"Erectile dysfunction medication interferes with the process that allows blood to leave the penis," adds Reitano. "Men with erectile dysfunction would benefit from having the chemicals leading to the erection outweigh the actions of the chemicals that cause the penis to lose its firmness, to have the systems that cause the inflow outweigh the chemicals that cause the outflow."
The answers to these questions, as well as physiological tests like an ultrasound or neurological assessment, can help determine the root cause of ED. Depending on the cause, different treatment options are available. Treatments range from medication, to hormone replacement therapy, to vascular surgery, to sex therapy and/or couples counseling. It sounds like you have ruled out many physical factors, in which case it may be useful to consider psychological factors. Often, couples counseling and/or sex therapy (as a couple or individual) can identify factors related to ED, help with communication, and improve sex for both partners. For a sex therapist, check out the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) web site and click on the "Locate a Professional" link.

The production factory of your semen is on an industrial scale, constructed from multiple locations in your genitourinary system. First there are the stars of the show, your spermatozoa, which are naturally synthesised in the seminiferous tubules within your testicles. During the ejaculation process, these then pass through your ejaculatory ducts and blend with fluids from your prostate, seminal vesicles and bulbourethral glands. This melting pot forms your semen as it arrives via urethral meatus (the end of your penis) to the cold light of day – or night.
Don’t panic. That will only make it worse. Erectile dysfunction is common. In younger age groups it is more likely to be a psychogenic issue around performance anxiety (don’t seek to be like a porn star is a top tip). In men between the ages of 40 and 70, it is estimated that 50 per cent will have some degree of erectile dysfunction. In this age group, there may be a more of a physical issue around blood flow. In either case, consult your doctor and they will be able to give you some more advice. An erectile litmus test is, if you are getting nighttime or early morning erections, it is likely a psychological not a physical vascular issue.
"Stress and anxiety can adversely affect sexual performance and are common causes of erectile dysfunction,” warns Feloney. “Feelings of stress and anxiety can also lead to depression and a loss of interest in sex." It's important to get these feelings out in the open where you can deal with them. Issues that can lead to erectile dysfunction include fear from previous bad experiences with sex, family or work related stress, poor communication with your partner, and unrealistic goals and expectations.

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