"I like to recommend that couples think outside the box," Dr. Hartzell said. "Intercourse doesn't always have to be the goal; look at sex as pleasure oriented vs. goal oriented." She suggested couples incorporating oral sex and manual stimulation into their bedroom routine. She also advised couples to "have fun" with their sex lives by not adhering to a specific schedule or routine: One woman she works with, for instance, leaves her partner's injection on her pillow as a subtle signal that she's in the mood to have sex.
Obesity. Obesity itself is not a risk factor for ED — but there is a connection. “The bigger concern is that obesity can lead to type 2 diabetes or vascular diseases, which are risk factors for ED,” says Montague. Morbid obesity, a term used to classify individuals who are significantly overweight, can cause hormonal changes that are triggered by excess body fat. In addition, obesity can put physical limitations on sexual intercourse.
...the root of the ground cover, Panax ginseng, which is the Asian species, and Panax quinquefolius, the American plant (grown mostly in Wisconsin). Ginseng is an "adaptogen," a medicinal herb that helps build and maintain body vitality, allowing users to better adapt to the stresses they face in life. Ginseng is available where herbal medicines are sold.
There can be both an indirect and direct way to achieve this. The reflex erection is the direct way, achieved by touching your penis to trigger the nerves in the lower part of your spinal cord and your peripheral nervous system. The psychogenic erection is the indirect way, via non-mechanical sexual stimulation (visual, for example) and sexual arousal. This activates the limbic system in your brain, sending electrical signals down to your erectile nerve centres via the lower regions of your spinal cord. The latter is why you can get both nocturnal or "morning glory" erections, rather non-erotically referred to as nocturnal penile tumescence. How romantic.
"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."
Medications. There are several different ED medicines that can help produce an erection, such as avanafil (Stendra), sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). These medications work the same way: they relax smooth muscle and allow increased blood flow into the penis. Testosterone replacement and medications injected directly into your penis to help with erection are also common.

Performance jitters. For some young men, the desire to perform well in bed can be so overwhelming that, in turn, it causes them to not perform at all. “When a younger man experiences ED, it often is associated with significant performance anxiety, which in turn increases the problem, sometimes turning a temporary situation (i.e., too much to drink that night) into a permanent problem,” says Jerome Hoeksema, MD, assistant professor of urology at the Rush University Medical Center in Chicago. “The more they worry about it, the worse it gets. Young men need to recognize this cycle and try to reduce the ‘stress’ surrounding sex.”
If the problem is physical, there are numerous treatments available, such as penile injections or penile revascularization surgery, which increases blood flow to the cavernosal artery of the penis. There are also medications like Viagra, Cialis and Levitra, but Lehmiller cautioned men with erectile difficulties not to self-medicate without seeing a doctor beforehand due to the potential negative side effects associated with such medications (such as chest pain or shortness of breath).
"This triggers the release of a neurotransmitter called dopamine, and it sends a chemical message from the brain to the penis, causing an increase of blood flow to the penis. The blood vessels leading to the reproductive system then relax and this allows increased circulation in the genital area. When you aren't aroused, the blood vessels in your penis are only partially open. But when your brain sends messages to your penis that you are ready for sex, the vessels open and allow more blood to enter the area. Because of the increased blood flow, blood gets trapped in the penis, which makes the penis expand and causes an erection."
Most of us are raised to believe that men are ravenous sex-beasts, eternally horny and only pretending to be a part of polite society so that they can find some new crevice to jam their Jeremy Irons into. So the first time we cross paths (and genitals) with a guy who can't get an erection, many of us immediately panic and assume that the problem must be us. We must be profoundly unsexy. After all, what could else possibly stop these hormone-addled maniacs from getting an erection?
UW Health urologists with advanced training offer medical and surgical treatment options for men and their partners affected by erectile dysfunction. There are several different ways that erectile dysfunction can be treated. For some men, making a few healthy lifestyle changes may solve the problem. Your urologist will help determine the most effective course of treatment for your condition. 
Assuming an absence of any significant spinal damage or hormonal disorders, the potential barriers are in fact different at stage one and two. At stage one, anything that causes impairment in your psychological ability to become stimulated will hamper an activation of your nervous system. At stage two, anything that contributes to a narrowing of blood vessels will hamper the engorgement of your erection.
It may be that after trialling all the above, including the little blue pills, you are still having challenges. There are always other options. The only issue is that they tend to move further away from science, proven efficacy and fact and more towards anecdotal evidence and illegitimate science, all while preying on a natural desperation to find a solution. I would say, if you are at this stage, go and see your doctor to discuss a referral to see a urology specialist. It may spare you dabbling, unsuccessfully, with the various less-proven methods, including:

Remember those cultural messages we discussed earlier, about how men are wild sex aliens from the planet Weenus? Well, men are raised hearing those messages, too, and they can end up screwing with their sexual self-image —for instance, they can lead men to obsess over their own virility, and panic about impressing a new partner, until they've thought their boner into a corner and can't get an erection. Performance anxiety is one of the most common culprits behind lost erections, especially among younger, less experienced men.

These specific chemicals are found in erectile dysfunction medications such as Viagra and Cialis."The chemicals that cause the outflow are called phosphodiesterases," says Reitano. "To give you a stronger erection, erectile dysfunction medications (PDE-5 inhibitors) block or inhibit the phosphodiesterases, which enables the blood vessels in the penis to stay open and receive more blood, creating a firmer and longer lasting erection. This is why the drugs are called phosphodiesterase inhibitors (PDE-5 inhibitors for short)."

Not to give your already stressed-out dude one more thing to worry about, but stress is the cause of 20 percent of all erectile problems, from one-off boner blunders to a lingering inability to get and maintain an erection. Of course, sex difficulties are just the tip of the stress-induced health problem iceberg — sustained stress can also lead to insomnia, stomach troubles, chest pains, anxiety, and more severe health issues in the long term.


Regular exercise and a diet rich in antioxidants is also the foundation of permanent weight control and diabetes prevention. Studies at the Duke University Diet and Fitness Center show that weight loss is strongly associated with better sexual function. Other studies show that diabetes is a major risk factor for ED, and that a healthy lifestyle prevents the disease and can restore erection function.
"Surprisingly, up until the 1980's, most sex experts held the Freudian view that weak erections were caused by deep-seated, unconscious neuroses or psychological problems," she explains. "This view has now widely been rejected by professionals in the field of sexuality and it's now understood that erection problems that stem from deep psychological problems are the exception, not the rule. A majority of weak erections are caused by a combination of sexual misinformation, relationship problems, depression and other life stresses."
"Surprisingly, up until the 1980's, most sex experts held the Freudian view that weak erections were caused by deep-seated, unconscious neuroses or psychological problems," she explains. "This view has now widely been rejected by professionals in the field of sexuality and it's now understood that erection problems that stem from deep psychological problems are the exception, not the rule. A majority of weak erections are caused by a combination of sexual misinformation, relationship problems, depression and other life stresses."

You may be unsurprised to learn that little has changed over the years when it comes to erections. In fact, this is probably only matched the pursuit of erectile greatness (judging by the growing column inches on the subject). But there too is a new kid on the sexual performance block: the volume of your semen – likely born out of the explosion of easily accessible online pornography and its warped portrayal of “what’s normal” in sex. Divided into two parts (one: your erection; two: your semen), here’s what you need to know about these two bedfellows...


Some of the most reliable ED stats have emerged from a large data collection effort called the Massachusetts Male Aging Study. According to that data, rates of ED among men tend to correlate with their age bracket, says Tobias Köhler, M.D., chief of the Division of Male Infertility at Southern Illinois University. “Roughly 40 percent of men in their 40s suffer from ED, 50 percent in their 50s, etc.,” he says.
Stiffy Solution: Again, saying "stop being so stressed out so you can get boners again" is easier said than done — but a lot of people find sexual dysfunction to be a stronger motivator to live a healthier lifestyle than the threat of, say, a heart attack down the road; so there's a chance that this could actually be a good thing in the long run for your boo, if it helps him take his stress seriously. Relaxation techniques like yoga, exercise, meditation, tai chi, and getting adequate sleep can all lessen the impact of stress on your body (and your dong).

The blood vessels in your penis are smaller than the larger veins and arteries in other parts of your body. What that means is the first sign of hypertension, heart disease, high cholesterol, and clogged arteries may not be a stroke or a heart attack. It will often be erectile dysfunction. Regular physical activity reduces your risks for cardiovascular disease (which is awesome), but it also lowers your risk for ED. If there’s a better reason to sweat through a spin class, I can’t think of one.
So not only are erectile problems common, they're nothing for you or your special friend to be freaked out about. Check out the nine most common reasons that dudes sometimes can't get it up, and get ready to become the soothing voice of reason the next time the guy you're with has a hard time pitching his tent in your happy valley. Everything (and every penis) is gonna be fine!

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