Difficulties with achieving satisfactory erections occur commonly. If the problem does not originate from lack of lust and is great enough to make normal intercourse impossible, the condition is called erectile dysfunction (impotence). Erection problems are caused by physical conditions, psychological factors or a combination.

The penis has three bodies containing a dense network of blood vessels along all its length. During erection blood is filled into the vessels of these bodies. The bodies then engorge, make the penis hard and rise it up. The filling of these bodies occur when the vessels leading blood to the penis relax and vessels draining the penis constrict their volume.

Before and during erection nerves lead impulses to the genitals. The nerve ends in this area then releases the substance nitrogen oxide. Nitrogen oxide will diffuse through the genital area and the penis and stimulate the reaction of the blood vessels in the penis.

Erection problems can occur because of disorders in the nervous system sending impulses to the genital area, problems with the blood supply to the penis and anatomical problems in the penis or genital area. Specific causes can be:

- Accidents, stroke, surgery or tumours hurting brain areas or areas in the spinal cord responsible for erection impulses.

- Multiple sclerosis, a disease hurting the isolating sheets around the neural fibres in the brain and spinal cord, can give erection problems.

- Accidents or diseases hurting nerves from the spinal cord to the genital region.

- Atherosclerosis caused by age or an unhealthy lifestyle, giving narrowing and hardening of blood vessels leading to the genital region.

- Injury to the erectile bodies caused by inflammation, accidents or diseases.

- Congenital malformations in the penis or genital region, for example hypospadias and epispadias.

- Peyronie's disease, a common inflammatory disease causing abnormal bending or twisting of the penis, and sometimes also hinder the filling of blood into the erectile bodies, sometimes gives problems for the erections.

- Circumcision causing the penile skin to be too tight, or causing extensive inelastic scars. Circumcission is a common procedure in many countries, either due to religious practice or exerted in order to treat foreskin problems. Even though circumcission appears to be a minor and simple procedure, it is very difficult to do it in the right degree and fashion. It is very difficult to take away the right amount of skin, because one does not know exactly  how much the penis will grow during puberty and how much skin the penis will need to have left. It is also difficult just to be careful and let a good amount of skin be left, because that can cause unpractical skin folds on the penis.

It is easy to take away too much foreskin so that the skin from the penile base to the penis head becomes too tight for the size of the penis. This problem will typicallly rise during puberty when the penis grows.  This can make a free erection process impossible so that the skin is stretched unpleasantly during erection or so that the penis is bent when erected.

It is also nearly imposible to controle the amount of scarring after circumcission, because different men and boys react differently during the process of healing. The scarring can also impose restrictions during engorgement of the penis.

-  Phimosis or too thight foreskin tip can sometimes make it impossible for the foreskin to whithdraw during erection and impose restrictions on the erection process.

- Side effects of medicines, such as medications taken for high blood pressure or depression.

- Zinc deficiency.

- Heart disease.

- Diabetes causing injury to the nerves and blood vessels to the penis.

. High blood pressure (hypertension).

. Liver or kidney disease.

- Alcohol or drug abuse impairing psychological and neural functions.

Psychological causes can interfere with the erection process by distracting a man from stimuli that normally would give him sexual arousal. Psychological issues account for about 40% of erection problems. Erection problems in men under age 50 are most likely to be caused by psychological factors. Psychological causes of erection problems include:

- Anxiety for not being able to perform sexually as well as the partner demands. Often a man is directly anxious of not getting an erection. The anxiety in itself has a direct hindering effect upon the erection. Anxiety sets the body in an allert state suited for fight and flight against an outer challange. In that state the body shuts down functions not necessary to tackle an outer enemy or problem. The enhanced allertness will be directed against the poor erections and thereby the anxiety rises even more and so does also the neurological state resulting from the anxiety that forbids erection to occur.

- Prolonged emotional upset, such as worrying, anxiety or anger due to a man's economical, professional or social situation. Also in this situation will the anxiety set the body into a neurological state that hinders erection. The worrying will also take the concentration away from the sexual stimuli so that he does not so easily sense all the things that can make him aroused.

- Relationship problems, for example when the woman has different preferences of sexual practice than the man. In this case the man will simply not be stimulated the way that is most efficient for him and he does not reach the necessary treshold of arousal to get a good erection. The preferances of the women can also sometimes be physically exhausting or painful for the man, resulting in poor erections.

- A man who looses sexual desire for his partner may develop erection problems.

- Recently widowed men can get erection problems.

- Some men have difficulty having sexual intercourse with their partner after she has given birth because he does not like the changes that the birth process has caused to the woman's body.

Anxiety for not getting an erection or for not performing sexually will nearly allways be a component in the cause of erection difficulties. Also in these cases where the cause is physical in the first place, anxiety for not getting an erection will soon creep in. This anxiety sets the body into a neurological state where errections are impaired. The anxiety will make the man even more allert against the problems so that the anxiety itself and this neurological state gets steadily worse.

If you have a lifestyle that makes you tired, this can make it more dificult for you to achieve an erection. Exagerated physical training can dimmish the lust for sex and dimmish the potency. Lack of sleep can also reduce the sexual drive and erectile potency. Masturbation is generally a good thing, but masturbating a short time before you shall have sex, can make your lust for sex less and also make you less able to achieve a good erection.

A habit of smoking that lasts some time can hurt the blood vessels in the perineal region and the penis and make it more difficult to achieve erections.

A habitual overconsume of alchohol will gradually reduce the potency and erectile ability. Consuming alchohol before you have sex, may reduce your ability to achieve a good erection, especially if the dosis of alchohol is high. However, some alchohol may take away psychological hinderances and thereby help you get an erection, even though the physical mechanisms necessary for erections will be somewhat paralyzed by the alchohol.

Obesity due to over-eating will always be of some hinderance for a good potency and erectile ability, partly because of the obesity itself and partly because obesity is associated with problems with the blood circulation.

When the erection problems is caused by fair for sexual situations, feair of not getting accepted by the partner or fair of not getting erection, the thoughts that cause the fear must be broken somehow. One way of breaking the fear, is to try having intimate plaeasure together by the partner without caring if you get an erection or not. There are many good things you can do to each other even without any erection. Then the arousal and erction will often emerge spontanously after some times. Herbal stimulants or pharmaceutical stimulants that enhance the arousal and help induce erection may also help.

Havings sex when you are not very tired, for example in the morning on a holiday can also help in these circumstances.

When a specific organic and psychological condition causes problems for the erections, this problem should be treated with appropriate methods that will vary according to the actual disease.

If the cause is heart disease or atherosclerosis, lifestyle changes and training adapted to the medical situation can often improve the general health situation and improve the erectile abilities.

If the cause of the erection problems is a problematic penile shape, for example curved or twisted penis by Peyronie's disease, using a mechanical penis reaction device for some time may help.

A general halthy lifestyle with a good diet, avoiding smoking, avoiding overuse of alchohol, enough sleep  and regular but not exagerated exercise will always contribute to a better potency and more easy erections.

On the marked you can also find herbal products to treat injured or diseased blood vessels in the genital area. These products typically contain herbal elements that experience has proven to stimulate tissue repair in blood vessels.

It is not always possible to cure the condition causing erectile problems.

Still the problems can often be overcom by medication exerting the following effects:

- Stimulating the vessels leading blood to the penis to relax so that blood more esily enters the penis.

- Stimulating the internal vessels in the erectile bodies to relax, so that these bodies get more easily filled with blood.

- Stimulating vessels draining the penis to constrict so that the blood is held inside the penis.

These drugs typically achieve this task by stimulating the release of nitrogen oxide in the genital area.

Viagra and Cialis are the best known pharmacological treatment for erection problems. In spite of what people often think, these drugs do not increase the sexual drive in the first place. Their effect is a pure stimulation of the blood vessel system around and inside the penis.If the sexual excitement is there, Viagra can help to achieve erection, if the drive and excitement lack in the first place, Viagra will not help.

There are also herbal products on the market that excert a stimulation upon the blood vessel system of the genital. Erection oils exert such a stimulation of the blood filling in the penis. They give an instant erection response, but the response only lasts 2-3 hours.

You can also find herbal products that both stimulate the gereral sexual libido, the sexual arousal and the genital blood vessel system. Such potency pills take a longer time to give effect, but the effect lasts for many hours or during the whole day. Such pills are of special help when the erection problems are due to other factors than problems with the genital blood vessels,  like psychological mechanisms, stressful life, nerve problems or physical exhaustion.

These products typically contain extracts of herbs with a long proven use and with scientifically proven effects of 4 kinds: Libido enhancement, stimulation of the blood vessel responce and tissue repair. Herbs with one or more of these effects used in such products are: Ginseng, Epidemium, Damiana, Saw palmetto, Ginko Biloba, Muira Pauma, Hawthorn, Maca, Yohimbe, Tribulus, Cuscuta, cayenne and Catuaba.

If it is not possible at all to achieve erection with any treatment, surgical implants can help to make the penis stiff and raised up enough to perform an intercourse. One type of implant is partly rigid bodies that make the penis permanently partially erected. Another type of implant is inflatable bodies that can make the penis fully erected when the need rises.

Sometimes there occur a problem that is nearly the opposite of the usual erection problem, that is priapism. By priapism, an achieved erection will not seace and the penis remains erect. When this occur, the blood vessels leading from the penis have got clogged or have got into a cramp state that will not finish. The reason can be an over-dose of stimulating drugs or an inflammation in the blood vessels that cause blood to coagulate. Sometimes a more serious disease affecting the blood composition is the cause, like leuchemia. If priapism is not treated as an emergency case, the tissue in the penis can get hurt and the penis can be rendered unfunctional. The treatment is draining of the blood from the penis by a small cut.