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Past trauma, stress, infections, and other factors can activate CDR and lead to a lowered cellular metabolic state and low libido. If you are taking nitrates for your heart, you SHOULD NOT take any PDE5 inhibitors. They are used by inserting your penis into the pump and then using the pump action to draw blood up into your penis. When an uncircumcised man is aroused, the glans enlarges and the foreskin draws back so that it is fully exposed. Screw the ball onto the jewelry to hold it in place once it s in the hole.