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Erectile dysfunction (ED) or impotence is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual activity. It turns out that a man often gets multiple erections throughout the night. Although middle-aged and older men are more likely to be impotent than younger men, impotence can strike at any adult age. A useful and simple way to distinguish between physiological and psychological impotence is to determine whether the patient ever has an erection. If you use these recreational drugs, however, you have bigger health problems than just impotence. It's important to realize that impotence may be a symptom of a more serious health problem, so if you're impotent, seek professional medical help immediately. The ring remains on the penis until intercourse is finished. This device works quite well, although some men complain about the discomfort of the elastic ring in addition to the hassle of, well, pumping up. Duplex ultrasound is used to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue. The effect that Brindley discovered established the fundamentals for the later development of specific, safe, orally effective drug therapies. Other studies have suggested that Tribulus also acts by increasing the level of dehydroepiandrosterone (DHEA), a naturally occurring substance in the body believed to be important for a healthy sex drive. Tribulus had been used as traditional medicine to treat sexual dysfunction and male infertility in Europe and Asia for many decades before improvement in scientific extraction techniques allowed identification of its active ingredient, protodioscin. Given the advances in medicine and nutrition research, however, it is no longer a scary thing. Impotence can be treated — sometimes even without drugs. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus. As testosterone and other male sex hormone levels start to drop after reaching middle age, low testosterone level is often the culprit in most intermittent impotence problems, especially in older men.