With drug therapy, there’s a risk of side effects such as headaches, back pain or an upset stomach. Before taking any medication for erectile dysfunction it is important to ensure your doctor is ok with that decision. Medication may not work for all men, for instance, if you have diabetes or have previously had prostate surgery. ED medication might also have serious risks if you’re currently taking nitrates (commonly prescribed for chest pain), have heart disease or have low blood pressure.22
The penile roots are enveloped by two pelvic floor muscles, the bulbocavernosus (BC) and the ischiocavernosus (IC). The IC muscle is the “erector muscle” and the BC muscle the “ejaculator muscle.” The BC and IC muscles are responsible for the ability to lift one’s erect penis up and down (wag the penis) as they are contracted and relaxed. Although not muscles of glamour, they are certainly muscles of “amour.” Although unseen and behind-the-scenes, hidden from view, these often unrecognized and misunderstood muscles have vital functions in addition to erection and ejaculation. When the pelvic floor muscles are not functioning optimally, one loses the potential for full erectile rigidity. Like other skeletal muscles, they can undergo “disuse atrophy,” becoming thinner, flabbier and less functional with aging, weight gain, sedentary lifestyles, poor posture, chronic straining and other forms of trauma, including pelvic surgery (e.g., prostatectomy). Exercising them can enhance sexual health; maintain sexual health; help prevent the occurrence of ED in the future; and help manage ED. Specifically, pelvic floor exercises can be beneficial with respect to the following spectrum of issues: ED; ejaculation issues including premature ejaculation; urinary incontinence; overactive bladder; post-void dribbling; and bowel urgency and incontinence. One of the challenges of pelvic floor training is that most men do not know where their pelvic muscles are located, what they do, how to exercise them, and what benefits exercising them may confer. In fact, many men don’t even know that they have pelvic floor muscles. Because they are out of sight, they are often out of mind and not considered when it comes to exercise and fitness. However, although concealed from view, they deserve serious respect as they are responsible for vital functions that can be enhanced when intensified by training. Pelvic floor muscle training before and after prostate cancer surgery can facilitate the resumption of urinary control and sexual function after surgery. Pelvic floor training is also useful for men who suffer with stress urinary incontinence following prostatectomy. This is a spurt-like urinary leakage that occurs at times of increased abdominal pressure, such as with sports and other high impact activities. Pelvic floor contractions on demand are a technique in which the pelvic muscles are braced and briskly engaged at the time or just before any activity that triggers the stress incontinence. When practiced diligently, this can ultimately become an automatic behavior and the incontinence improved, if not resolved.
Wine – especially red wine – is a great source of the antioxidant phytochemical resveratrol, which helps open the arteries by enhancing the production of nitric oxide. Nitric oxide allows the blood vessels to expand, and this is how Viagra works. But while the little blue pill only works on tiny blood vessels, resveratrol helps your main arteries too. Make sure you stop at one or two glasses of wine – too much alcohol leads to the dreaded droop.
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.
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. 
For obvious reasons, ED can be a sensitive subject, one that until relatively recently men were more likely to try to hide than to deal with. Fortunately, a deeper understanding of the variety of causes of erectile dysfunction has led to medications, therapies, and other treatments that can be more individualized and more likely to be effective—and more open discussion about addressing the concern.
Nitric oxide is made internally from L-arginine, which is an amino acid found in red meat, poultry, fish, and dairy products. In other words, L-arginine is the building block for nitric oxide, which is essential for erections. A lack of one can lead to a lack of the other. However, there’s a problem when it comes to treating L-arginine deficiency with supplements.
Nature’s ultimate example of truth in advertising, chili peppers bring the heat. They contain capsaicin, a natural chemical that lends spicy food its pleasurable pain and has serious fat-burning and libido-revving benefits. Research has shown that it boosts testosterone and increases circulation — all good news for your erection and what you do with it. Capsaicin also boosts the release of endorphins, which in turn stimulate desire.
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.
Erectile dysfunction can occur for various reasons. A health condition, an emotional or relationship problem, a certain medication, smoking, drugs, and alcohol all have the potential to cause ED. Some people want a quick fix, so they rush to their doctor hoping to get medication, not knowing that there are natural home remedies for erectile dysfunction.
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.
By far the most common cause of ED is vascular dysfunction. When the arteries that supply the penis with blood to achieve and maintain an erection are blocked or hardened, or the lining of these arteries are damaged, blood flow is reduced. Vascular dysfunction not only affects the small arteries of the penis, but the larger coronary arteries of the heart too. Astute doctors now recognize that ED may actually be an early warning sign of impending cardiovascular disease, showing up several years before a cardiovascular event like a heart attack or stroke.2 To maintain healthy vascular function, and in turn, normal erectile function, consider these supplements:
The oyster has always had an aphrodisiac reputation. One reason may be that oysters have high levels of the mineral zinc, which plays an important role in the production of the male hormone testosterone, and low levels of testosterone could be one reason for erectile dysfunction. Research presented at an American Chemical Society meeting may offer another connection: Raw shellfish contain compounds that stimulate the release of sexual hormones in both men and women.
Yohimbine is an indole alkaloid derived from the bark of the African yohimbe tree (33). Yohimbine has been noted to treat fatigue, depression, diabetes, and sexual dysfunction. A meta-analysis of seven placebo-controlled trials (34) deemed yohimbine superior to placebo for the treatment of ED with rare adverse events. The proposed mechanism of action (35) is via the inhibition of central alpha-2-adrenergic receptors, decreasing central inhibition of arousal, and increasing penile nerve stimulation resulting in increased NO. Common side effects include headache, sweating, agitation, hypertension and insomnia. Contraindications include patients on tricyclic antidepressants, anti-hypertensives and central nervous system stimulants.
Ginkgo biloba. Ginkgo is an herb that is used in Chinese medicine that’s thought to improve blood flow. "Any ED treatment that improves blood flow may help," explains Dr. Harris. "An erection is just blood in and blood out." However, the evidence that ginkgo can improve blood flow in ED is limited, and most experts say the jury is still out. In addition, ginkgo can increase the risk for bleeding problems if combined with certain medications, such as warfarin (Coumadin).
Since time immemorial, TCM has been adopted by many cultures and is widely practiced in Asian countries despite paucity of level 1 clinical evidence and limited published safety records. TCM is more congruent with Asian values, beliefs and philosophical orientation to health, simple administration, readily available and ease of access or procurement, and general belief that TCM is safer. While Asian males are clearly different from their Western counterparts with respect to biology, culture and beliefs, the practice of TCM appears to be adopted by many Western nations lately. Many men seek TCM to avoid embarrassing visits to physicians and potential side effects of pharmaceutical drugs, or after becoming frustrated with the outcome of modern medicine. Patients are choosing to take more responsibility for their health by exploring a variety of non-pharmaceutical drugs and wellness practices. Furthermore, TCM such as herbal medicine does not address a specific organ system only and is meant to restore and realign the vital energy within the body, which is responsible for ageing, clinical diseases and the deterioration of bodily function; while in Western medicine, each pill is intended for a specific organ/system and that a patient may need a collection of pills to treat multiple comorbidities, rendering modern medicine less attractive to TCM.
The use of shock wave therapy has revolutionized the treatment of many aspects of medicine. High intensity extracorporeal shockwave therapy has been used for the treatment of nephro-urolithiasis while medium intensity shockwave therapy is used by orthopaedic surgeons to treat joint pain as well as tendinitis. Low intensity shockwaves therapy was first noted to improve ischaemia-induced myocardial dysfunction in animal studies when low intensity shockwaves were applied to porcine myocardium (13). Shockwaves induces a localized stress on cell membranes in the same way that shear stress affects endothelial cell membranes (14) and this triggers the release of angiogenic factors, such as increased NO production through increased activity of endothelial NO synthase (eNOS) and neuronal NO synthase (nNOS), platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF) (15). These shockwaves also cause membrane hyperpolarization (16), activation of the Ras signaling pathway, non-enzymatic synthesis of NO and induction of stress fibers and intercellular gaps (17).
Spice up your love life with chillies. When your face flushes after eating a curry, that’s the blood vessels expanding thanks to the effect of the chillies. And it’s not just the blood vessels in your face that get the boost. Biologically speaking a hard-on is simple hydraulics – more liquid (blood) being forced into little tubes (blood vessels) in your penis – so what you need is a strong heart and smooth, healthy pipework.
Tiffany La Forge is a professional chef, recipe developer, and food writer who runs the blog Parsnips and Pastries. Her blog focuses on real food for a balanced life, seasonal recipes, and approachable health advice. When she’s not in the kitchen, Tiffany enjoys yoga, hiking, traveling, organic gardening, and hanging out with her corgi, Cocoa. Visit her at her blog or on Instagram.
No matter what erectile dysfunction treatment or treatments (whether herbal remedies or not) a man ultimately decides upon, experts say it's important to eat healthily and to avoid smoking and heavy drinking. Moreover, adequate exercise, stress reduction, and sleep can improve erectile dysfunction in many. In addition, says Lamm, "A loving, receptive, and responsive partner is a home run. After all, this is still a couple's issue."
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."
If you want to go long enough to help your date reach the big O, reach for some oatmeal. The popular breakfast cereal is a good source of l-arginine, an amino acid commonly used to treat erectile dysfunction. Plus, whole grains like oatmeal also help lower cholesterol levels. Having high cholesterol can lead to atherosclerosis, a condition that clogs and narrows arteries, impairing blood flow. This could eventually lead to heart problems, but you’ll likely notice issues below the belt first. The arteries surrounding the genital area are narrower than coronary blood vessels, so they’re more susceptible to clots. Simply put, the better your cholesterol levels are, the better your erection will be, too.
According to the Cleveland Clinic, “because erectile dysfunction is caused by a complex set of psychosocial, neurologic, and vascular factors, a specific cause in a patient may remain ambiguous.” The root causes are often related to a blockage or dysfunction of blood vessels. For example, ED can be due to conditions like atherosclerosis or diabetes, hormonal imbalances or problems related to mental health. It’s been found that common causes typically include one or more of the following factors: (2)
With the advent of the “little blue pill” men’s sexual health has been thrust into the public eye and now, rather than worrying in embarrassed silence about “performance” issues, men are able to openly seek the help they need to function at their best. This is good news for the 30 million American men who suffer from erectile dysfunction or ED.1 And because 70 percent of ED cases are physiological in nature (it’s not just in your head) and often a sign of some other serious health issue, it is wise to address and correct the underlying physical imbalances that are hindering performance in the first place, ensuring both shortterm happiness and long-term health.
In a prospective human phase 1 open-label and single-arm study reported by Haahr et al. (27), 17 men with refractory post radical prostatectomy ED were given a single intracavernosal injection of autologous adipose-derived regenerative cells (ADRCs) freshly isolated after a liposuction. The procedures were well-tolerated and over a 6-month follow-up period, 8 of 17 men showed improvement of their erectile function.
Having your current medication checked – if you are taking medication already, it could be that your erection problems are a side effect. Have a doctor check whether this is the cause of your problems and if it is, you might be able to switch medications and then find that your erectile dysfunction goes away completely – or at least improves. Medications that can cause erection problems include:
Get your vitamins from whole foods and not through artificial supplements! Vibrantly colorful fruits such as berries (strawberries, blackberries, blueberries and raspberries) contain abundant anthocyanins. Tomatoes and tomato products are rich in lycopenes. Cruciferous vegetables (broccoli, cauliflower, Brussel sprouts, kale and cabbage) and dark green leafy vegetables are fiber-rich and contain lutein and numerous healthy phytochemicals. A healthy diet should include protein sources incorporating fish, lean poultry and plant-based proteins such as legumes, nuts, and seeds. Include fish that have anti-inflammatory omega-3 fatty acids like salmon, sardines, and trout. Healthy fats (preferably of vegetable origins like olives, avocados, seeds and nuts) are preferred. An ideal diet that is both heart-healthy and prostate-healthy is the Mediterranean diet. Follow, "Let food be your medicine” by Socrates.
Erectile dysfunction (ED) is a common sexual problem affecting many men irrespective of cultures, beliefs and nationalities. While medical therapy for ED has been revolutionized by the advent of oral phosphodiesterase type 5 inhibitors and intracavernosal injection of vasoactive agents, recent technological advances such stem cell therapy, low intensity shock wave and newer generation of penile prosthesis implant offer hope to men who do not respond to conventional medical therapy. In contrast, traditional and complementary medicine (TCM) focuses on the restoration and better overall bodily regulation with the use of various herbal and animal products as well as exercises to invigorate qi (energy) in vital organs. Western medicine involves an analysis of ED symptom and underlying causes that contribute to ED, while TCM emphases the concept of holism and harmonization of body organs to achieve natural sexual life. 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.
Encouraging evidence suggests that ginseng may be an effective herbal treatment for ED. However, further, larger, and high-quality studies are required before firm conclusions can be drawn. Promising (although very preliminary) results have also been generated for some herbal formulations. Overall, more research in the field, adhering to the CONSORT statement extension for reporting trials, is justified before the use of herbal products in ED can be recommended.