One of the first steps is to distinguish between physiological and psychological ED. Determining whether involuntary erections are present is important in eliminating the possibility of psychogenic causes for ED.[1] Obtaining full erections occasionally, such as nocturnal penile tumescence when asleep (that is, when the mind and psychological issues, if any, are less present), tends to suggest that the physical structures are functionally working.[20][21] Similarly, performance with manual stimulation, as well as any performance anxiety or acute situational ED, may indicate a psychogenic component to ED.[1]
Getting hard is also an overwhelmingly mental task. "Yes, men are saddled with the scheduled 'morning boner' and may experience an occasional random erection but by and large an erection needs to be achieved through mental stimulation," says Backe. "If you aren't turned on, your body isn't going to send more blood to the penis — bottom line. So, ultimately, you need a clean and clear mind for healthy and clear erections. Keeping the mind healthy will allow proper mental stimulation to occur at the right time."

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Depression and anxiety: Psychological factors may be responsible for erectile dysfunction. These factors include stress, anxiety, guilt, depression, widower syndrome, low self-esteem, posttraumatic stress disorder, and fear of sexual failure (performance anxiety). It is also worth noting that many medications used for treatment of depression and other psychiatric disorders may cause erectile dysfunction or ejaculatory problems.
Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both cases, an intact neural system is required for a successful and complete erection. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems.[19] Spinal cord injury causes sexual dysfunction including ED. Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also be caused by prolonged exposure to bright light.
For more information, check out the related Q&As. And while you're determining the cause of your partner's ED, you can still be intimate with activities other than intercourse that you both enjoy. As an exercise, you can try focusing on non-genital sensations, such as kissing and cuddling. You can also pleasure by caressing, touching, and stroking one another, having oral sex, or incorporating sex toys into your sex play. What non-intercourse intimacies do you enjoy? What about your partner? Have you discussed all the things you like that don't require an erection? Enjoying each other's company might give you both the emotional support and physical intimacy you need to help maintain a spark and eventually get the fire going again. Good luck,
Depression and anxiety: Psychological factors may be responsible for erectile dysfunction. These factors include stress, anxiety, guilt, depression, widower syndrome, low self-esteem, posttraumatic stress disorder, and fear of sexual failure (performance anxiety). It is also worth noting that many medications used for treatment of depression and other psychiatric disorders may cause erectile dysfunction or ejaculatory problems.
Men who smoke are twice as likely to experience ED as non-smokers. Smoking damages your blood vessels. Even if your nervous system is functioning well, getting an erection still might be difficult if your blood vessels are damaged by smoking. However, quitting can improve your health immediately: your chance of a cardiac event decreases, your blood pressure improves, and your circulation improves within 2-12 weeks, which is incredibly helpful in preventing ED.
I am a woman who is currently in menopause. My sex drive has increased and i believe that it can equate to a teenage boy. My s.o. has erection dissatification. He can not penetrate. He prefers oral. He will become erect and orgasm. He works very hard to please me but sometimes I want intercourse. It makes me feel like he isnt attracted to me. I have been with him for quite some time and believe he has always had this problem. I dont understand why. I understand when you say that your wife has no interest. It can be hurtful.

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
A malleable penile prosthesis usually consists of paired rods that are inserted surgically into each of the corpora cavernosa. The rods are stiff, and basically to have an erection, one bends them up and when finished with intercourse they are bent down. They do not change in length or width. The malleable penile prosthesis has the lowest risk of malfunction, however they have the least normal appearance.

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PDE 5 inhibitors are broken down primarily by enzyme, cytochrome P450enzyme CYP3A4. Medications that decrease or increase the activity of CYP3A4 may affect levels and effectiveness of PDE 5 inhibitors. Such drugs include medications for the treatment of HIV (protease inhibitors) and the antifungal medications ketoconazole and itraconazole. Thus caution is recommended.
Erectile dysfunction, commonly referred to as ED, is defined as the inability to attain or maintain an erection needed for sexual performance. It affects over 12 million men in the United States alone. Although erectile dysfunction can affect men of any age once they pass puberty, it is most common in men over 40 years old and its likelihood increases with older age.
Erectile dysfunction (ED), or impotence, is a common sexual problem in men, especially aging men. Although there are a number of medications, supplements, and gadgets that claim to help men overcome this problem, some men prefer to try erectile dysfunction exercises. There are a number of specific exercises to improve ED, and many of them concentrate on strengthening the pelvic floor muscles. Most doctors also believe that a regular exercise regimen can help a man get and maintain a stronger erection for a longer period of time.

How do you please a man with ED?


Men with a rare heart condition known as long QT syndrome should not take vardenafil since this may lead to abnormal heart rhythms. The QT interval is the time it takes for the heart's muscle to recover after it has contracted. An electrocardiogram (EKG) measures the QT interval. Some people have longer than normal QT intervals, and they may develop potentially life-threatening abnormal heart rhythms, especially when given certain medications. Men with a family history of long QT syndrome should not take vardenafil, as it is possible to inherit long QT syndrome. Furthermore, vardenafil is not recommended for men who are taking medications that can affect the QT interval such as quinidine (Quinaglute, Quinidex), procainamide (Pronestyl, Procan-SR, Procanbid), amiodarone (Cordarone), and sotalol (Betapace).
"This can take some time, but it can help to stop a cycle of too much anxiety, followed by an erectile issue. It also can help you realize where you draw the most physical pleasure. People tend to focus only on the genitals when it comes to sex. However, they can experience pleasure all over their bodies. If they learn how to utilize this, it can be a resource for future arousal, fun and pleasure."
Medicines are usually the main treatment for erection problems. But some men try complementary therapies. If you don't want to use medicine, or if medicine doesn't work for you, you may want to talk with your doctor about some of the following options. Most of these treatments need more research before doctors can know if they work for sure.footnote 2 Treatments include:
If you are taking medications (alpha-blockers) for problems with an enlarged prostate, you should discuss your prostate medications with your doctor. Alpha-blockers also can cause lowering of the blood pressure. Thus your doctor will need to carefully watch your blood pressure when you start the PDE5 inhibitor. Common alpha-blockers include doxazosin (Cardura), terazosin (Hytrin), and tamsulosin (Flomax).
Prevention of some of the causes that contribute to the development of erectile dysfunction can decrease the chances of developing the problem. For example, if a person decreases their chances of developing diabetes, heart disease, and hypertension, they will decrease their chances of developing erectile dysfunction. Other things like stopping smoking, eating a healthy diet (heart healthy with adequate vitamin intake), and exercising daily may reduce a person's risk.
Oral therapy (pills) is the least effective and the most likely to be associated with liver problems, even though this is a small risk. This is related to the first-pass effect of all medications ingested via the digestive system. Once absorbed from the intesting, all food materials must pass through the hepatic (liver) system and be metabolized. As such, the actual delivery to the systemic blood system is low due to the liver metabolism of the testosterone. For this reason, the oral doses are quite high in order to get serum levels higher. 

I thought about checking into a penis ring myself, cus i’m fixing to turn 34, havn’t been with a girl since 2008, but started dating this girl, and we was starting to mess around, but i couldn’t get it in her cus it wouldn’t fit, and since that time i can’t seem to keep it up long enough to even do 4 play. think i will try the lube and ring and see how it goes..
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.
Having erection trouble from time to time isn't necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

I thought about checking into a penis ring myself, cus i’m fixing to turn 34, havn’t been with a girl since 2008, but started dating this girl, and we was starting to mess around, but i couldn’t get it in her cus it wouldn’t fit, and since that time i can’t seem to keep it up long enough to even do 4 play. think i will try the lube and ring and see how it goes..

Apart from that, one can also have better sex due to the excellent flow of blood in the dick. One can experience intense orgasms as well. If you are the one who is suffering from any issue of erectile dysfunction or even the premature ejaculation, then this device can assist in curing all by normalizing the flow of blood in the penis and even relaxing the penis veins.
Male erectile problems often produce a significant emotional reaction based on the impact of erectile dysfunction on confidence, self-esteem, and morale in most men. This is described as a pattern of anxiety and stress that can further interfere with normal sexual function. Such "performance anxiety" needs to be recognized and addressed by a doctor.
Have you heard about the famous Kegel exercises women often turn to for help? Well, these exercises are not for women only. You can perform them also and get the same beneficial effects as women. Kegel exercises for men are often recommended by many doctors to be used in the treatment of erectile dysfunction. Kegel exercises will strengthen your pelvic floor muscles. In order to perform these exercises, you will need to locate your pelvic floor muscles (to do that you will need to stop the process of urinating a couple of times) and squeeze them a couple of times. Start performing these exercises a couple of times a day and see the results for yourself.

Geraerts, I., van Poppel, H., Devoogdt, N., de Groef, A., Fieuws, S., & van Kampen, M. (2016, January–February). Pelvic floor muscle training for erectile dysfunction and climacturia 1 year after nerve sparing radical prostatectomy: A randomized controlled trial [Abstract]. International Journal of Impotence Research, 28(1), 9–13. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26538105

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The "Am I Normal?" study examined more than 15,000 men in the UK. The average erect penis was 5.16 inches (13.1cm), while the average flaccid penis was 3.61 inches (9.2cm). But maybe take this with a pinch of salt – the "study limitations" section of the research paper states “relatively few erect measurements were made in a clinical setting and the greatest variability between studies were seen in the flaccid stretched length”. Yes, how hard is too hard to yank for a study?
Stage 3: When you feel you are ready for next step then move to stage 3. This stage is a bit tricky and requires patience & good concentration. Start contracting the PC muscle slowly and lightly, hold for 2-3 seconds then release. Again contract a bit deeper than previous one and release. Repeat the process till you reach the deepest point and hold there for 20 seconds at least. Then release slowly. This way one set done. Do 2 sets daily.
Dr. Niket Sonpal is the Associate Program Director of the Internal Medicine Residency at Brookdale Hospital Medical Center in Brooklyn and an Associate Professor at Touro College of Osteopathic Medicine. He’s a practicing Gastroenterologist and Hepatologist with a focus on Men’s and Women’s Health, and a regular contributor to Women’s health, Shape and Prevention Magazine.
#9 Work out and look sexy. Better yet, start working out. A good cardio workout makes you feel fit and healthy, and it greatly improves your flexibility and blood circulation. When you look good, you’d feel alive down there. And the increased blood circulation would ensure that your boneless buddy would be upright and hard for a long time. [Read: Guide to dressing for sex]
Don't forget mental health, either! "If you are experiencing stress at work, in your relationships or at home, open up communication about these issues," notes Axe. "Try natural stress busters like spending time outdoors, taking some vacation time for yourself or seeing a therapist. You also need to make sure that you are getting enough rest every night — seven to nine hours of sleep per night." 

The recommended starting dose of vardenafil is 10 mg taken orally approximately one hour before sexual activity. A doctor may adjust the dose higher or lower depending on efficacy and side effects. The maximum recommended dose is 20 mg, and the maximum recommended dosing frequency is no more than once per day. Patients can take vardenafil with or without food. As with sildenafil, for vardenafil to be effective, sexual stimulation must occur.
The penis is composed of three cylinders: two on the top, the corpora cavernosa and one on the bottom, the corpus spongiosum. All of these are involved in the process of an erection. The corpora cavernosa are composed of potential spaces that can distend with blood, causing rigidity of the penile shaft. The corpus spongiosum is important for rigidity of the glans of the penis. When aroused, stimulated chemicals are released from the nervous system (nitric oxide is one) that stimulate the arteries to the penis to relax and increase blood flow into the penis. These potential spaces, like a sponge, can expand when more blood flow comes in the penis. Each corpora cavernosa is surrounded by an outer coating the tunica albuginea. When the penis fills with blood, these potential spaces, the sinusoids, compress the veins in the corpora against the side of the tunica albuginea, thus preventing blood from leaving the penis. It is this compression of the veins that allows for the erection to become fully rigid.

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