Here are the main causes of impotence. 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. More drastically, inflatable or rigid penile implants may be fitted surgically. In these cases, all the plumbing is OK, but the otherwise healthy man is unable to achieve an erection. It does not work immediately.
So, before you invest in costly and potentially dangerous chemical drugs, you may want to consider natural treatments for impotence. 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. A note of caution: Although there are many Tribulus extracts available over the counter today, almost all of these have been found not to contain any significant amount of the active ingredient.
More drastically, inflatable or rigid penile implants may be fitted surgically. Men with primary impotence have never had sufficient erections for satisfactory intercourse. If you suspect this may be the cause, you can perform a simple test to see if impotence is just in your mind. To determine this, a man can simply wet and affix a small stamp on his flaccid penis before going to bed. In fact, almost 100% of men who use cocaine regularly are impotent. 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. Ultrasound is then used to see vascular dilation and measure penile blood pressure. The effect that Brindley discovered established the fundamentals for the later development of specific, safe, orally effective drug therapies. If the stamp is no longer in place by morning, it means that a nocturnal erection occurred.