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.
Physical and emotional stress — whether over-exercising, under-sleeping or just dealing with everyday stressors like work and a busy schedule — causes an increase in “stress hormones,” including cortisol and adrenaline. Stress can lower desire for sex. This is because stress can contribute to fatigue or preoccupation with other tasks. It can also significantly affect blood flow by increasing inflammation.
She is ‘a pile of mashed potatoes’, her breasts are a ‘tragedy’, she looks terrible in clothes but even worse when nude, wanted surgery for ‘a quick fix’ because she is too lazy to exercise, she has never looked worse, etc … and you are faking erectile dysfunction because you do not want to talk about the fact that you are still crying over a breast reduction that you didn’t want her to get.
Dietary supplements are another avenue that patients can explore when it comes to treating their ED. Many products exist on the market but be warned that they may not have the scientific proof that can support claims of better erections. In one study done on multiple supplements that were proven to not work, it was found that patients found improvement in their ED 25 percent of the time. This suggests that supplements that do not work have a "placebo effect." This means that if a patient believes the medication truly works, he will notice improvements in his symptoms. This is a psychological phenomenon and can also be considered a root of why ED can occur. Depression or anxiety are two common reasons for ED and if patients take supplements that they believe will help them, they may have more confidence in sustaining an erection. 
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).
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.
These underrated kernels are rich in zinc, and people with higher levels in their system have been shown to have a stronger drive than those with lower levels. They’re also a good source of magnesium, which boosts testosterone and keeps sperm healthy and viable. Pine nuts are the primary ingredient in pesto, so go Italian on your next date night, or sprinkle them on a salad with avocado, tomatoes and salmon.
The Aztecs referred to avocados as testicles because of their scrotum-like appearance. They were onto something. The green fruit is rich in potassium, vitamin B6 and vitamin E, nutrients that have been associated with increased libido. Plus, avocados’ good monounsaturated fats protect your heart and boost circulation, while their abundant minerals and carotenoids supply energy and stamina. For some creative ways to consume the fruit, check out our 10 avocado recipes for weight loss.
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.
Poor sleep patterns can be a contributing factor for erectile dysfunction, Mucher says. One review published in the journal Brain Research emphasized the intricate relationship between the level of sex hormones like testosterone, sexual function, and sleep, noting that testosterone levels increase with improved sleep, and lower levels are associated with sexual dysfunction. Hormone secretion is controlled by the body’s internal clock, and sleep patterns likely help the body determine when to release certain hormones.