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All three medications enhance the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow. Erectile Dysfunction as Warning Sign Making life style improvements (for example; quitting smoking, and exercising more), Trauma to the pelvic region or spinal cord can damage veins and nerves needed for erection. Surgery of the colon, prostate, bladder, or rectum may damage the nerves and blood vessels involved in erection. Prostate and bladder cancer surgery often require removing tissue and nerves surrounding a tumor, which increases the risk for impotence. Reality: Although the majority of diagnosed ED cases are a result of physical diseases that cause damage to nerves, fibrous tissues, and arteries (such as diabetes, MS, vascular disease, and neurological disease), experts theorize that up to 20 percent of ED cases are due to anxiety, stress, depression, and other psychological factors, according to the National Kidney and Urologic Disease Information Clearinghouse (NIDDK). One of the most common psychological causes of erectile dysfunction is performance anxiety that may result after several failed attempts at intercourse. The anxiety may increase, leading to more failed attempts, ultimately resulting in a cycle of anxiety and sexual failure. Alprostadil has also become available in some countries as a topical cream (under the brand name Befar),[23] and preliminary studies have shown a clinical efficacy of up to 83%.[24] It has an onset of action of 10–15 minutes and its effects can last over 4 hours.[citation needed] Might other non-surgical treatments, such as self-injections, urethral suppositories, or vacuum devices, be helpful? Why or why not? Viagra online ANSWER: Erectile dysfunction (ED), or impotence, refers to the persistent or recurrent inability to achieve or maintain an erection. It is a common condition with 52 percent of men aged 40-70 reporting some degree of impotence or erectile dysfunction. Ejaculation has two phases -- in the first, the vas deferens, the tubes that store and transport sperm from the testes, contract to squeeze the sperm toward the prostate gland and urethra and seminal vesicles release secretions that make semen. 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