There are two forms of impotence: primary and secondary. A useful and simple way to distinguish between physiological and psychological impotence is to determine whether the patient ever has an erection. A vacuum erection device helps draw blood into the penis by applying negative pressure. Several types of FDA approved vacuum therapy devices are available with a doctor's prescription. Furthermore, studies have shown that lack of testosterone leads to a range of other sexual performance problems, including premature ejaculation and low sex drive. Tribulus had been used as traditional medicine to treat sexual dysfunction and male infertility in Europe and Asia for many decades before improvement in scientific extraction techniques allowed identification of its active ingredient, protodioscin. Impotence can be treated — sometimes even without drugs. as Tribulus shows positive effects only after two to three months. John Brinkley initiated a boom in male impotence cures in the U.S. 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.

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This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. In fact, almost 100% of men who use cocaine regularly are impotent. This device works quite well, although some men complain about the discomfort of the elastic ring in addition to the hassle of, well, pumping up. Some of the most popular herbs available on the market today are Tribulus, yohimbe, ginkgo biloba, and others.

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