Erectile Dysfunction: Trusted and timely health information for men

Erectile dysfunction (ED) is the medical term given when a man cannot sustain an erection long enough to have sex, or when it is impossible to have an erection at all.

In some cases, a man can have an erection, but then lose it during intercourse. Also called male impotence, it affects over 15 million men in the United States.

Frequent cases of erectile dysfunction can cause emotional and relationship problems, and even cause self-esteem problems for some men. By the time they reach their 40’s, many men may have already experienced an occasional incident of erectile dysfunction but in most cases, it is a temporary condition. If symptoms continue then medical treatment should be considered. Your physician can help determine the erectile dysfunction treatment that is just right for you. including but not limited to the use of the best penis pumps for ED.

What are the Causes of Erectile Dysfunction?

During an erection, the penis becomes engorged with blood as blood vessels enlarge or dilate and allow an increased flow. Erectile dysfunction may occur due to a variety of medical conditions, including damage to the nerves, arteries, muscles and tissue. In order for an erection to take place, a series of precise events occur, which include nerve impulses in the brain, spinal column, and area around the penis. When those nerve impulses are received, the muscles, fibrous tissues, veins and arteries respond, which result in an erection. However, if there is a disruption in any of those signals, it can result in erectile dysfunction instead of an erection.

Often times a disease may be the cause of erectile dysfunction. Diseases, such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease, account for about 70 percent of ED cases.

Another possible cause of erectile dysfunction may be recent surgery, especially radical prostate and bladder surgery for cancer. Sometimes the surgery can injure nerves and arteries near the penis, causing erectile dysfunction. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and fibrous tissues of the area around the penis.

There are also a number of prescription drugs that affect some nerve centers, resulting in erectile dysfunction. Many common blood pressure drugs, antihistamines, antidepressants, tranquilizers, and other medications can produce ED in a man. Medical experts also have discovered that psychological factors, including stress, anxiety, guilt, depression, low self-esteem and fear of sexual failure can cause erectile dysfunction.

Other possible causes are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as not enough testosterone.

What are the symptoms of Erectile Dysfunction?

The symptoms of erectile dysfunction occur when a man cannot achieve an erection, or he has difficulty sustaining an erection long enough to reach orgasm during sex.

If erectile dysfunction occurs only occasionally, it is considered normal. However, if a man is experiencing frequent problems related to ED, then he should consult with a physician.

How is Erectile Dysfunction diagnosed or evaluated?

Patient History

If your physician suspects that you may be suffering from erectile dysfunction, they will review your medical and sexual history. In many cases, your medical history will reveal a few clues as to the cause of your ED. Learning about a patient’s sexual history and practices will also assist the physician. There may be problems associated with the patient’s sexual desires, ability to maintain an erection, ejaculation or orgasm.

Reviewing any drugs that have been prescribed for other medical conditions may also suggest a cause of erectile dysfunction. Drug interference with a man’s ability to have an erection accounts for one-fourth of all ED related cases. Your physician will be able to determine if substituting certain prescription medications will solve the problem.

Physical Examination

When your physician performs a physical examination, they may discover the cause of your erectile dysfunction. In some cases, a man’s penis may not respond to touching, which may indicate a problem in the nervous system. In other cases, abnormal secondary sex characteristics, such as hair pattern or breast enlargement, can point to hormonal problems. If that is the case, that would indicate that the endocrine system is involved.

Your physician will also check for any circulatory problems by observing decreased pulses in the wrist or ankles. Sometimes, however, the clue to your erectile dysfunction lies in the penis itself. If your penis bends or has a slight curve, the erectile dysfunction could be the result of Peyronie’s disease.

Laboratory Tests

Your physician may also order several laboratory tests to help confirm the diagnosis of erectile dysfunction. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. They may also perform a test that will measure the amount of free testosterone in your blood, which will reveal information about possible problems with the endocrine system, especially in patients who are experiencing a reduced sexual desire.

Other Tests

Healthy men normally have several involuntary erections each night while they are sleeping. Your physician will perform a routine test to determine if you are having those involuntary erections at night. If you are, that would indicate the problem may be more psychological than physical. It should be pointed out, however, that no test is infallible, and your physician will work with you to determine the cause of your erectile dysfunction.

Psychosocial Examination

To determine if your erectile dysfunction problem may be psychological, your physician may perform a psychosocial exam. This exam, which uses an interview and a questionnaire, reveals certain psychological factors to help uncover the reason for the ED. The man’s sexual partner may also be interviewed, to help determine sexual expectations and perceptions during intercourse.

What are the treatments and drugs to treat Erectile Dysfunction?

Many physicians will seek treatments that run from the least invasive to the most invasive. In many cases, if the patient is on medication for high blood pressure, they will check to see if there are any side effects that may be the cause of the erectile dysfunction.

Sometimes a patient will know of a medication they are taking that is causing problems with erections, and they will share that information with their physician. Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered.

In March 1998, the Food and Drug Administration (FDA) approved Viagra to treat ED, the first pill in a new drug class, phosphodiesterase inhibitors. In August 2003, the FDA gave approval to a second oral medicine, vardenafil hydrochloride (Levitra). Additional oral medicines have since been approved (Cialis, tadalafil) and more are being tested for safety and effectiveness.

Taken an hour before sexual activity, phosphodiesterase inhibitors such as Viagra and Levitra work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

The Basics of Female Masturbation- Masturbation Tips for Women

The first and probably most important aspect of masturbation is your thoughts and feelings both before and during. You must be fully relaxed without stress or worry.

It is essential to make some time for you and only you. Find a time of the day when you will not be disturbed. Turn off your television, cell phone and anything else that can distract you. Having children may add to the hassle of making a proper time and place.

The bathroom is a good choice, as you have a lock on the door, shower head, and tend not to be bothered while “showering”. The other most common place is your bedroom. A lock on the door is necessary to be confident that you will have no unwanted visitors. Candles add to the setting in either room. 

Learn What Makes Your Clitoris Feel Good

Exploring your own body is essential. If you are very unfamiliar with your body, review our anatomy page and orgasm page. Understanding what makes you feel good and what doesn’t is very important before starting. Some women do not like penetration with their own fingers while others love it. No two women’s anatomies are alike.

Move your labia, see anatomy page, and begin lightly rubbing your clitoris in different motions. Begin with an up and down motion. Vary the speed your fingers move until you find what works. Understand that the slightest movement change can make the world of difference. It takes some women years to master the technique. Now, try a circular movement, rubbing your clitoris both clockwise and counterclockwise starting from a variety of origins. Some women like to start this motion an inch or so above the clitoris.

Try one, two, or three fingers. An easy way to master this motion is to pretend that you are drawing circles on and slightly above and below your clitoris with your forefinger or forefinger and middle finger. Keep exploring until you find what makes you feel good. Also, at different points of your sexual stimulation, different techniques will have different effects on you. So, don’t give up because it doesn’t feel good right away.

Learn What Else Works

Invest in some lubricant and begin exploring penetration with your finger(s). Once you are moderately aroused using the above stimulation methods, begin slowly inserting your forefinger one and two knuckles deep into your vagina. Slowly thrust your finger in and out simulating intercourse.

Vary the speeds.

Try curling your finger up when you are inside and feel the upper portion of your vaginal wall. With your finger inserted, move your forefinger in a circular motion to feel all 360 degrees of your vagina. Be sure to touch every little crevice and rub it with different strengths and motions. Try adding a finger or two. Once you think you have an idea of what feels good, begin trying this in different positions such as standing, lying on your stomach, legs around a chair’s back, etc. Be creative. This is your alone time. Nothing is wrong – you control every aspect of this and no one else can know or see you. Do not feel uncomfortable. 

Techniques and Methods

Manual Stimulation

 Circular Motion:

Place either your forefinger or your forefinger and middle finger on top of you clitoris. Begin moving them in a circular motion over top of the clitoris, possibly extending a bit below or above your clitoris. Using lubrication can increase the intensity of your orgasm and decrease the length of time needed as well.

 Clitoral Kneading:

Gently grab your clitoris between your thumb and forefinger. Knead it back and forth like there is a marble sized piece of dough between your fingers. Vary the speed and strength.


This technique works for few women, but works extremely well for these few. Spread your labia exposing your vagina. Now, gently tap your clitoris and some of the are just under. Again, this feels good for very few women.

 Finger Penetration:

This is a simple ease way to achieve orgasm when doing in addition to the above circular motion method. Using lubricant or first getting aroused with an above method, insert one or two fingers inside your vagina, thrusting in and out. Different speeds and multiple fingers can spur a spontaneous orgasm. Read the sections above for more information.


Using water to your sexual advantage in the shower both alone and with a partner can be a very fulfilling experience. Below are some techniques.

 Faucet Flow:

Most bathtubs will allow for this type of body position. If yours does not, you may want to purchase a showerhead with a rubber hose so that you can aim it wherever you please.

First, turn the running water on in your bathtub gently and to a temperature that is lukewarm. You do not want to scold your genital area! Now, lie on your back with your feet towards the running water. Scoot forward in the bathtub and let your feet slide up the shower wall or in the air. Align your vagina with the falling water. Letting it fall on your clitoral area and your vagina may be enough.

You may want to use any of the above methods in addition to this. You can vary the strength of the flow and the temperature of the water. I can not emphasize enough – do not make drastic changes in the temperature! Scolding in that area is not pleasant!

 Showerhead Massage:

If you have tried all of the above methods including the faucet flow then you this one will probably be self-explanatory. Each showerhead is different. Experiment with different positions, temperatures, and strengths of the water. Some heads even have different massaging options. Aim the water stream wherever it feels good. That’s it. This is a great daily wake up when showering!



Using the best G-Spot vibrators is much more effective in achieving orgasm in most women. Purchasing one with varying speeds is a good idea. Rubbing it all over your body, especially the nipple area, inner thighs, and clitoris are among the most favorite spots.

Many like to use a moderate to fast speed until slightly before climax and then lower the speed to bring the sensual pleasure down. Continue this until you can’t continue “holding” the orgasm. Some women like using a gel-coated, penis shaped vibrator to stimulate the clitoris and use it as a dildo, turning the vibration on and off.


Using a dildo instead of your fingers, or instead of a man for that matter, can be a powerful sexual experience. I would not recommend latex as it is difficult to keep clean. Gel coated dildos are preferable. Infections can easily occur when it is not kept meticulously clean. The technique is similar to that of finger penetration and clitoral stimulation should be used as well. Using some of the water stimulating methods in addition to a dildo is a fun variation.