A bad lover blames his tool. Women know that the problem is not always in the genital member but in the sexual act.
And that begins a long time before penetration.
But many good, sensitive, lovers have flaccid parts that do not perform. The cause is sometimes physical and sometimes psychological and sometimes both.
Nowadays doctors tend not to look for causes, other than for obvious things such as diabetes or other causes of arterial disease. They get straight on with treatment.
But in men themselves, the search goes on, looking for external stimuli, when personal reassessment of individual values might be more appropriate.
Alcohol raises the urge and lowers the inhibitions but it also impedes the performance.
Some drugs, recreational or pharmaceutical, can improve function but they may do so at the price of dependency.
Mankind's search for aphrodisiacs wreaks carnage on the animal kingdom. There is no evidence that powdered rhinocerous horns produce a horn in the morn in humans. These poor creatures, and many others, are slaughtered on a myth.
Viagra and Cialis and other products can produce temporary erectile but this does not guarantee pleasure to either sexual partner.
Caverject injections into the penis are eye-watering to contemplate but they produce physical results.
A vacuum pump creates an erection that can then be captured temporarily by an elastic band at the root of the penis In time the blood vessels inside the penis re-grow so that the pump becomes less necessary.
An inflatable implant can be surgically inserted into the shaft of the penis and pumped up when needed. Evidently Jane Fonda mentioned, in her book, the effectiveness of this method.
This week it has been reported that ultrasound shock waves on the shaft of the penis can have similar effects in improving the blood supply. It is hoped that a course of nine sessions lasting 15 minutes each, could provide a lasting cure.
But eventually it all comes back to individual sensitivity and the acceptance that a great deal of sexual pleasure can come from mutual loving, even in the absence of erection or orgasm.
Inevitably sexual capacity fades in time as men get older. The prowess of the teens and twenties gradually withers. What could previously be done every day twice weakly becomes possible only twice weekly.
Yet some men appear to be very well endowed, not necessarily in the size of their wedding tackle but in their capacity to maintain their sexual activity when other men have retired. Charlie Chaplin fathered a child in his eighties.
Urologists, and other doctors who specialise in the treatment of erectile dysfunction, can be very much in demand. They meet an important clinical need. However, at times there is a mercenary aspect to some private practice. Maybe some ultrasonologists will shortly be joining that private medical gravy train for no better reason than that.