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.
In a 2005 study, three months of twice-daily sets of kegel exercises combined with biofeedback and advice on lifestyle changes, such as quitting smoking, losing weight, and limiting alcohol, worked far better than just giving the participants advice. “Wearing tight pants will affect impotence along with some other medical conditions like diabetes and heart disease,” which can also affect a man’s degree of impotence, Dr. Jennifer Burns, specializing in family practice with an emphasis on gastrointestinal health at the BienEtre Center, told Medical Daily.
During sexual stimulation, sexual thoughts, or nocturnal erections, the neurotransmitter nitric oxide (NO) is released from the endothelial cells and the parasympathetic nerve terminal causing relaxation of two cylinder-like muscles called the corpora carvenosum. Nitric oxide influences an increase in concentrations of cyclic guanosine monophosphate (cGMP), which after numerous pathways triggers smooth muscle relaxation, and simultaneous closing of small veins traps blood in the cavernosal muscles, keeping blood in the cavernosal tissues that cause and maintain an erection.
In one study, men with a Vitamin D deficiency were nearly 33% more likely to have ED. But you don’t need that much sun exposure to get a healthy amount of Vitamin D. As little as 15–20 minutes a day is enough. Taking Vitamin D is a good idea, especially if you are over 65. Vitamin D can also help if you’re obese or dark-skinned (dark skin limits the amount of Vitamin D you naturally, produce)
Issues relate to 'autoimmune type manifestations, joint pains, fatigue issues, rashes, sun-sensitivity, erectile dysfunction,libido issues, lack of energy and motivation, dry eye and sjogren's like symptoms, neuropathy for some, insomnia, etc. Any potential medications, therapies, or ways to approach these problems will be explored with great interest. Other questions involved 're-treatment' for relapsers, and issues around optimal dosing, and the role of Ribavirin.
Much of the evidence shows high rates of vitamin D deficiency in patients with erectile dysfunction. In fact, one study of 3,400 participants found that men with vitamin D deficiency were 32% more likely to have trouble with erections when all other risk factors were controlled for. It’s a little on the nose that you need vitamin D for your “D,” but hey—science can be funny too.
How men can improve their sexual performance Many men want to know how to enhance their own and their partners’ sexual satisfaction. However, placing too much emphasis on performance can lead to anxiety. Certain lifestyle changes can help to reduce sexual anxiety, improve erectile dysfunction, and increase stamina. In this article, we describe 13 methods to try. Read now

Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject Impulse, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include papaverine, alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).
It’s no secret that oily coldwater fish like wild salmon, sardines, and tuna are overflowing with omega-3 fatty acids, but here’s something you may not know: The nutrient not only benefits your heart but also raises dopamine levels in the brain. This spike in dopamine improves circulation and blood flow, triggering arousal. There’s more: “Dopamine will make you feel more relaxed and connected to your partner, which makes intercourse more fun,” says Tammy Nelson. Just make sure you’re ordering the right kind by reading this special report: 8 Mistakes You’re Making When Buying Salmon!
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. 
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.
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.

Ginseng, specifically “red ginseng,” is known as the “herbal Viagra” that helps puts to rest men’s bedroom woes. Red ginseng is when the root has been steamed and then dried. The ginseng root is the part of the plant that is mostly used as a natural remedy when in its supplement form. However, the plant must be grown for a minimum of five years before it can be used. In a 2008 review, seven studies on red ginseng and ED, ranging in dosages from 600 to 1,000 milligrams three times a day, were found to provide evidence for the effectiveness of the herb in ED treatment.
A recent study found that men with erectile dysfunction who ate pistachio nuts every day for three weeks experienced significant improvement in sexual issues, including ED, sexual desire, and overall sexual satisfaction. The benefits of pistachios for erection problems may be due to a protein called arginine, which may help relax blood vessels. "This is another example of how good circulation is good for sexual health, which is good news because I eat a lot of pistachios," says Dr. Daneshgari.
A recent study found that men with erectile dysfunction who ate pistachio nuts every day for three weeks experienced significant improvement in sexual issues, including ED, sexual desire, and overall sexual satisfaction. The benefits of pistachios for erection problems may be due to a protein called arginine, which may help relax blood vessels. "This is another example of how good circulation is good for sexual health, which is good news because I eat a lot of pistachios," says Dr. Daneshgari.
Dan practices a unique blend of conventional and holistic medicine, drawing on his extensive experience with integrative techniques like healing touch, guided imagery and yoga. By fostering an understanding of the deep connections between body, mind and spirit, Dan seeks to help every patient unlock his or her own innate healing ability. He received his MD from the Hahnemann College of Medicine and completed his residency in family practice through UCSF. Dan is a fellow of the Wilderness Medical Society, is a clinical instructor at UCSF, and is certified with both the American Board of Family Medicine and the American Board of Holistic Medicine. Dan is a One Medical Group provider and sees patients in our San Francisco offices.

The treatment of ED using TCM ties in with the treatment of late-onset hypogonadism (LOH). LOH occurs due to the breakdown in coordination between the heart and the kidneys, deficiencies of the spleen and kidney (yang), deficiencies of the liver and kidney (yin) and deficiencies of the kidney (yin and yang). The endocrine function of the pituitary and gonads becomes disordered with age due to a depression of overall function. This results in accumulation of free radicals and other toxins that cannot be relieved solely with male hormone supplementation. Warm yang can energize kidneys to benefit the body, remove toxins, invigorate qi and promote blood circulation. Free radicals are removed, blood fat regulated, cardio-cerebral blood flow improved and again the key here is to improve the function of the digestive, respiratory and endocrine systems, hence regulating the body in every aspect holistically (28).
"This is the first study to look at the association between flavonoids and erectile dysfunction, which affects up to half of all middle-aged and older men," said lead researcher, Professor Aedin Cassidy. "Men who regularly consumed foods high in these flavonoids were less likely to suffer erectile dysfunction. In terms of quantities, we're talking just a few portions a week."
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.
To understand the physiology of erectile dysfunction, we need to know erection first. An erection occurs when impulses from the brain and genital nerves cause blood to fill the two chambers known as the corpora cavernosa in the male penis. This causes the penis to expand and stiffen. Anything that blocks these impulses or restricts blood flow to the penis can result in ED. This block may be caused by psychological, neurologic, hormonal, arterial, or cavernosal impairment or even from a combination of all these factors.3

Saw palmetto. Saw palmetto comes from the fruit of a small palm tree. It has been used to treat symptoms in men with an enlarged prostate gland, such as difficulty urinating, and it has been recommended to treat ED caused by an enlarged prostate. However, several recent clinical trials did not show that saw palmetto works any better on an enlarged prostate than a placebo does. "There is no evidence that saw palmetto should be used to treat erectile dysfunction," says Dr. Gilbert. Like ginkgo biloba, saw palmetto can interact with some prescription medications.
For example, you’ll often hear that watermelon is a great remedy for ED.  This belief seems to come from a study done in 20075, which showed that consuming watermelon could raised levels of L-arginine in the bloodstream.  L-arginine is used in the production of nitric oxide (NO), which is a key to healthy erections (see our article, “How Do Erections Work“).  However, the study did not show that consuming watermelon actually improved erections.  Also, the subjects consumed the equivalent of three eight-ounce glasses of watermelon juice per day!
In addition to being leaner and lower in calories than conventional cuts, grass-fed beef offers a host of benefits, from muscle-building to fat-burning to heart protection. You can add assistance in the bedroom to its list of good qualities; it’s an excellent source of Vitamin B12. A recent report from Harvard University highlighted a study that has linked low levels of B12 to erectile dysfunction. So, eat up! Bonus: It’s one of the healthy fats that actually makes you skinny.

Regular consumption of various types of cabbage, such as white cabbage, cauliflower, broccoli, and Brussels sprouts help get rid of the excess amount of estrogen, a female hormone. The increased estrogen levels interfere with the testosterone production. By the way, red radish and white turnips have the same effect as cabbage. In addition, to cleanse the body of toxins leading to high estrogen levels, it’s necessary to add a sufficient amount of high-fiber foods to your diet. These foods include most fresh fruits and vegetables.
Another potential cause of ED is prediabetes and diabetes—35-50 percent of men with diabetes also have ED. Chronically elevated blood sugar damages the arteries (there’s the vascular connection again) and nerves, including those that stimulate the penis. Prediabetes and diabetes are also generally accompanied by excess weight, especially around the mid-section. These excess fat cells convert testosterone into estrogen, negatively altering the testosterone to estrogen ratio. This excess estrogen, independent of prediabetes and diabetes, interferes with the hormonal cascade necessary to produce and maintain an erection. Although many men may reach for a testosterone booster, a more effective means is to improve the body’s metabolism and elimination of estrogen and to lose excess weight around the middle. To support healthy blood sugar balance and estrogen metabolism try:
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.

This ancient whole grain is a great addition to your pantry if you’re suffering from quinoa fatigue, but it’ll also help you if things are drooping in the bedroom. Rich in manganese and iron, it also contains all eight essential amino acids, which boost energy levels. And for grains with as much protein as teff and quinoa, click here for Protein-Packed Power Grains!


Processed Foods tend to have fat, salt, and sugar added to them, as well as preservatives and other chemical additives that can be harmful to your health. Processed foods include frozen foods, canned foods, processed meats, and many snack foods. Some research links eating processed foods to depression, which is something that can cause erectile dysfunction.

This ancient whole grain is a great addition to your pantry if you’re suffering from quinoa fatigue, but it’ll also help you if things are drooping in the bedroom. Rich in manganese and iron, it also contains all eight essential amino acids, which boost energy levels. And for grains with as much protein as teff and quinoa, click here for Protein-Packed Power Grains!

Ditto on the rubbing of the pants. Quite uncomfortable. When mine gets really bad, my testicles have a pins and needles like sensation, and shrink up as well. They also ache when hanging though, this is very odd that our symptoms match up so well. But "nothing is wrong with us". Well, thats what i was told at least. The urologist said "thats your penis' natural reaction to cold or adrenaline.
If you bike a lot and have a very narrow saddle on your bicycle, consider switching to a "no-nose seat" which is wider at the back than a conventional saddle, allowing more of your weight to be distributed to the sitting bones. Make sure the seat is level or angled slightly downward and at a height that allows your knee to be just slightly bent at the bottom of the pedal cycle. Raising the handlebars on your bike so that you're sitting upright may also help.
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