There are many different reasons a man’s ability to sustain or maintain an erection may be impaired. Impotence is the most common sexual disorder among men. It is thought that most men should be able to achieve and maintain an erection well into their 80s, but about 25 percent of all men over the age of 50 are thought to experience some form of impotence. By the age of 75, half of all men will be impotent. Impotence may come and go, depending on the state of their physical health as well as their stress levels. One of the number one causes of impotence is cardiovascular disease. Cardiovascular disease may restrict blood flow to the penile tissues, which greatly affects a man’s ability to achieve and maintain an erection during sexual arousal.

A complete sexual behavioral cycle of males involved pre sexual performances, copulation and ultimate ejaculation. Pre sexual behavior comprises physical contact with the female, sniffing and licking of female genital area, licking of their own penis, and few mounts without intromissions. Although all induced females were screened for receptivity, some females showed a mild rejection in the beginning. However, there were no rejections when they were coupled with very active males. All animals which completed the behavioral cycle showed a normal pattern of behavior (not an aberrant sexual behaviour) during the observation period.

Yohimbine significantly increased subjective measurements of sexual desire, sexual satisfaction, frequency of sexual contacts, and erection quality during sexual intercourse. Each subject also underwent a sleep study and researchers found that yohimbine also objectively increased the rigidity of erections while sleeping. [12] Yohimbine appears to alleviate both physical and psychological symptoms associated with ED.


Supplementation of 5 mg of zinc/day for two weeks led to a prolongation of ejaculatory latency; 711.6 sec. (SEM 85.47) vs. 489.50 sec. (SEM 67.66), P < 0.05 and an increase in number of penile thrusting; 52.80 (SEM 11.28) vs. 26.50 (SEM 6.17), P < 0.05, compared to controls. The same group had elevated prolactin (PRL) and testosterone (T) levels compared to controls at the end of treatment period; PRL- 7.22 ng/dl (SEM 3.68) vs. 2.90 ng/dl (SEM 0.34) and T- 8.21 ng/ml (SEM 6.09) vs. 2.39 ng/ml (SEM 1.79), P < 0.05. In contrast, reduction of libido was evident in the same group, but this effect was not statistically significant (P > 0.05). However, partner preference index was positive and 5 mg zinc supplementation did not exert a significant adverse effect on the muscle strength and co-ordination. The subset of rats supplemented with 1 mg/day did not show a difference from the control group while supplementation with 10 mg/day led to a reduction of the libido index, number of mounts and intromissions.
A study from the University of the West in the United Kingdom found that pelvic exercises helped 40 percent of men with ED regain normal erectile function. They also helped an additional 33.5 percent significantly improve erectile function. Additional research suggests pelvic muscle training may be helpful for treating ED as well as other pelvic health issues.
L-arginine, an amino acid that is naturally present in the body and helps make nitric oxide, supports a successful erection. Nitric oxide is responsible for making the blood vessels relax, which helps sustain an erection for men. A 1999 study, observed the effects of six weeks of high-dose (5 grams/day) orally administered nitric oxide (NO) donor L-arginine on men with organic ED. Thirty-one percent of those who took 5 grams/day of L-arginine experienced significant improvements in sexual function. Burns told Medical Daily, “l-arginine and deer antler velvet” have been the most popular go-to natural treatments for men.

DHEA. Dehydroepiandrosterone (DHEA) is a hormone produced in your body’s adrenal gland that aids in the production of testosterone and other hormones. Since testosterone is critical for healthy male sexuality, supplementing with DHEA may help with issues like sluggish libido and impotence. One double-blind, placebo-controlled study found subjects given 50 milligrams of DHEA every day for six months experienced improvement in symptoms of E.D.


Unfortunately, many of the same factors that brought the Italian Renaissance to an end—among them corruption, wars, and a widespread backlash over secularism and indulgence (leading to the “Bonfire of the Vanities”)—also terminated the “rebirth” in Spain. Chasing heresies became a sport that led to the resurrection of the Inquisition, which unlike its prior appearances operated completely under royal authority, rather than the aegis of the church.
Hypercholesterolemia (high cholesterol) is one of the main risk factors in the development of atherosclerosis, a condition that with the development of statins over the last 20 years has become more treatable, but not without consequences. Statins have been shown to reduce the incidence of cardiovascular events by 25–40%, yet this reduction is no big deal, especially considering that many patients need additional therapy to reach more optimal lipid levels and prevent cardiovascular events.
The Florida Sexual History Questionnaire, a 20-item questionnaire that assesses interest and desire for sexual activity, sexual development, current sexual behaviors, and satisfaction with current sexual activity, was used to assess male sexual dysfunction. Individuals responded to each question by choosing one of six ordinally scaled response categories, with higher scores representing better functioning. Scores on the Florida Sexual History Questionnaire have been shown to significantly discriminate between men with and without impotence25 and between men with primary organic and primary psychogenic erectile dysfunction.26 According to Geisser et al,25 the Florida Sexual History Questionnaire has high internal consistency as well as split-half reliability. Chronbach's alpha has been reported to be as high as 0.90, and Spearman Brown's coefficient is reported to be 0.86.

Partner preference index in both 5 mg zinc treated group and controls was positive. In the control group, time spent by males, with estrous and diestrous females, was 21.75 sec. (SEM 2.26) and 13.62 sec. (SEM 1.05) respectively. In the zinc treated group they spent 20.87 sec. (2.09 SEM) with estrous and 14.37 sec. (SEM 0.70) with diestrous females. The PPI of controls and zinc treated group was 8.12 Sec. (SEM 2.32) and 6.50 Sec. (SEM 1.76) respectively. There was no significant difference between the two groups, P > 0.05.
This content is strictly the opinion of Dr. Josh Axe and is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Dr. Axe nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.
Yohimbine hydrochloride is the principal alkaloid of the bark of the African yohimbe tree. It is primarily selective for the presynaptic alpha-2 receptor that enhances the central release of norepinephrine1,2 or even epinephrine,3 although the latter is controversial.4 This central action increases sexual arousal2,5 and appears similar to the central alpha-2 adrenergic mechanism that initiates hot flashes.6 Peripherally, yohimbine may partially antagonize norepinephrine-induced contraction of corporeal cavernosal smooth muscle.7,8 The action is that of an antagonist to postjunctional alpha-2 adrenergic receptors, but a direct effect on vascular smooth muscle is also possible.9

Cavallini, G., Modenini, F., Vitali, G., & Koverech, A. (2005, November). Acetyl-L-carnitine plus propionyl-L-carnitine improve efficacy of sildenafil in treatment of erectile dysfunction after bilateral nerve-sparing radical retropubic prostatectomy. Urology, 66(5), 1080-5. Retrieved from http://www.sciencedirect.com/science/article/pii/S0090429505006515
Relevant publications were searched up to November 2010 in the MEDLINE (PubMed) database. The citation lists of randomized controlled trials on the effect of aerobic training and Erectile Dysfunction management using the International Index of Erectile Function (IIEF) as treatment outcome measure. Studies on different operative techniques on the effects of aerobic training for men with Erectile Dysfunction due to arterogenic Erecile Dysfunction were selected. Data on participants' characteristics, study quality, population, intervention, treatment outcome were collected and analyzed.
Another study discovered that nicotine significantly reduced participants' physical arousal in response to erotic films; the erections achieved by study participants who had ingested nicotine were 23% smaller than those who hadn't. This is in spite of the fact that participants didn't report feeling any less psychologically aroused by the erotic films.
In conclusion, aerobic training can successfully treat ED in selected patients with arterogenic ED. However, there are very few high-quality randomized trials regarding aerobic training and ED. Practitioners should bear in mind that aerobic training and other risk factors modification is associated with higher rates of ED management success.Since these results are based on small studies, the evidence would be stronger if confirmed by large trials. Effectiveness data were limited; however, the effectiveness of ED is largely determined by the patient health status and associated condition. In addition, work is needed in the standardization of follow-up protocols, evaluation of ED management success and failure, patient selection, and statistical analysis. More randomized studies that compare various exercise techniques are warranted. These studies should evaluate efficacy, complications, quality of life, cost implications, and long-term outcomes of ED management compare to other therapeutic modalities available. Also more database search is also warranted to further broaden the data search on the topic.

But researchers emphasize that immediate-release niacin should remain as a treatment option for high cholesterol. "The point of our study is not that niacin should be avoided, but that the immediate-release preparation is the preferred form, and that medical supervision and evaluation are necessary for people taking this drug," said James McKenney, professor and chairman of the division of clinical pharmacy at the Medical College of Virginia.

Parameters evaluated in this study are determinants of some important aspects of the male sexual competence. Libido index, intromission and mount latencies are indicators of libido, arousability and motivation. Copulatory efficiency and inter-copulatory intervals are indicators of sexual vigor, while penile thrusting is an indicator of penile erection.[8,11,14,15] Our results showed that the libido index was significantly reduced in the 10 mg/day zinc saulphate treated group. In the same group, majority of the animals (62%) failed to complete their sexual behavioral cycle within the observed period. Though these unsuccessful rats showed the initial steps of the cycle such as licking, physical contacts with the females and few mounts and intromissions, they were inactive at later stages. Therefore a significant reduction of the libido index, number of intromissions, mounts, and ejaculations were observed in the high dose of zinc treated group compared to controls.

The sunshine vitamin will brighten things up in the bedroom. In a recent study published in the Journal of Sexual Medicine, Italian researchers found that of 143 men with erectile dysfunction, 80% had less-than-optimal levels of D, and the men with severe ED had, on average, a 24% lower level of D than with a milder condition. They theorize that low levels of D damage blood vessels and lead to a shortage of nitric oxide.
One of the keys to addressing erectile dysfunction is improving the functioning of the endothelium, which is the inner lining of blood vessels. Wayne Hellstrom, MD, urology professor at Tulane University School of Medicine says keeping endothelium healthy can help you improve erectile functioning. Cardio training helps with this, as does resistance training. Adding weight training to cardio training increases muscle mass and bone strength helps your balance and stability (which can help prevent injuries) and can help lower blood pressure as well. Improved muscle definition can also be great for self-esteem, and that can’t hurt.

The key to all of this is the endothelium, the inner lining of blood vessels that helps blood flow smoothly. Regular exercise has been shown to improve the way the endothelium works. The endothelium lines the blood vessels in the heart and the penis, explains Dr. Hellstrom, but the blood vessels in the penis are about one-third the size of those in the heart. So if you fail to have erections due to vascular problems, that indicates that you’re at risk for heart problems as well.
DHEA. Dehydroepiandrosterone (DHEA) is a hormone produced in your body’s adrenal gland that aids in the production of testosterone and other hormones. Since testosterone is critical for healthy male sexuality, supplementing with DHEA may help with issues like sluggish libido and impotence. One double-blind, placebo-controlled study found subjects given 50 milligrams of DHEA every day for six months experienced improvement in symptoms of E.D.
The truth is medication or psychosexual counselling are the first treatments a doctor will suggest because they’ve been proven to work. If a doctor has approved a medication for you then it’s safe. If you would still like to see if herbal supplements work for you, then there is a list below of supplements thought to work for erectile dysfunction. Just before you invest your money in them, remember they aren’t proven to work:
Stress is another main cause of impotence in men. Psychological stress lowers libido in general and may suppress a man’s ability to become aroused, causing impotence. This is usually temporary and is easier to reverse than cases of physiological impotence. Nonetheless it is extremely important to manage stress levels when working to reverse impotence. Whether a man is experiencing impotence due to physiological reasons or psychological reasons, stress plays a key role. Any man that is experiencing erectile dysfunction will experience higher levels of stress because of the condition itself. Stress management skills need to be in place when working to reverse impotence.

The improvements in IIEF-erectile function domain (IIEF-EF) score for moderate and severe ED patients in the niacin group were 3.31 and 5.28 and in the placebo group were 2.74 and 2.65, respectively. In the lower range of mild and mild-to-moderate ED, there was no significant improvement in erectile function. Of the 160 patients in the study, 32 were using statins; 18 in the niacin group and 14 in the placebo group. For patients not receiving statin treatment, there was a significant improvement in IIEF-Q3 scores (0.47) for the niacin group, but not for the placebo group. To summarize, niacin alone can improve the erectile function in patients suffering from moderate to severe ED and dyslipidemia.


Between 2001–2006, one-third of the US population had insufficient amounts of vitamin D, according to the Institute of Medicine. Risk factors for vitamin D deficiency include obesity and high BMI, not enough sun exposure or outdoor activity, having darker skin and suffering from certain from inflammatory conditions like Crohn’s disease. You can get a blood test to find out if you’re vitamin D deficient.
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