Many erection problems can be prevented or even reversed by a more relaxed approach to sex and by rediscovering sensuality. Sexual intimacy is a form of communication. If you and your partner talk about your lovemaking, it will help reduce your stress and anxiety, so that your sexual activity becomes more relaxed. Many people avoid talking about problems in their sexual relationship. It may gradually become more difficult to get and maintain an erection as you get older. However, foreplay and the right environment can increase your ability to have an erection, regardless of your age.

Yes, they both do. Smoking causes damage to blood vessels and this slows blood flow to the penis. In one study it was found that male smokers with high blood pressure and/or other risk factors were more than twice as likely to have complete ED than those who didn't smoke. If you drink alcohol, it’s best to have no more than two drinks a day. Alcohol slows down your central nervous system and can make it more difficult for you to get an erection.

Vacuum devices are small pumps attached to a cylinder you fit around your penis. Air is pumped out of the cylinder to create a vacuum, and the lowered pressure increases blood flow into the penis. The blood is trapped by rolling a special rubber ring down to the base of the penis.

More fashionable versions of these rings, made from metal or studded leather, can also be bought from sex shops, if it appeals to you to make the intervention less clinical in this way. The pumps are useful for all types of erection problems (physical, psychological, or a combination of both). Vacuum pumps are generally safe, simple to operate and can be used as often as desired. However, improper use can damage your penis and so they must be used under a doctor's care. While you may need to interrupt foreplay to use them, you can also incorporate use of the pump into erotic play, making it less medical and more natural.

It can be both, but most often the cause is physical. A firm erection is the result of a whole series of psychological and physical events. If a problem occurs at any step in the process, the erection may be absent, insufficient or short-lived. There is therefore a range of possible causes of erectile disorder.

These can be grouped into two general types: physical (related to the blood vessels and/or nerves) and psychological. Most erection problems are due to a combination of these factors. Until the early 1990s, most cases of erectile dysfunction were thought to be of psychological origin, but new research has shown that the causes are physical in 85 to 90% of cases.

The most common cause of erectile dysfunction is damage to arteries, smooth muscles and fibrous tissues.

Many men suffer from erectile dysfunction. But only 10% ever seek treatment. Here are the answers to some frequently asked questions on erectile dysfunction (ED).

Yes, while episodes of ED are common in younger men, it is much more frequently found in older men. Current statistics are not available for South Africa, but in America about 10% of men are believed to be affected. Incidence rises with age: about five percent of men at the age of 40 and between 15 and 25% of men at the age of 65 suffer from erectile dysfunction and the percentage grows to 70% as men reach 80 years of age. As men age, they typically report some loss of sexual desire as well, although neither loss of desire nor erectile dysfunction is an unavoidable feature of ageing.

Yes, it does. Especially if it was the result of a stressful situation which has been resolved, or an injury that has healed. What is priapism? In layman's terms, basically an erection that won't subside. This can be caused by anti-impotence drugs. This condition can be dangerous and can cause permanent damage to your penis. If an erection lasts for more than four hours, you need to get to a doctor immediately.

Determining the cause of erection problems is often the key to reversing them. Since both physical and psychological factors are often involved, it can be complicated to make an exact diagnosis.

As part of the initial evaluation, your doctor may do the following:

• History taking. He may ask about your sex life, diseases you’ve had and drugs prescribed to you. This will enable him to review risk factors.
• A complete physical exam (including the abdomen, penis, prostate, rectum, and testicles). If the penis does not respond as expected to certain touch stimuli, there may be a problem with the nervous system. Abnormal secondary sex characteristics, such as loss of armpit or pubic hair, can suggest problems in the endocrine system affecting hormone levels. A circulatory problem might be indicated by, for example, an aneurysm in the abdomen (such as disease of the large artery, the aorta, which supplies blood to the abdomen and lower limbs).
• Routine lab tests. These include blood counts, urine analysis, lipid profile, and measurement of liver enzymes and creatinine (a waste product of protein metabolism). If sexual desire is low, the levels of testosterone in the blood may be measured to determine if there are any endocrine abnormalities.
• Nocturnal penile tumescence testing. This test, which monitors if you have erections while asleep, can often help to determine whether the cause is predominantly psychological or physical. Physically healthy men have involuntary erections in their sleep; if these occur, the cause is more likely to be psychological. However, these tests are not completely reliable, and have not been standardised. The modern era of effective oral treatment has reduced the indications for penile tumescence testing drastically.
• Tests to evaluate the penile arteries and veins. This includes the use of medication to assess erections, ultrasound and angiography (a radiographic technique for examining the anatomy of a blood vessel).
• Extensive nervous system tests. These are not well standardised and are generally done only at major medical centres.
• Psychological evaluation. This may be recommended when a major psychological cause is suspected.

You and your doctor will use the results of the examination and tests to develop a treatment plan that may include medications, other non-surgical treatments or surgery.

Yes, it is, in the sense that many men have erectile problems, especially at times of great changes in their lives. In fact it is probably more widespread than people realise, as proven by the popularity of anti-impotence drugs on the market. It is estimated that men with erectile problems take an average of five years before going to the doctor. It should not be ignored, as erectile problems often point to other physical problems, such as diabetes.

An erection begins with sensory and mental stimulation. Impulses from the brain travelling down the spinal column and impulses from the nerves in the penis relax smooth muscles in two spongy cylinders that run the length of the penis, parallel to the urethra (the conduit for urine and semen). When the impulses cause the muscles to relax, blood flows into spaces in the spongy tissue, and this pressure makes the penis swell out. A membrane surrounding the cylinders helps to trap the blood in the penis and maintain the erection. The penis returns to its flaccid state if the muscles contract, stopping the inflow of blood and opening outflow channels.

An erection problem can occur if any of the events in this sequence are disrupted: the problem may involve mental processes, nerve impulses, or responses in muscles, fibrous tissue, veins and arteries in the penis.

Psychological problems, such as anxiety, interfere with the erection process by distracting the man from things that would normally arouse him.