The article discusses erectile dysfunction (ED) with the special emphasis on epidemiology, as well as the currently available medical treatments. Describing treatment methods authors paid special attention to natural therapies (as Panax ginseng, Tribulus terrestris, Vaccinium macrocarpon), because taking into consideration their safety profile, they appear to be an important alternative to therapies with synthetic molecules. From substances of natural origin, extract from the fruit of Tribulus terrestris ranks itself high on in collation at the end. The results of most clinical trials and experiments clearly demonstrate its effectiveness in improving sexual function in men.
Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing some men to function normally. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in men who get normal erections.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Intensive lifestyle changes that include a Mediterranean type diet, circuit-type resistance training, with 15- to 60-second rest between sessions has shown to improve erectile score in a randomized trial. Men in the intervention group had a significant decrease in glucose, insulin, low-density lipoprotein cholesterol, triglycerides, and blood pressure, and a substantial increase in HDL cholesterol.15

Many products contain undocumented “fillers” that can cause allergic reactions.  In recent years, the FDA has found over 300 herbal products that contain hidden, deceptively labeled, or dangerous ingredients4. And since 2015, the FDA has released public warnings on more than 160 ED supplements and “male enhancement” products found to contain dangerous ingredients and contaminants5 .   An independent study of FDA data, conducted in 2018, found almost 800 herbal supplements that contained unlisted ingredients6.

These “sea pistachios,” as Kimmy Schmidt called them, are no joke.They’re one of the richest food sources of erection-enhancing Vitamin B12 you can find. The boner-boosting bivalves are also high in L-arginine, an amino acid that converts to nitric oxide (NO), the Marvin Gaye of naturally occurring gases: It causes blood vessels to relax and facilitate blood flow, helping you get and stay hard. Additionally, clams are high in muscle-building protein.
Another age-old therapy for ED is acupuncture. This is an ancient Chinese treatment where thin needles are inserted into specific points of the body to relieve all kinds of illnesses. Acupuncture has been used to treat ED for years. Studies show that acupuncture improves erection as well as in the treatment of erectile dysfunction with psychological cause.18

3. Testosterone replacement. Before oral medications like Viagra, testosterone was routinely used to treat erectile dysfunction as it is central in the male sexual response, including the desire for sex and the process of getting an erection. Testosterone can be administered in a number of ways, for example orally, by means of an injection, skin patch, or subcutaneous (under the skin) pellet. 
Following the breakthrough in ED treatment using PDE5-inhibitors, Western medicine has now moved on to a new frontier of regenerative medicine, with stem cell and gene therapy leading the way (25). There is a practical need for novel therapy as a significant portion of diabetic or post-prostatectomy ED patients do not respond to oral pharmacotherapy. To date, stem cells derived from different sites including adipose tissue-derived stem cells, bone marrow mesenchymal stem cells and muscle-derived stem cells have been investigated using animal models for ED, to study their effects on neural, vascular, endothelial or smooth muscle regeneration (25,26).
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So, how to increase the sexual potency? Firstly, get rid of bad food habits and revise your diet consuming more foods rich in zinc, protein, vitamins, and essential fatty acids. Often, the opponents of vegetarian diet and raw food diet argue that vegetarianism/veganism and sex are incompatible. Moreover, they assert that abstinence from meat leads to a substantial decrease in male potency. Allegedly, to make a sex life active, the male diet must necessarily include meat. And more is better. In fact, this is not true. The main thing is to ensure that you get all essential nutrients from food. And the foods of plant origin are a great source of these nutrients. Let’s consider the issue in more detail.
Move a muscle, but we're not talking about your biceps. A strong pelvic floor enhances rigidity during erections and helps keep blood from leaving the penis by pressing on a key vein. In a British trial, three months of twice-daily sets of Kegel exercises (which strengthen these muscles), combined with biofeedback and advice on lifestyle changes — quitting smoking, losing weight, limiting alcohol — worked far better than just advice on lifestyle changes.
In addition, when research has shown a nutrient such as zinc or niacin to improve sexual function, it's usually in people who are deficient in it. So, before you stock up on over-the-counter nutritional supplements for ED, speak with your doctor. He can test you for deficiencies and steer you toward the most effective and safest way to treat your erectile dysfunction. 
Dr. Niket Sonpal is the Associate Program Director of the Internal Medicine Residency at Brookdale Hospital Medical Center in Brooklyn and an Associate Professor at Touro College of Osteopathic Medicine. He's a practicing Gastroenterologist and Hepatologist with a focus on Men's and Women's Health, and a regular contributor to Women's health, Shape and Prevention Magazine.
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)
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. 
There have been some studies to suggest that a placebo effect that improves ED may work for some men. One study found that men taking an oral placebo pill showed as much improvement in ED symptoms as men who took actual medication to improve ED. Conversely, men who were given therapeutic suggestions to improve ED did not see signs of symptom improvement.
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