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New Restorers Decision Making Guide to How to Restore Your Foreskin

Author: Steve R.H.

Article source: http://getplasticsurgery.info/. Used with author's permission.

How to Restore Your Foreskin A New Restorer's Decision Making Guide by Steve R.H., FRC Site Editor (email with Q's or Support steve@foreskinrestorationchat.info )

CONTENTS SECTION

A......Short Intro to the Restorer's Restoration Decision Guide

1......Are you ready for the non-surgical restoration commitment?

2......Tight Circumcision? - How tightly were you circumcised?

2a.....Tapeless Devices? Or Taping Methods?

3......Restoration methods for very tightly circumcised men

4......Restoration methods for men with average or somewhat looser circumcisions

5......Vitamin / Health Assistance for skin health and skin cell growth

6......Removing Tape from the penis without pain, sores, tears, or rips

7......Methods to keep the tape from coming off prematurely

7a.....When do I tell my partner about my restoring? Should I tell him/her?

8......24/7 Restoring? Or Cyclical Restoring. Which is faster? (New Medical Research Info)

A. Short Introduction to the Restorer's Restoration Decision Guide There are many answers on the internet. This is a dilema in itself because so much information answers questions but creates confusion. Confusion creates a problem when it comes to making decisions - and coming up with the right questions, at the right times. Foreskin restoration information 'overload' frequently causes depression and anxiety in men who have just learned about restoring.

This guide is an attempt by a somewheat experienced foreskin restorer to help put some method to the madness of information, after you've decided to non-surgically restore your foreskin. Hopefully it will alleviate some of the confusion and mistakes I personally have experienced during my restoration, and those that I have heard of first hand. Maybe sparing you some embarrassments, depression, confusion, or frustration.

1. Are You Ready for the Non-Surgical Restoration Commitment? If you think that a successful foreskin restoration of your own is possible without considerable emotional fortitude, sorry to have to disappoint you. A non-surgical restoration can take years. Average lengths of time would be useless to report except to serve as inspiration or loose guidelines, so it *is* reasonable to assume that a man with an average circumcision (ie. not too tightly circumcised) can complete a restoration - that is, a man can obtain full coverage of the glans of the penis to look uncircumcised - in about 2-years on average. With some dedication. And certainly with an large emotional commitment.

You must realize that after you decide to restore your foreskin, there is not going to be a magic-pill that will regrow your foreskin overnight. When we speak of an 'emotional commitment' - it means a commitment to yourself and your sexual pleasure and identity.

BE READY TO SPEND AT LEAST ONE FULL YEAR RESTORING!!

We all often think we have a high level of patience, but what many men discover, after starting their restoration, is that their patience is really 'stretched' to the limit, and unfortunately most men who start restoring - quit. Whether it is out of depression that their restoration is not progressing fast enough, or the man's thought that "it's simply not possible". Many of these men re-appear years later saying "I wish I hadn't given up years ago, or I'd be finished restoring by now!" - moral of the story - don't start unless you plan on sticking with it. It will save you emotional exhaustion and disappointment. Just remember - it *is* - absolutely - possible to restore your foreskin and grow new skin cells!

2. Tight Circumcision? - How tightly were you circumcised? Just as there are a vast variety of shapes, sizes, and appearances of all penises, circumcised or not; there are just as many variations on methods, and variations of circumcisions. Tight/close circumcisions. Loose circumcisions. Circumcisions that leave a man looking practically uncircumcised, etc.

(a) If your penis experiences pain or a tight pulling sensation while fully erect - you were circumcised tightly/aggressively.

(b) If your penis bleeds or forms any little tears anywhere along the penile shaft when you obtain erection - you are much too tightly circumcised.

(c) Can't move any - or hardly any - skin onto your glans while erect? You likely had an average North American Circumcision.

(d) Able to - with minor pulling - roll skin up onto the glans while erect? You probably had a looser circumcision

(e) Able to easily roll skin to almost cover the glans while erect? - You have a very loose circumcision.

If you feel your circumcision falls into A, B, or C, then you may have to start your restoration with some of the less aggressive restoration methods - and will most likely be required to - at least start - with a taping method. There is nothing wrong with this. Many, many men start with taping - and finish their restoration taping. This author included. If you believe you fall into categories D or E, you may be able to start slightly ahead of the men circumcised more tightly. You may be able to begin with a tapeless device if you chose. There is some debate as to whether tapeless or tape-utilizing methods produce faster or slower results. It has been this author's experience that taping methods produce the best, fastest results. This of course is this author's personal experience only.

Tightly circumcised men, regretfully, will be the most likely restorers to spend a longer amount of time restoring to completion. If you are circumcised tightly, keep in mind, however, that as you develop and grow more new skin, restoring becomes exponentially faster as there are more skin cells to divide to create new cells - causing the restoration of your foreskin. SO, tightly circumcised: don't despair!

Users of the FRC website (http://foreskinrestorationchat.info) have frequently reported having started AND FINISHED restoring even tho their circumcisions and penile skin as a result, were - in their words - "tight as a drum" Again - do NOT despair. Many circumcised men have suffered privately behind closed doors as a result of their overly tight circumcisions (one is tempted to call such circumcisions "clumsy, botched") - have begun restoring, and have reported a night-and-day improvement in their sex lives - and yes, their male or female sex partners do report such happiness at the marked imrprovement in their restoring partner's pleasure responses, as well as their own pleasure being given to them by their newly restoring partners.

2a. Tapeless Devices? Or Taping Methods?

There are many "tapeless devices" available by many commercial manufacturers all over the internet. It is important to realize that there is no need to purchase these commercial devices to restore your foreskin. The reason these manufacturers have designed these devices is to fulfill a niche market - the market of men who are restoring but cannot, for one reason or another, deal with using tape methods. NOTE: That most surgical tapes, such as 3M MicroPore or Rejuvenesse are hypo-allergenic and if you get sores or irritations from those tapes, chances are that you are not using proper tape application methods. Methods on application of tape or tapeless devices can be found on the main FRC page.

NOTE TO TIGHTLY CIRCUMCISED MEN: You will most likely need to start restoring - at least for a couple months - using the X-Taping (Cross Taping) method to loosen-up some skin on your penis to open up some more opportunity to use more aggressive, faster methods. It is possible for a tightly circumcised man to even start with T-Taping (this author's favorite method).

NOTE TO LOOSELY CIRCUMCISED MEN: You have the luxury to pick and chose which method or commercial device you chose to use for your restoration. While this author doesn't personally feel tapeless methods/devices are unnecessary, many men prefer tapeless devices because of the ease of use (eg. can be removed very quickly for intimacy, no peeling tape off the penis, no making t-tapes, etc.). If you are loosely circumcised, or believe you are, try starting with the T-Tape/Tension-Strap method. There is a great link on the FRC site, linking to the exceptional "T-Tape Picture Book" - a photo-guided instruction manual for those who want to try the great T-Tape foreskin restoring method.

Loosely circmcised men usually need not start with a X-taping method (which is used most often by tightly circumcised men to obtain some more useable skin for faster methods). Some tapeless methods you can order include the: TLC-tugger, CAT II Pro, Tug-a-hoy. (Links all on FRC) Tapeless devices (or "tuggers" as they are often called) do have some advantages, as alluded to above. For one, not having to place tape - an adhesive - on the skin of your penis is a major enticement to tapeless tuggers for many restoring men.

Almost every tape a restorer can use will still leave some amount of residue on the skin, after removal. There are lotions (mineral oil with citrus extract products, for example) that will literally disolve away most surgical tape residue from the penile skin when using a taping method, and you simply rinse away with water. This is not a very time consuming process.

When you get accustomed to 'taping' you find you can apply your t-tapes in as little as 30-seconds, and remove it completely (including all residue that may be left) in about 5-minutes (soaking in warm water time, then slowly pulling the soaked tape away from the skin, removing any residue, etc.)

Another "bonus" to tapeLESS methods regards urination. Let's face it, you will have to 'go' at least a few times a day, and worse if you're a coffee drinker! (Make a mental note: If wearing tape on your penis when you go to the office, reduce your coffee consumption, or your boss may wonder why you've disappeared to the bathroom back and forth for half of the day!)

Tapeless methods do allow for urination without having to remove the device. Not all tapeless methods allow urination without removal - but it has become a common feature in most varying designs. Wearing a T-Tape for example, one must unclip the tension strap and 'open' the end of the T-Tape to pull the skin back to urinate, then reverse the process when finished. Experienced tapers, however, can often accomplish this with great discretion and speed even at a public urinal! It's recommended you get to know your device while utlizing "public stalls" in washrooms. Try not to smile - you'll soon become famiiar with how disruptive 'bathroom breaks' become while restoring - tapeless or not. Don't lose your sense of humor over all of this, because in retrospect most men do have stories they like to share or report that are nothing short of hillarious (ie. man wearing a PUD - a metal tugger - went through a security checkpoint at an airport...not hard to guess what that poor guy went through!). Think of the bar stories you'll have!

Bottom line when it comes to tapeless or tape methods is a matter of purely personal choice.

3. Restoration Methods for Very Tightly Circumcised Men

Tightly circumcised? You are in good company. Millions of men are circumcised too tightly. Most circumcisions in North America are done to the standard of the Jewish custom of "bris periah" - the complete and utter removal of the entire foreskin and all of it's components (ie. the frenelum, inner mucosal skin, etc.). This is usually accomplished by circumcising infants with a Gomco Circumcision Clamp, or Plastibell device. Some men manage to escape such radical circumcisions, but most do not - not in North America anyway.

For the tightly, radically circumcised man, there are some methods to begin a foreskin restoration.

1 - You should spend a few months X-Taping to loosen some of the tight skin on your erect penis

2 - Manually pulling on the skin with your fingers (see Manual Rest. link on main page) to loosen skin, 10-15mins at a time, a few times a day.

When the skin is loose enough from the X-taping and/or Manual restoring methods, you can 'graduate' to wearing a more comfortable T-Tape and tension strap to expedite the skin growth process. Whenever you have the opportunity (eg. after using the washroom, after/during showers, etc.) you should manually pull tightly on the shaft skin, up over the glans as far as you can without causing pain. PAIN IS NEVER, EVER A GOOD INDICATION OF PROPER RESTORING.

One way many tightly circumcised men "get in" some easy to accommodate manual restoring, and in fact the same method many restorers regardless of their type of circumcision use, is to do as follows:

While erect - right after your shower and you have dried off is best - grab about midway up the penis with your thumb, index, and middle fingers, forming a decent grip around your penis. Then simply pull the skin (which will already be somewhat tight from the erection) back towards the body and hold it for 15-20 seconds, then rest for about 30-seconds, repeat. Do this for five to ten minutes - but stop if you start feelings your penis and skin becoming raw or sore. This method will do more to loosen a tight circumcision than you might imagine, and again, looser skin opens doors to easier use of faster, more aggressive methods of restoration.

"I'm so tightly circumcised that I really doubt there is any skin to successfully restore." - Untrue. ALL skin will stretch, grow, and create new skin cells if put under tension. No matter how little you have. It may start off with some difficulty, and start off somewhat slowly, but remember, speed of skin growth only becomes exponentially faster as you gain and 'loosen' more.

4. Restoration Methods for Men with Average or Looser Circumcisions

For men circumcised in a manner that left some amount of loose skin on the shaft of the penis, there are some more options open and available to you in your restoration. Just as men tightly circumcised, you have the option of X-taping, but you can also easily use T-Taping, or even try a commercial 'tugger' or two. In the interest of simplicity of access, and short-term cost, I recommend starting off with T-Taping (see links on FRC). Looser skin allows you to more comfortably wear a T-Tape as well. Looser skin, means more skin - when T-Taped and under tension with your tension strap attached to your T-Tape, the tension pulls the penils shaft skin and remaining foreskin out over the glans and allows the whole contraption to accommodate erections either at night - or spontaneous ones during the day. Many tapeless devices simplt cannot accommodate erections and must be removed at night to ensure no damage occurs - but to be fair, a select few tapeless device manufacturers and home-made tapeless tugger designs can and are worn at nightt and can accommodate erections.

So take your pick guys, if you got away with a loose circumcision, you have many options available to you. It is recommended that you examine the Foreskin Restoration Methods Comparison Chart, you can find the link to that as well on the FRC website.

5. Vitamin / Health Assistance for Skin Health and Skin Cell Growth

As you would expect, when you are ungoing your own non surgical foreskin restoration, it's best to be in, and remain in good overall health.

There are a vast number of men who use Vitamin E religiously, both orally and topically. In light of new medical research on vitamin E and it's possible link to an increase in morbidity, this author will not recommend any 'good' internal doseage of Vitamin E. "E" can, and maybe should be applied to the penile skin that is under tension - in between restoring sessions. It appears (from many men's reports and personal experience) that a simple 400IU Vitamin E caplet broken open and spread and massaged into the skin is both soothing, and actually seems to speed the healing of irritated skin. Ph-neutral soaps or soapless body cleansing lotions enriched with Vitamin E, used in the shower, might also be useful.

There is very experimental medical research out of Beijing, China, that has proven a medical agent called Papaverine Topical Cream actually sped the growth of skin! This is a very short exerpt from a medical abstract from the Southern-2 Ward, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China: "This study shows that the rate of tissue expansion can be accelerated by topical application of papaverine cream"

This information is not provided in this text to get your hopes up. It's provided to show that research into skin, cell, and tissue growth is happening right now, around the world. Eventually circumcised men will be able to very rapidly restore their foreskins with these medical - albeit non-surgical - methods if the speed of this type of research grows - or at least continues.

Until science evolves to a point whereby we can smear some cream on a circumcised penis and within a day or two have a newly regrown restored foreskin, let's be practical! It is critical to maintain skin moisture in between wearing your tape or tapeless devices ('while you are restoring'). Many men find simple mineral oil too greasy and tends not to absorb quickly enough into the skin, but if you find your skin does absorb mineral oil quickly, massage that into your skin daily in between taping (being very sure to thoroughly cleanse all trace of oil before next restoring-session!). This author prefers to use: "Vaseline (brand) Intensive Care Unscented Extra Strength Lotion" (containing many moisturizers and Virtamin E - for 'very dry skin')" Now that Vaseline got the plug (!) I must say that this particular brand of moisturizer absorbs *very* quickly, is completely greaseless with no oils, and is all sorts of great! After a great deal of experience with different lotions for moisturizing after restoring-sessions, this one hands down must be given a try by all restorers. Another suggestion often offered by restorers is to use a lotion with not only Vitamin E, but also with Lipids.

It is suggested that lipids actually enhance the speed of the skin repair and cellular restoration process. Take it for what it is worth. There is sufficient conflicting evidence both that prove lipids are helpful and that lipids are useless to warrant your own research into "lipids" on the internet to make this decision.

Ensure you are eating a healthy amount of fish. If you aren't, include some in your diet, as it is suggested fish oils are essential to skin health. Also, a good, trusted namebrand multi-vitamin once a day, with perhaps the addition of fish oil (cod liver oil, halibut liver oil...) supplements as they are good for the skin would be useful. Useful not only for healthy skin, but also for your general health! Be aware however, that this author is not a doctor and these are (not medical) suggestions made from personal experiences, reading, and those experiences and reports of other restoring men. Use good sense and consult your GP before you decide to start supplementing your diet with vitamins.

6. Removing Tape from the Skin Without Pain, Tears, Sores, Rips...

Even tho this section best belongs in a taping-methods guide, I felt it important enough to make a short entry on this matter in this guide. Many of you reading this will have already decided to start restoring and are perhaps reading this reflecting, or referring to it. Many of you are also causing yourself damage using a taping restoration method - not necessarily by too much tension or improper taping procedures - but by plain, simple tape removal ! A great many restoring men have been either turned off of restoring altogether because of the pain they cause themselves removing their tapes, or it converts men to a search for a tapeless tugger product. There are a few very, very simply rules to removing your tape without pain, tears, sores, or rips:

Soak in a hot bath for five minutes and then remove tape slowly under the water Always remove the skin from the tape - not the tape from the skin (what this means is, grab the tape and slowly roll the skin off the grip of the tape, do not pull on the tape, roll or push down on the skin AWAY FROM the tape) You can purchase a citrus mineral oil - rub it over the taped area, wait for a minute, and gently and slowly remove the tape (keeping the above rule in mind!) All residue should come off with the tape. If it doesn't, the citrus in the oil will make the residue simple to roll off.

Never try to remove your tape (unless it's an emergency!) without at least soaking it in some form of oil-based lotion, very warm baths/water, or something to loosen the bond that the tape has created between itself and your skin. If you feel any pain at all removing your tape, chances are you are going to have either a sore, or irritated spot at that location after you get the tape off. Don't ake any chances, remove the tape slowly, it can be done within 5-minutes without any negative effects!

7. Methods to Keep the Tape from Coming Off Prematurely

If removing the tape is the least of your problems after you start trying out the taping method, then keeping he tape ON, or keeping it from slipping, will be the next problem you're likely to encounter. Some men find that they cannot keep their tapes from losing grip and slipping off the skin after even 4 or 5 hours. The point here is to have the tape stay-put where you placed it, for as long as you want it to stay there. Try these methods:

From the drugstore, purchase a small bottle of $3 or $4 "Friar's Balsam" (Tincture of Benzoin) It is a type of astringent. With a Q-Tip, paint a very thin layer over the area of skin on which you will be placing the tape. Let the liquid painted on the skin dry for about 30-seconds before applying your tape. Then apply your tape as usual.

The Friar's Balsam holds AMAZINGLY well, and requires that you soak in the hot bath for a few minutes longer to get the tape to come off later.

Another suggestion. Lightly dust the area of your body that is likely to have your penis held against (your leg, your lower stomach - if sleeping with your tension strap over your shoulder) with unscented baby powder. It will absorb any extra moisture caused by the heat of the penis being held against the body so tightly by tension. You can also dust the outside of the tape lightly with baby powder as well, which will help absorb any moisture that might othewise infiltrate the delicate surgical tape.

ALWAYS: Ensure that if you use the T-Tape method, that you place the midline of the "T" along your Point of Equilibrium (POE) on your penis. The POE is the point around your penis on the skin where if the tape is applied and pulled, equal tension is spread over both the inner and outter area of skin. In most men just starting to restore, with an average circumcision, the POE is usually right along your circumcision-line. In tightly circumcised men who may have difficulty locating their POE, use the circumcision-line as well, as your POE. Taping along your POE will ensure that the tape is baring the load of the tension equally, so that the adhesive holds longer without one area slipping, causing the whole tape to fail.

7a. When do I Tell My Partner About my Restoring? Should I Tell Him/Her?

Having to discuss this issue with anyone, particularly your most intimate friend - your partner, can be the most difficult thing to do. The chances of you being able to hide your restoration process from your loved one will be next to impossible. So it has to be dealt with sooner or later. Express how important "trying this out" is to you. Be prepared to answer the question "why would you want to do this?" - It invariably seems to be the first or second question that comes up! That is something no Guide can help you answer. But it is certainly something worth taking some time to consider. "Why do you want to restore?"

Men and women have contacted me in relation to their partner's restoration. All have said that they are supportive of their partners' restoration efforts, and in some cases they were the one who introduced them to the idea in the first place! It's rare to hear of an unsupportive partner - even if their level of support is purely a matter of tolerance out of love for them. Your partner may ask you if you are doing this because they of them - because they "can't please you anymore". It's important to make sure that your partner is told - frankly - that restoring your foreskin is a decision for you, about you, and something you want - nothing to do with them, you just hope that they will be supportive and not think you are crazy for doing this.

Inform them that most men's sexual pleasure increases greatly as a result of restoration, and many of their partners report enhanced sexual pleasure as well. Ultimately your choice to restore could potentially enhance both of your sex lives! Two documents you can show your partner, when you "come out to them" about restoring, can be found at the following links:

Why Would a Circumcised Man Want to Restore His Foreskin (http://foreskinrestorationchat.info/jfaq.html) by John Geisheker, J.D., LL.M (General Counsel, Doctor's Opposing Circumcision, D.O.C. http://faculty.washington.edu/gcd/DOC/ )

What is Foreskin Restoration by FRC, Document appears on main page of site (http://foreskinrestorationchat.info)

8. 24/7 Restoring? Or Cyclical Restoring. Which is faster? (New Medical Research Info)

There is nothing more hotly debated in the restoration community than the issue of how long to wear the tension/weight on the skin in order to obtain the maximum skin cell growth in the shortest time. For a long time, the general restoratin community was convinced that a restoring regimen as close to 24/7 as possible was optimal. In other words, it was believed - and still is by some - that foreskin restoration would be completed/achived faster the longer you were 'stretching' the skin.

Well, medical research in every shape and form is luckily, always evolving. For years, the co-founder of NORM (National Organization of Restoring Men) Wayne Griffiths, has tried to convince restoring men that a 24/7 regimen is not the answer to the most expeditious skin growth. The following is a quote from a posting in the FRC Forums by Wayne Griffiths:

"When we look at the body builders, trying and successfully getting more muscle and you have a muscle to be lengthened for sure the Dartos/Peripenic muscle... you need to follow as the most recent research has indicated, and as i have been 'preaching' for 15 years, growth is had when the cells have a chance to perform mitosis. One needs to understand that just looking at it in a mechanical/physical situation, if you were a rubber band stretched to the fullest extent, could you tie a knot in the middle of yourself? I think not. So the resolving of the chromatin of the nucleus into a threadlike form, which separate into segments or chromosomes, each of which separated longitudinally into two parts, one part of each chromosome being retain in each of two new cells resulting from the original cell.

"The three papers researching tissue expansion have only been done since 1997 + - and the latest in 2004...have shown that cyclical moderate tension is the most successful and productive method of growing new cells. These studies i am sure will change to some extent the regimen for tissue expansion in the medical field for harvesting." (Wayne Griffiths, NORM - http://www.norm.org)

Taking this information into consideration, a 12-hour restoring day, with 8-12 hours off, each day, 6-days a week, would seem to be an appropriate suggestion. Of course, for any new restorer, the length of time you may be able to tolerate wearing your device or tape could be very short. It takes a while to become used to wearing tapes and devices and thus be able to comfortably wear them for longer periods of time.

This document should not be taken as medical advice and is meant to compliment, rather than supplant the relationship between you and your doctor.

Steve R.H. is the Site-Owner and Editor of FRC - the ForeskinRestorationChat.Info website. He holds a college degree in Journalism and Business, currently finishing his studies in Private Investigation, and has been widely published in local and national print media. He has been involved in the restoration community for a decade. http://foreskinrestorationchat.info for detailed info.


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Erectile dysfunction

Erectile dysfunction (ED) affects the lives of many middle-aged men and their partners. The term erectile dysfunction covers a range of disorders, but usually refers to the inability to obtain an adequate erection for satisfactory sexual activity. Although erectile dysfunction, formerly called impotence, is more common in men older than 65, it can occur at any age. An occasional episode of erectile dysfunction happens to most men and is normal. As men age, it's also normal to experience changes in erectile function. Erections may take longer to develop, may not be as rigid or may require more direct stimulation to be achieved. Men may also notice that orgasms are less intense, the volume of ejaculate is reduced and recovery time increases between erections. Erectile dysfunction may also be a sign of a physical or emotional problem that requires treatment.

Erectile dysfunction was once a taboo subject, but more men are seeking help. Doctors are gaining a better understanding of what causes erectile dysfunction and are finding new and better treatments.

This Website discusses all about erectile dysfunction, physiology of the normal erection and the pathophysiology, and treatment of ED.

What is Erectile Dysfunction?

Erectile dysfunction or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. There are various underlying causes, such as diabetes, many of which are medically reversible.

The causes may be physiological or psychological. Psychological impotence can often be helped by almost anything that the patient believes in; there is a very strong placebo effect.

Due to its embarrassing nature and the shame felt by sufferers, the subject was taboo for a long time, and is the subject of many urban legends. Folk remedies have long been advocated, with some being advertised widely since the 1930s. The introduction of perhaps the first pharmacologically effective remedy for impotence, sildenafil (trade name Viagra), in the 1990s caused a wave of public attention, propelled in part by the news-worthiness of stories about it and heavy advertising.

The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina. It is now mostly replaced by more precise terms.

Signs and symptoms:

Erectile dysfunction is characterized by the inability to maintain erection. Normal erections during sleep and in the early morning suggest a psychogenic cause, while loss of these erections may signify underlying disease, often cardiovascular in origin. Other things leading to erectile dysfunction are diabetes mellitus (causing neuropathy) or hypogonadism (decreased testosterone levels due to disease affecting the testicles or the pituitary gland).

Here are some causes of Erectile Dysfunction:

* Arousal: The first step is sexual arousal, which men obtain from the senses of sight, touch, hearing and smell, and from thoughts.

* Nervous system response: The brain communicates the sexual excitation to the body's nervous system, which activates increased blood flow to the penis.

* Blood vessel response:. A relaxing action occurs in the blood vessels that supply the penis, allowing more blood to flow into the shafts that produce the erection.

Physiology of normal erections:

Penile erections involve an integration of complex physiologic processes involving the CNS, peripheral nervous system, and hormonal and vascular systems. Any abnormality involving these systems, whether from medication or disease, has a significant impact on the ability to develop and sustain an erection, ejaculate, and experience orgasm. Tumescence, the vascular filling of the cavernous bodies, relies on neural and hormonal mechanisms operating at various levels of the neural axis. This is unique among visceral functions because it requires central neurological input.

Andersson et al summarized some of the information related to the pathways involved in erectile function. The degree of contraction of corpus cavernosal smooth muscle determines the functional state of the penis. The balance between contraction and relaxation is controlled by central and peripheral factors that involve many transmitters and transmitter systems. At the cellular level, smooth muscle relaxation occurs following the release of acetylcholine from the parasympathetic nerves.

Pathophysiology of erectile dysfunction:

Erectile Dysfunction is essentially a vascular disease. It is often associated with other vascular diseases and conditions such as diabetes, hypertension, and coronary artery disease. Other conditions associated with Erectile Dysfunction include neurologic disorders, endocrinopathies, benign prostatic hyperplasia, and depression. Conditions associated with reduced nerve and endothelium function, such as aging, hypertension, smoking, hypercholesterolemia, and diabetes, alter the balance between contraction and relaxation factors. These conditions cause circulatory and structural changes in penile tissues, resulting in arterial insufficiency and defective smooth muscle relaxation. In some patients, sexual dysfunction may be the presenting symptom of these disorders.

Treatment:

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