The man's comfort level is also frequently a factor, especially in maintaining an erection. More than nine clinical studies performed by six universities and academic hospitals on this purified extract have confirmed the herb's beneficial effect. In all, these studies proved that Tribulus works very well in curing sexual dysfunctions and maximizing sexual performance when taken regularly. Men with primary impotence have never had sufficient erections for satisfactory intercourse. Although middle-aged and older men are more likely to be impotent than younger men, impotence can strike at any adult age.

Ultrasound is then used to see vascular dilation and measure penile blood pressure. The same goes for alcohol and narcotics, like heroin and cocaine. If you suspect this may be the cause, you can perform a simple test to see if impotence is just in your mind.

One of the most underestimated causes of impotence is cigarette smoking — as if you need yet another reason to quit. The practice, which involved inspection of the complainants by court experts, was declared obscene in 1677. Men with secondary impotence are typically able to engage in intercourse only 25% of the time. Be sure to select a Tribulus extract that contains at least 45% protodioscin.. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. Men with primary impotence have never had sufficient erections for satisfactory intercourse. It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). So, before you invest in costly and potentially dangerous chemical drugs, you may want to consider natural treatments for impotence. 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.