The American Association of Clinical Endocrinologists lists a number of factors that they believe must be taken into account when a patient comes for evaluation of sexual dysfunction:

• marital status
• length of relationship
• health of partner
• emotional closeness (how comfortable the couple are with each other)
• similarity of views of the couple
• level of commitment to each other
• effectiveness of communication between the couple
• need for stress therapy or relationship counseling
• sexual history of the couple - e.g., is the man simply experiencing changes related to ageing?
• blood chemistry, particularly a hormonal profile

Written by the same experts who constructed The-penis.com, there is text on ED treatments here.

There have been a whole variety of aids to overcome erectile dysfunction developed in the last few years, all designed to keep a man hard and erect, ranging from injections into the penis, through vacuum pumps with rubber rings around the base of the penis to keep the blood in it, through drugs inserted into the urethra, to the biggest one of all - the removal of the penis's natural internal erectile chambers and their replacement with steel or plastic rods.

I think a guy would have to be in a very bad way to have such drastic surgery, and the other treatments have pretty much been replaced by Viagra and Cialis.

But even with the assistance of these two excellent drugs, much can be done to reverse the process of erectile dysfunction by ensuring that you keep sexually active and follow some psychological principles about healthy relationships and sexual techniques.

The most common complaint about sexual dysfunction from men is only being able to achieve partial erections, or rapidly going soft after penetration.

But if erections occur during the night or early morning on awakening, the cause of your sexual difficulties may well be emotional or psychological. This may mean counseling or therapy can help address the psychological issues at work.

Erectile dysfunction

As a man gets older it is only natural for his erection is to become less firm and occasionally to disappear completely during sexual activity.

This change in erectile ability with age tends to be gradual and affects a man from his early 50s onwards. Statistics show that at least one third of people in their 60s have sexual intercourse once a week or more.

Many of these episodes of sexual intercourse will end without the man ejaculating - however, this can be seen as a normal age related change in sexual function, and not a sexual dysfunction.

The inability to get an erection - or full ED - can strike a man at any age from his 20s onwards. One episode of erectile failure is not unusual and can affect a man in many different circumstances; the usual cause of erectile failure is anxiety or stress, for example caused by the fear of being discovered having sexual relations, or the fear of getting the woman pregnant.

Another common cause of erectile dysfunction is some issue of conflict with one's sexual partner.

Particularly in young men erectile failure is often a good indication that they are not actually ready for sex or that they have an issue with their sexual partner usually that they don't want to be having intercourse with her) which is causing them stress and anxiety.

Even so, if a man fails to get an erection for the second time in sequence when he is having sexual intercourse he is likely to experience considerable anxiety around his impotence.

The problem is compounded by the fact that impotence or erectile dysfunction is very often seen as a shameful or secretive condition, which means that few men actually seek help for it; this is a shame since the cause of impotence is often completely curable.

Lack of sexual information, embarrassment, stress or anxiety are all possible candidates to provoke sexual dysfunction of one kind or another.

Even when erectile dysfunction is related to a physical problem such as diabetes, the emotional issues associated with this can be dealt with and this often significantly resolves the erectile difficulties.

Erectile dysfunction and YOU, the man!

• Most men experience erection problems in their lives because of alcohol, stress or mental problems. A problem once in a while is not a sign of long term problems or recurrent problems.

• Physical health factors affect a man's ability to get and keep an erection. You can lose erections just by worrying about your sexual ability - sexual performance anxiety.

• Many men view erectile dysfunction as a real challenge to their self-esteem.

• A man may have feelings of sexual inadequacy or sexual guilt because he no longer sees himself as a man. And erectile dysfunction can seem like the first sign of his physical decline toward maturity, old age and inevitable death.

• Most men are reluctant to ask for help with erectile dysfunction. These false beliefs are all likely to affect a man's ability to get an erection, especially as he gets older:

• Men should express feelings of warmth, love, intimacy and continue to maintain connection with a partner.
• Intimate physical contact with a partner does not have to lead to sexual intercourse and if a couple can accept this, the pressure to get erect is reduced.

Treatment for erectile dysfunction

• Yohimbine was once a useful first-line treatment for some men with erection problems. It helps about a fourth of all men but side effects include sweating, anxiety, a racing pulse.

• Penile Injection Therapy, too, was once a very effective treatment for many men, and side effects were reduced with the mix of prostaglandin E-1.

• Currently, Viagra or Cialis are more useful, more pleasant to take, and more acceptable to most men.

• Devices that produce penile erection by vacuum suction are safe, effective, and economical.

• In general, though, the most effective cures for ED are the psychologically based approaches, either behavior therapy or counseling and sexual psychotherapy.

• Penile implants are a last resort, and should only be installed surgically when everything else has failed.

Psychological issues that come up with erectile dysfunction

• Relaxation helps the whole process of recovery from erectile dysfunction. The substitution of relaxation over anxiety about sexual performance helps to maintain an erection.

• With erectile dysfunction, both members of the couple need to be considered. She may, for example, see her partner's erection failure as an emotional lie detector (if she believes he is having an affair, for example.)

• Or she may see an erection as evidence her man loves her or desires her. If so, for her, the absence of his erection may seem to show he doesn't find her attractive. Then, erectile dysfunction can become a major issue really quickly.

• A man who has an erection problem may feel ashamed, certainly embarrassed, probably "less of a man," and so he may withdraw from his partner.

• With the lack of ability to get erect and sexually perform, he may have a drop in sexual desire or libido. This can escalate into a refusal to kiss, hold or even hug her; he may find reasons to avoid sexual encounters.

• He may refuse to discuss the issue, believing it to be more of a character trait or personal failing, so his partner feels rejected, neglected, and undesirable - she may be filled with self-doubt and wonder about her own attractiveness.

• A woman may think her partner does not care for her and come to the conclusion he is having an affair. Or she may be afraid to bring up the subject and so each partner becomes more isolated and miserable.

• Women whose partners have erection problems may feel feel inadequate. A woman may even blame herself and feel hurt and angry about her partner's physical and emotional withdrawal.

How does stress affect erectile dysfunction?

Stress is something you see as harmful or threatening, something which makes your flight or fight response kick off, and produce adrenaline - which is an erection inhibitor.

Continuing stress can cause the body to produce long-term stress hormones like cortisol, which are even more likely to inhibit erection.

If you have a medical condition which interferes with your erectile capacity, that is even more likely to make your erection disappear: drugs used to deal with high blood pressure, sedatives, anti-acid medications like ranitidine, anti-depressants, tranquilizers, and some pain pills will all have a role in inhibiting erections.

Fortunately, the side effect of impotence is reversible when the dosage is altered, or a different medication is prescribed by the physician.

Medical conditions associated with impotence are diabetes, kidney and liver disease, some heart conditions and various surgical procedures such as cancer surgery of the bowel, bladder, and prostate gland.