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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. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. 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. In all, these studies proved that Tribulus works very well in curing sexual dysfunctions and maximizing sexual performance when taken regularly. These studies showed that Tribulus helps treat impotence caused by low testosterone levels or an imbalance in the body's level of sex hormones. Impotence caused by psychological factors is often temporary; it lasts as long as the underlying factor is still there. Although they are often dismissed as ineffective solutions to impotence, more and more clinical research studies have found that herbs can help impotent men. The same goes for alcohol and narcotics, like heroin and cocaine. A vacuum erection device helps draw blood into the penis by applying negative pressure. Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley dropped his trousers and demonstrated to a shocked Urodynamics Society audience his papaverine-induced erection. The drug Brindley injected into his penis was a non-specific vasodilator, an alpha-blocking agent, and the mechanism of action was clearly corporal smooth muscle relaxation. In these cases, all the plumbing is OK, but the otherwise healthy man is unable to achieve an erection. It is estimated that about 10% to 20% of impotence cases are the direct result of various psychological factors, such as low self-esteem, depression, and — especially — stress and anxiety (general and performance anxieties). To determine this, a man can simply wet and affix a small stamp on his flaccid penis before going to bed. 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. Boredom, marital problems or negative feelings toward your partner may contribute to an impotence problem. Men with secondary impotence are typically able to engage in intercourse only 25% of the time.