Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Erectile dysfunction (ED) is a common occurrence in society with a prevalence of about 26 cases per 1,000 patients [1]. This equates to about 150 million cases of ED worldwide. It is a condition where patients are unable to maintain adequate blood flow into their penis to sustain an erection. As a person ages, the probability of having ED grow but no age group is safe from this condition. In a study of Romanian men, it was determined that about 3 percent of males aged 15 to 25, 7 percent of males aged 25 to 45 and 22 percent of males 45 to 65 had ED [2]. Once a man reaches 70, ED can be seen in 84 percent of the elderly. In most cases, ED is a condition that manifests because of a much larger systemic disease. Some of the most common risk factors include cardiovascular disease, hypertension, diabetes mellitus, tobacco use, hyperlipidemia, metabolic syndrome or depression [3].

While carrots have always been touted for their benefits for the eyes, studies reveal that carotenoids, vitamins, and minerals present in carrots act as antioxidants, anticarcinogens, and immune enhancers. Carrots also boast of antihypertensive, hepatoprotective, renoprotective, and wound healing benefits as well as cardio- and hepatoprotective, antibacterial, antifungal, anti-inflammatory, and analgesic effects. Studies on male rats have shown that carrots can exert an effect on fertility by elevating testosterone levels in them.10


While Western medicine emphases the link between cardiovascular function and ED, TCM places importance on liver and kidney ailments as causative factor for development of ED. Western medicine involves a step-wise approach by targeting the relevant organ systems to treat various clinical symptoms; but TCM focuses on restoring the balance between various organs to achieve harmony and holistic approach to inner sense (4). The following article reviews our current understanding regarding the philosophical approach, and evaluates the evidence surrounding various ED therapies between mainstream Western medicine and TCM (see Table 1).
Penile vibratory stimulator is a battery operated device with oscillating discs that can provide excitation of afferent penile nerves at various regulated frequency and amplitudes. PVS has been utilised to activate the ejaculatory reflex for patients with spinal cord injury above T10 seeking to collect retrogradely ejaculated semen in fertility treatment (10). The Viberect is a vibratory stimulation handheld device approved by FDA for treatment of ED. It is clamp-shaped with two oscillating discs facing each other near the tips, and the glans penis is placed between the two oscillating discs to receive concurrent dorsal and ventral stimulation at adjustable frequencies and amplitudes.
Researchers at Johns Hopkins University last year looked at 3,400 healthy Americans and found that men who were vitamin D deficient were 32% more likely to have trouble getting it up than those with sufficient levels, even after adjusting for other ED risk factors. In fact, the connection is so common, Walker says D levels are something he always checks in ED patients. Why? The sunshine vitamin is crucial for keeping the endothelial cells that line blood vessels healthy. Without enough of the stuff, blood flow is inhibited, affecting everything from your heart to your hard-on.

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
The brew is rich in compounds called catechins, which have been shown to blast away belly fat and speed the liver’s capacity for turning fat into energy. But that’s not all: Catechins also boost desire by promoting blood flow to your nether region. “Catechins kill off free radicals that damage and inflame blood vessels, increasing their ability to transport blood,” says Cassie Bjork, RD, LD of Healthy Simple Life. “Catechins also cause blood vessel cells to release nitric oxide, which increases the size of the blood vessels, leading to improved blood flow,” she explains. Blood flow to the genitals = feeling of excitement, so sipping the stuff will, well, make you want to get it on. Bjork suggests drinking four cups a day to feel the full effects. Pick up one of our 5 favorite teas for weight loss.

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.


Arginine. The amino acid L-arginine, which occurs naturally in food, boosts the body's production of nitric oxide, a compound that facilitates erections by dilating blood vessels in the penis. Studies examining L-arginine's effectiveness against impotence have yielded mixed results. A 1999 trial published in the online journal BJU International found that high doses of L-arginine can help improve sexual function, but only in men with abnormal nitric oxide metabolism, such as that associated with cardiovascular disease. In another study, published in 2003 in the Journal of Sex & Marital Therapy, Bulgarian scientists reported that ED sufferers who took L-arginine along with the pine extract pycnogenol saw major improvements in sexual function with no side effects. Arginine can be helpful, says Geo Espinosa, ND, director of the Integrative Urological Center at NYU Langone Medical Center. Espinosa says that men with known cardiovascular problems should take it only with a doctor's supervision; L-arginine can interact with some medications.


Diseases like diabetes, cardiovascular disease, atherosclerosis, kidney disease, obesity, multiple sclerosis, and depression, and activities like bicycling, smoking, alcohol or drug abuse can impair blood flow or nerve impulses throughout the body. Surgery, as well as certain medications, can also result in ED. However, this may be a temporary problem.4
A daily dose of niacin improves erectile function, particularly in men with high cholesterol, according to a 2011 study in The Journal of Sexual Medicine. The vitamin helps increase blood flow and reduce inflammation—one of the underlying causes of both high cholesterol and erectile dysfunction. “Vitamin B3 is also used to make sex hormones and other important chemical-signal molecules,” says Fisch. Like many of the others on our list, this tablet is most powerful when taken in conjunction with others: A cocktail of propionyl, L-carnitine, L-arginine, and niacin taken for three months improved 40% of erections in a study from researchers at Sapienza University of Rome in Italy.
Another natural treatment for erectile dysfunction to consider would be vitamin E. This is a vitamin that has been linked to chronic diseases in the past due to the antioxidant effects of this vitamin. Considering ED could be a manifestation of another chronic condition, it makes sense that vitamin E may have a role in reducing the symptoms of the disease. As a person ages, it is natural for the body to undergo more oxidative stress and damage as cells do not function as well as they once did. Rats who were given supplemental vitamin E were found to have reduced levels of oxidative damage to their tissues and had levels of NO and other factors that help induce an erection more similar to younger rats compared to rats without vitamin E supplementation. If patients incorporate vitamin E into their vitamins and dietary supplements for ED, their ED should improve. [9]
It’s the truth: You reach a certain age where having sex isn’t as easy or satisfying as it used to be. Many factors can contribute to erectile dysfunction (ED) — anything from smoking to cardiovascular disease to general stress — and you shouldn’t be shy about discussing any erectile problems with your doctor. If there’s an underlying health condition causing your troubles, treating the cause may get you back to top form in no time.
Sexual dysfunction has been evaluated in ancient literature of TCM in terms of subjective sensation and the actual sexual performance (3). In TCM, methods and matters related to direct sexual activity is described in terms of “ten motions”, “seven impairments” and “eight benefits”, which asserted that the ideal intensity and frequency of sexual activity should be moderate. TCM is all about balance, to achieve better overall regulation of the yin and the yang. The aim of treatment of ED using TCM is not for the end point of a penile erection but rather for a natural and harmonious sex life. TCM aims to achieve regulation in terms of the man’s anxiety, fatigability, changing hormonal levels, insomnia and gastroparesis. Medicine to invigorate qi can enhance physical fitness, and medicine to warm the kidneys can regulate sex hormones, increase libido, invigorate the spleen, regulate the stomach and improve general well-being (3). Medications used to treat a “stagnated liver” provide tranquilization and helps to stabilize the mind, hence improving mental processes and emotional wellness. As a result, the patient’s overall condition and quality of life is improved.
Usually patients will try less invasive alternatives to treat impotence before opting for surgery. These alternatives may include supplements, herbs, lifestyle changes and even medications. In cases where other treatments do not work to resolve ED, surgery might be a last-resort option. Surgery involves implanting a penile prosthesis. This is a saline-filled silicone device or a malleable device. Although the likelihood of serious side effects is considered to be low, certain risks are associated with surgery to correct erectile dysfunction. These side effects may include: anesthetic risk, device infection, and device malfunction or mechanical failure. Some studies have found that five years following surgery around 10–20 percent of men experience device malfunction and failure. Infection rates are low. Around one percent of men who opt for this type of surgery get an infection.

Gutiérrez-González, Enrique; Castelló, Adela; Fernández-Navarro, Pablo; Castaño-Vinyals, Gemma; Llorca, Javier; Salas-Trejo, Dolores; Salcedo-Bellido, Inmaculada; Aragonés, Nuria; Fernández-Tardón, Guillermo; Alguacil, Juan; Gracia-Lavedan, Esther; García-Esquinas, Esther; Gómez-Acebo, Inés; Amiano, Pilar; Romaguera, Dora; Kogevinas, Manolis; Pollán, Marina; Pérez-Gómez, Beatriz. “Dietary Zinc and Risk of Prostate Cancer in Spain: MCC-Spain Study.” Nutrients. Jan 2019, 11(1).
In a study by Segal et al. (11), 4 out of 5 healthy individuals were able to achieve tumescence beyond 60% maximum rigidity when subjected to PVS using the Viberect® alone, with no other external visual sexual stimulation. In a randomized controlled study by Fode et al. (12) involving 68 men who underwent nerve-sparing radical prostatectomy, 30 men who received PVS to the frenulum daily for 6 weeks, using the Ferticare® vibrator, showed a trend towards better erections. After 1 year, 53% in the PVS group had an IIEF score ≥18 compared with 32% in the control group, although no statistical achievement was achieved. The role of PVS in penile rehabilitation is based on the postulation that PVS provides early activation of the parasympathetic erectile spinal centres at S2–S4 level, which result in early recovery of the neuropraxic cavernosal nerves.
And what about L-citrulline? Watermelon has the highest concentration in nature (particularly the white rind), followed by onions and garlic. Just one standard serving of yellow watermelon provides enough L-citrulline to boost sexual performance. My advice is that you might want to stick to watermelon and not onions and garlic to boost your nitric oxide production before going on a date!
How common is impotence? According to findings from several studies, including “The Massachusetts Male Aging Study,” overall prevalence for men between 40–70 years old is around 52 percent (or around 30 percent of all men between 18–60 years old). That’s right — nearly half of all men over 40 experience erectile dysfunction symptoms at some point. Not surprisingly, research demonstrates that impotence is increasingly prevalent with age. Around 40 percent of men in their 40s experience sexual dysfunction. Up to 70 percent of men in their 70s experience ED. (1) Every year more than 617,000 new cases of impotence occur in the United States alone.

Yohimbe. Before Viagra and the other prescription erectile dysfunction drugs became available, doctors sometimes prescribed a derivative of the herb yohimbe (yohimbine hydrochloride) to their patients suffering from ED. But experts say the medication is not particularly effective, and it can cause jitteriness and other problems. "It's not a great drug," says McCullough. "And I suspect the herb is not as potent as the pharmaceutical version." What's more, evidence shows that yohimbe is associated with high blood pressure, anxiety, headache, and other health problems. Experts discourage its use.

And what about L-citrulline? Watermelon has the highest concentration in nature (particularly the white rind), followed by onions and garlic. Just one standard serving of yellow watermelon provides enough L-citrulline to boost sexual performance. My advice is that you might want to stick to watermelon and not onions and garlic to boost your nitric oxide production before going on a date!
The search for a cure for erectile dysfunction (ED) dates back way before the introduction of Viagra in the 1990s. Natural aphrodisiacs, from ground rhinoceros horn topa chocolate, have long been used to increase libido, potency, or sexual pleasure. These natural remedies are also popular because they’re said to have fewer side effects than prescribed medications.
Pomegranate juice. Drinking antioxidant-rich pomegranate juice has been shown to have numerous health benefits, including a reduced risk for heart disease and high blood pressure. Does pomegranate juice also protect against ED? No proof exists, but results of a study published in 2007 were promising. The authors of this small-scale pilot study called for additional research, saying that larger-scale studies might prove pomegranate juice's effectiveness against erectile dysfunction. "I tell my patients to drink it," says Espinosa. "It could help ED, and even if it doesn't, it has other health benefits."
The Epimedium plant is a flowering perennial found throughout Asia and parts of the Mediterranean. Horny Goat Weed’s active ingredient is icariin, a falvonol glycoside and reputed to improve cardiovascular function, hormone regulation, modulation of immunological function and antitumor activity (44). Icariin has also been shown to have a PDE5i effect. Animal studies have been carried out showing improvements in penile hemodynamic parameters. There is one report of tachyarrhythmia and hypomania with the use of this herb (45).
The average normal level at your age is over 600 ng/dL and the current thinking from the AACE guidelines is that levels under 325 ng/dL are the new treatment (or further diagnosis at least) indicated. If you have symptoms be sure your doctor knows about them because this is a piece they need to know. Try to find out if your form of Hypogonadism is primary or secondary.
A 2000 study conducted at the Institute of Sexology in (where else?) Paris found that muira puama, a Brazilian shrub traditionally used in South African folk medicine as an aphrodisiac, increased libido in a majority of men who complained of impotence and a lack of desire. Other studies show this happy-making herb also counteracts chronic stress, depression and nervous exhaustion.
A study in the Journal of Sexual Medicine found that a large percentage of men with ED also have low levels of vitamin D. If you’re experiencing ED, you may want to have your level of vitamin D checked. Other symptoms of a low vitamin D level may be too subtle to notice. However, if you have serious vitamin D deficiency, you may have bone pain or muscle weakness. Vitamin D levels can be checked with a simple blood test and for most people corrected with a supplement.
Red Ginseng — One small randomized trial found evidence that red ginseng may offer modest improvements in ED symptoms (as compared with placebo). A meta-anaylsis published in the British Journal of Clinical Pharmacology states, “Traditionally red ginseng has been used to restore and enhance normal well-being, and is often referred to as an adaptogenic….Possible mechanisms of action of red ginseng include hormonal effects similar to those of testosterone. Others have postulated that red ginseng might induce relaxation of the smooth muscles.”  (5)
Recent University of Texas findings suggest that men who drink two to three cups of java a day—or 85 to 170 milligrams of caffeine from other beverages—are 42 percent less likely to have erectile dysfunction than those who consume up to seven milligrams of the stimulant daily. And those who throw back four to seven cups were 39 percent less likely to have the condition than their less jittery counterparts. The trend holds true among overweight, obese and hypertensive men, but not for those with diabetes, a condition that often causes the issue. So, how exactly does drinking coffee keep things going strong? The scientists say that the stimulant triggers a series of reactions in the body that ultimately increase blood flow south. And get the abs you want—quickly—and melt up to 10 pounds in one week with our new diet plan, The 7-Day Flat-Belly Tea Cleanse!
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If you can't take one of these oral medications, your physician may have you try Caverject (alprostadil for injection), a hormone that you inject into your penis using a fine needle, or Muse (alprostadil urogenital), a tiny suppository that you insert into the tip of the penis. Both of these will bring on an erection within five to 15 minutes without sexual stimulation.
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