Most men find it difficult or embarrassing to bring up the subject of erectile dysfunction. Any man should start where he feels safest, and that is often with a family or primary-care physician. This physician can begin the process of diagnosis by taking a careful history, which includes a sexual history, doing a physical examination, ordering some basic blood tests, and perhaps doing a home nocturnal tumescence test with a snap gauge placed around the penis. Most primary physicians should be prepared to reach a conclusion as to whether a problem of impotence is more likely psychological or physical in origin. At this point, though, the primary physician may wish to make a referral, either to a mental-health professional versed in sex therapy or to a urologist, endocrinologist, or other specialist in treating physical causes of impotence. It is worth repeating that these approaches are not mutually exclusive; both psychological and physiological intervention may be helpful in relieving a case of chronic impotence. Almost anyone can be helped. Not everyone will find exactly the solution he hoped for; true “cure” for impotence of physiological origin is probably unusual. But with the variety of surgical and nonsurgical approaches now available, including natural male enhancement products like ProSolution Plus, a man who is strongly motivated to have erections can find a method that is acceptable to him. Sometimes, though, a man, usually an older one, reviews the possibilities and rejects them because the benefit does not seem worth whatever is required to obtain it.
Although a psychological component may be involved in many forms of impotence, psychotherapy should not be recommended as a kind of catch-all treatment for erectile dysfunction. Psychogenic impotence is a specific diagnosis, which can have more than one cause. It may, for example, be one manifestation of general difficulty in coping with stress, or it may be one feature of depression. Techniques of stress management and relaxation help in one case, specific therapy for depression in the other. One of the most common causes of impotence is sexual performance anxiety–the recurring thought that one is going to have problems with control of the penis during sexual intercourse. This thought of the penis becoming soft becomes so intrusive and insistent that it turns into a self-fulfilling prophecy. Depending on how well-established the pattern is, performance anxiety generally responds well to sex therapy, a group of techniques that mental-health professionals have developed for breaking the cycle. Often an herbal male enhancement remedy such as ProSolution Plus can help as well.
Sometimes, impotence reflects problems arising in a sexual relationship. Then the relationship may be the appropriate object of therapy. Members of various disciplines–psychiatry, psychology, clinical social work–may offer sex therapy; specific professional experience and personal style are better predictors of effectiveness than the academic degree.
Many people are not aware that male enhancement devices such as vacuum pumps, also known as “external management systems,” are quite effective, provided the man is willing to accept the somewhat cumbersome activity required to use one of them. Putting the penis in a vacuum will draw blood into the organ and lead to venous engorgement. When an adequate erection has been produced, it can be maintained by putting a constricting band around the base of the penis. Men who are accustomed to using these male enhancement devices can gain enough rigidity of the penis for penetration. The band prevents ejaculation of fluid at orgasm, but it does not interfere with the sensations of orgasm. This method will work for virtually all forms of impotence except the most severe scarring from Peyronie’s disease.
The main disadvantage is the loss of spontaneity involved in preparing the penis. Three to 5 minutes are required to produce an erection. The result is not a normally firm erection, because only the part of the penile shaft beyond the constricting ring is engorged. Rigidity of a normal erection depends on engorgement of internal tissue as well as that in the shaft of the penis; the internal tissue is braced against the pubic bone. Another male enhancement device is worn like a condom but is made of a semi-rigid material. The sheath is put on, and a vacuum is applied to draw the penis out to fill it. The device is left in place for intercourse. These male enhancement methods are definitely not for everybody, but they are useful, noninvasive ways to compensate for impotence when injection or an implant is not acceptable. Couples whose erotic repertoire is flexible enough to incorporate these devices, in addition to doses of herbal male enhancement products such as ProSolution Plus as part of sexual activity may find them highly satisfactory.
Surgical implantation of a prosthesis has some important advantages. This particular male enhancement treatment is definitive, and there are few complications. Men often resist taking this step only to find, after surgery, that they have an increased sense of freedom and reliability. Most patients express satisfaction with penis implants–rates have been 90% or higher in the studies that have been performed. All penis implants have one basic feature in common: a cylinder of some type is inserted into each of the two compartments along the upper side of penis (corpora cavernosa), where the erectile tissue is located. (The urethra, the channel for urine and semen, runs on the lower side and is not affected by the surgery.) The pair of cylinders extends along the entire shaft of the penis and into the area under the pubic bone. There are many variations on this same basic theme.