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Penile prostheses come in two basic types, malleable or inflatable, and both involve surgery to implant the devices in the penis. In the case of the inflatable prosthesis, your surgeon must also implant a pump and a reservoir to hold the fluid that is used to inflate the penis for sexual activity.

For both malleable and inflatable prostheses, the surgeon will implant two cylinders — usually made of medical grade silicone. One goes into each of the penis’s two corpora cavernosa, which are cylinders of erectile tissue that ordinarily fill with blood to create an erection.

According to the Urology Care Foundation, the malleable implants create “a degree of permanent penile rigidity or firmness that enables the man to have sexual intercourse.” A malleable implant can be bent downward to allow urination or upward to facilitate sexual intercourse.

Other components for the inflatable prosthesis include the aforementioned pump and reservoir, the former implanted in the scrotum and a fluid-filled reservoir implanted under the skin of the lower abdomen. To prepare for sexual activity, the man triggers the pump that draws fluid from the reservoir to fill the cylinders in the penis making it rigid enough for intercourse.

Key factors in how you and your doctor decide to treat your ED include the cause of the dysfunction, your overall health, other medications you may be taking, and the ease with which you can tolerate various treatments.

If the cause appears to be psychologically based, you may have to spend some time with a psychiatrist or psychotherapist to work through the hangups and anxieties that are interfering with your ability to achieve an erection.

For the vast majority of men, the first line of attack against ED is drug therapy, which involves taking one of the FDA-approved PDE5 inhibitors, which temporarily increase blood flow to the penis and allow erection to occur.

If drugs don’t work or are inappropriate, your doctor may suggest that you use a vacuum constriction device (penis pump) or penile injection therapy. Finally, there is surgery, which sometimes can restore normal nerve and vascular function in the penis or implant a device that makes it possible for you to have an erection when appropriate.

There is no fail-safe way to pinpoint any one cause of erectile dysfunction, so it is often necessary for you to sit down with your doctor and together consider all the factors in your medical history that might be causing your ED.

That said, if you’re a relatively young man under the age of 40 and are unaware of any physical ailments, such as atherosclerosis, diabetes, or high blood pressure that might cause erectile dysfunction, then the odds are that your ED is psychologically rooted.

To see whether anxiety over your sexual performance might be responsible for your problems, do a little soul-searching on your own. AskMen.com suggests that performance anxiety may well be the culprit if you often obsess over “how long you lasted, how good or bad you were in bed, what your partner thought of the sex, [or] a past sexual experience that didn’t go as planned.”

Actually, there are a couple of devices that might be referred to as penis pumps. One of these works as part of a prosthetic implant system that consists of thin cylinders surgically implanted in the penis into which a saline solution can be pumped from a reservoir that is implanted under the skin of the lower abdomen. When activated, the cylinders fill with the saline solution that creates an erection suitable for sexual activity.

There’s also an external type of penis pump, technically known as a vacuum constriction device. The device consists of an acrylic cylinder that can be fitted over the flaccid penis. A pump, powered by hand or battery, then removes all of the air in the cylinder creating a vacuum. The vacuum draws blood into the shaft of the penis, causing it to become erect. A constriction band can then be fitted to the base of the penis to keep the blood from flowing out until sexual activity is complete. Using the constriction device for more than 30 minutes is inadvisable, according to WebMD.

If you’re asking this question, the odds are pretty good that you do have ED, according to MensHealth.com. It cites a study in which 1,000 men were asked if they had erectile dysfunction. That study, published in “BMC Urology,” revealed that 90 percent of men who claimed they were “unsure” suffered from at least some degree of this problem.

With normal erectile function, a man should be able to achieve and maintain an erection strong enough for intercourse. As he ages, it may be necessary to have more foreplay or self-manipulation to stimulate the penis, but erection should still be attainable. When it’s either difficult or impossible to get an erection or if an erection disappears before sexual activity is completed, it’s a pretty sure sign that you’re suffering from ED.

If these erectile difficulties occur only once in a great while and can be blamed on fatigue, too much to drink, or other temporary causes, it’s probably not a cause for panic.

Because ED can occur as a result of different physiological and psychological causes, most doctors first attempt to narrow down the range of possibilities by having you fill out a questionnaire that covers both your medical and sexual history, according to WebMD.

Among the many tests doctors use to diagnose ED are a complete blood count, or CBC, which can show if you’re suffering from anemia-related fatigue, which can cause ED, and a blood glucose test to determine if you have diabetes, a major cause of erectile problems. A blood test to determine blood lipid levels can indicate you’re suffering from atherosclerosis, another cause of ED. Because improper functioning of your liver and/or kidneys can contribute to ED, your doctor will probably run liver and kidney function tests.

Blood hormone studies can tell if your testosterone levels are low, while urinalysis can reveal the presence of kidney disease, diabetes, or a testosterone deficiency, all of which are possible causes of ED. The stamp test can show whether you’re having nocturnal erections. If you are, the ED cause is more likely to be psychological in nature. Other diagnostic testing may be ordered to determine how well the nerves and blood vessels serving the penis are functioning.

While erection difficulties are increasingly common after the age of 50, they are certainly not inevitable, according to an AARP report. The association cites the results of a landmark University of Chicago study, which found that roughly one-third of all men between the ages of 50 and 64 suffer from ED. Among men between the ages of 65 and 85, the incidence of ED jumps to 44 percent, according to the University of Chicago study. This latter statistic offers some encouragement for older Americans, because it indicates that more than half of elderly men manage to escape the frustration and embarrassment of ED.

However, once you’ve reached the age of 50, you’re likely to experience certain changes in the nature of your erections, according to AARP. Sexual fantasies may no longer be sufficient to trigger erections, and direct fondling may be needed to achieve erection. Also, erections tend to rise more slowly and are not as rock-hard as they were in your younger years.

According to a study published in the August 2003 issue of “Annals of Internal Medicine,” 4 percent of health professionals between the ages of 53 and 90 reported that they first experienced ED between the ages of 40 and 49. Of course, it may be argued that these older men tended to remember their younger years in a more positive light than was actually the case.

Part of the problem with such studies and surveys is the inexactitude of terminology. At the other end of the scale from the study cited above are the findings of the Massachusetts Male Aging Study, which found that a whopping 40 percent of men are affected by ED by age 40.

What isn’t clear from either of these studies is whether the questioning addressed occasional erection difficulties or persistent erectile dysfunction, which are two very different things. The former can be caused by having too much to drink, extreme fatigue, a bout of performance anxiety, or just having a lousy day. Persistent ED, of course, is a problem that must be treated on an ongoing basis.