Impotence or erectile dysfunction is a man's difficulty to have or maintain an erection. The causes of erectile dysfunction may be physiological or psychological. Physiologically, erection is a hydraulic mechanism based upon blood entering and being retained in the penis, and there are various ways in which this can be impeded, most of which are amenable to treatment.

Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this can often be helped. Notably in psychological impotence there is a very strong placebo effect (see the "self esteem" article).

Erectile dysfunction, tied closely as it is to cultural notions of potency, success and masculinity, can have devastating psychological consequences including feelings of shame, loss or inadequacy; often unnecessary since in most cases the matter can be helped. There is a strong culture of silence and inability to discuss the matter. In fact around 1 in 10 men will experience recurring impotence problems at some point in their lives.

Erectile dysfunction is very common. Although it tends to be more common in the over 40-year-old age group, it can affect men of all ages. Studies have shown that:

• 52% of all men between the ages of 40 and 70 have some degree of erectile dysfunction.
• At least one in ten men cannot get an erection at all (referred to as "complete erectile dysfunction").
• The majority of causes of erectile dysfunction are physical in nature.
• There is a strong association between age and ED: 39% of men at the age of 40 and 67% at the age of 70 are affected by minimal, moderate or complete ED.

The most common physical causes of old age erectile dysfunctions are:

• Fatigue
• Brain or spinal-cord injuries
• Alcohol, tobacco and drug use
• Hypogonadism (which leads to lower testosterone levels)
• Liver or kidney failure
• Multiple sclerosis
• Parkinson's disease
• Radiation therapy to the testicles
• Stroke
• Some types of prostate or bladder surgery
• High blood pressure
• High blood sugar
• Hardening of the arteries

There is also the possibility that your erectile problems are caused by some medicine you are using. In this case your physician may be able to change your medication.

Psychological issues that can lead to erectile dysfunction:

• Feeling depressed
• Feeling so self-conscious that you can't enjoy sex
• Thinking that your partner is reacting negatively to you
• Feeling nervous about sex, perhaps because of a bad experience or because of a previous episode of impotence
• Feeling stressed, including stress from work or family situations
• Being troubled by problems in your relationship with your sex partner

One treatment for impotence is psychosexual therapy. In psychosexual therapy or psychotherapy, the man and his partner are given techniques or exercises to help them renew their intimacy, sexual relation, sexual interests, and arousal. This can be done through discussions and activities that can lift the stress or anxiety that cause impotence.

Another cure for impotence can be behavior modification. A positive outlook (as talked about in the "Self confidence" article) about one's self, performance, and even his partner can bring about change and improvements.

To do this, here are a few suggested tips:

• Do a little reality check including a check on your personal situation and your present situation with your partner.
• Talk with your partner to make things easier and lighter. It lifts up your burden and at the same time you are confident that there is someone who listens to you.
• Your lifestyle is very important and it affects your penile health a great deal, so do a check on your lifestyle. Just like taking care of the rest of your body, you should also take care of your penis. Trim down your fat, alcohol and nicotine or tobacco intake. Eat healthier and try to do some exercises.
• If you still have more concerns, then it's time that you should seek professional advice from a trained therapist or doctor.

If you want additional help in overcoming or preventing impotence, Penis Enlargement Institute recommends the PenisHealth™ exercise program. Besides enlarging your penis it keeps your sexual organ healthy and energized by increasing blood flow and naturally stimulating growth of new tissue.

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