Dilation of the arteries that feed blood to the penis results in engorgement of the spongy tissue. Simultaneous contraction of the muscles at the base of the penis prevents the blood from draining out through the veins, thus maintaining the erection.

Nerves in the spinal cord also control erection, which receive input from physical contact to the penis and/or surrounding areas, sexual thoughts, dreams, or images, and sex hormones.

Barring an erectile disease, and provided there is sufficient blood flow and nerve impulses, a man is capable of getting an erection when sexually stimulated. It is important to know that erections come and go. The ability of a man to get an erection is an automatic, normal function similar to his ability to breathe and blink his eyes.

IMPORTANT DISTINCTION Please note that you can open or close eye lid at will voluntarily, but you cannot bring about erection by will. You can raise your hand voluntarily, but you cannot command or cause erection voluntarily.
PITFALL- DON’T CHECK YOUR ERECTIONS THIS WAY.
Most people who suspect they have difficulty in getting erection TRY TO GET ERECTION by making conscious effort and keep watching the result. They DO NOT GET ERECTION not because they have erectile dysfunction, but because erection cannot be voluntarily willed.

Reference

http://healthguide.howstuffworks.com/erection-dictionary.htm

A boy/man/guy afflicted with ED (Erectile Dysfunction) can have difficulty that spills in to other areas of his life (aspects other than sexual life) 24 x 7. The mind becomes unquiet even if he imagines he has ED, that is in the absence of proven ED. ED, unfortunately, becomes a self fulfilling prophecy.

CAUSES OF SITUATIONAL ED
What this means is -
IMPORTANT -
a man may not really have ED, but the doubt, the apprehension, the belief, just the imagination, fear or worry of ED (impotence) can lead to impotence/erectile dysfunction.
The other causes of situational ED is
fatigue,
distraction,
ignorance,
inadequate sexual arousal (no mood)
and
disturbance (some physical or emotional disturbance as having had a bad day or the mood is not just right).

Often in this type of ED the sexual act is mechanical (without enough sexual arousal) or forced attempt at sexual intercourse, that is, attempting sex in the absence of high sexual arousal, as in situations when sex is motivated mainly by intention of pregnancy or when the Doctor has recommended certain dates for sexual intercourse to facilitate conception or to avoid pregnancy.

It may also occur just because he/she believes he/she is expected to do sex (important situational reason) as on occasions such as the first night after wedding (Suhagrat) when he is really not prepared for it.

FEAR OF FAILURE
PERFORMANCE ANXIETY
Fear of failure is a common cause of Erectile Dysfunction.
It is well known that PERFORMANCE ANXIETY causes impotence or failure to obtain or sustain erection.
If the boy (guy/man) is under pressure resulting from too much desire to impress her, example, as in extra marital affair (includes premarital affair) or during honey moon (wrongly believing that first impression is the last impression).

MYTHS MISCONCEPTIONS
He may be stressed out due to high expectation from one self or lack of confidence of one’s sexual ability or misconception, myth or wrong belief about genitals or their ability.

Prognosis
GOOD NEWS is almost often, especially under the guidance of an experienced counsellor (Sex Therapist), this man’s ED is curable.

Definition
WHAT IS SITUATIONAL ED?
Situational Erectile Dysfunction (ED) is TEMPORARY inability in obtaining and or maintaining Erection good enough for satisfactory sexual intercourse.

Note that this ED is temporary and almost always curable even without medicines usually with the help of an expert marriage or sex counsellor.

Differential Diagnosis
WHAT IS NOT SITUATIONAL ED?
In contrast to situational ED is ORGANIC ED, that is ED, which is because of causes such as actual damage caused by disease processes such as Diabetes or Hypertension. Thus, pathological process is implicated in the causation of Organic Erectile Dysfunction.

See http://my.opera.com/drashok/blog/2009/09/15/about-doctor

ARTIFICIAL method of increasing penis size

surgical treatment for Erection

Erectile Dysfunction: Penile Prosthesis
These devices are either malleable (bendable) or inflatable.

malleable (bendable) implants

The simplest type of prosthesis consists of a pair of malleable (bendable) rods surgically implanted within the erection chambers of the penis. With this type of implant the penis is always semi-rigid and merely needs to be lifted or adjusted into the erect position to initiate sex.

inflatable prosthesis

Today, many men choose a hydraulic, inflatable prosthesis, which allows a man to have an erection whenever he chooses and is much easier to conceal. It is also more natural.
click to know

how penile implant works

When should you use penile implant?

A penile implant is usually used when there is a clear medical cause for ED and when the problem is unlikely to resolve or improve naturally or with other medical treatments.
Attribution:
Acknowledgement: webMD
WebMD Medical Reference provided in collaboration with the Cleveland Clinic
SOURCE:
American Urological Association., Mentor Corporation.

Edited by John M. Baird, MD, FACS on January 01, 2007
‘Portions of this page © The Cleveland Clinic 2000-2004

Team lead my Mathew C. Raynor of the Department of Urology, Vanderbilt University Medical Center, Nashville, Tenessee, USA, used epigastric vessel for reanastomosis (joining of blood vessels) in penis. They used robot to get the epigastric artery. The entire procedure required 3 cm incision, which is better alternative to large midline incision. There work on five patients who had severe pelvic (hip bone) trauma following accident was published in the Journal of Sexual Medicine yesterday September 25, 2009. This article is quoted below verbatim.

From
Journal of Sexual Medicine
Early View (Articles online in advance of print)
Published Online: 25 Sep 2009

© 2009 International Society for Sexual Medicine

Robot-Assisted Vessel Harvesting for Penile Revascularization

Mathew C. Raynor, MD,* Rodney Davis, MD, † and Wayne J.G. Hellstrom, MD, FACS*
*Department of Urology, Tulane Health Sciences Center, New Orleans, Louisiana, USA; † Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Correspondence to Wayne J.G. Hellstrom, MS, FRCS, Chief, Section of Andrology, Tulane University Health Sciences Center, Department of Urology, 1430 Tulane Avenue, SL-42, New Orleans, LA 70112, USA. Tel: (504) 988-5372; Fax: 504-988-5059; E-mail: whellst@tulane.edu
Copyright © 2009 International Society for Sexual Medicine

KEYWORDS

Erectile Dysfunction • Trauma • Arteriography

ABSTRACT

Introduction. Ideal candidates for penile revascularization include young patients with documented vasculogenic erectile dysfunction usually resulting from pelvic trauma. Historically, large midline incisions were necessary to harvest the epigastric vessels for penile revascularization. We report our experience with robot-assisted epigastric vessel harvesting for use in penile revascularization procedures.

Aim.

To describe our technique and experience with robot-assisted vessel harvesting for use in penile revascularization.

Methods.

Five patients were selected for penile revascularization. Each patient suffered pelvic crush injuries resulting in post-traumatic erectile dysfunction. Each patient had no significant prior medical history and had normal erectile function prior to injury. Penile duplex Doppler ultrasound studies using vasoactive agents demonstrated decreased arterial inflow. Complementary pelvic angiography documented the corresponding arterial lesions. Each patient underwent attempted penile revascularization using a modified Virag-V technique.

The epigastric artery was harvested robotically and transposed through a 3 cm incision at the base of the penis. Microscopic revascularization was performed by anastamosing the epigastric artery to the deep dorsal vein. Distal dorsal vein ligation of the subcoronal plexus was performed to limit glans hyperemia.

Main Outcome Measures.

Description of a new method of vessel harvesting for penile revascularization.

Results.

Penile revascularization was successful in four out of five patients. One patient had complete thrombosis of the deep dorsal penile vein and underwent subsequent penile prosthesis implantation. Each patient undergoing successful revascularization was discharged home two days postoperatively and has reported resumption of sexual activity.

Conclusions.

The robot-assisted approach to epigastric vessel harvesting is an ideal minimally-invasive complement to penile revascularization. This procedure negates the need for a large midline incision and may shorten recovery time. Our described technique offers a novel option for the application of minimally-invasive technology, but longer-term follow-up is needed to further evaluate the success of penile revascularization. Raynor MC, Davis R, and Hellstrom WJG. Robot-assisted vessel harvesting for penile revascularization. J Sex Med **;**:**–**.

DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1743-6109.2009.01462.x About DOI

Download
Prescription Information on Caverject (c)

Self Injection to get Erection Satisfactory for Sexual Intercourse

• Who can use Caverject Injection?
• Who cannot use Caverject Injection?
• What is Caverject Injection?
• How to use Caverject Injection?
• How not to use Caverject Injection?
• What does Caverject Injection look like?
• What are the side effects of Caverject Injection?
• What precautions should be taken when using Caverject Injection?
• What Adverse Effect of Caverject Injection need URGENT medical treatment?
• How does Oral PGE5 Inhibitors like Viagra (c) [Sildenafil Citrate] compare with Caverject Injection? Which is the better and Why?
• References

What is Caverject Injection?

Manufactured and Marketed by Pfizer
CAVERJECT IMPULSE (c) is brand name of Injection in the Penis (Intracavernosal Use) of Alprostadil.
CAVERJECT Dual Chamber System contains alprostadil as the naturally occurring form of prostaglandin E1 (PGE1)

Caverject Alprostadil Injection for Erection Satisfactory for Sexual Intercourse

How to use Caverject Injection?

The site of injection is usually along the dorso-lateral aspect of the proximal
third of the penis. You must be taught by your doctor how to inject before using this drug.

What are the side effects of Caverject Injection?

The most common side effect of CAVERJECT IMPULSE is mild to moderate pain after injection. About one third of patients reported this pain but few stopped CAVERJECT IMPULSE for this reason.
Men may get a small amount of bleeding at the injection site.

What Adverse Effect of Caverject Injection need medical attention?

Call your doctor if you notice any redness, lumps, swelling, tenderness, or curving of the erect penis. Lumps or curving of the erect penis, including a condition called Peyronie”

How not to use Caverject Injection?

CAVERJECT IMPULSE should not be used more than 3 times per week. There must be at least 24 hours (1 day) between each dose. It should produce an erection in about 5 to 20 minutes that should last about 1 hour.

QUESTION

Dear Doctor,
is there any relation between erectile dysfunction and mastrubation?

REPLY

Masturbation never causes any side effects whatsoever even if a person believes he has begun early in childhood, for long time, too much.

After masturbation means friction on penis skin in a manner that increases excitement until there is orgasm and discharge of semen.

In all male, after discharge of semen there is a ‘time interval’ called the ‘refractory phase’ when even in presence of sexual excitement erection does not happen.

This is not called erectile dysfunction. Not getting erection immediately after sexual intercourse or masturbation is like taking pause to rest so that the tissues and sexual system can restart later.

Masturbation done early in life or any time is not a cause of Erectile Dysfunction.

I hope it answers your query.
Best Regards,
Dr. Ashok Koparday

QUESTION CONTINUES

Dear doctor,
thanks from your letter,I think that my problem is more psychological than physical.
For example when I am watching porno films (that I watch always when I have time, and it’s my hobby) I have a good erection.
Even I have upto 20 or 30 minutes full ererction.But when I face the real sex( which I had not more than 4 times in my life) I can’t get erection.
So please let mew know if my guess about this problem is right, or I have another problem?
And please show me the solution.

Best Regards
xxx XXX xxx

REPLY

PROBLEM SOLVED
Hi,

Your guess about the problem is accurate.

But when I face the real sex( which I had not more than 4 times in my life) I can’t get erection.

This is performance related where anticipation of possible failure can (not always) cause difficulty in erection. The severity depends upon the extent to which you are conscious about assumed possibility of not being able to do sex while you indulge in sex.

And please show me the solution.

Your solution is in your query itself.

I have a good erection. Even I have upto 20 or 30 minutes full ererction

The above sentence means your sexual apparatus is fine.

Example
You are like a student who has prepared very well for his exams, but some amount of tension remains while you actually go to give your exams. When you sit to write the answer paper everything goes smooth because you are well prepared. The surest and safest method that prepares you for sexual intercourse is masturbation. Be confident because you have direct evidence of good erection in your own hand.
Please let me know if you have any additional questions or issues.
Best regards,
Dr. Ashok Koparday MBBS FCSEPI

1. impotence resulting from a man’s inability to have or maintain an erection of his penis wordnet.princeton.edu/perl/webwn

2. Erectile dysfunction (ED or (male) impotence) is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis.
   There are various underlying
   causes, such as cardiovascular leakage and
   diabetes, many of which are medically treatable. …
   en.wikipedia.org/wiki/Erectile_dysfunction

3. The inability of a man to obtain or sustain an erection. Abbreviation: ED
   en.wiktionary.org/wiki/erectile_dysfunction

4. a consistent inability to sustain an erection sufficient for sexual intercourse. Also commonly known as impotence. …
   1stpropeciaprescription.com/Order/Order_Form/Medical_Definitions/medical_definitions.html

5. The loss of a man’s ability to have an erection. Some men may become impotent after having diabetes for a long time because the nerves or blood vessels have become damaged. Sometimes the problem has nothing to do with diabetes and may be treated with counselling.
   www.diabetesnsw.com.au/about_diabetes/diabetesdictionary.asp
6. Also known as “ED,” the loss of the ability to produce and/or sustain an erection (while desire for sex remains unchanged).
   www.dattolifoundation.org/glossary.htm
   Problems that a man may have in achieving an erect (firm) penis.
   www.spinalnet.co.uk/EEndCom/GBCON/homepage.nsf/(VIEWDOCSBYID)/1E68230AB2F65FF100256C59003EBE2C
   The inability to have or to maintain penile erection of sufficient firmness for coitus; also known as inhibited sexual excitement.
   www.crsupport.info/health_topics/sex-glossary-E.html

1
wordnet.princeton.edu/perl/webwn
2
en.wikipedia.org/wiki/Erectile_dysfunction
3
en.wiktionary.org/wiki/erectile_dysfunction
4
1stpropeciaprescription.com/Order/Order_Form/Medical_Definitions/medical_definitions.html
5
www.diabetesnsw.com.au/about_diabetes/diabetesdictionary.asp
6
www.dattolifoundation.org/glossary.htm
7
www.crsupport.info/health_topics/sex-glossary-E.html

BASICALLY PENILE DOPPLER STUDY IS SONOGRAPHY OF PENIS (USG)

It involves the use of an ultrasound unit to see inside the penis to look at the arteries and veins, and measures the blood flow in and the blood flow out of the penis.

The penile doppler test is pain free.
How is Penile Doppler Test Done?
However, the test does involve an injection into the base of the penis at the start. During this injection, the substance that opens up the arteries, bringing blood into the erection chambers, is introduced into one of the erection chambers. This is the starting event for an erection. It is important to stimulate the blood flow into the penis during this study to see how it might function in real life.
USES OF INTRA PENILE INJECTION
This injection is used for

• diagnosis and treatment of people with – ED – Erectile Dysfunction (Injection is not for every person with ED.) Not only does this injection allow us
• to learn about the workings of the penis, This test gives important information as to the nature of penile function, both in the erect and non-erect state.
  it also
• gives experience as to what this form of therapy is and
• whether the injection will be useful as treatment for a person with Erectile Dysfunction.

Intracavernosal Injection of Vasoactive Substance like Papaverine was the main treatment for Erectile Dysfunction. Even today such injection in the penis is useful for people having Erectile Dysfunction. ED

RISKS OF INJECTION IN PENIS
Intra penile injection is used in people with Erectile

Priapism is a risk associated with intra penile injection.
If this occurs, your physician will have to resolve this issue by using another counteracting substance. Thus it is controllable/manageable.
It is very important that a non-bendable, non-reversible erection be treated within a few hours maximum after it occurs. Failure of letting your physician reverse this prolonged erection could lead to long-term damage and must be avoided.

We hope this information allows you to undergo this study if required in a more relaxed and knowledgeable atmosphere. We will be happy to answer questions. Typically, patients are seen back approximately a week after this to allow the physician ample time to review and interpret the study prior to your follow-up visit.
At the time of your follow-up visit, implications of the study in terms of your treatment options will be discussed.

http://emedicine.medscape.com/article/777603-overview

Introduction:

Rigiscan plus is an ambulatory non-invasive monitoring device which collects, stores and evaluates data of penile rigidity and tumescence.

Monitoring

Monitoring can be done either during sleep (nocturnal) or during daytime (real time).

Materials and Methods:

135 patients, aged 20 to 50 years were studied.
After standard questionnaire and detailed physical examination they were categorized into 3 groups.

1. Group A: 85 patients

   having various sexual myths, performance anxiety, etc.

2. Group B: 32 patients
   having marital problems, unconsummated marriage, marital dispute, or divorced.
3. Group C: 18 patients
   having diabetes or other organic problems.

PROCEDURE

Real time monitoring with rigiscan was done, 2 hours

after consumption of tablet Sildenafil 50 mg with visual

sexual stimulation (VSS). If there was no erection the

dose of tablet Sildenafil increased to 100 mg at the same time or in the next sitting.

RESULT

Result was classified into 3 groups:
1.Good, sustained erection;
2.Unstable erection;

3. Poor erection.
Results:
Group A: 55 of 85 patients
had very good erection, 22 had unstable erections and 8 patients did not show any response. With 100 mg sildenafil in remaining 30 patients, 15 had shown good erections,
10 had unstable erections and
5 had no erection.
Group B: 10 of 32 patients
had good erections with 50 mg of
table sildenafil. With 100 mg sildenafil 12 of 22 patients had unstable erection and 10 had no erection.
Group C: 6 of 18 patients
had unstable erections while remaining
12 had no erections. With 100 mg 4 men had good
erections.

Discussion:

This test provide objective evaluation of ED and is less time-consuming and cheaper than
NPT.

Objective evaluation of erectile dysfunction –
using

Rigiscan/VSS test/Sildenafil test

–an experience
V. Gupta
Andrology Clinic, Bilaspur, India

For downloading pdf paste this link in your browser
www.asiaandro.com/1008-682X/9/415.pdf

* Systemic diseases associated with ED

o Diabetes.To Top of the Post

o Scleroderma

o Renal (kidney) failure

o Liver cirrhosis

o Hemochromatosis (too much iron in the blood)

o Cancer and cancer treatment.To Top of the Post

* Diseases of the nervous system associated with ED

o Epilepsy

o StrokeTop of the Post

o Multiple sclerosis

o Guillain-Barré syndrome

o Alzheimer disease

o Trauma.To Top of the Post

o Parkinson disease

* Respiratory disease associated with ED: Chronic obstructive pulmonary disease.To Top of the Post

* Endocrine conditions associated with ED

o Hyperthyroidism

o Hypothyroidism.To Top of the Post

o Hypogonadism

* Penile conditions associated with ED

o Peyronie disease.To Top of the Post

o Priapism (painful, abnormally prolonged erections)

* Mental conditions associated with ED

o Depression Top of the Post

o Widower syndrome

o Performance anxiety

* Nutritional states associated with ED

o Malnutrition.To Top of the Post

o Zinc deficiency

* Blood diseases associated with ED

o Sickle cell anemia.To Top of the Post

o Leukemias

* Surgical procedures associated with ED

o Procedures on the brain and spinal cord.To Top of the Post

o Retroperitoneal or pelvic lymph node dissection

o Aortoiliac or aortofemoral bypass.To Top of the Post

o Abdominal perineal resection

o Proctocolectomy

o Radical prostatectomy

o Transurethral resection of the prostate ([TUR] Prostrate Surgery).To Top of the Post

o Cryosurgery of the prostate.To Top of the Post

o Cystectomy