Sexual Health & Well Being

[MrDevil]

I hope the following facts will help some bros who like to know more about one's sexual health & well being, ways to improve and aviod unhealthy habbits, though it may sounds too ideal to be practical in all cases but there are no harms to gain the knowledge.

I would welcome any bros to share their views, situation and discuss more. Bear in mind that all the info provided are for reference and discussion.

[MrDevil]

Impotence is the inability to achieve or maintain an erection sufficiently rigid for sexual intercourse, ejaculation, or both. Sexual drive and the ability to have an orgasm are not necessarily affected. Because all men experience erection problems from time to time, doctors consider impotence to be present if attempts at intercourse fail on at least 25% of attempts.

Impotence is not new in medicine or human experience, but it is not easily or openly discussed. Cultural expectations of male sexuality inhibit many men from seeking help for a disorder that can, in most cases, benefit from medical treatment. The term "impotence" comes from Latin and means loss of power; a more accurate term is "erectile dysfunction." The condition is normal and usually temporary, so it is highly unfortunate that the common term for it implies a sweeping diminution in a man's overall capabilities.

The Penis and Erectile Function
The Structure of the Penis. The penis is composed of the following structures:


Two parallel columns of spongy tissue called the corpus cavernosa, or erectile bodies.
A central spongy chamber called the corpus spongiosum, which contains the urethra, the tube that carries urine from the bladder through the penis.
These structures are made up of erectile tissue. Erectile tissue is rich in tiny pools of blood vessels called cavernous sinuses. Each of these vessels are surrounded by smooth muscles and supported by elastic fibrous tissue composed of a protein called collagen.

Erectile Function and Nitric Oxide. The penis is either flaccid or erect depending on the state of arousal. In the flaccid, or unerect, penis, the following normally occurs:


Small arteries leading to the cavernous sinuses contract, reducing the inflow of blood.
The smooth muscles regulating the many tiny blood vessels also stay contracted, limiting the amount of blood that can collect in the penis.
During arousal the following occurs:


The man's central nervous system stimulates the release of a number of chemicals, including nitric oxide, which is now considered the main contributor for eliciting and maintaining erection.
Nitric oxide stimulates production of cyclic GMP, a chemical that relaxes the smooth muscles in the penis. This allows blood to flow into the tiny pool-like cavernous sinuses, flooding the penis.
This increased blood flow nearly doubles the diameter of the spongy chambers.
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 becomes rigid and erect.
After ejaculation or arousal, cyclic GMP is broken down by an enzyme called phosphodiesterase-5 (PDE5), and other compounds are released that cause the penis to become flaccid (unerect) again.
Important Substances for Erectile Health
A proper balance of certain chemicals, gases, and other substances is critical for erectile health:

Collagen. The protein collagen is the major component in structural tissue in the body, including in the penis. Excessive amounts, however, form scar tissue, which can impair erectile function.

Oxygen. Oxygen-rich blood is one of the most important components for erectile health. Oxygen affects two substances that are important in achieving erection:


Oxygen suppresses transforming growth factor beta 1 (TGF-B1). TGF-B1 is a component of the immune system called a cytokine and is produced by smooth muscle cells. It appears to stimulate collagen production in the corpus cavernosum, which can lead to erectile dysfunction.
Oxygen enhances the activity of prostaglandin E1. Prostaglandin E1 is produced during erection by the muscle cells in the penis. It activates an enzyme that initiates calcium release by the smooth muscle cells, which relaxes them and allows blood flow. Prostaglandin E1 also suppresses production of collagen.
Oxygen levels vary widely from reduced levels in the flaccid state to very high in the erect state. During sleep, oxygen levels are high and a man can normally have three to five erections per night, each one lasting from 20 to 40 minutes.

Testosterone and Other Hormones. Normal levels of hormones, especially testosterone, are essential for erectile function, though their exact role is not clear.

Erectile Dysfunction and Oxygen Deprivation
Erectile dysfunction most commonly occurs when the penis is deprived of oxygen-rich blood. When oxygen levels to the penis are low, an imbalance occurs in two important substances, TGF-B1 and prostaglandin E1:


TGF-B1 levels increase, which trigger production of collagen, a tough protein that forms all types of connective tissue, including scar tissue.
In addition, there is a reduction in prostaglandin E1, a chemical that suppresses collagen production and relaxes the smooth muscles to allow blood flow resulting in an erection.
When TGF-B1 levels increase and prostaglandin E1 levels decrease, smooth muscles waste away and collagen is overproduced, causing scarring, loss of elasticity, and reduced blood flow to the penis. A number of conditions can deprive the penis of oxygen-rich blood.

Blockage of Blood Vessels (Ischemia). The primary cause of oxygen deprivation is ischemia--the blockage of blood vessels. The same conditions that cause blockage in the blood vessels leading to heart problems may also contribute to erectile dysfunction. For example, when cholesterol and other factors are imbalanced, a fatty substance called plaque forms on artery walls. As the plaque builds up, the arterial walls gradually narrow, reducing blood flow. This process, known as atherosclerosis, is the major contributor to the development of coronary heart disease. It may also play a role in the development of erectile dysfunction.

[MrDevil]

A large survey in 2000 suggested that nearly 620,000 American men between ages 40 and 70 experience erectile dysfunction of any degree each year. An estimated 20 million and 30 million men in the US have erectile dysfunction at some point during their lives. Only 10% of these men, however, ever confer with a physician about this problem.

Being older is primarily associated with impotence in most men. At a major professional meeting in 2000, experts reported survey results finding that 44% of men over age 50 experienced some degree of erectile dysfunction, but less than a quarter of them discussed their problems with a physician. Many felt this was simply an aging problem. Nevertheless, impotence is not inevitable with age. In another survey of men over 60 years old, 61% reported being sexually active, and nearly half derived as much if not more emotional benefit from their sex lives as they did in their 40s.

Severe erectile dysfunction in elderly men often has more to do with disease than age itself. In particularly, older men are more likely to have heart disease, diabetes, and hypertension than younger men. Such conditions and some of their treatments are major factors in erectile dysfunction.

So many physical and psychological situations can cause erectile dysfunction, in fact, that a man should consider brief periods of impotence to be as normal as having a cold. In fact, a cold is one common condition that can cause temporary impotence. It is safe to say, then, that every man experiences erectile dysfunction from time to time. Nevertheless, if the problem is persistent, men should seek professional help, particularly since erectile dysfunction is usually treatable and it may also be a symptom of a more widespread problem.

[MrDevil]

Differentiating Between Physical and Psychological Causes of Erectile Dysfunction
Over the past decades, the medical perspective on the causes of impotence has shifted. Common wisdom used to attribute almost all cases of impotence to psychological factors. Now investigators estimate that up to 85% of impotence cases are caused by medical or physical problems. Only 15% are psychologically based.

It is often difficult to determine if the cause of erectile dysfunction is a physical or psychological one, or even some combination. The following may be helpful:


Physical impotence can be caused by internal medical causes (e.g., diabetes, high blood pressure) or by external causes (e.g., surgery, injury, medications). Erectile dysfunction due to medical conditions usually develops 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 known medical conditions, then the patient needs medical attention by a urologist specializing in impotence.
Psychological impotence tends to develop rapidly and be related to a recent situation or event. The patient may be able to have an erection in some circumstances but not in others. Being able to experience or maintain an erection upon waking up in the morning suggests that the problem is psychological rather than physical.
It should be strongly noted that in virtually every case of impotence there are emotional issues that can seriously affect the man's self-esteem and relationships. Negative emotions may even perpetuate erectile dysfunction that has been caused by a medical condition that has been successfully treated. Many men tend to fault themselves for their impotence even if it is clearly caused by physical problems over which they have little or no control.

Emotional Disorders Associated with Erectile Dysfunction
Anxiety. Anxiety has both emotional and physical consequences that can affect erectile function. It is among the most frequently cited contributors to psychological impotence. Excessive concern about sexual performance is often referred to as performance or "honeymoon" 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. Even simple stress may promote the release of brain chemicals that disrupt potency in a similar way.

Depression. 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
Troubles in relationships often have a direct impact on sexual functioning. Partners of men with erectile dysfunction may feel rejected and resentful, particularly if the affected man does not confide his own anxieties or depression. 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. It can be very difficult for the man to perform sexually when both partners harbor negative feelings.

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

Smoking
Smoking contributes to the development of impotence, mainly because it compounds the effects of other disorders of the blood vessels, including high blood pressure and atherosclerosis. For example, a 2001 study concluded that among men with high blood pressure, smoking causes a 26-fold increase in erectile dysfunction.

Alcohol
Alcohol has also been implicated in causing impotence. A small amount releases inhibitions, but having more than one drink can depress the central nervous system and impair sexual function.

Exposure to Estrogen-Like Chemicals
Some evidence suggests that exposure to estrogen-like chemicals, such as those found in DDT and other pesticides, may contribute to erectile dysfunction. (Such chemicals have been associated with low sperm counts and infertility in men.)

Lack of Frequent Erections
Infrequent 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 erections men have while sleeping or awake may be a natural protection against this process.

[MrDevil]

ifferentiating Between Physical and Psychological Causes of Erectile Dysfunction
Over the past decades, the medical perspective on the causes of impotence has shifted. Common wisdom used to attribute almost all cases of impotence to psychological factors. Now investigators estimate that up to 85% of impotence cases are caused by medical or physical problems. Only 15% are psychologically based.

It is often difficult to determine if the cause of erectile dysfunction is a physical or psychological one, or even some combination. The following may be helpful:


Physical impotence can be caused by internal medical causes (e.g., diabetes, high blood pressure) or by external causes (e.g., surgery, injury, medications). Erectile dysfunction due to medical conditions usually develops 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 known medical conditions, then the patient needs medical attention by a urologist specializing in impotence.

Psychological impotence tends to develop rapidly and be related to a recent situation or event. The patient may be able to have an erection in some circumstances but not in others. Being able to experience or maintain an erection upon waking up in the morning suggests that the problem is psychological rather than physical.
It should be strongly noted that in virtually every case of impotence there are emotional issues that can seriously affect the man's self-esteem and relationships. Negative emotions may even perpetuate erectile dysfunction that has been caused by a medical condition that has been successfully treated. Many men tend to fault themselves for their impotence even if it is clearly caused by physical problems over which they have little or no control.

Emotional Disorders Associated with Erectile Dysfunction
Anxiety. Anxiety has both emotional and physical consequences that can affect erectile function. It is among the most frequently cited contributors to psychological impotence. Excessive concern about sexual performance is often referred to as performance or "honeymoon" 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. Even simple stress may promote the release of brain chemicals that disrupt potency in a similar way.

Depression. 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
Troubles in relationships often have a direct impact on sexual functioning. Partners of men with erectile dysfunction may feel rejected and resentful, particularly if the affected man does not confide his own anxieties or depression. 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. It can be very difficult for the man to perform sexually when both partners harbor negative feelings.

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

Smoking
Smoking contributes to the development of impotence, mainly because it compounds the effects of other disorders of the blood vessels, including high blood pressure and atherosclerosis. For example, a 2001 study concluded that among men with high blood pressure, smoking causes a 26-fold increase in erectile dysfunction.

Alcohol
Alcohol has also been implicated in causing impotence. A small amount releases inhibitions, but having more than one drink can depress the central nervous system and impair sexual function.

Exposure to Estrogen-Like Chemicals
Some evidence suggests that exposure to estrogen-like chemicals, such as those found in DDT and other pesticides, may contribute to erectile dysfunction. (Such chemicals have been associated with low sperm counts and infertility in men.)

Lack of Frequent Erections
Infrequent 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 erections men have while sleeping or awake may be a natural protection against this process.

[newyorker88]

Thanks for the infor! Mr Angel.... er.. Devil

[MrDevil]

Originally posted by newyorker88
Thanks for the infor! Mr Angel.... er.. Devil

errr perhaps I woke up from the wrong side of the bed this morning, suddenly feeling like becoming angel... heheheheh even Devil got to know how to be a good devil.

[MrDevil]

Heart Disease, Diabetes, and Other Conditions that Affect Blood Vessels

A number of conditions share a common problem with erectile dysfunction--which is impaired ability of blood vessels to open and allow normal blood flow. Such conditions include diabetes, hypertension, coronary artery disease, kidney failure, peripheral artery disease, and stroke. Increasingly, researchers are studying the role of nitric oxide, which plays a major role in keeping blood vessels open, in all of these disorders

Some of these diseases, notably the following are highly associated with erectile dysfunction and have other factors involved in its development:

Diabetes. Diabetes, for example, may contribute to as many as 40% of impotence cases. Between one-third and one-half of all diabetic men report some form of sexual difficulty. Blocked arteries and nerve damage are both common complications of diabetes; when the blood vessels or nerves of the penis are involved, erectile dysfunction can result.

High Blood Pressure (Hypertension). Erectile dysfunction is a very common problem in men with high blood pressure. The disease process is the major contributor to impotence, but many of the drugs used to treat hypertension also cause it. Newer anti-hypertensive agents, including angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) are less likely to cause erectile dysfunction. In fact, ARBs may be particularly effective in restoring erectile function in men with high blood pressure who suffer from impotence.

Other Common Medical Conditions That Contribute to Erectile Dysfunction

Parkinson's Disease. As a risk factor for impotence, Parkinson's disease (PD) is an under-appreciated problem. It is estimated that about one-third of men with PD experience impotence. The physical cause of PD-related impotence is most likely an impaired nervous system. Depression and lowered self-esteem also contribute to erectile dysfunction in these patients.

Multiple Sclerosis. Multiple sclerosis (MS), which affects the central nervous system, also precipitates sexual dysfunction in as many as 78% of male patients. (Corticosteroids, which are common treatments for MS, may improve sexual function.)

Other Common Medical Conditions. Other medical conditions that have been associated with erectile dysfunction in some cases include allergies, thyroid problems, lung disease, and epilepsy.

Prostate Cancer and Its Treatments

Advanced prostate cancer can damage nerves needed for erectile function. Prostate surgery and surgical and radiation treatments for prostate cancer can also cause impotence. [See Well-Connected Report #33, Prostate Cancer.] A number of treatments for sexual dysfunction are available that may help some men. [See treatment sections.]

Prostate Cancer Surgery (Radical Prostatectomy). The first nationally representative study to evaluate long-term outcomes after radical prostatectomy concluded that impotence occurs far more frequently than previously reported. Those who have so-called nerve-sparing surgeries have better results than those whose surgeries affect the nerves around the prostate. Some evidence also suggests that sexual function rates might improve if the nerve-sparing prostate surgeries also spare the ducts that carry semen.

Some studies suggest that impotence after prostate surgery may in part be due to injury to the smooth muscles in the blood vessels. Early treatments to maintain penile blood flow, particularly alprostadil injections, may helpful in restoring erectile function. In one study, men administered injections every other night for six months. They then started taking sildenafil (Viagra) three months after surgery. At six months, 82% of these men achieved penetration compared to only 52% of men who took Viagra only. The vacuum pump may serve a similar purpose as the injections.

Radiation. Although it is generally believed that radiation poses a lower risk for impotence than does surgery, studies have reported similar rates after three years. Experts suggest radiation injures the blood vessels and so lead to erectile dysfunction over time. Some studies report a lower risk for impotence from brachytherapy, a radiation technique that involves the implantation of radioactive "seeds" compared to external-beam radiation. Still, there have been very few studies that have lasted more than two years. One five-year study reported a high long-term rate of impotence (53%) with brachytherapy, which is close to that of standard externally administered radiation. Early use of alprostadil injections and Viagra may help these men as well as those who had surgery.

Drug Treatments. Prostate cancer medical treatments commonly employ androgen-suppressive treatments, which cause erectile dysfunction.

Surgical Treatments that Affect Intestinal Tracts
Surgery for Colon and Rectal Cancers. Surgical and radiation treatments for colorectal cancers can cause impotence in some patients. In general, colostomy does not usually affect sexual function. However, wide rectal surgery can cause short term or long-term sexual dysfunction. Total mesorectal excision (TME) may pose fewer risks than standard surgery. Sildenafil (Viagra) may help many men who experience this after surgery. [See Well-Connected Report #55, Colon and Rectal Cancers.]

Surgical Treatment of Inflammatory Bowel Disease. Rectal excision for inflammatory bowel disease (IBD) can cause impotence, but rates are low (2% to 4%). Sildenafil (Viagra) is very effective in restoring potency after IBD surgery.

Operations for Fistulas. Surgery to repair anal fistulas can affect the muscles that control the rectum (external anal sphincter muscles), sometimes causing impotence. (Repair of these muscles may restore erectile function.)

Treatments for Benign Prostatic Hyperplasia (BPH)
Surgery and drug treatments for benign prostatic hyperplasia (BPH) can also increase the risk for impotence, although to a much lesser degree than surgery for prostate cancer.


Between 4% and 10% of patients who have transurethral resection of the prostate (TURP) and open prostatectomy for BPH report impotence afterward. The risk is very low, however, in men who were functioning normally before surgery.

Finasteride (Proscar) has been associated with impotence in between 6% and 19% of patients. Anti-androgen agents used to treat BPH can also cause erectile dysfunction.

Medications

About a quarter of all cases of impotence can be attributed to medications. Many drugs pose a risk for erectile dysfunction. Some authorities go so far as to say that nearly every drug, prescription or nonprescription, can be a cause of temporary erectile dysfunction.

Among the drugs that are common causes of impotence are the following:


Drugs used in chemotherapy.

Many drugs taken for high blood pressure, particularly diuretics and beta-blockers.

Most drugs used for psychological disorders, including anti-anxiety drugs, anti-psychotic drugs, and antidepressants, especially selective serotonin reuptake inhibitors (SSRIs). Newer antidepressants pose fewer problems.
Anti-androgens, including drugs known as gona111ropin-releasing hormone agonists. They are used in prostate cancer and also for treating BPH.
Drugs that sometimes cause impotence include:

Older anti-ulcer medications (cimetidine).
Anticholinergic drugs (including some antihistamines).
Antinausea agents, particularly metoclopramide (Reglan).
Antifungal drugs (especially ketoconazole).
Physical Trauma, Stress, or Injury
Injury to the Spine. Spinal cord injury and pelvic trauma, such as a pelvic fracture, can cause nerve damage that results in impotence. Other conditions that can injure the spine and effect impotence include spinal cord tumors, spina bifida, and a history of polio.

Bicycling. Studies have indicated that frequent bicycling may pose a risk for erectile dysfunction by reducing blood flow to the penis. The greatest risk is in cyclers who sit upright while cycling.

Note: Vasectomy does not cause erectile dysfunction. When impotence occurs after this procedure, it is often in men whose female partners were unable to accept the operation.

Hormonal Abnormalities
Hypogonadism (Testicular Failure). Hypogonadism in men is a deficiency in male hormones, usually due to an abnormality in the testicles, which secrete these hormones. It affects four to five million men in the United States. In addition to impotence, hypogonadism causes reductions in energy, sex drive, lean body mass, and bone density. Hypogonadism can be caused by a number of different conditions. Among them are the following:


Disorders in the pituitary or hypothalamus glands.
Malnutrition.
Genetic factors.
Myotonic dystrophy.
Orchitis (inflammation of the testicles).
Physical injury.
Mumps.
Radiation treatments.
Exercise-induced hypogonadism. Only a few cases of exercise-induced hypogonadism have been identified in men. Some researchers believe, however, that certain athletes may be at risk, including those who began endurance training before full sexual maturity, have very low body weight, and have a history of stress fractures.
Low Testosterone Levels. Only about 5% of men who see a physician about erectile dysfunction have low levels of testosterone, the primary male hormone. In general, lower testosterone levels appear to reduce sexual interest, not cause impotence. A 1999 study, however, suggests that testosterone levels are not an accurate reflection of sexual drive.

[MrDevil]

Other Hormonal Abnormalities. Other hormonal abnormalities that can lead to erectile dysfunction include:


High levels of the female hormone estrogen (which may occur in men with liver disease).

Abnormalities of the pituitary gland that cause high levels of the hormone prolactin are particularly likely to cause impotence.
Other, uncommon hormonal causes of impotence include an underactive or overactive thyroid or adrenal gland abnormalities.

Varicoceles

A varicocele is an enlarged (varicose) vein in the cord that connects to the testicle. Varicoceles are found in 15% to 20% of all men and in 25% to 40% of infertile men. When varicoceles occur in both testicles, they may contribute to hormone imbalances that cause erectile dysfunction.

Other Problems in Sexual Function

Premature Ejaculation

Premature ejaculation is the most common male sexual dysfunction and occurs in as many as 40% of men. It is defined as the inability to delay ejaculation to the point where both partners are satisfied. This can vary widely depending on the preferences of the partners. Younger men tend to have this problem more than older men. Anxiety is a major factor at any age. In general, the longer the duration between ejaculations, the faster they are. Various techniques are available to help delay orgasm. The standard medications used for this condition are the selective serotonin reuptake inhibitors (SSRIs), which include Prozac and Paxil. Some studies suggest that sildenafil (Viagra) in combination with an SSRI may be helpful.

Peyronie's Disease

Peyronie's disease is an accumulation of scar tissue within the penis shaft, which causes it to curve. The curvature can make erection and intercourse difficult and painful. This condition may be associated with an injury to the penis, but no clear information exists on its origin. Some men may not even be aware that they have it, and there is some evidence that it may be more common than currently believed. In one study, 6.7% of men with an average age of 62 had signs of curvature, but only 2.2% were aware of any difficulties. The disease often goes into a type of spontaneous remission, and some individuals who had previously experienced erectile dysfunction are able to resume sexual activity. Scarring may still cause erection problems, however, even in these cases.

Treatment for Peyronie's Disease. If Peyronie's disease is treated early, ultrasound, heat application, and anti-inflammatory drugs may help reduce scar formation. Some experts believe that the extracorporeal shock wave therapy (ESWT) is the safest and most effective first-line therapy. ESWT uses sound waves to break up scar tissue. It has been used with some success.

Studies are also suggesting that the calcium channel blocker verapamil may be very beneficial. It can be administered using injection, as a gel patch, or through a process called electromotive drug administration (EMDA), also referred to as iontophoresis. EMDA delivers the agent through an electrical transport of charged molecules. Some studies are reporting good success with EMDA delivery of verapamil along with the steroid dexamethasone.

In severe cases of scarring, the only treatment is surgery to straighten the penis and reduce the curve. Penile implants may also be beneficial.

Priapism

Priapism is a sustained, painful, and unwanted erection that persists despite a lack of sexual stimulation. Generally, priapism results when the smooth muscle tissue remains relaxed so that a constant flow of blood into the vessels of the penis occurs with no leakage back out. The development of priapism has been associated with urinary stones, certain medications, neurologic disorders, and, more recently, with self-injection therapy used for impotence.

Treatment of Priapism. If priapism occurs, applying ice for 10-minute periods to the inner thigh may help reduce blood flow. Erections that last four hours or longer require emergency care.

[MrDevil]

Temporary erectile dysfunction is very common and usually not a serious problem. Nevertheless, if the condition is persistent, psychological effects can be significant. Erectile dysfunction can have a devastating impact on a relationship and can cause extreme depression, which may become chronic if not treated. When a consistent pattern of sexual dysfunction extends over a prolonged period of time, a serious physical or emotional disorder may be present.

Persistent impotence may also be a symptom of a serious medical condition, such as heart disease, diabetes, hypertension, sleep disorders, or circulatory problems. For example, in a study of men who had suffered heart attacks, 75% of them had experienced erectile dysfunction on average 68 months before the heart attack.

Erectile dysfunction can also indicate the presence of injuries or the long-term effects of smoking, heavy drinking, or unhealthy diet.

[simplyhorny]

Thanks bro Devil! Felt that I've just attended a crash course of sexual biology. May be you can consider taking up a doctorate... then next time, we can call you Dr Devil...