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It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). There are two forms of impotence: primary and secondary. The man's comfort level is also frequently a factor, especially in maintaining an erection. Injecting prostaglandin, a hormone-like stimulator produced in the body, induces erection. Now it is also defined as the inability to maintain an erection or ejaculate.

Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. Impotence caused by psychological factors is often temporary; it lasts as long as the underlying factor is still there. During the late 16th and 17th centuries in France, male impotence was considered a crime, as well as legal grounds for a divorce.

Other studies have suggested that Tribulus also acts by increasing the level of dehydroepiandrosterone (DHEA), a naturally occurring substance in the body believed to be important for a healthy sex drive. as Tribulus shows positive effects only after two to three months. 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. The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for impotence. These involuntary erections mean that everything is fine with the nerves, muscles and arteries involved in the erection process, and signals that the cause of impotence is elsewhere. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for impotence. Surgery on the spinal cord, prostate, bladder, or pelvis can lead to impotence by damaging essential nerves, tissues, muscles, or arteries. It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM).