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John Brinkley initiated a boom in male impotence cures in the U.S. During the late 16th and 17th centuries in France, male impotence was considered a crime, as well as legal grounds for a divorce. Although they are generally safe and free of side effects (unlike chemical drugs), it is important to know that the quality of their extraction and preparation processes varies widely. During the late 16th and 17th centuries in France, male impotence was considered a crime, as well as legal grounds for a divorce. There are two forms of impotence: primary and secondary. Several types of FDA approved vacuum therapy devices are available with a doctor's prescription. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. The man's comfort level is also frequently a factor, especially in maintaining an erection. More drastically, inflatable or rigid penile implants may be fitted surgically. 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. Men with primary impotence have never had sufficient erections for satisfactory intercourse. Secondary impotence, defined as the loss of erectile function after a period of normal function, is more common. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. Men with secondary impotence are typically able to engage in intercourse only 25% of the time. Once an erection is achieved, the man places the elastic ring on the base of his penis, which keeps blood from draining from the penis back into the body. Impotence can be treated — sometimes even without drugs. The practice, which involved inspection of the complainants by court experts, was declared obscene in 1677. In fact, almost 100% of men who use cocaine regularly are impotent.

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