There are many causes of erectile dysfunction (or impotence). 20 years ago the majority of impotent men were suffering from psychological problems such as stress, anxiety, depression and anger. Only a minority of men had a physical cause fro their impotence. There was no drug based treatments available so doctors concentrated on the psychological.

The whole pattern of impotence has changed enormously in the last 20 years. Nowadays the main causes of impotence are physical illnesses. The big three are diabetes, heart disease and obesity. For instance men suffering from diabetes have getting on for a 50% chance of suffering from impotence. Bearing in mind there are over a million diabetes sufferers in the UK thats a potentially large problem.

Having a lousy job, big mortgage and long hours wasnt and isnt an aid to a great sex life. Those problems still remain today but have been joined and to some extent overwhelmed by physical worries. So are drugs such as Viagra, Cialis and Levitra the best answer?

The anti impotence drugs Viagra, Cialis & Levitra work by increasing blood flow into the penis, which leads to an erection. They block a chemical in your body called phosphodiesterase type 5(PDE5). This relaxes blood vessels and increases blood flow through them. This leads to an erection. Theres no doubt drugs are the quickest way to bypass erectile difficulties. Most men taking anti impotence drugs get an erection and can perform again.

However if the main problem is obesity perhaps losing weight might be a better thing to do. It is of course not a quick fix like drugs are. In the long term however it may do more good as obesity is linked with many problems such as heart disease, increased risk of cancers, sleeping problems and a general lack of energy.

There are of course other possible treatments such as a vacuum pump and ring. The vacuum created draws blood into the penis and causes an erection. The ring is applied at the base of the penis to maintain it. It probably doesnt help foreplay if there is a 10 minute pause to fit the pump and use it.

On balance for most men, the anti impotence drugs Viagra, Cialis and Levitra are the best treatment. However partners mustnt be forgotten. As the saying goes it takes two to tango. How is your partner feeling? What do they think? What do they want? Its easy to be selfish and focus on yourself. Finally dont forget its not how big it is thats important, its how you use it! Sex is a shared experience.

Andy Duncan is a doctor and freelance medical writer. For more information on erectile dysfunction please visit www.pain-rehab.co.uk