Booze. Most men have learned: One too many cocktails doesn’t improve performance; instead, it can have the opposite effect. During a recent study of 1,506 Chinese males, the men who drank three or more drinks a week were more likely to have ED or some form of sexual dysfunction. “Men may find that alcohol decreases social inhibition, which makes it easier to approach a woman,” says Montague. “But alcohol is a depressant, and at higher quantities it can reduce both a man’s desire and ability to perform.”
These medications don’t work for everyone but they are easy to use and work for around 60% of people who try them. They work by making it easier to get an erection by reducing the effect of (inhibiting) the chemical PDE-5. This chemical is used in the body to make sure there isn’t too much blood in the penis during an erection, but if you have erectile dysfunction then this chemical ends up over-compensating.

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.


Premature ejaculation was reported by 36 out of 96 (37.5%) subjects, out of which, 27 (28.12%) had complaints of ejaculating within the first minute itself and the rest (9.38%) ejaculated within three minutes of intromission. The next most frequent sexual dysfunction reported was low sexual desire, which was reported by 36 out of 100 subjects. Erectile dysfunction was reported by 33.3% of the subjects with difficulty in achieving erection in 19 subjects (19.79%) and difficulty in maintaining erection in 13 subjects (13.54%).
Illegal drugs don’t just affect and suppress the central nervous system. They cause serious damage to blood vessels. And any damage to blood vessels or normal blood flow will eventually cause erectile dysfunction. Some experts even argue that a single use of any of these chemicals can lead to subsequent ED. Chronic use raises the risk even more. If you have a substance addiction speak to your physician. There’s always help available.
For most men, improving erectile dysfunction means improving blood flow to the penis. Immediate relief often requires medications that increases nitric oxide (NO) in the blood vessels of the penis. NO causes the smooth muscle cells in the blood vessels of the penis to stretch, which increases the flow of blood. NO also keeps the smooth muscle cells younger and helps prevent and even reverse hardening and narrowing of the blood vessels over time. Proper diet (see more below) and regular exercise are key because both can boost NO.
The first goal in treating ED is to manage your diabetes. This includes keeping your blood sugar and blood pressure under control. If ED persists, treatments are available. While oral medications are a common first therapy, they don’t work for all men with diabetes. The penile implant may be an option. The implant is concealed inside the body. It offers support for an erection whenever and wherever desired.
"Sexual relations are not only an important part of people's wellbeing. From a clinical point of view, the inability of some men to perform sexually can also be linked to a range of other health problems, many of which can be debilitating or potentially fatal," says Professor Gary Wittert, Head of the Discipline of Medicine at the University of Adelaide and Director of the University's Freemasons Foundation Centre for Men's Health.
When you become aroused, your brain sends chemical messages to the blood vessels in the penis, causing them to dilate or open, allowing blood to flow into the penis. As the pressure builds, the blood becomes trapped in the corpora cavernosa, keeping the penis erect. If blood flow to the penis is insufficient or if it fails to stay inside the penis, it can lead to erectile dysfunction.
Is your erectile dysfunction due to psychological (stress, relationship problems, etc.) or physical factors? Your doctor may ask if you note erections at night or in the early morning. Men have involuntary erections in the early morning and during REM sleep (a stage in the sleep cycle with rapid eye movements). Men with psychogenic erectile dysfunction (erectile dysfunction due to psychological factors such as stress and anxiety rather than physical factors) usually maintain these involuntary erections. Men with physical causes of erectile dysfunction (for example, atherosclerosis, smoking, and diabetes) usually do not have these involuntary erections. Men with psychogenic erectile dysfunction may relate the onset of problems to a "stressor," such as failed relationship. Your doctor may suggest a test to determine if you have erections during sleep, which may suggest that there may be a psychological cause of the erectile dysfunction.
Patient can inject medications directly into the corpora cavernosa to help attain and maintain erections. Medications such as papaverine hydrochloride, phentolamine, and prostaglandin E1 (alprostadil) can be used alone or in combinations to attain erections. All of these medications are vasodilators and work by increasing blood flow into the penis. Prostaglandin E1 (Caverject, Edex) is easier to obtain; however, it is associated with penile pain in some individuals. The use of combinations of two or three of these medications can decrease the risk of having penile pain.
The first is a vacuum erection device (VED).  The device, which can be purchased on line and used at home, is placed over the penis, then pumped up to create a vacuum around the penis. This draws blood into the penis, creating an erection. One study found that the dropout rate with the VED was quite high, with only 50% of couples finding the treatment satisfactory. 2

Venous leak occurs when veins are unable to keep enough blood in the penis for a suitable erection.  As noted above, a firm erection results when blood flows into the penis.  Veins normally constrict to keep the blood inside until the man ejaculates.  A venous leak prevents blood from staying in the penis.  Instead, blood leaks back into the body and the erection fails to stay rigid.


If the patient reports a history of trauma to the genitals that preceded his erectile dysfunction, further evaluation with pharmacologic injection and penile color duplex ultrasound (PCDU) would be indicated to assess for arterial insufficiency or venous occlusive dysfunction (19). Prior to PCDU, however, you might give him a trial of oral PDE5 inhibitors. If those medications are effective, you have effectively ruled out significant arterial insufficiency or venous leakage disease as an etiology. Regardless of outcome of PCDU, no surgical intervention would likely be offered to this man who responds well to oral agents.
"We used to think that ED in young men was 90 percent psychological, but we now know that most cases are caused by a combination of risk factors. Erectile function depends on hormones, blood supply, nerve function, and psychological health,” said Run Wang, MD, professor of urology at The University of Texas Health Science Center in Houston and director of sexual medicine at MD Anderson Cancer Center.

The obvious risks are the same that accompany any surgery: infection, pain, bleeding, and scarring. If for some reason the prosthesis or parts become damaged or dislocated, surgical removal may be necessary. With a general success rate of about 90 percent, any of the devices will restore erections, but they will not affect sexual desire, ejaculation, or orgasm.

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