ED is caused by vascular, hormonal, neurogenic, pharmacological, or psycho-genic factors. Performance anxiety where the person fears failing in a sexual scenario is a common psychogenic cause for ED.3 Neurogenic causes are related to diseases like Alzheimer's, Parkinson's, stroke or spinal cord injuries. Radical removal of the prostate (also called prostatectomy) is the cause of nerve-related ED as nerve injury is possible despite advances in surgical methods.4
Picture this: Draw one circle about the diameter of a Number 2 pencil and another circle that is smaller and about the diameter of a stirrer in a drink side by side. The larger circle is the approximate diameter of a good-sized coronary artery. The smaller circle is approximately the diameter of the pudendal artery, the major blood supply to the penis.
Porn induced erectile dysfunction occurs if the blood flow to the penis is not enough. This may happen because of unhealthy blood vessels. Many male aging studies show that a healthy food and ED risk decrease are interrelated. Thus, the consumption of fruits, vegetables, and whole grains reduces the ED symptoms, while the consumption of red meat and refined grains increases them.
Experts don't yet know whether the vitamin folic acid (also known as folate) is an effective natural treatment for erectile dysfunction. Research has shown that for some men, taking sildenafil (Viagra) together with folic acid and vitamin B6 seemed to help with erectile dysfunction more than taking medicine alone. Some experts contend that folic acid improves the function of the blood vessels involved in erections. But scientists say they need more studies to know if folic acid helps erectile dysfunction, either alone or in combination with other treatments.
Prescription drugs called “oral phosphodiesterase-5 (PDE5) inhibitors” are considered the “first-line non-invasive treatment” options for patients with ED. These include the drugs that go by brand names: Sildenafil, Vardenafil or Tadalafil. They work by helping the smooth muscle cells lining the blood vessels that supply the penis with blood to work properly. This allows a man to maintain an erection more easily.
Do not exceed 1 capsule in 24 hours. This is only intended for those 18 and over. Do not use if you are pregnant, nursing, or intend on becoming pregnant. If you have any current heart issues, such as but not limited to, hypertension, heart disease, and high cholesterol do not use. If you have any other medical issues such as prostate cancer and prostate enlargement do not take. Do not take this product if you're on any medications such as MAOI's or nitrates. Consult with your physician or health care provider to using the product.
ED is often treated with psychotherapy, behavior modification techniques, oral medications, locally injected drugs, vacuum devices, and sometimes even surgically implanted devices. In rare cases, surgery of the blood vessels may be necessary. In most cases, even when a physical cause is identified, emotional or psychological factors play a role as well.
Coffee / Caffeine.  A study found that men who consume the equivalent of 2-3 cups of coffee per day have a 39% lower incidence of erectile dysfunction than men who do not drink coffee11. Although the study showed a correlation between drinking coffee and  a lowered incidence of ED, it did not demonstrate a causative relationship.  Note that consuming larger amounts of coffee can raise stress and adrenaline levels, and can actually contribute to ED.
Older age. A man’s risk increases past the age of 40, as age is the variable most strongly associated with impotence. This is due to changing hormones, higher risk for heart problems and those affecting circulation, and decreased sexual desire that often occurs with increasing age. For example, based on findings from the National Health and Social Life Survey, it’s been found that “men between 50–60 years old are more than 3 times as likely to experience erection problems and to report low sexual desire compared to men aged 18 to 29 years.” (3)
A cold slice of watermelon can do more than just satisfy thirst and hunger during the warm summer months; it can help with bedroom satisfaction. Citrulline, the amino acid found in high concentrations of watermelon, is found to improve blood flow to the penis. A 2011 study revealed men who suffered from mild to moderate ED and took L-citrulline supplementation showed an improvement with their erectile function and were very satisfied. Natural watermelon juice, or “nature’s Viagra,” can also be easier on the stomach, since taking pills like Viagra can cause nausea and diarrhea.

3. Testosterone replacement. Before oral medications like Viagra, testosterone was routinely used to treat erectile dysfunction as it is central in the male sexual response, including the desire for sex and the process of getting an erection. Testosterone can be administered in a number of ways, for example orally, by means of an injection, skin patch, or subcutaneous (under the skin) pellet. 

In TCM, the meridian system is thought to represent a path through which the life energy qi flows and as discussed in earlier section, the “Jing” (kidney) qi plays an important role in penile erection. Acupuncture helps to correct the imbalances to relieve physical symptoms by stimulating various meridian points. The Shensu (BL23), Zusanli (ST36) and Neiguan (PC6) points represents important acupoints for penis stimulation and thus has a positive homeostatic effect on the autonomic nervous system, and potentially modulate NO release (55,56). While some studies have showed up to a third of patients reported improvement in penile erection and sexual activity, systematic review showed insufficient data to conclude that acupuncture is an effective intervention for treating ED (56,57). Therefore, further scientific research is required to investigate whether there are specific benefits of acupuncture for men with ED before acupuncture can be accepted as evidence-based practice.


In a study done to determine if vitamin D supplementation would actually help patients with ED, 143 patients with ED were tested to determine vitamin D levels. It was found that of these cases, 46 percent of patients suffered from substantial vitamin D deficiency and only 20 percent were found to have adequate levels of vitamin D. In these cases, it was also determined that inadequate arterial blood flow was the root cause of ED more commonly in patients with low vitamin D levels. [8] Vitamin D supplementation can improve both these parameters. 
Penile implants - are generally used if physical damage (like an accident) makes the anatomical parts needed for an erection not work. These are inserted by surgery and can provide a permanent treatment choice if others fail to work. The implants can be semi-rigid or inflatable. They can be pretty expensive and are not usually available on the NHS.
A number of nonprescription products claim to be herbal forms of Viagra. Some of these products contain unknown amounts of ingredients similar to those in prescription medications, which can cause dangerous side effects. Some actually contain the real drug, which should be given by prescription only. Although the Food and Drug Administration has banned many of these products, some potentially dangerous erectile dysfunction remedies remain on the market.
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