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
Penile prosthesis implant remains the most effective and permanent treatment for ED. Penile prosthesis implants can be broadly divided into malleable and inflatable prostheses (20). Malleable penile prosthesis, also known as semi-rigid prosthesis, does not allow for (physiological) flaccid state of the penis. The patient can bend the prosthesis upwards for sexual intercourse and downwards for concealment. Although the angle of prosthesis concealment has improved with recent devices, however due to the constant rigid state of the penis, they are still less comfortable compared to their inflatable counterparts, are more likely to cause social embarrassment and associated with higher risk of implant erosions (21). However, malleable prosthesis still has its place for the treatment of ED as these implants are easier to handle, easier to place and would benefit patients with impaired manual dexterity.
There are currently two models of the inflatable penile prosthesis (IPP), namely, the two-piece IPP vs. the three-piece IPP. The three-piece IPP consists of a pair of corporal cylinders, a scrotal pump and an abdominal reservoir filled with saline. Owing to the presence of the reservoir, the corporal cylinders can be completely deflated to give the patient the physiological flaccid state when not in use, and likewise a maximally turgid state when inflated (21). The two-piece IPP lacks an abdominal reservoir and is often offered in patients with whom placement of reservoir is challenging or not possible such as following radical cysto-prostatectomy with orthotopic ileal neobladder creation, or patients who had previous open book fracture of the pelvis with metal implants. The concept of ectopic reservoir placement has allowed many of these men the option for three-piece IPP placement (22). Technological advances have improved mechanical reliability, reduced prosthesis infection risk and offered excellent patient and partner satisfaction rate (23).
When it comes to scientific development, in Western medicine, an analytic approach is often used to identify and resolve medical challenges. A hypothesis is first derived through general observations of a phenomenon. A research plan is then carefully designed and data collected. Once sufficient data is collected, critical statistical evaluations are done and conclusions are drawn (4). Every aspects of a disease entity are studied from macroscopic to microscopic views, down to the cellular and molecular levels. The deep understanding of the role of cGMP-specific phosphodiesterase type 5 enzymes in ED and the use of phosphodiesterase-5 inhibitors in treatment of ED exemplifies the success of this approach.
The medications also require a healthy endothelium and healthy arteries capable of providing increased blood flow to work. If the sex organ arteries the size of a swizzle stick are severely diseased, there will be no “bada-boom bada-bing” an hour after taking them. These medications only work by enhancing the natural effects of a healthy endothelium.
Eating more fruit, vegetables, fish, and less red meat and refined grains can decrease the risk of ED. Maintaining a healthy weight is also important, since men who have a waist that is 42-inches or more are 50 percent more likely to get erectile dysfunction. Obesity increases the risk of vascular disease and diabetes, which are known to 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)
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Some scholarly minds believe it wasn’t an apple, but a pomegranate with which Eve tempted Adam in the Garden of Eden. She was smart: A recent study published in the International Journal of Impotence Research discovered that pomegranate juice, rich in antioxidants that support blood flow, can help improve erectile dysfunction. Though this study was funded by POM Wonderful, animal studies have also shown that the elixir improves long-term erectile response, so it’s definitely worth a shot–literally. Knock a shot back or water your juice down a bit: One cup of tart POM Wonderful packs 31 grams of sugar.
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.
Pay attention to your vascular health. High blood pressure, high blood sugar, high cholesterol, and high triglycerides can all damage arteries in the heart (causing heart attack), in the brain (causing stroke), and leading to the penis (causing ED). An expanding waistline also contributes. Check with your doctor to find out whether your vascular system — and thus your heart, brain, and penis — is in good shape or needs a tune-up through lifestyle changes and, if necessary, medications.
Quien és mas macho? A recent study by French researchers found that men who eat the most spicy foods tend to have higher testosterone levels than those with milder palates. Study authors attribute the T-boosting effects in part to capsaicin, a compound in chilies that previous research has associated with increased testosterone levels. Seriously spicy serrano peppers are also packed with quercetin, a nutrient shown to boost testosterone levels in the body by reducing the amount that’s otherwise flushed out by the kidneys. Capsaicin, the compound that makes tabasco sauce hot, releases chemicals that increase heart rate, mirror signs of arousal and rev up things.

"Just because there is evidence doesn't mean it's good evidence," says Andrew McCullough, MD, associate professor of clinical urology at New York University Langone Medical Center in New York City, and one of the original clinical investigators for the ED drug Viagra (sildenafil). "And before men with ED start down the naturopathic route, it's smart to make sure that there isn't some underlying medical condition that needs to be corrected." Moreover, it is estimated that 30 million American men have erectile dysfunction, and 70% of cases are a result of a potentially deadly condition like atherosclerosis, kidney disease, vascular disease, neurological disease, or diabetes. Additionally, ED can also be caused by certain medications, surgical injury, and psychological problems.
L-arginine, or arginine, is an amino acid found in red meat, poultry, fish, and dairy products that helps expand blood vessels and increase blood flow. “The body uses this semi-essential amino acid as the primary building block for nitric oxide,” explains Harry Fisch, M.D., clinical professor of urology and reproductive medicine at Weill Cornell Medical College/New York Presbyterian Hospital.
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.
The same device is considered a vacuum erectile device (VED), when it is used to increase inflow of the blood to the penis without a constriction band. Regular use of VED in post-prostatectomy patient increases penile oxygenation and is accepted as a valid option in penile rehabilitation. Recent study reported transient increase in oxygenation to the glans penis and corporal bodies were detected by oximetry after VED was applied, providing proof for possible role for VED to counter the early penile hypoxia, cavernosal fibrosis and long-term ED after radical prostatectomy (9).
Korean red ginseng, also known as Asian ginseng or Chinese ginseng, is believed to be a highly effective natural remedy for treating ED. It is a traditional Asian remedy for sexual dysfunction and is widely used in the United States. Studies have shown that red ginseng can have significant therapeutic effects on penile rigidity and girth, libido, and patient satisfaction. It also has a reassuring safety profile, making it one of the most popular and proven natural remedy for ED.12

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.

Erectile dysfunction (ED) is commonly called impotence. It’s a condition in which a man can’t achieve or maintain an erection during sexual performance. Symptoms may also include reduced sexual desire or libido. Your doctor is likely to diagnose you with ED if the condition lasts for more than a few weeks or months. ED affects as many as 30 million men in the United States.
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