Though this subject used to be taboo, it is now a very widely discussed topic. Men have always suffered from erectile dysfunction, but in the past it was always viewed as a sign of weakness or impotence in all areas. Thankfully, through our evolving as a society this is now not the case. Today there are a plethora of options for men who suffer from erectile dysfunction as well as those who simply would like to have bigger, stronger, fuller erections. 

Step 1

Look into prescription medications or generic equivalents. Today’s medicine is well equipped to deal with the issues of erectile dysfunction. If you’ve been unable to achieve or maintain a solid erection during intercourse, there are many safe drugs that can help with your problem. Viagra is perhaps the most well known of all the drugs. It should be taken 30 minutes prior to sexual activity and will cause the penis to become erect for the duration of the sex. For those men who don’t want to feel like they have to plan all their sex, Cialis allows one to take a pill at least 30 minutes before sex, but lasts 72 hours leaving the patient feeling prepared and not having to worry about taking the pill so often. Please discuss all the options with your doctor to determine which is right for you.

Step 2

Try topical creams. If you don’t feel like going the prescription drug route, there are creams out there that can help you accomplish a sustainable erection. These creams can be bought online, or purchased at a novelty sex store in your area (assuming your area has such kinds of businesses). Working much in the same way as the prescription drugs, topical creams are simply applied to the penis and should work immediately. The major complaints by patients is the mess caused by the creams as well as making it obvious to the partner that some sort of extra help is needed to achieve an erection.

Step 3

Experiment with exercises. Sometimes the key to lasting longer and achieving an erection lies in simply strengthening the muscles in the penis.
Try the following exercise: the next time you urinate, squeeze the muscle in your penis that stops the flow of urine (without using your hand). This is the same muscle needed for stronger bigger erections. Work it in the same way you would work any other muscle by means of a series of progressive exercises. Try progressively contracting the muscle for longer and longer periods and repeat throughout the day. This will help allow blood to keep trapped in the penis and in turn allow bigger stronger erections tat last longer.

Step 4

Eat the right foods. Each culture around the world has found “natural aphrodisiacs” in different types of food. And, though there is little science to back it up, it could be the right mentality if thought about in reverse. Though there might not be foods that help achieve an erection, there could be foods that might eventually prevent an erection. Keep yourself on a healthy well balanced diet and improvements in energy should be seen immediately. As your general health improves, so will your sexual state. Blood flow is the essential element in having an erection. Therefore, it is best not to eat food that could clog arteries or veins, thus inhibiting blood flow throughout the body including the penis.

Step 5

Smoking causes of erectile dysfunction. There is no denying it. Nicotine plays a big role in constricting blood flow. Keeping nicotine out of the body and exercising often will you’re your body in the ideal conditions for being able to achieve high quality natural erections.

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All three medications work in the same way. The drugs are all phosphodiesterase type 5 or PDE-5 inhibitors. PDE-5 is an enzyme that breaks down cGMP, which is the chemical responsible for relaxing the muscles along the penis and increasing blood flow in the penis – in effect, creating an erection. The three erectile dysfunction medications all work towards inhibiting PDE-5, which will then keep cGMP levels high enough to supply adequate blood to the penis to create an erection. This also works in women by relaxing the clitoral smooth muscles, also allowing blood to flow into the clitoris.

No matter what the cause of a man’s erectile dysfunction, all three drugs have high success rates in producing erections. In fact, it has been reported that 70-80% of men enjoy satisfactory results from using the medications (NEnglJ Med 1998; 338: 1397).

Women have also benefited from the effects of the drugs. Recently, 200 postmenopausal women with problems in sexual stimulation participated in a placebo-controlled study. For 12 weeks, half of the women were given Viagra, while half received placebo. After the 12 weeks, there was a significant improvement in the sexual experience of the women who used Viagra, except for those who had been previously diagnosed with hypoactive sexual desire (JUrol 2003; 170:2333-2338). This shows that Viagra also improves the sexual sensations for women just like in men, but it does not enhance sexual desire.

PDE-5 inhibitors are very effective for patients, particularly men, with antidepressant-associated sexual dysfunction (AASD). A placebo-controlled study was conducted recently on 90 men with AASD. For 6 weeks, half of the men were given Viagra and the other half received placebo. After the 6-week period, 59% of the men who were given Viagra reported a “very much improved” sexual performance as opposed to only 6% of the men who received placebo. By the end of the six weeks, most of the subjects were taking 100 mg doses. (JAMA 2003; 289: 56-64).

It has been commonly observed that in AASD patients, while there is general satisfaction when it comes to having erections, patients usually complain about experiencing delayed ejaculation. Many men have attested that this problem can be avoided by taking higher doses of PDE-5 inhibitors (PDE-5Is). Based on these claims, Columbia University researchers conducted a study on the possible effects of higher doses of Viagra for AASD-afflicted patients who are experiencing delay in ejaculations.

In the study, subjects were given a low dose of Viagra (25mg) in the beginning and were instructed to continuously increase the dosage until results can be seen. There were 21 men who participated in the study. Four of them responded to doses from 25 - 100 mg. Patients dropped out of the study until only 10 men remained who were still experiencing delay of ejaculation. Nine of the 10 responded to the medication after taking doses of between 150 and 200 mg. This is already twice the FDA’s recommended dosage of 100 mg, but few side effects were reported. (J Clin Psychiatry 2003; 64:721-725).

There are a number of unsuccessful PDE-5I users who could get more response from the medications simply by knowing more about the drugs. Urologists claim that about 40-55% of men who seem to get no results from PDE-5Is can achieve the desired results by changing the way they take the medications and following instructions more concisely (J Urol 2003; 170: 2356-2358). Here are some simple things patients can do to maximize the effects of the PDE-5Is:

1. Take the recommended dose in the correct time frame which is usually between 30 minutes and 4 hours prior to having any sexual activity.
2. Take an adequate dose of the medication. If you are taking 50 mg of Viagra, or 10 mg of Levitra or Cialis, and it does produce any results, double the dosage and see the difference it can make.
3. Cialis may be taken whether you have eaten anything or not, but Viagra and Levitra must be taken on an empty stomach in order to work.
4. If the first time does not work, don’t give up right away. Results get better every time, so keep trying.
5. Although these medications are very effective, they cannot work on their own. You will still need to be aroused sexually for the erection to develop.

The question still remains – which of the three medications is the best? As of this writing, no studies have yet been conducted to compare the effectiveness, side effects, or food interactions of all three PDE-5Is.

Some people claim that Levitra shows results faster than Viagra, and that it can be absorbed better after a meal. All three drugs produce the same side effects except for one or two differences. All three drugs are also not to be mixed with any kind of nitrate. It is also not advisable to mix PDE-5Is with doxazosin, but in Cialis, it is strictly prohibited.

In order to more clearly see the differences between the three medications, please refer to the following chart:

So far, only Lilly/ICOS have come up with head-to-head data attained from published studies. All three of these studies dealt with the personal preference of the respondents, instead of actual performance of the medications. It has been determined in all three studies that when asked to select between Cialis and Viagra, most men chose Cialis because it may be taken even after eating, and its effects last much longer. (European Urology 2004; 45:499-509; Clin Ther 2003; 25:2724-37; Clin Ther 2003; 25:2709-23.)

The conclusion: All three medications are effective, but Cialis lasts six times longer, and that may be all the difference it takes

Administration and Effect: Sildenafil is effective within 20 to 40 minutes. The drug works only when the man experiences some sexual arousal.

Mechanism of Actions: Sildenafil was originally developed for heart disease, but was found to have a unique mechanism of action that targeted only factors in the penis. The drug blocks the enzyme phosphodiesterase. This regulates the levels of cyclic GMP, a chemical that is produced in the penis during sexual arousal and which is the primary chemical that relaxes smooth muscles and increases blood flow.

Common Side Effects Common side effects include the following:

*Flushing.
*Muscle aches.
*Gastrointestinal distress.
*Headache.
*Nasal congestion.

Cialis: is a strong and highly-selective PDE5 inhibitor and may not affect other parts of the body, including the brain, heart, kidney and eyes. Clinical trials show significant success rates in up to 88% of patients. It appears to take effect in 15 minutes and the effects last up to 24 hours. Improved results were reported in men suffering from erectile dysfunction of varying severity and causes. Common side effects include headache, muscle pain, stomach upset following meals, and back pain.

Vardenafil : is another PDE5 inhibitor currently being investigated. A small study concluded that it increased penile rigidity and tumescence. More work is needed however.

Erection can occur throughout life, happening before birth and into the 90’s in healthy men. Nocturnal erections occur during all male dreams (regardless of what the dream is about), unless the man has physical problems (this is the easiest way to determine if impotence is physical or emotional in nature). The so called “morning erection” is the result of being wakened during, or just after a dream; and it can be a very persistent erection. While a morning erection is not a sign of arousal, its presence and the pleasurable sensations it can create may result in arousal.

Men have only very limited control over their erections. During puberty the young man is often embarrassed by erection in public settings, but he gradually becomes able to suppress erections when the stimulation is mild. Likewise, it is impossible to “will” an erection, although sexual thoughts can cause erection. During prolonged foreplay a man’s erection may go away; this is normal, and is not a sign of lessening interest.

General health and physical exhaustion can affect erection; when very tired, a man may be able to have only a partial erection, but still be able to climax. Erection is lost in two stages; the initial stage is very quick, but usually leaves the penis firm enough to continue intercourse. The second stage is somewhat slower and is effected by a variety of things including age (which tends to speed it), and arousal level before climax, with higher (or longer) pre-climax arousal generally resulting in slower lose of erection

Although the head (or glands) of the penis is very sensitive to touch, touch alone does not bring about an erection. The epicentre responsible for such essential arousal is actually within the brain. Only after the brain receives visual, audio or mentally stimulating input will it transmit (via the central nervous system) instructions to the smooth muscles along the penis to relax. Specifically the release of nitric oxide in the corpora cavernosa relaxes the smooth muscles. At the same time, the artery to the penis widen to twice its diameter, increasing the blood flow sixteen-fold, and the veins which carry blood away from the penis are blocked. As a result, the two spongy-tissue chambers in the shaft of the penis fill with blood and the penis becomes firm. The corpora cavernosa, acting like a sponge, fill with blood. In fact, the corpora absorb up to eight times more blood than when the penis is flaccid. As your penis swells and lengthens, the filled corpora cavernosa press against the veins. The veins surrounding the chambers are squeezed almost completely shut by this pressure. The veins are unable to drain blood out of the penis and so the penis stays rigid and erect. This condition normally keeps this erection firm enough for intercourse.

At this most basic level this function is considered to be normal if a man is able to maintain his erection sufficiently long to engage in satisfying intercourse and the subsequent ejaculation. The length of time a man might stay continuously erect can be on the average be about 30 - 45 minutes. Of course the duration of his erection vary greatly, in which case it may be a shorter or a great deal longer. After ejaculation or cessation of further stimulation to the penis itself or to the brain excess blood will be allowed to drain away, while the level of blood flow into the penis returns to normal. The penis once again becomes flaccid as it loses the built up pressure.

Erectile quality or intensity may depend on the kind of stimulation the brain receives. Acts as simple as kissing or “petting” are at times sufficiently arousing to bring about an erection. Viewing a sexually titillating movie or photographs will arouse most men to erection. Beyond this the particular nature of erotic images will have varying effects, as men tend to have a broad range of sexual tastes and desires. While some men may become highly aroused by simple stimulation, others thrive on fetishes.

The male libido reacts to a wide variety of stimulation. To consider a man sexually dysfunctional solely by measuring his arousal during intercourse, with a long term partner, is simply too limited as well as illogical. Certainly there are men who are not only fulfilled, but thrive in life-long monogamous relationships. There is really no size fits all when it comes to men’s sensibilities and needs. It would be a mistake however to insist that all men can achieve the same purpose, blissfully maintaining a long-term relationship, which is both sexually and emotionally satisfying.

What if things aren’t quite working that way? There are a number of conditions which may diminish or otherwise influence this process, these are known and considered less than one very general catch all term: Erectile Dysfunction, which is technically defined as “the inability to achieve or maintain an erection sufficient for sexual intercourse”. This is one of the most common sexual ailments in men. Although erectile dysfunction can be primarily psychological in origin, for most men it’s more likely a physical disorder, often with some psychological overlay. While some men assume that erectile failure is a natural part of the aging process and tolerate it; others find it devastating. Withdrawal from sexual intimacy because of fear of failure can damage relationships and have a profound effect on the overall well being of the couple.

The Massachusetts Male Aging Study measured several health related variables in 1290 men aged 40 to 70 years. Erectile dysfunction was very common. Fifty two per cent of the men reported some degree of impotence-mild in 17.1%, moderate in 25.2%, and complete in 9.6%. Complete impotence was reported by 5% of men at 40 years of age and 15% at 70 years of age.

Over the past decades, the medical perspective on the causes of impotence has shifted. It was easy to routinely attribute almost all cases of impotence to psychological factors. Now investigators estimate that between 70% and 80% of impotence cases are caused by medical problems. It is often difficult to determine if the cause of erectile dysfunction is physical or psychological, or even some combination. The following may be helpful in understanding the difference.

1) Psychological impotence tends to be abrupt and related to a recent situation. The individual may be able to have an erection in some circumstances but not in others. The inability to experience or maintain an erection upon waking up in the morning suggests that the problem is physical rather than psychological.
2) Physical impotence occurs gradually but continuously over a period of time. If impotence persists over a three-month period and is not due to a stressful event, drug use, alcohol, or medical conditions, the individual may needs to seek medical attention from a urologist specializing in impotence.

In virtually every case of impotence, there are emotional issues that can seriously affect the man’s self-esteem and relationships, and may even cause or perpetuate erectile dysfunction. Many men tend to fault themselves for their impotence even if it is clearly caused by physical problems over which they have little control.

Anxiety has both emotional and physical effects that can affect erectile function. It is among the most frequently cited contributors to psychological impotence. Anxiety over sexual performance is often referred to as performance anxiety and may provoke an intense fear of failure and self-doubt. It can sometimes set off a cycle of chronic impotence. In response to anxiety, the brain releases chemicals known as neurotransmitters that constrict the smooth muscles of the penis and its arteries. This constriction reduces the blood flow into and increases the blood flow out of the penis. Simple stress may even promote the release of brain chemicals that negatively affect potency in a similar way.

Depression is strongly associated with erectile dysfunction. In one study, 82% of men who reported moderate to severe erectile dysfunction also had symptoms of depression. Depression can certainly reduce sexual desire, but it is often not clear which condition came first.

Problems in Relationships often have a direct impact on sexual functioning. A lack of communication among the partners can lead to partners of men with erectile dysfunction feeling rejected and resentful. Both partners commonly experience guilt for what they each perceive as a personal failure. Tension and anger frequently arise between people who are unable to discuss sexual or emotional issues with each other. Such a situation makes it very difficult for the man to perform well.

Socioeconomic Issues like losing a job or having lower income or education increases the risk for impotence.

Smoking (particularly heavy) is frequently cited as a contributory factor in the development of impotence.

Alcohol has also been implicated in causing impotence. In small doses, alcohol releases inhibitions, but in doses larger than one drink, it can depress the central nervous system and impair sexual function.

Lack of Frequent Erections deprive the penis of oxygen-rich blood. Without daily erections, collagen production increases and eventually may form a tough tissue that interferes with blood flow. The spontaneous erection men experience while sleeping or awake may be a natural protection against this process.