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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 works as follows: The cylinder is placed on the penis and the pump is then used to draw air out of the cylinder. 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. In this case, the impotence lasts as long as you are taking the drugs. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. One of the most promising herbs is the purified extract of Tribulus terrestris. If you suspect this may be the cause, you can perform a simple test to see if impotence is just in your mind. . Impotence can be treated — sometimes even without drugs. This form of impotence is rare and often caused by extreme psychological conditions, such as intense fear of intimacy, extreme feelings of guilt and severe anxiety. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections. If you suspect this may be the cause, you can perform a simple test to see if impotence is just in your mind. In these cases, all the plumbing is OK, but the otherwise healthy man is unable to achieve an erection. Boredom, marital problems or negative feelings toward your partner may contribute to an impotence problem. Duplex ultrasound is used to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue.