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Other studies have suggested that Tribulus also acts by increasing the level of dehydroepiandrosterone (DHEA), a naturally occurring substance in the body believed to be important for a healthy sex drive. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A note of caution: Although there are many Tribulus extracts available over the counter today, almost all of these have been found not to contain any significant amount of the active ingredient. More drastically, inflatable or rigid penile implants may be fitted surgically. It's important to realize that impotence may be a symptom of a more serious health problem, so if you're impotent, seek professional medical help immediately.

Impotence caused by psychological factors is often temporary; it lasts as long as the underlying factor is still there. During the late 16th and 17th centuries in France, male impotence was considered a crime, as well as legal grounds for a divorce. Although they are generally safe and free of side effects (unlike chemical drugs), it is important to know that the quality of their extraction and preparation processes varies widely.

Secondary impotence, defined as the loss of erectile function after a period of normal function, is more common. Given the advances in medicine and nutrition research, however, it is no longer a scary thing. It turns out that a man often gets multiple erections throughout the night. 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. Now it is also defined as the inability to maintain an erection or ejaculate. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it. In this case, the impotence lasts as long as you are taking the drugs. The vacuum forces blood into the penis, which in turn causes an erection. Although middle-aged and older men are more likely to be impotent than younger men, impotence can strike at any adult age.