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Injecting prostaglandin, a hormone-like stimulator produced in the body, induces erection. Prescribed drugs used to treat high blood pressure, ulcers, depression, and prostate cancer, as well as medications to prevent baldness or aid in dieting, can have side effects that include impotence. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections. In both conditions, an intact neural system is required for a successful and complete erection. The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for impotence. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems.[17] Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also be caused by prolonged exposure to bright light. Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. In these cases, all the plumbing is OK, but the otherwise healthy man is unable to achieve an erection. If you suspect this may be the cause, you can perform a simple test to see if impotence is just in your mind. More drastically, inflatable or rigid penile implants may be fitted surgically.

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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. 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. If never, the problem is likely to be physiological; if sometimes (however rarely), it could be physiological or psychological. Although they are generally safe and free of side effects (unlike chemical drugs), it is important to know that the quality of their extraction and preparation processes varies widely.

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