particular patient, such as diabetes, hypertension, medication, recent heart attack, etc.) experience sexual problems. Has this happened to you?" This approach further educates the patient and reassures him that his symptoms are common.


The topic should be brought up in a non-threatening, non-confrontational manner, "Are you or your partner experiencing sexual problems?" More focused questions may provide information on the patient's sex life. This information may help assess the patient's sexual problems which otherwise remain un-seen and undiagnosed and untreated.




The International Index of Erectile Function (IIEF) is a valuable tool for defining the area of sexual dysfunction. The IIEF is designed to be a self-administered measure of erectile dysfunction. The IIEF also establishes a reliable baseline that can be used to monitor changes related to treatment. IIFF is based on your self scoring on the following questions:


How satisfied are you with Erectile Function?
How satisfied are you with your Intercourse experience?
How satisfied are you with your Orgasmic function?
How satisfied are you with your sexual desire?
How is your overall level of satisfaction with sex?




Physical Exam of Patient with Erectile Dysfunction




A physical examination can give clues to systemic problems. For example, if the penis is not sensitive to touching, a problem in the nervous system may be the cause.


Abnormal secondary sex characteristics, such as hair pattern or breast enlargement, can point to hormonal problems, which would mean that the endocrine system is involved.


The examiner might discover a circulatory problem by observing decreased pulses in the wrist or ankles. And unusual characteristics of the penis itself could suggest the source of the problem-for example, a penis that bends or curves when erect could be the result of Peyronie's disease.




During the physical examination, signs of hypogonadism, such as gynecomastia or the loss of axillary and pubic hair, should be noted.The genital examination should include an evaluation of the size and consistency of the testes.


The penis should be examined for any fibrosis and plaques indicative of Peyronie's disease.


Finally, the bulbocavernosus and cremasteric reflexes should be assessed to eliminate a neurologic cause of the erectile dysfunction. The bulbocavernosus reflex is elicited by squeezing the glans penis while observing for contraction of the external anal sphincter.


Laboratory Tests for Erectile Dysfunction




Several laboratory tests can help diagnose ED. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes.
Measuring the amount of free testosterone in the blood can yield information about problems with the endocrine system and is indicated especially in patients with decreased sexual desire.




The laboratory evaluation should be directed by the history and physical examination findings.




The patient should be screened for any undiagnosed medical disease that may be the underlying cause of erectile dysfunction.




A urinalysis, complete blood count and basic chemistry panel will help to rule out most metabolic and renal diseases.  In elderly men, because thyroid disease can present subtly, the thyroid-stimulating hormone level should be measured to rule out thyroid dysfunction. In one study of men who underwent an endocrinologic evaluation for erectile dysfunction, 6 percent were found to have hypothyroidism, and their erectile function improved with treatment.




Some authors advocate measuring prolactin and free testosterone levels as part of the initial evaluation.The value of this routine testing is uncertain, however, because the incidence of endocrinopathy presenting as erectile dysfunction is reportedly only 2 percent.


A reasonable strategy is to obtain a free testosterone level in all men aged 50 and older and in those younger than 50 who have symptoms or signs of hypogonadism such as decreased libido, bilateral testicular atrophy or a reduced amount of body hair.




The prolactin level should be measured if the free testosterone level is low, the patient has a substantial loss of libido or a prolactinoma is suspected on the basis of a history of headache with visual field cuts Measurement of luteinizing hormone levels can be reserved for use in distinguishing primary from secondary hypogonadism in men with low testosterone levels.




Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out certain psychological causes of ED. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then ED is likely to have a physical rather than psychological cause. Tests of nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be applied for best results.




Initial Treatment of Erectile Dysfunction


In all instances, medical conditions having an impact on erectile function should be corrected or their progression controlled.


However, treatment of these conditions does not guarantee the return of erectile function. Consideration should be given to discontinuation of any medication suspected of contributing to the erectile problem or, if required, switching to an alternative medication less likely to interfere with erectile function.


Patients and their partners should be educated about sexual issues and concerns. Discussing ways to enhance romance and caressing may help couples have more satisfying sex lives.




Patients with low testosterone and normal prolactin can be considered for testosterone replacement. Before the initiation of testosterone therapy, the patient should be evaluated for the possibility of an occult prostate malignancy, which may be stimulated by supplemental testosterone. Testosterone replacement may increase libido without improving erectile function.
Most patients with elevated prolactin levels can be managed medically, but some will require neurosurgical treatment.




Given the effectiveness of several treatment modalities (e.g., oral or intraurethral medication, vacuum constriction devices), it is reasonable to consider initiation of treatment for the remaining patients regardless of the erectile dysfunction etiology.


Patients with suspected vasculogenic or neurogenic causes can be considered for a trial of therapy in the primary care setting. Patients with a suspected psychogenic etiology should be considered for sexual counseling or psychiatric referral as well.




Patients requesting a more comprehensive evaluation or those not responding to initial therapy should be referred for further evaluation and treatment.


Diagnosing Erectile Dysfunction




It may be possible for a doctor to diagnose and treat erectile dysfunction in one visit, but follow-up visits may be necessary. Your doctor may want you to return to discuss results of blood tests or other tests - to make sure you understand as much as you can about your condition. Your doctor may also want to talk with your partner or discuss your treatment options with you. While a primary care doctor can usually diagnose and treat erectile dysfunction, in some cases consultation with a specialist such as a urologist or endocrinologist is necessary.
 


During your initial visit, your doctor will want to confirm the diagnosis of erectile dysfunction, assess the severity of the problem, and identify any treatable conditions that may be linked to your erectile problems - and find possible treatments for them. For most men, this can be done with a basic assessment. In some cases, more involved testing is needed.




To identify what's causing the problem and determine the best treatment for you, your doctor will ask detailed questions about your erectile function and sexual relationships. Talking in depth with your doctor about sex may make you feel anxious or embarrassed. But erectile dysfunction is a common medical condition, and doctors are used to discussing it. Your doctor may even ask directly if you're having any sexual issues during a visit for something else. But if you're having erectile problems, don't hesitate to bring up the issue yourself. Many men don't get the treatment they need because they're reluctant to talk to their doctor.




Your doctor will discuss your concerns and expectations, including why you're seeking help now for the problem, what you think the cause of your erectile dysfunction may be, and what you hope to gain from treatment. Your doctor may also want to get your partner's perspective - by asking you or by talking to your partner directly. Your doctor may have you fill out a questionnaire to help determine the cause of your erectile dysfunction or to assess whether treatment is working.
Your doctor may ask how long you've had the problem and how concerned you and your partner are about it. Your doctor may also ask if you have tried treatment for erectile dysfunction in the past. Your doctor will likely ask if you have had changes in sexual desire and how often you have intercourse.


Questions that your Doctor May Ask You


To help determine what's causing your erectile dysfunction, your doctor may ask:


If you can achieve self-stimulated erections
If you have spontaneous erections at night or when you wake up in the morning
Whether your erectile dysfunction started suddenly or developed over time
How long your erections last and how hard they are
Whether you can maintain an erection long enough to have sexual intercourse
If sex is painful for you


Your doctor will want to know if you have any chronic medical conditions, what medications you're taking, and may ask questions about your lifestyle, such as how much you drink and whether you use tobacco. These factors can all affect sexual function.




Health Conditions Linked to Erectile Dysfunction




Diabetes
Heart disease
Clogged arteries (atherosclerosis)
Prior surgeries
Low testosterone (hypogonadism)
Cancer
Psychological conditions such as depression
Medications
Some over-the-counter medications and herbal supplements
Heavy alcohol use
Too much caffeine
Tobacco use
Poor diabetes control
Damage to pelvic nerves caused by prolonged pressure from a narrow bicycle seat
Illicit drugs such as marijuana, MDMA (Ecstasy) and heroin
Use of narcotic pain medications such as codeine




The Role of Psychological Factors in Erectile Dysfunction




The mind plays an important role in sex - and in erectile function. In some cases, erectile dysfunction can have a psychological rather than a physical cause. If your doctor suspects your erectile dysfunction is linked to a psychological condition, you may need treatment for that condition or your doctor may refer you to a specialist such as a psychiatrist or counselor. Your doctor may want to see your partner as well, and may recommend that you both see a specialist. Signs that suggest your erectile dysfunction may be linked to a psychological problem include:


Your erectile dysfunction started suddenly rather than coming on gradually
Your erections subside early during sexual contact
You can achieve self-stimulated erections
You have spontaneous erections at night or when you wake up in the morning
You have premature ejaculation
You're unable to ejaculate
You have relationship problems
You have been going through stressful life events
You have symptoms of a psychological condition such as depression
You may need to see a specialist




Treatment Strategies for Erectile Dysfunction




If an underlying medical condition has been diagnosed, treatment of that disease is appropriate; however, therapy for chronic diseases such as diabetes, hypertension and atherosclerosis does not guarantee the return of erectile function.




Any evidence of hypogonadism, hypothyroidism or other endocrine causes should be thoroughly investigated and treated. As a risk factor for atherosclerosis and a common underlying cofactor, smoking should be avoided. If the patient smokes, methods of smoking cessation should be explored.




Consideration should be given to changing prescription drugs that could be contributing to the problem .
Many specific therapeutic options are now available for erectile dysfunction, with varying degrees of patient satisfaction. These include established nonpharmacologic treatments such as vacuum erection devices, penile prostheses or penile revascularization.


Referral to a psychologist or psychiatrist with expertise in sexual dysfunction may be beneficial for patients with psychogenic erectile dysfunction.




Medications used for Erectile Dysfunction




Oral medications available to treat ED include:
·        Sildenafil (Viagra)
·        Tadalafil (Cialis)
·        Vardenafil (Levitra)


All three medications work in much the same way. Chemically known as phosphodiesterase inhibitors, these drugs enhance the effects of nitric oxide, a chemical that relaxes muscles in the penis. This increases the amount of blood flow and allows a natural sequence to occur - an erection in response to sexual stimulation.




These medications don't automatically produce an erection. Instead they allow an erection to occur after physical and psychological stimulation. Many men experience improvement in erectile function after taking these medications regardless of the cause of their impotence.


These medications share many similarities, but they have differences as well. They vary in dosage, duration of effectiveness and possible side effects. Other distinctions - for example, which drug is best for certain types of men - aren't yet known. No study has directly compared these three medications.




Viagra, Levitra and Cialis are often the first treatment tried for erectile dysfunction - the inability to achieve or sustain an adequate erection for sexual activity. For most men with erectile problems, they work well and have few side effects. All three medications improve erectile function in the same basic way, but the effects of tadalafil (Cialis) last longer. This and a few other minor differences among these medications may make one a better choice over another for some men.




Viagra, Levitra and Cialis: How they work


Viagra, Levitra and Cialis increase levels of nitric oxide, a chemical produced by your body during sexual stimulation that causes blood vessels in the penis to relax and open. This allows you to achieve and maintain an erection. These medications don't automatically trigger an erection; sexual arousal is needed to start the whole process.


Which is best for you?




Viagra, Levitra and Cialis each have a slightly different chemical make up. These minor differences affect the way they work, such as how quickly they take effect and wear off; how they interact with other medications; and side effects. Your doctor will consider these factors when deciding if one of these medications is a good choice for you. Your doctor will also consider any other health problems you have and whether any of your current medications could cause problems when taken with Viagra, Levitra or Cialis.




Not safe for everyone




Although these erectile dysfunction medications can help many people, not all men can safely take them. Viagra, Levitra and Cialis may not be a good choice if you have:


Heart problems, including a recent heart attack, heart pain (angina) during sex, heart failure, heart rhythm problems (arrhythmias)
High or low blood pressure (hypertension or hypotension) that isn't controlled
A history of stroke within the last six months
Relatives with retina disorders, including retinitis pigmentosa
Sickle cell anemia, leukemia or other health conditions that can cause an erection that won't subside (priapism)
Interactions with other medications




Tell your doctor about all medications you take, including herbal remedies. A number of other drugs, including certain antibiotics, anti-seizure medications, blood thinners and anti-arrhythmic heart medications can affect how well Viagra, Levitra or Cialis work and cause other side effects.




A few medications should never be taken with Viagra, Levitra or Cialis, or should be used with caution:




Never take Viagra, Levitra or Cialis if you take nitrate drugs to treat chest pain due to heart problems (angina). Like Viagra, Levitra and Cialis, nitrates dilate blood vessels. Their combined effects can cause dangerous low blood pressure and loss of consciousness. Medications that contain nitrates include:
Nitroglycerin (Nitro-Bid, Minitran, others)
Isosorbide dinitrate (Dilatrate-SR, Isordil, others)
Isosorbide mononitrate (Imdur, Monoket, others)
Recreational drugs such as amyl nitrite or nitrite ("poppers")
Don't use Viagra, Levitra or Cialis within four hours of taking an alpha blocker. Alpha blockers can cause dangerously low blood pressure when combined with drugs for erectile dysfunction. Examples of alpha blockers include: tamsulosin (Flomax), terazosin (Hytrin) and doxazosin (Cardura).
If you do use an alpha blocker, never take sildenafil (Viagra) in doses above 25 milligrams.
There's one exception to the rule about not taking alpha blockers with medications for erectile dysfunction: Tadalafil (Cialis) has been approved for use with the alpha blocker tamulosin (Flomax).






Common side effects


Viagra, Levitra and Cialis don't usually cause severe side effects. Some men have reported headache, flushing, indigestion, and a stuffy or runny nose after taking Viagra, Cialis or Levitra. Men taking Levitra have also reported back pain and muscle aches. In some men, Viagra caused temporary vision changes, such as "blue" vision.




Rare but serious side effects


Vision loss. A few men using Viagra, Levitra and Cialis have had permanent vision loss due to a condition called nonarteritic anterior ischemic optic neuropathy (NAION). However, it's unclear whether the drug - or an underlying condition - caused blindness. If you have a retinal disorder, such as diabetic retinopathy, see your eye doctor before taking any medication for erectile dysfunction.


Sudden hearing loss. Some men have reported hearing loss after taking Viagra, Levitra and Cialis. However, it isn't clear whether the hearing loss was directly caused by taking these medications. If you're taking one of these medications for erectile dysfunction and have sudden loss of hearing, don't take any more of the medication and seek medical help right away.


An erection that doesn't subside on its own. Called priapism, this rare condition can be painful and requires medical treatment to avoid damage to your penis. If you have an erection that lasts more than four hours, see your doctor.


Erectile dysfunction: The Underlying Causes




Taking Viagra, Levitra or Cialis without treating the original problem may improve sexual performance, but don't ignore an underlying issue by just taking pills to treat the symptom of another health issue.


Getting proper treatment for the underlying cause of erectile dysfunction may help you prevent related health problems and improve sexual performance. A number of conditions can cause or worsen erectile dysfunction:


Heart disease. In some cases, erectile dysfunction is the first sign of serious heart or blood vessel problems such as hardened arteries (atherosclerosis).


Diabetes. Over time, uncontrolled diabetes can damage blood vessels and nerves, making it more difficult to get or keep an erection.


Psychological issues. Depression or anxiety can cause sexual problems and often requires psychological counseling or medications to get better.


Being overweight. Being overweight or obese can cause or worsen erectile dysfunction because of hormonal changes and related cardiovascular issues. Increased physical activity and losing weight can improve your overall health and sexual function.
Low testosterone. Men who have low testosterone levels (hypogonadism) may need testosterone replacement therapy to increase sex drive and sexual performance.


Lifestyle choices. Unhealthy habits such as drinking too much alcohol, smoking, using illegal drugs and a sedentary lifestyle can all worsen erectile dysfunction.




Vacuum Devices as Treatment for Erectile Dysfunction




Mechanical vacuum devices cause an erection by creating a vacuum around the penis that draws blood into the penis, engorging it and expanding it.


The devices have three components:A plastic cylinder, in which the penis is placed; A pump, which draws air out of the cylinder; and An elastic band, which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body.


One variation of the vacuum device involves a semirigid rubber sheath that is placed on the penis and remains there after erection is attained and during intercourse.




Surgical Options to Treat Erectile Dysfunction


Surgery usually has one of three goals:


to implant a device that can cause the penis to become erect
to reconstruct arteries to increase flow of blood to the penis
to block off veins that allow blood to leak from the penile tissues


Implanted Devices


Implanted devices, known as prostheses, can restore erection in many men with ED. Possible problems with implants include mechanical breakdown and infection, although mechanical problems have diminished in recent years because of technological advances.


Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.
Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid.


Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.


Surgery to repair arteries can reduce ED caused by obstructions that block the flow of blood. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch or fracture of the pelvis.


The procedure is almost never successful in older men with widespread blockage.


Surgery to veins that allow blood to leave the penis usually involves an opposite procedure-intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes the rigidity of the penis during erection.


However, experts have raised questions about the long-term effectiveness of this procedure, and it is rarely done.
The past several decades have ushered in a new treatment era for ED. Because of the advent of many advances, today urologists are helping millions of impotent men perform better and longer.




Penile Prosthesis to Treat Erectile Dysfunction


For most men, the initial medical treatment will be an oral medication such as sildenafil citrate. If this treatment is unsuccessful, second-line treatment options are ordinarily considered.


If these second-line treatments fail or if the patient and his partner reject them, then the third-line treatment option, penile prosthesis implantation, is considered.


Penile prostheses are devices that are implanted completely within the body. They produce an erection-like state that enables the man who has one of these implants to have normal sexual intercourse.
There are two erection areas in the penis. All penile prostheses have a pair of components that are implanted within both of these erection areas.


The simplest penile prostheses consist simply of paired flexible rods that are usually made of medical-grade silicone, and produce a degree of permanent penile rigidity or firmness that enables the man to have sexual intercourse. These devices are either flexible  or inflatable.


The flexible prosthesis can be bent downward for urination or upward for intercourse. Inflatable penile prostheses are  gizmos that can be inflated for erection..




The inflatable devices consist of a pump which is placed inside the scrotum (the sac that contains the testicles) and the inflatable part which is implanted inside the penis (the part called the corpora cavernosa)




Three-component inflatable penile prostheses have paired cylinders, a scrotal pump and an abdominal fluid reservoir. With these three-component devices, a larger volume of fluid is pumped into the cylinders for erection and out of the cylinders when erection is no longer needed.




Penile prostheses are implanted by making an incision above or below the penis. This procedure requires anesthesia. After the procedure pain medications are used while waiting for the surgical wound to heal.


After about a month the patient is able to resume sexual activity. Infection is a potential complication of penile implants, and if that happens the prosthesis has to be removed from the body.




Mechanical failure is more likely to occur with inflatable than with rod prostheses. The inflatable prosthesis contains saline , which is salt water , this may leak into the body.  If there is mechanical failure re-implantation may be necessary. The mechanical failure rate may be as high as 10 to 15 %.




Penis Pumps for Erectile Dysfunction


Penis pumps are somewhat clumsy to use, but they do work. They are safe to use. They are more favoured by older married men. It is allowable to use this in combination with other measures such as medications or even an implant.




Penis pumps have the advantage of being inexpensive, of course the initial cost is high, but after that there is no more costs. Many older men prefer these since it helps them avoid talking to the doctor about their sexual problems.


Men like it because you can 'create' an erection at will, and end it when it is no longer needed. And yes, women do find it comical to see their spouse pump it up like as if it was bicycle. "Pump up your bicycle honey!" And of course the great Austin Powers was using it too !


Pumps do need some skill to operate, since it is very mechanical. It is also a bit humiliating to tell the simpering woman, "Darling wait a while while I get my member pumped up". And not uncommonly she will tell her partner, "I am going to start without you…."


Some men find the sheer unnaturalness of the whole thing very unsettling, while others take the view that something is better than nothing.




Penis pumps can work great, but it needs a couple with a lot of mutual love and respect and patience to make it work satisfactorily , otherwise it can turn into a comedy of errors, hurt feelings and resentment.




It may be difficult to get a good seal at the base of the penis when using the pump, this can be fixed by shaving the pubic hair at the base of the penis.




Some men complain that the semen does not go properly when they ejaculate. Some manufacturers make constriction rings with a small cutout that may help with this.




Adverse effects of penis pumps:


Using a penis pump is safe for most men, but side effects can include:
Hemorrhagic spots on the penis (petechiae)
Numbness or coldness of the penis
Pain or bruising of the penis
A sense of trapped semen during ejaculation or delayed ejaculation




Using a penis pump will not make your penis larger, contrary to popular belief. While ads on the Internet market penis pumps with the claim that they can be used to increase penis length or girth, there is no evidence that they work for this purpose. While using a penis pump is a safe way for men with erectile dysfunction to achieve an erection, attempting to use a penis pump to enlarge the penis can cause injury.




Although penis pumps are a safe erectile dysfunction treatment for most men, if you have certain health problems such as blood coagulation problems or sickle cell anemia, or you take certain medications such as blood thinners, you need to be more cautious when using this method.




Talk to your doctor about your health conditions and any medications you're taking to make sure you are getting the safest and most effective erectile dysfunction treatment.


Although it can take some time to get comfortable using a penis pump and there are some drawbacks, using a penis pump is a safe, effective and noninvasive way to treat erectile dysfunction. Used on their own or in combination with other treatments for erectile dysfunction, penis pumps help many men continue to enjoy an active sex life.




Vascular surgery for Erectile Dysfunction:




There are two types of vascular surgery available for men with erection dysfunction due to vascular causes.




Penile arterial revascularization for Erectile Dysfunction


This procedure is used when there is a blocked or nonfunctional blood vessel. The basic strategy is to re-route the blood flow so that the blocked area is bypassed. It is the same principle used in coronary artery bypass surgery.


Generally this is used when the blood vessel in question has been injured or damaged, such as in the course of an accident or blunt trauma. It is used in young men without atherosclerosis.




Venous ligation surgery for Erectile Dysfunction


This procedure is much more trickier. The reasoning behind this technique is based on the fact that the 'hardness' of the penis is due to retention of blood in the venous sinuses of the penis. This procedure seeks to fix 'leaky veins' that prevent the erection from lasting for a sufficiently long period of time.


Success rates are low, and it is not a favoured surgery. But only your doctor can tell you if you are a candidate for this procedure.


Diabetic patients and patients with widespread hardening of the blood vessels may not be a candidate for either of these vascular procedures. Also it is not suitable for smokers since the ongoing vascular damage from nicotine puts you in a total no-win position.


If you are a smoker, you will need to sit down and think hard what is more important to have on your lips- a woman's kiss or tobacco's kiss.




Intracavernosal injections for Erectile Dysfunction


Penile injection therapy is a relatively quick and effective way to send drugs directly into the penis where they expand the vessels, relax the tissue and increase blood flow for an erection.


Injectable medications are also used to create erections. And yes, you guessed right, they are injected into the penis. Yikes! That sounds painful and it is !
Another problem is that it could lead to priapism which means your penis becomes hard AND painful and stays that way for a long time. Not fun at all! Several medications are used for this purpose.


The choices include Prostaglandin E1, Phentolamine and Papavarine.  Another issue with these medications is the possibility of scarring in the penis.  If you are one of those super-brave souls go ahead and talk to your doctor about it.


Intraurethral suppositories for Erectile Dysfunction




This is yet another 'not-so-much-fun' technique in the arsenal or erection treatment measures. It involves introducing a pellet of medication into the opening at the tip of the penis.


It can cause mild bleeding and pain the penis. It can also cause vaginal itching, something that may not endear you to your girlfriend ("Darn, there come Mr.Poison Ivy again with his hardon")


If you and your girlfriend are both braver than Robin Hood and decide to use the pellets, remember not to use it if she is pregnant, because the medication use, Prostaglandin can cause uterine contractions. Also, remember to remain standing for at least fifteen minutes after inserting the pellet, before you start the festivities.




Home Remedies for Erectile Dysfunction




Erectile dysfunction is the inability to obtain an adequate erection for satisfactory sexual activity. The best way to treat erectile dysfunction is to have a look on your lifestyle and dietary habits. There are some simple home remedies for erectile dysfunction that may help you to improve erection naturally.


Zinc is an essential mineral that is said to be helpful in boosting sexual desire and helping to remedy erectile dysfunction. It may be worth a try, as long as you remember that most remedies work on the principle of trial and error.
A fiber rich diet is obviously good for your sex life and to prevent erectile dysfunction since a diet that is low in fat will prevent or minimize atherosclerotic changes to your blood vessels.


A mixture of walnuts and honey, along with milk is said to be effective for erectile dysfunction. It may be worth a try, since it is not expensive.


Ginko is a common herb from Asia that is widely used for erectile dysfunction. It enhances blood flow in the penis. It is said to work by relaxing the smooth muscles of the penis.


Ashwagandha is another Asian herb that is used widely to increase strength and sexual function. The name Ashwagandha is an ancient Sanskrit word that roughly translates as 'the fragrance of horses'. It is also used as a health tonic.


Ground carrots heated in milk is another home remedy that has been used. You can easily find more information about this online.


Yet another home remedy is a combination of walnuts, raisins, prunes, apricots and lemons, along with honey.
And another not-so-fragrant combination is warm water in which onion pieces have been steeped for ten minutes. This person drinks this water three times a day for a month. Again results vary so much with these remedies.


Vitamin A deficiency has been blamed for sexual dysfunction. It has been suggested that eating a diet rich in Vitamin A may be helpful to improve your sex lfie. But keep in mind that too much of Vitamin A can be harmful.




Prevention of Erectile Dysfunction




Although most men experience episodes of erectile dysfunction from time to time, you can take these steps to decrease the likelihood of occurrences:


Work with your doctor to manage conditions that can lead to erectile dysfunction, such as diabetes and vascular disease.


Limit or avoid the use of alcohol.


Avoid illegal drugs such as marijuana.


Stop smoking.


Exercise regularly.


Reduce stress.


Get enough sleep.


Get help for anxiety or depression.


See your doctor for regular checkups and medical screening tests.




Coping with Erectile Dysfunction


Whether the cause is physical factors or psychological factors or a combination of both, erectile dysfunction can become a source of mental and emotional stress for the couple. Everyone experiences erectile dysfunction sometimes. Do not let one event strike a body blow at your self esteem.


Don't think that one event of below-par performance is a permanent strike against your virility and masculinity. And your partner should have sufficient love in her heart towards you as well as sufficient patience and understanding. Only if these events occur again and again or they are interfering with your or her satisfaction do you need to do something about it.


Remember to reassure your partner that your performance problem is not because of lack of interest in her. Reassure her that you find her attractive. An erection is the best compliment a man can pay to a woman.
And the absence of it may be viewed by a woman as a testimonial to her unattractiveness. And don't make matters worse by sneaking to your computer to look at some 'girls gone wild'. 


Talk with her, explain what is happening, talk with your doctor, educate yourself about these matters, and look at all treatment options. Try simple things first before you mortgage your house to get treatment for Mr. Penis (especially since your insurance company has little or no sympathy for your penis, and would rather pay for your castration surgery than for your erection surgery)


Social and job pressures may also be a factor. The workplace especially in places like America has criminalized normal male-female interaction so much that impotence and lack of sexual interest in women is now seen as a fantastic positive qualification in any male member of the workforce. Previously such extreme legalization of male-female interaction was seen only in some very old fashioned middle eastern countries. Face it, it hard to switch from the 8am to 5pm 'eunuch mode' to a 'man mode' at bedtime. The way the legal climate in America is changing, it is not unreasonable to expect that in future the only 'legal' and 'ethical' way of male-female interaction will be inside government approved labs after signing lawyer approved forms for penile entry.
If you are seeing a marriage counselor or a sex therapist , make sure that your partner fully supports and participates in this. It is of the greatest importance that no concerns or questions should be left unanswered. This can help you address concerns you both have about erectile dysfunction and can be an effective treatment.




Quitting smoking can help remedy Erectile Dysfunction




There is all kinds of good reasons why you should quit smoking. If lung cancer does not scare you, and not being able to breathe does not worry you and the high cost of cigarettes does not faze you, you should at least quit smoking for the sake of your penis.


Face it, your cigarette is no substitute for your penis. Show your penis some respect, get rid of the cigarettes, and see how much fun you will have. There is all kinds of treatments available now for tobacco addiction.


Quitting smoking can be very difficult and there is no single best way that works for all people. No matter what approach you choose, support from your family and friends is the single most crucial factor.


One approach is to gradually cut back over a few weeks or even months, giving yourself enough time to wean yourself off the addictive effects of tobacco. 
Once you quit, avoid places with tobacco smoke. Avoid places where you used to smoke. Keep yourself busy, there is some truth to the old saying, "the idle mind is the devil's workshop".


The nicotine patch, nicotine gum, or other medication that may be prescribed to help you quit can be helpful but they will not take away your cravings to smoke.


Talk to your doctor to see if you should try these techniques. Another approach is to make a clean break. Do not allow yourself to smoke "now and then." An addiction to nicotine can be reactivated anytime, even years after quitting.


Take it a day at a time Keep in mind that even though the craving to smoke may haunt you, those cravings are short lived and they will go away as long as you don't cave in.  There is plenty of smoking cessation programs available, these range from medication centered programs to hypnosis based programs.


Check out the various options, educate yourself. Remember, your sex-life is worth it.


Exercise regularly


Regular exercise can improve your health in many ways. This is what regular exercise can do for you:
Strengthen the heart
Improve the flow of oxygen in the blood
Build energy levels
Lower blood pressure
Improve muscle tone and strength
Strengthen and build bones
Help reduce body fat
Help reduce stress, tension, anxiety and depression
Boost self-image and self-esteem
Improve sleep
Make you feel more relaxed and rested
Make you look fit and healthy (and increase the chances of your getting some sex in the first place J  )




To get the most benefit, you should exercise at least 20 to 30 minutes, three times a week.
Plan a routine that is easy for you to stick to, and then stick to it. Don't plan on doing more things than you can manage. Stick to simple activities first. Don't start with something too strenuous if you are not used to it. Choose an activity you genuinely enjoy. Exercising should be fun, not a burden. Try to make your exercise schedule as varied as possible so that you don't get bored and quit!


Stick with it. If you exercise regularly, it will soon become part of your lifestyle. If you feel you need supervision or medical advice to begin an exercise program, talk with your doctor. Your physical therapist may also be able to help guide you with exercise decisions. 




Reduce stress


Stress is common to everyone. Our bodies are designed to feel stress and react to it. It keeps us alert and ready to avoid danger. But it is not always possible to avoid or change events that may cause stress and it is easy to feel trapped and unable to cope. Stress reduction is a crucial part of treating erectile dysfunction.
Learning an effective means of relaxation and using it regularly is a good first step. Yoga or meditation are useful options.  Allow yourself some "quiet time," even if it's just a few minutes.
If all else fails, try to remove yourself from the sources of stress that are sucking the life out of you. If it is your job, try to find a new line of work. If it is your neighbors find a new neighborhood. If it is the way of life in the country where you are living, change your country. Do whatever you takes. You live only once. You are under no obligation to anyone to accept anything that is to your detriment.  Talking with a trusted and understanding friend or family member can go a long way. Seeking professional assistance can help you gain a new perspective on how to manage some of the more difficult forms of stress. Keep a positive attitude. Believe in yourself.  Accept that there are events you cannot control. Be assertive instead of aggressive or passive. Learn to relax. Eat well-balanced meals. Minimize the use of alcohol and caffeine. And last but not the least, get enough sleep.


Pearls of Wisdom (and also some nuggets of stupidity) About Erectile Dysfunction


Erectile dysfunction is one of the fastest growing disorders in the world, with millions of men being affected.


Erectile dysfunction treatment can be extremely expensive. It is estimated that some men are spending more on their erection medications than what they would pay at a high priced 'service-station' in Las Vegas. It is outrageous that one would have to cough up hundreds of dollars a week for the sheer privilege of getting a reasonable erection. And it is immoral for the drug industry to capitalize on the misery of couples in this manner.


Fixing erectile dysfunction is easier said than done. Since time immemorial various creative individuals have come up with all kinds of ingenious methods to prolong the human erection. Some of these have worked, some have not. Some so called medications that have worked have been abandoned once people started reading the 'small print'.


Erectile dysfunction causes such misery and trauma to the marriage, the only other thing that causes such havoc in the bedroom is domestic violence. In a way many women view ED as abuse, where their husband or boyfriend is failing to provide for the woman mentally and physically, it is beginning to be considered as a form of abuse, though it is not legally recognized as such.


Vitamins for erectile dysfunction have been tried out. Vitamin A is a prominent member of this category of fixes. The best we can say about it is that it does not do any harm if used in therapeutic doses as recommended by the physician. Overdosing on these vitamins is a surefire way to create havoc.


Medications that cause erectile dysfunction have been known to medical science for a long time. Doctors are generally too embarrassed to bring up these 'uncomfortable' topics when discussing with their patients, with the consequence that poor Mr. Smith wakes up wondering why his pride and joy is wilting despite his wife being as hot as a spring chicken on speed.


Causes of erectile dysfunction are many, and can fill an entire book. If you have a potentially treatable cause, it is vitally important that you treat it first before jumping into any kind of treatment programs.


Erectile dysfunction creams include Alprostadil. This seems to work for some people, but is expensive, like most erectile dysfunction medications. The thing ot remember is that all men get dumped into the 'erectile dysfunction' basket, but before shovelling some Viagra down your throat, the smart thing to do is try simple , easy and inexpensive things to see if you can prolong your erection.


Natural remedies for erectile dysfunction are galore. Every form of natural medicine, from native American medicine to Thai medicine and Chinese medicine have their own therapies for ED. Again it is your personal choice to decide whether to try it out or not. The key is to balance the benefit and the expense. Most of us don't have unlimited money to spend on our penis. We need money to buy bread , ham and vegetables, so unless you are a wall-street broker,           Mr. Penis is not always at the top of the priority list.


Erectile dysfunction cure may or may not be possible. Often it is just a matter of managing the problems that interfere with erections that are sufficient. Do not get caught up in the idea that you can find a 'fix-it-all' silver bullet. There isn't any. It is a matter of intelligently pursuing solutions that work.


What causes erectile dysfunction?  The causes are too many to mention here. You can find out more from the free ebook that is available on this site. But suffice to say, there is more causes than you can shake a stick at. The key is to differentiate between causes you can fix and causes you are stuck with.


Cure for erectile dysfunction is a common headline on internet pages and magazines these days. And most of these disappoint us, when we read the fine print that states all kinds of absurd adverse effects and problems that would scare the daylights out of your genitals.


Erectile dysfunction cures are many but not all of them work. To figure out which one is right for you, you need to know something about the anatomy and physiology of the sexual system. Until you educate yourself in this matter, you are in no position to decide what is wise and what is not.


New treatments for erectile dysfunction are many. Some of these are just old wine in new bottles. And some of these are so new, we dont know yet what the long term side effects will be. And remember that many new medications have a habit of showing up on TV  a few months later with the punch line '"did your heart stop because of this medication? Call us!"


Erectile dysfunction remedies are galore. This includes home remedies and folk remedies. Just remember, it is your body. Use these thing with caution. Again, something that is time-honored may be worth a try, and is probably safer than something the drug companies cook up, since their stuff always hides behind so called 'studies' which basically is merely some university professor who wants to keep is job performing a circus act.


Erectile dysfunction help is now forthcoming. Check google for the many forums, there is a lot of people out there sharing their views and experiences. Dont be shy about talking about your views and your problems. You may even be able to help someone.


Erectile dysfunction remedy is what all men want most these days. Because almost all men, regardless of age are running into this problem sooner or later. It has become more common than the common cold, and this is quite alarming, because this is a relatively new phenomenon.


Treating erectile dysfunction is something that clinics all over the world are doing these days, and charging hefty amounts of money. The medications are costing more than what you would pay for a new car. It is worthwhile checking for more affordable and more natural alternatives before shelling out the money which you could instead use to pay for that shiny new car that you wanted, instead of for a shiny new erection which is less likely to impress her than a brand new Volkswagen or Lexus.


Sudden erectile dysfunction is a terrifying thing that happens to some men. It is generally a transient thing that does not happen again. Of course if it keeps happening , it is a cause for concern. Generally this happens with younger men who are in the presence of a woman whom they find overwhelming sexually, and these unfortunate men lose all confidence in their ability to hose down this amazon.


Causes of erectile dysfunction in young men always need to be properly investigated. Hormonal insufficiency is relatively rare, but must not be missed in the course of the investigations. Generally there is nothing wrong with these studs, and many of them suffer from premature ejaculation, where they last a miserable two minutes, much to the disappointment of their girlfriends, who start looking for creative reasons to break up with them!


Herbal creams for erectile dysfunction are used worldwide. Many ayurvedic creams are on the market that claim to turn your noodle into solid kryptonite that can stun the daylights out of Paris Hilton. Again, check around, ask other guys who have used it before you use it.


Erectile dysfunction pumps do work. They are kind of expensive, but nothing compared to the daylight robbery indulged in by pill manufacturers. They are also a bit comical, but then there is nothing wrong with adding some comical drama to the bedroom. If you cant maker her come, at least make her laugh!


Erectile dysfunction and heart disease have an alarming connection. In fact, ED may be a warning sign that your blood vessels are basically on their last legs, and you better do something about it.


Erectile dysfunction forums are popping up all over the internet, which is a testimonial to the severity and epidemic nature of erectile dysfunction. Join a forum today, make your voice heard. It will go a long way towards helping you find the solutions you want.


Erectile dysfunction drugs include many products such as Viagra and Cialis. Do your homework, look up their side effect profile, and count the cash in your pocket, decide what is more important  for you, bread and ham for dinner, or an after-dinner erection?


Erectile dysfunction treatments need to be approached with due care. Ask the guys at work what they are using. First try out simple things like the Delayer Technique, which basically prolongs your erection.


Erectile dysfunction vacuums do work. Again, they also provide some comical entertainment. If your girlfriend likes saturday night live, she will love your vacuum device, she will laugh so hard she will have an orgasm. But hey, these gizmos do work, buy one, but use it with care, dont damage your pride and joy.


Which erectile dysfunction drug is best ? Hell, who knows! No one really knows, and there really isn't a best treatment for ED. It is trial and error, it is whatever works, and whatever you can afford without taking out a third mortgage.


Erectile dysfunction caffeine use is a common thing that many guys are using. It is not entirely safe. Caffeine speeds up your heart, and this may not be a good idea if you have any heart problems.


Doxycycline side effects include erectile dysfunction. Discuss this with your doctor. See if he can give you a different medication if this is causing problems.


Alcohol and erectile dysfunction have a strong connection. So beware you guys who make all your pickups in the bar. She can still function with a couple of pints on board, but you won't be able to function, and next thing you know, you will be making love to the whiskey bottle while she is off with a real man!


Erectile dysfunction and nutrition have a connection of sorts. A unhealthy diet that is high in fats will eventually kill off your sexual function, that is common knowledge. All those cheeseburgers that you are gulping down are going to make your cholesterol go through the roof, and eventually clog up those tiny blood vessels that keep your penis alive and useful.


Foods that help erectile dysfunction have been a focus of much attention. Lot of this attention has been focussed on the humble carrot. Many recipies are available online to help you with eating carrots, and anyway it does not do any harm. It also helps your eyes , so even if it does not help your sex life, at least you will be able to see better, and maybe read some girlie magazines in dim light, while hiding from your wife.


Erectile dysfunction symptoms include an erection that is not firm enough to enter the woman, or not lasting long enough to satisfy the woman. And believe me, most women fake orgasms to console their incompetent and impotent husbands, so dont pat yourself on your back when she moans after thirty seconds of breathtaking action. You are not even close, and she is not  either. And no cigar! (apologies to Bill)


Erectile dysfunction pharmacy ? Hey how many of us sneak up to the pharmacist and ask him, "Buddy, do you have something that is not as pricey as viagra?" Well, what can I say to that!? Good luck!


Male strap on for erectile dysfunction. Now that is truly medieval, I am almost sure that this is what Chengiz Khan used when his hordes where rampaging through the Steppes. Well you could ask your wife and see what she says. Be forewarned, you may get a dose of your own medicine!


Cardiovascular leakage and erectile dysfunction. A topic often raised in online forums. Does anyone know what it really means? Basically, any kind of cardiac insufficiency is going to affect all of your systems, including your sexual system. Any heart disease needs to be treated promptly, and in these instances erections or the lack thereof maybe the least of your problems. So if you have swollen feet or you cant breathe properly at night, talk to your doctor about it first thing tomorrow morning!


Best pills for erectile dysfunction... groan... there is no 'best pill' guys, just like there is no 'silver bullet' to fix anything. It is different for everyone. Viagra is well established. And there are several other drugs in the same category. It depends also on what other meds you are on, and whether there are any interactions. Again, if you do get erections, but have problems getting the erections to last, the Delayer Technique may be your ticket to sexual nirvana.


Erectile dysfunction exercise is something everyone wants to know about. There are exercises for penile enlargement, and then there are specific maneuvers for prolonging erection. Google it out. There are other exercises beside the delayer technique, it is worthwhile looking into everything before deciding what to do about your sex life.


Cold toes and erectile dysfunction is something that someone asked about on a popular forum. Cold toes may be a sign of vascular insufficiency, or may be a sign of thyroid problems. Or it may be an entirely harmless coincidence. Eitherway, tell your doctor about it. If you are a smoker, this may be warning sign that it is time to quit.


Does taking too much pepcid ac cause erectile dysfunction? Interesting question, there is no clearcut evidence that tells us that pepcid can do that. However it is not a bad idea to contact the manufacturer and find out about this. Most likely this is just an unfounded online rumor.


Erectile dysfunction study research projects are many , and are being conducted by major universities. Certain types of erectile dysfunction may quality for treatment drugs and monitoring. Some of the studies even pays the participants.


Erectile dysfunction and diet supplements have been in the news. There is no concrete evidence that tells us that this works, but there are many guys who swear by these diet supplements. Many of the ingredients lack scientific information which is a problem if you want to research what is it that you are going to pop in your mouth. But then if your sexlife is in crash mode, it may not be a bad idea to check it out.


Marijuana and erectile dysfunction is a question often raised. Does marijuana make it worse or better? Overall, the bottomline isthat marijuana screws up your brain to such an extent that it is not worthwhile, even if there were any benefits.


Herbs for erectile dysfunction: Palmetto, Ginko, Ginseng, Valerian etc are some of the herbs that are used by various herbal physicians. Most people don't know enough about these to dabble in it, so if you are interested, google for a naturopathy in your area of the world. And remember, the claim that natural medications don't have any side effects is all hogwash. All medicines have side effects, it is merely a question of whether anyone has recognized the side effects or not.


Over the counter erectile dysfunction medications: If you are a pharmacist, I am sure that some eager guy has already asked you if you have something cheap to fix his erections. Unfortunately there is no over the counter cheap and easy erection medications that are safe to use without some kind of professional guidance.


Hereditary erectile dysfunction : Doctor, is it hereditary ? No, ED is not hereditary. There is a fair chance that your descendants will have funfilled and fulfilling sex lives even if you don't. So don't shed any tears over future generations. Besides they will be using the kind of medical technology in future that would make our jaws drop !


High cholesterol and erectile dysfunction do have a clear cut connection. Eat right, guys. What is more important, a double whopper or a double wham-wham with the love of your life?  Get your priorities right, and that huge steak dinner isn't as glamorous as they make it out to be.


Treatment for erectile dysfunction diabetes : Diabetes hits every part of your body, and the sexual system is no exception. As a devastating disease that hits both blood vessels and nerves, the damage from diabetes is twinfold. The only solution is to treat your diabetes aggressivley, and keep your fasting glucose levels and HbA1c exactly where your doc says it should be.


Natural treatment for erectile dysfunction: 'natural' is a tricky word. Everything you have on planet earth is techjnically 'natural'. Don't let the word 'natural' derail your reasoning and logic. Afterall, cocaine is natural, mosquitoes are natural.... But as long as it means that you are trying out simple and inexpensive measures to treat your health problems, it makes sense.


Erectile dysfunction and diet: You are what you eat, right? Not necessarily. If you eat a lot of carrots it does not mean you will turn into a carrot, it is quite possible that eating a diet rich in vitamins can enrich your sex life. And on the same token, eating huge steaks daily does not necessarily turn you into s stud bull. If anything, all that cholesterol will clog up your blood vessels so that your Johnson will be as effective as the studbull after the castration ceremony.


Can you masturbate if you have erectile dysfunction ? You betcha! At least one embarrassed girl has silently laid there and watched while her beau used his hand on himself, while she served in the rold of  pin-up girl. Your masturbatory skills don't necessarily translate into sexual skills. Self gratification is anything but gratifying though.


Erectile dysfunction counseling: Does counselling help? Or is it just some stand-up bullshitting? There is good and bad to counselling. A wise and understanding counsellor can draw a couple's attention to simple things that they may be overlooking, simple things that could fix their marriage. The lousy counsellor is someone who is in hot pursuit of "doing the right thing", which is an euphimism for blowing up someone else's life. After all, 90 % of all evil on earth is created by good guys with 'good intentions', something that always baffles the bad guys who are always trying so hard to do bad stuff!


Erectile dysfunction treatment devices are many. Penile pumps are one type of device that has become popular. The downside is that this involves the loss of natural flow to the act of lovemaking, where your partner has to 'start alone' while you are pumping up your engine.


Erectile dysfunction prevention: can it be prevented? Studies show that if you use it more, you are less likely to lose it. So the bottomline is that you need a woman who is worth making love to, so that your penis does not die early.


Erectile dysfunction rings. These are a dream come true to the Scrooges among us, these are simple and they do work to some extend. These are little more than glorified rubber bands, but heck why not! The beauty of the world is in little things, and it is little things that hold up big things, and the humble rubber band is a case in point.


Erectile dysfunction Mayo clinic: The Mayo and other clinics around the world have dedicated treatment programs for erectile dysfunction. It has become an industry all in itself, one of those so called 'recession-proof' industries. No matter how bad the economy is, a guy will still raise the cash to fix his tool.


Massage for erectile dysfunction, does it work? There are special massage techniques for the penis, but it is not known if these actually do anything to improve your erectile function. At least it is a fun treatment !
Hypnosis for erectile dysfunction has been tried, and does work sometimes. You can even find tapes online from hypnotists who claim that it can heighten your sexual function. And it could help those who are having problems lasting in bed. But be sure to find a hypnotist who knows what he is doing, not just someone with a so called diploma.


Monoclonal gammopathy + erectile dysfunction. Anything that causes peripheral neuropathy can also cause erectile dysfunction, and monoclonal gammopathy is no exception. If you have other symptoms such as numbness or tingling in your fingers and toes, you probably need to talk with your doctor.


Neurological muscle fatigue erectile dysfunction : Erectile dysfunction does not always happen due to problems with the penis. It can also be because your muscles are not strong enough to perform the physical act, or your nerves are not functioning properly enough to carry those complicated commands from the brain.


Natural home remedy for erectile dysfunction :  The hippocrates oath tells doctors, 'do no harm to your patient'. There is no such oath telling patients 'don't screw up yourself', but that is just a commonsense rule, try home remedies that are harmless, even if they don't work. Check with someone who has tried it, and avoid anything that is too wild! Don't tie your dong to the pickup truck to make it stronger, for example.


History of erectile dysfunction. ED is as old as the hills. History is rife with stories of domination and submission and wars over women. In fact the history of the world can be summaried as the long and unending saga of men trying to prove their manhood, often as a substitute for sex which they lack. Take the case of our old friend Adolf. he had only one testicle. Makes you wonder, if he had had both testicles and a good sex life, would he have been so destructive?  Studies do show that women who get good sex are less destructive and hateful and vicious.


Foods for erectile dysfunction : this is what everyone wants to hear about. Are there foods that increase your sexual function and the firmness of your erection ? Many East Asian countries use exotic food preparations that supposedly increase sexual function. Do these work? They do work for some people, and if nothing else, they do taste good. And of course no one can deny the fact that the reproductive rate in these parts of the world far exceed other parts of the world.


Herbs and erectile dysfunction : Valerian is a herb that is often mentioned in 'nature cure' circles. Many of the herbs are available online or from naturopathy stores. The key is to talk with someone who is familiiar with them before trying it out, no matter how brave and reckless you feel. This is all the more important if you suffer from any medical conditions.


Home remedies for erectile dysfunction : There is probably more tricks in this category than there are in the Great Russian Circus. Everything from raw eggs to rubber bands and duck tape has been tried out by various basement 'scientists' with too much time on their hands. Again, play it safe. Do not try anything that involves messing with your breathing. Yoga has been tried by some, and I have heard that certain yogic postures can improve blood flow to the genitals.


Hypertension erectile dysfunction : Do you have high blood pressure? Treat it. Treat it today, there is nothing more dangerous than untreated high blood pressure. It can damage all the blood vessels in your body including those to your penis, your stomach and your brain (in their order of importance to men, ha ha !)


Prostate and erectile dysfunction : Prostate disease can impair erectile function. Surgical operations on the prostate are notorious for ruining your erections. Talk to your doctor before prostate surgery to see how it can be done safely without jeopardizing your one and only hobby (golf is not the only thing that involves putting things in holes)


Testosterone and erectile dysfunction of course are linked together. However testosterone deficiency as a cause of erectile dysfunction is relatively rare. It does happen, but more often not. If you have other feminzing characteristics, such as lack of facial hair or pubic hair, you should talk with an endocrinologist and get it all checked out.


Pills for erectile dysfunction : Viagra, Cialis and Levitra lead the pack, and many more are joining the club. Unfortunately everyone wants a prepackaged solution to every problem, which is why the docs are slamming people with a pill to eat, a pill to poop, a pill to smile, a pill to sleep, a pill to wake up, a pill to smile, a pill to not smile too much... and of course pills to get hard.. Good heavens, they are even selling them to women now! (ever heard of a BS diagnosis called female erectile dysfunction?)


Chiropractic treatment is also used by some for erectile dysfunction. Again no one knows what is the reasoning behind it, but it seems to be helping some believers, and it is not too expensive, at least when compared to the urologist visit.


Clotting disorder erectile dysfunction : Hematological disorders can cause erectile dysfunction. If you have any problems with blood clotting, talk with your doctor.


Can acupuncture help erectile dysfunction? It seems to help some people. Again remember this is all trial and error. The acupuncturist will not guarantee any results. But it may be worth a try, accupuncture has turned out to be surprisingly effective over the years for all kinds of different ailments. Also keep in mind, it depends on the skill of the physician too. So pick someone who has been doing this for a long long time, even if he does not speak a word of your own language.


Erectile dysfunction vitamins : this is one of the most commonly asked questions in forums. Vitamin A has been shown to help some people. Keep in mind though that excess of Vitamin A can cause side effects, so don't exceed the recommended daily dose.


Erectile dysfunction doctors visit : Something that would make most men shake in their boots is to visit the doctor to get help for erectile dysfunction, especially if the doctor happens to be an attractive young woman. Hey swallow that embarrassment, put on your bravest face and go see her. It is not as bad as it sounds. And she will most likely be able to help get your life back on track.


Causes erectile dysfunction : This includes systemic diseases such as neuropathy or diabetes or heart disease, as well as conditions that affect the sexual system, and conditions that affect the hormonal axis of the body. The sex act hinges on all kinds of different systems of the body working in sync, and if  any of these goes out of whack, everything just crashes.


Erectile dysfunction tools : Physicians use various assessment tools to quantitate and measure sexual function. The international scoring system is widely used. But don't let those numbers dishearten you, they are only numbers. The only number that really matters is the number of times your girlfriend moans while you pound her.


Erectile dysfunction medications: Viagra is currently the king of the ED pill world, the reigning Zeus. But Levitra and Cialis are providing a lot of competition. If you go to their website you can get detailed information about each one of these meds, except that all the websites are deafeningly silent about the cost. They should throw in a free car with every 1000 pills or something, considering how much it costs to buy those darn pesky things.


Erectile dysfunction in young men : increasingly becoming a problem in many parts of the world, especially in the United States. One possible theory is the illegalization and criminalization of everything related to sex, in such a way that if you get hard, that raises your chances of going to prison by a couple of points. Even innocent compliments to a woman are now labelled as 'sexual harassment' and once you get that label you might as well jump off a cliff. There is even a theory gaining ground that erectile dysfunction in young men in America may be an evolutionary phenomenon, just as the Ostrich lost its ability to fly , these men may be gradually evolving into the 'unisex' 'perfect human' that the psychiatrists and legal eagles and religious zealots want.


Erectile dysfunction medication can be very expensive if you don't have insurance. Many men are buying these online. Often times the quality is questionable, but generally products coming from Canda are said to be of good quality.


Natural home remedies for erectile dysfunction : Folks have been throwing everything including the proverbial kitchen sink at erectile dysfunction, it is always hit and miss. The best thing to do is to try something that is simple and inexpensive, and go from there.


Lymphoma erectile dysfunction : Malignancies that interfere with blood function can also interfere with erections. Lymphoma is a common type of cancer that among other things can also cause problems with sexual function.


Male erectile dysfunction has been around for a long time. Now the 'thinkers' have thought up another new diagnosis : female erectile dysfunction ! Jiminey Cricket ! What will they think of next ? Male hysterectomy ?


Nitric oxide for erectile dysfunction : Nitric Oxide is a vasodilator, something that dilates the blood vessels. This little chemical is what makes Viagra work. These medications are not safe in men who are using nitrates for coronary artery disease.


New drugs for erectile dysfunction : Many new drugs are under development , the commonsense thing to do is to wait till at least an year has elapsed after the drug is made available for public use, because only then will you be able to know about the extent of the adverse effects. Getting hard is important, but keeping your heart and lungs and brain safe is even more important.


Is erectile dysfunction reversible ? That depends on the cause. If the nerves have been surgically cut, such as during prostate surgery , it is not possible to reverse it. It is important to realize that ED is a big spectrum, with symptoms varying from erections that don't last long enough to erections that just dont happen. And the treatment varies depending on the severity.


Nervousness erectile dysfunction: Many nervous young (and not so young) men have erectile dysfunction. In many of these instances what is missing is a sympathetic and loving partner. Yes indeed siree, there are instances where the cure for ED is to dump your crappy girlfriend and find yourself a female woman instead of a wanna be man-woman.


Nervous erectile dysfunction : Is this happening because I am too nevrous? Maybe, maybe not ! Just because you are nervous does not mean that you cannot have some other medical condition. This is not to underestimate how powerful anxiety can be. Many men do well on anti-anxiety medications, but this has to be decided on a case by case basis.


Natural remedy for erectile dysfunction : some types of erectile dysfunction are amenable to natural and simple remedies. But sometimes the only thing that will work is the old and trusted Viagra. But before you freak out and buy a lifetime supply of Viagra and buy shares in ED companies, try out the simple remedies that are available.


Exercises to overcome erectile dysfunction : Are there specific exercises that improve sexual function? Aerobic exercises that bring down your weight may improve your sexual function, especially if you are overweight. The Delayer Technique uses a special exercise / technique to delay ejaculation so that your erection lasts for a long time.


Fungus causes erectile dysfunction : Any kind of infection affecting your sexual system can interfere with sexual function. Does it burn or hurt when you pee? Does your penis hurt when you wake up in the morning. You may need to see a urologist. Also  ask your girlfriend if she is having any pain or discharge from her vagina.


Exercise for erectile dysfunction : The Delayer Technique is one of the techniques that have been devised to prolong erection. Masters and Johnson has their own methods to prolong erection. And there are various publications that offer other techniques.


Otc meds for erectile dysfunction ? Good luck finding one ! The pharmacist is going to look at you really weird when you ask for OTCs for ED. And probably after you leave he will tell his buddy, "What a cheapo, if he can't afford Viagra, how can he afford a woman?"   Shut up, you pill pusher. Not all women are as high maintanence as your wife.


Erectile dysfunction vacuum treatment : No, don't hook up the vacuum cleaner to your penis ! The vacuum devices are specific instruments to create erections. These devices are generally available in adult stores everywhere. Read the instructions, and use it with care. If your penis starts to hurt, stop doing what you are doing.


Get rid of erectile dysfunction: It is not like killing cockroaches in the basement. It is not about 'getting rid' of it, it is all about making it functional, so that you can live with your penis, because that is the only one you got.


How to treat erectile dysfunction. This is a question that millions of searchers are asking google. And there is around 30 million answers, that tells us something about the extent of the problem worldwide. It also tells us that there is no easy solutions.


Homemade erectile dysfunction medications : Many a frugal and creative guy has asked himself this question. How can I create a home made medication to treat erectile dysfunction. Hmm.. that is easier said than done. And if you succeed in doing that, please let the world know, and the world will beat a path to your door, even if you live in Antarctica or Arkansas.


Herbal erectile dysfunction : Just as there are herbal treatment for ED, there are also herbs that among their side effects is erectile dysfunction. The neem tree leaf is supposed to have such effects, it is widely used in eastern dental preparations. Also of historical interest is the fact that this leaf was used by Asian monks who wanted to live a life of chastity.


Herb for erectile dysfunction : Ginko and Ginseng have been widely used. Keep an eye on your blood pressure if you use it, and don't use it if you have a history of any end-organ disease as a consequence of hypertension.


Hypertension and erectile dysfunction : High blood pressure along with high cholesterol and diabetes leads to hardening of the arteries, and hard arteries mean soft penis. So keep tabs on your blood pressure. The incredible truth is that millions of men have never ever had their blood pressure checked even once, which is alarming when you consider that untreated blood pressure has consequences such as stroke and heart attacks.


Support groups erectile dysfunction : Go on google and search for "support groups" + erectile dysfunction + the name of your town or country. There are plenty of support groups where you can exchange information and find out more. And amazingly enough, there are some women members in some of these groups!


Using injection therapy for erectile dysfunction : Injections of Alprostadil and Papaverine have been used to treat erectile dysfunction. That takes a lot of guts to stick a needle in your pride and joy. It also makes women feel guilty when the man has to endure such hardship just to get hard for her!


Trimix for erectile dysfunction: Trimix is an injectable medication for treating erectile dysfunction that doctors are using when Viagra fails. This is a relatively new drug, and there are some unknowns, which is common with all new drugs.


Treatment psychological erectile dysfunction : Before we call something psychological, we have to make sure that there is nothing organic that is going on which could explain the symptoms. Years back, all sorts of sexual problems were declared as psychological. Yes there is a large percentage of men who do have psychological problems, but even in those cases a detailed workup is needed to rule out any other medical problems.


Treatment of erectile dysfunction with sickle cell: Sickel cell disease leads to clots in the blood vessels. It can lead to painful erections. This condition is more common in Africans. Treatment options include blood transfusions and other measures.


Vacuum devices for erectile dysfunction : Mechanical vacuum devices cause erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. The devices have three components: a plastic cylinder, into which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis to maintain the erection.


Vacuum erectile dysfunction device : The vacuum erection device has  three components: a plastic cylinder to hold the penis ; a pump which pulls air out of the cylinder; and an elastic band, which is placed around the bottom of the penis to keep it erect.


Woman dealing with erectile dysfunction : Different women react differently to erectile dysfunction in their boyfriend or husband. Some react with anger and frustration. Some others use the opportunity to turn him into a 'her' and take charge of the home. Some start cheating on the spouse. And there are some who work with the spouse to find a solution.


What is an erectile dysfunction : ED is a phenomenon where the erection of a man's penis is not firm enough or long lasting enough to perform sexual intercourse satisfactorily. This is also a very subjective thing. One minute of wiggling around may be graded as more than enough by a doctor who is just reading 'criteria' off a book, but it will not suffice for a woman who feels she is being left high and dry.


What are the symptoms of erectile dysfunction ? Well, one big symptom is a girlfriend or wife who is looking around to see who is available to please her. You don't need a certificate from a 'certified medical practitioner' to figure out that your Johnson is wilting. Ask your wife, she will diagnose you in a jiffy.


Pump for erectile dysfunction: The pump is part of the vacuum device. A pump  draws air out of the cylinder. An elastic band, which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body.


Rating male erectile dysfunction products : Every product claims they are the best thing ever created ever since God created Eve. When there are too many great claims, the best thing to do is to start with simple options that are free or cheap, and then work your way up the ladder.


Psychological erectile dysfunction cures at home : Your biggest resource could be your wife or girlfriend, if you have a totally open and uninhibited relationship with her. If the relationship is strained with other problems or there are inhibiting factors to sexual communication, then talking with her may not do much , you may need a counsellor.


Propranol  erectile dysfunction : Propranolol is a beta blocker and is one of the blood pressure medications that indeed does cause erective dysfunction in some men. If this becomes a problem, talk to your doctor about switching to a different medication.


Patient experience : What have individual patients been experiencing with erectile dysfunction treatments? The best place to find out are the forums. This is the one place where people can be totally themselves, totally uninhibited. But watchout, they can also be incredibly mean !


Sexually transmitted disease + erectile dysfunction : Diseases such as Chlamydia and Syphilis can cause erectile dysfunction. If you or your girlfriend has been diagnosed with any sexually transmitted diseases before, check with your doctor to see if you need to be re-treated. And yes, it pays to be faithful..


Situational erectile dysfunction : We have all been there.. the first date, and the first hug.. the first touch of female flesh.. and the loss of control that follows. It is normal, that happens to everyone. But if it happens all the time, it needs to be fixed. If you peak just from looking at a woman walking down the street, boy you have a problem!


Surgery erectile dysfunction : surgical options for ED include implanting a penile prosthesis, which a device that can be placed inside the penis. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis.


Erectile dysfunction spray: Minoxidil spray is being tried out by the manufacturer as a solution for erectile dysfunction. Stay tuned, we should be hearing more from them soon. So far no one's penis has fallen off. Minoxidil is an old drug that has been widely used for baldness.


Solutions to erectile dysfunction : There is hundreds of solutions, the trick is to find out which solution does the most good for you with the least hassles. And also we have to factor in the cost. When hospitals say 'cost effective' they are thinking of their gigantic coffers. When the little guy says 'cost effective', he is talking about his little wallet, and it is blatantly unfair that he should have to choose between his wallet and his weiner.


Smoking and erectile dysfunction : Real men don't take long cylindrical objects in their mouths. So take the hint, and mail your remaining cigarettes back to Phillip Morris with a thank you note. Believe me, one minute on top of a woman is more exciting than one hour of sucking off a cigarette. Nothing kills penises quicker than cigarettes. Tobacco is a penisicide, it kills your penis dead dead dead !


Overcome erectile dysfunction : Yes we can overcome ! ED is not the end of the world. And it is not the 16 th century where you would have permanently said goodbye to all manly pleasures. This is the century where anything is possible. If they can make penicillin out of mouldy bread, science sure can make something out of your penis !


Curing erectile dysfunction : The pursuit of the cure for ED has been as energetic as a cure for cancer. OF course it is not very glamorous to have a ED fundraising event. ED research does not need funding. ED fulds itself. There are men who would give their right arm, just to have a solid erection for an hour. There are men who sign and fondly remember the days when they could actually firm up ! Thankfully we have a full range of treatments available these days including pills, creams, sprays, injections and pumps.


Clonezepam erectile dysfunction : All benzodiaepine durgs have the capability to interfere with sexual function. It is always a matter of balancing the risk against the benefit. If you have tremor , your doctor may treat you with clonazepam, and your need to treat your tremor (which otherwise would make you unemployable) may be more important than your need for sex (which may not be a priority especially if you don't have a girlfriend or wife)


Drugs and erectile dysfunction : You have heard of all kinds of reasons as to why you should not use drugs. There are legal reasons, moral reasons, financial reasons, medical reasons, blablabla reasons, the Pope said so,.... but there is only one fun reason why you should avoid drugs- drugs will destroy your sex life, and effectively turn you into an eunuch. Now that is a hell of a more powerful reason than some goon with a badge and a gun.


Erectile dysfunction  psychology : ED begets ED. Once you fail in bed, the humiliation and despair and embarrassment makes it highly likely that you will fail again in bed, and with each failure your confidence level drops until you are too scared to even touch your girlfriend. Aside from getting your physical problem treated, a lot needs to be done to bring back your confidence.


Endocrine causes erectile dysfunction: Thyroid problems or Adrenal problems or Pituitary problems can lead to erectile dysfunction. Your doctor will check for other clues such as an unusually low pulse rate or blood pressure, vision problems etc.


Drugs for erectile dysfunction : Cialis and Viagra occupy the top spots, but there are many other drugs under development. And it is not just pills, there are injectables, nasal sprays and penis sprays also under development. The Golden Era of the Chemically Altered Penis has started !


Alcohol induced erectile dysfunction : What good old Shakespeare said centuries back still holds good, Alchohol creates Desire, but takes away the power to perform those desires. You will end up drooling all over her, without accomplishing anything of note.


Aspirin use and erectile dysfunction : Aspirin is being used in combination with Viagra nowadays by some physicians , based on the reasoning that the combination may provide better quality erections.


Aging and erectile dysfunction: ED is not an inevitable part of aging. There are several 'old pops' who are more virile than a 19 year old gladiator, and there and twenty year olds who have the libido of a wet hen. Yes folks, it  all depends on good genes!


Adderall and erectile dysfunction: ED is indeed one of the side effects of Adderall. Talk with your doctor. See if he can cut back on the dose to see if that improves your sexual function. If all else fails see about switching to a different med.


Can meth cause erectile dysfunction? You betcha! Meth is the enemy of sex. Stay as far away as you can from such junk. God created sex. Man created meth (and lot of other things too)


Erectile dysfunction aids: There are pumps and vacuums made by several manufacturers that are easily available, the prices tend to be reasonable. Be sure to read the instruction booklet first, don't just stick it in and expect a miracle!


Erectile dysfunction and cuckolding: Some unfortunate men do end up in this tragic situation where the woman actually enjoys their lack of erections and uses the psychological advantage to totally lord it over them, and the humiliation of the situation overwhelms these men into total submission.


Erectile dysfunction running : Being overweight or obese can cause or worsen erectile dysfunction because of hormonal changes and related cardiovascular issues. Increased physical activity and losing weight can improve your overall health and sexual function.
A New Remedy for Impotence and Erectile Dysfunction

A major and often unnoticed reason behind marital problems is sexual dissatisfaction. The  reasons vary, and there may be a myriad of scientific explanations as to why a relationship did not work.  In recent times numerous solutions have been designed to remedy the issue of sexual insufficiency, where a man is unable to satisfy the woman of his life, mostly because his erections do not last long enough. Most men last an average of 2-5 minutes in bed, whereas it takes most women around 15-45 minutes to reach orgasm. 

The Delayer Technique is a very simple pressure point technique that delayes ejaculation for as long as you want to delay it. It allows you to maintain your erection until your wife is totally satisfied, while allowing you to have multiple orgasms. You can make love for as long as you want, or make love several times a day.

There is no guarantee that it will work for you. But it is an innovative technique that has the potential to transform your sex life for the better in a way that could surprise you. But it is entirely upto you to decide what is best for your sexlife, don't let any website or internet resource or any 'expert' tell you what to do.



                                        


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Disclaimer: The Delayer Technique has never been scientifically studied by physicians or researchers. This item is sold subject to the condition that it is clearly understood and accepted that the sale of this ebook is for entertainment and information and does not in any way comprise medical advise or consultation. Please consult with a physician for treating any and all medical issues. The Delayer Technique is like the Kamasutra, a totally unscientific yet effective method that may help your love life. We promise you nothing, we merely inform you of what we believe to be an effective but home-made technique to prolong erections. By purchasing this, you are agreeing that you will be using it entirely at your own risk. You may or may not see results that are to your liking. Our liablity in any case will be limited to replacing the cost of the Delayer Technique. If these terms are not acceptable to you, please do not order or use this product.

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Impotence definition and treatment
Impotence treatment with prescription drugs
Impotence cure depends on men
Impotence causes and treatment with pills
Male sexual satisfaction, age and impotence
Talk with your doctor about erectile dysfunction
Erectile dysfunction is a common problem
Sexual anatomy and erectile dysfunction
How does erection and ejaculation occur?
Why does erectile dysfunction happen?
Heart attacks and erectile dysfunction
Leading causes of erectile dysfunction
Different types of erectile dysfunction
Male sexual response cycle and ED
Medical conditions, causes of ED
Premature ejaculation and erectile dysfunction
Retarded ejaculation- erectile dysfunction
Retrograde ejaculation- ED
Loss of Libido and ED
Decreased orgasmic intensity and Erectile dysfunction
Effects of erectile dysfunction
How is erectile dysfunction diagnosed?
Examining a patient with erectile dysfunction
Erectile dysfunction and laboratory tests
Initial treatment of erectile dysfunction
Diagnosing erectile dysfunction
Erectile dysfunction and the doctors visit
Diseases linked to erectile dysfunction
Psychology of erectile dysfunction
Treatment options for erectile disorder
Medications used for erectile dysfunction
Which erectile dysfunction medication is best
Adverse effects of ED medications
Erectile dysfunction underlying causes and implications
Vacuum devices to treat erectile dysfunction
Surgery to treat erectile dysfunction
Penile prosthesis to treat erectile dysfunction
Penile pumps for erectile dysfunction
Vascular surgery for erectile dysfunction
Intracavernosal injections for erectile dysfunction
Intraurethral suppositories for erectile dysfunction
Home remedies for erectile dysfunction
Prevention of erectile dysfunction
Coping with erectile dysfunction
Lifestyle modifications and Impotence
Impotence treatment with drugs
Impotence drugs and alprostadil
Temporary impotence and psychological factors
Information about impotence and aids to treat it
Smoking marijuana causes impotence
Alchohol causes impotence
Treat bicycle induced impotence
Diabetes and Impotence, the link
Yohimbe and treatment of erectile dysfunction
Erectile dysfunction treatment and cost
Fixing erectile dysfunction
Remedy for impotence caused by vasectomy
Male enhancement with penis pumps
Male dysfunction and impotence problem
Impotence remedies include penile injections
Women who create impotence
Emotional impotence and the visit to the urologist
Alchoholism and impotence in vasogenic disease
Old impotence vs young impotence
Medical versus physical impotence
Mental impotence and age
Impotence the sense of loss and the solutions
Induced impotence and cuckolding
Impotence cream pellets and psychological impotence
Herbal medications and impotence
Organic impotence and diabetic problems
Impotence help and acupuncture
Prostatectomy can cause impotence
Medicine and pills for impotence
Impotence cures and advise for males and females
Claudication impotence and vascular damage
Impotence issues and ejaculation problems
Penile psychological impotence
Mens impotence and claudication
Impotence aid and vasculogenic impotence
Impotence while using condom
Mens impotence and mental issues
Impotence- causes and penile injection therapy
Prostate impotence and cure
Impotence pills and pumps - not the sole solution
Impotence treatment- drugs and dangers
Impotence without related vasculogenic problems
Impotence clinics and penis pumps
Doctors and impotence clinic
Male impotency and ejaculation
Nervousness and erectile dysfunction
Is erectile dysfunction reversible?
Nervous erectile dysfunction
OTC medications for erectile dysfunction
Erectile dysfunction vacuum treatment
Exercise for erectile dysfunction
Exercises to ovecome erectile dysfunction
Get rid of erectile dysfunction
How to treat erectile dysfunction
Fungus causes erectile dysfunction
Herbal erectile dysfunction
Homemade erectile dysfunction medications
Support groups for erectile dysfunction
Hypnosis for erectile dysfunction
Neurological muscle fatigue and ED
Natural treatment for erectile dysfunction
Erectile dysfunction and diet
Erectile dysfunction and counselling
Herbs for erectile dysfunction
Erectile dysfunction and diet supplements
Erectile dysfunction exercise
Best pills for erectile dysfunction
Cold toes and erectile dysfunction
Erectile dysfunction and abuse
Medications that cause erectile dysfunction
Erectile dysfunction- vacuums do work
Erectile dysfunction treatments
Erectile dysfunction pumps work
Erectile dysfunction forums
Erectile dysfunction and nutrition
Treating erectile dysfunction
Causes of erectile dysfunction in young men
Sudden erectile dysfunction
Erectile dysfunction remedies
New treatments for erectile dysfunction
Erectile dysfunction cure
Natural remedies for erectile dysfunction
Erectile dysfunction creams
Vitamins for erectile dysfunction
Erectile dysfunction aids
Aging and erectile dysfunction
Aspirin use and erectile dysfunction
Can Meth cause erectile dysfunction?
Drugs for erectile dysfunction
Drugs and erectile dysfunction
Clonazepam and erectile dysfunction
Erectile dysfunction psychology
Curing erectile dysfunction
Smoking and erectile dysfunction
Erectile dysfunction spray
Surgery for erectile dysfunction
What is erectile dysfunction?
Treating your erectile dysfunction
Treatment psychological erectile dysfunction
Vacuum devices for erectile dysfunction
Woman dealing with erectile dysfunction
Trimix for erectile dysfunction
New drugs for erectile dysfunction
Natural remedy for erectile dysfunction
Hypertension and erectile dysfunction
Nitric oxide for treating erectile dysfunction
Lympoma and erectile dysfunction
Erectile dysfunction in young men
Erectile dysfunction medications
Erectile dysfunction tools
Causes of erectile dysfunction
Pills for erectile dysfunction
Testosterone and erectile dysfunction
Prostate and erectile dysfunction
Home remedy for erectile dysfunction
Foods for erectile dysfunction
History of erectile dysfunction
Erectile dysfunction rings
Natural home remedy for erectile dysfunction
Hereditary erectile dysfunction
Erectile dysfunction and caffeine
Foods that help erectile dysfunction
Erectile dysfunction symptoms
Which erectile dysfunction drug is best?
What causes erectile dysfunction?
Herbal creams for erectile dysfunction
Erectile dysfunction and heart disease
Cardiovascular leakage and erectile dysfunction
Erectile dysfunction remedy
Erectild dysfunction help
Pepcid and erectile dysfunction
Alchohol and erectile dysfunction
Over the Counter erectile dysfunction meds
Can you masturbate if you have ED ?
Erectile dysfunction prevention
Erectile dysfunction clinic
Herbs and erectile dysfunction
Situational erectile dysfunction
Sexually transmitted disease and erectile dysfunction
Psychological erectile dysfunction cures
Pump for erectile dysfunction
What are the symptoms of erectile dysfunction?
Erectile dysfunction doctor visit
Erectile dysfunction medications cost
Male erectile dysfunction
Herb for erectile dysfunction
Injection therapy for erectile dysfunction
Erectile dysfunction research study
High cholesterol and erectile dysfunction
Massage for erectile dysfunction
Erectile dysfunction treatment
Hypertension erectile dysfunction
Vacuum erectile dysfunction device
Cure for erectile dysfunction
Erectile dysfunction pharmacy
Chiropractic treatment for Erectile Dysfunction
Erectile dysfunction cures
Causes of erectile dysfunction
Erectile dysfunction drugs
Natural home remedies for erectile dysfunction
Rating male erectile dysfunction products
Adderall and erectile dysfunction
Erectile dysfunction and Vitamins
Running and erectile dysfunction
Doxycycline and erectile dysfunction
Erectile dysfunction with sickle cell
Endocrine causes of erectile dysfunction
Monoclonal gammopathy and erectile dysfunction
Male strap on for erectile dysfunction