The causes of erectile dysfunction are multiple and can be age-related issues, health-related issues or psychological problems - such as stress and chronic tiredness.

Specific steps take place to produce and sustain an erection. If something affects any of these factors or the delicate balance among them, erectile dysfunction is the likely outcome.

- 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 vessels' response. The blood vessels that supply the penis relax, allowing more blood to flow into the shafts, which produces the erection.

Nonphysical causes may account for impotence. They may include:

1. Psychological problems. The most common nonphysical causes are stress, anxiety and fatigue. Impotence is also an occasional side effect of psychological problems such as depression.
2. Negative feelings. Feelings that you express toward your sexual partner - or that are expressed by your sexual partner - such as resentment, hostility or lack of interest also can be a factor in erectile dysfunction.

Physical causes account for many cases of erectile dysfunction and may include:

- Nerve damage from longstanding diabetes (diabetic neuropathy)
- Cardiovascular disorders affecting the blood supply to the pelvis
- Certain prescription medications
- Operations for cancer of the prostate
- Injuries of the spinal cord
- Multiple sclerosis
- Hormonal disorders
- Alcoholism, a long history of tobacco consumption and other forms of drug abuse

In fact, erectile dysfunction may be one of the first signs of an underlying medical problem.

The physical and nonphysical causes of erectile dysfunction commonly interact. This is why it is very hard to tell what has originated the condition.

Of course we are all expecting straight answers to our problems and we won't settle for less! But what can you do aside of going to your family physician and getting tested for as many things as possible until he or she is satisfied that you are in good health? What can you do if you want a better sex life, a bigger penis, more control over your erections and just to be a better lover all-round?

Fortunately there are a few ways to go about penis enlargement:
A. Surgery.
You can try surgery, but this is both expensive and unsafe. Nobody in their right mind would spend $4,000+ only to be left with a scared penis and a lifetime of regrets.

B. Penis enlargement pills, patches, creams, lotions, supplements.
They don't work. Just as simple as that, all these natural substances won't do anything at all for the length and girth of your penis. If you think you can get as big as 9 inches or more just by taking a pill and rubbing some oil into your penis, then think again. And again, and again until you decide against spending hundreds or thousands of dollars on scams.

C. Penis enlargement pumps.
Dangerous! It is than surgery if you ask me. Penis pumps are dangerous devices even for people who want to achieve an erection, let alone trying to increase the size of your penis using one. The vacuum they create will help you get an erection, but you need to check, double-check and triple-check to make sure you are doing everything right or you'll damage your penile tissue for life. And no, they won't increase the size of your penis.

D. Jelqing and penis stretchers
Penis extenders and jelqing exercises represent the safest male enhancement method you can find. Penis extenders work by forcing the connective tissue that makes up the body of your penis to produce more cells, thus helping you achieve a longer, fuller penis in both flaccid and erect state.

They won't deliver results overnight. You won't buy anything today and get a 10 inches penis by tomorrow. And there is no promise that you will achieve the desired results with absolutely no effort whatsoever on your side. You have to understand that you will need to dedicate time and effort to see results, but boy what results will you see! This is no miracle cure, no snake oil, this is the safest male enhancement you can find and as such you will have to work to get there. But you will get there! And you will be more than pleased with the results, believe me!