The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.
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.

If other options sound boring, maybe you should consider a fun, revved-up option like salsa dancing. You and your partner can lose yourself in the music, and it’s an intense exercise that engages the senses, combining cardio, balance, and coordination. Plus salsa dancing is great for keeping weight under control because it burns a lot of calories. Furthermore, it’s an activity that can build self-confidence, and if you’re single, the classes can be terrific for meeting new people. Regular exercise doesn’t have to be drudgery, and there are many types of dance classes that can seriously improve fitness and help you address erectile dysfunction.
ED can also occur among younger men. A 2013 study found that one in four men seeking their first treatment for ED were under the age of 40. The researchers found a stronger correlation between smoking and illicit drug use and ED in men under 40 than among older men. That suggests that lifestyle choices may be a main contributing factor for ED in younger men.
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.

Vitamin B5 (Pantothenic acid) is irreplaceable if you wish to increase life expectancy. Vitamin B5 has a positive impact on the nervous system and intestinal motility. Calcium pantothenate is a form of vitamin B5 that has a powerful anabolic effect, enhances the synthesis of steroid hormones, and takes part in the synthesis of coenzyme A. In addition, calcium pantothenate helps release energy from foods. So, to a large extent, it improves your body’s endurance and stamina, as well as increases human tolerance to different loads.
Because cholesterol is a building block for testosterone, drugs that interfere with cholesterol production can lower levels of this hormone (Journal of Sexual Medicine, April, 2010). French and Dutch researchers have reported that decreased libido and erectile dysfunction may be associated with statin-type drugs (British Journal of Clinical Pharmacology, Sept. 2004; Drug Safety, July, 2009).
To locate the muscles these exercises engage, try to stop and restart the flow of urine mid-stream. Just do this once, because if you do it too much it can affect the passage of urine. Once you’ve located these muscles, you can tighten and draw the muscles in, feeling them lift upward. Hold for a count of five, then release. It’s recommended that men do 8 to 10 repetitions, resting in between. Ideally, each series of 8 to 10 should be followed by 5 to 10 quick squeezes and releases, and men should work up to doing the whole process four or five times per day for best results.
I was impressed with the questionnaire to make sure the meds I requested were right for me and the follow up email from the prescribing doctor to see if I needed any support. The meds came promptly, were well packaged and are comfortably in date - I thought they might be very near their sell by date but I was wrong to be suspicious. If I ever need this service again I wouldn't hesitate.

Can one of the B vitamins actually improve erectile dysfunction?  The research makes a strong case that Niacin, a.k.a. Vitamin B3, does indeed do just that for a big percentage of men. Of course, this is a inexpensive help to erectile issues, as high niacin foods and supplements are cheap and readily available.  Below I summarize the most prominent human evidence to date that shows which men will likely benefit and why:
Acupuncture may help treat psychological ED, though studies are limited and inconclusive. You’ll likely need several appointments before you begin to notice any improvements. When choosing an acupuncturist, look for a certified practitioner who uses disposable needles and follows U.S. Food and Drug Administration guidelines for needle disposal and sterilization.
Because the study included only subjects with dyslipidemia, the results may not be applicable to those with ED who have a normal serum lipid profile. Furthermore, patients using aspirin or NSAIDs were excluded to avoid the effect of these drugs in inhibiting prostaglandin D production, which may be one of the potential mechanisms for the effects of niacin on ED. It should be noted that it is quite common for ED patients to have coexisting cardiovascular disease that requires the use of aspirin. Therefore, further study on the interaction of aspirin and niacin in ED patients may be needed to establish the role of niacin in clinical usage.
Vitamin C has been associated with higher sperm counts. You can get it naturally from strawberries, raspberries and blueberries, which are anthocyanins, colorful plant chemicals which help keep your arteries unclogged, boosting circulation and erection quality. In supplement stores, you’ll find all manner of megadoses — steer clear of those; they might do more harm than good.

a) Some Vegetarians and Vegans.  It should be pointed out that certain animal-based foods are known for being the highest providers of niacin. So does this mean that animal-emphasized diets will result in increased blood flow over vegetarians?  My experience on the Peak Testosterone Forum has been the opposite and this is the subject of my book The Peak Erectile Strength Diet. Basically, a great many plant foods directly stimulate nitric oxide and will increase blood flow while lowering blood pressure. In fact, some plant foods can lower blood pressure as much as modern hypertension medications. See my page on Flaxseed and Blood Pressure for an example of that. High nitrate foods, such as spinach, arugula and beets, are yet another example.
So what causes erectile dysfunction?  Sometimes it is a circulation problem.  Sometimes it is a low testosterone issue.  Sometimes it is not.  Testosterone (T) supplementation can help ED and low libido in cases of low T and even if there is a normal T level at baseline, ED can be helped.  In cases where thyroid under or overactivity is causing T levels to be less than optimal.  Aging is also a problem as T levels drop after mid 20’s and as adipose tissue increases and aromatase enzyme conversion of T to Estrogen correspondingly increases.  This causes an unfavorable E:T ratio which equates to low T.

Along with promoting overall health, a sufficient daily magnesium intake can help significantly if you take zinc to promote healthy erectile function or to help alleviate ED. Zinc is often recommended as a natural ED remedy, particularly for men who have a zinc deficiency, according to MayoClinic.com. Magnesium helps regulate zinc levels in the body to support healthy erectile function. Herbs, vitamins and minerals, including magnesium, haven’t been widely studied in terms of their true benefits for men with ED or other erectile problems, but maintaining adequate levels of essential vitamins and minerals may help a doctor narrow down the cause of such problems.
I was impressed with the questionnaire to make sure the meds I requested were right for me and the follow up email from the prescribing doctor to see if I needed any support. The meds came promptly, were well packaged and are comfortably in date - I thought they might be very near their sell by date but I was wrong to be suspicious. If I ever need this service again I wouldn't hesitate.

Research in the medical journal Experimental and Therapeutic Medicine found that supplementing with the mineral zinc, along with the vitamins folic acid and biotin, as well as the herb Rhodiola rosea improved ejaculatory control in males suffering from premature ejaculation. Premature ejaculation is a common type of sexual dysfunction that affects 20 to 30 percent of men between the ages of 18 and 55. The low incidence of any side-effects of these natural treatments may also make it preferable to drug treatments by many men.


Could the bark of a tree actually increase libido and improve impotence? Well yes it can… Yohimbe bark (Pausinystalia yohimbe), one of the most popular herbal remedies for male sexual dysfunction, has been shown in studies to increase blood flow to the genitals of both men and women, proving to be helpful for those with low libido. Though Yohimbe can be used by women, its actions have been shown to be extremely supportive for men experiencing erectile dysfunction due to stress or as a side effect of physiological health issues.
Men, aged 40–80 y, were recruited from new consultations seen for erectile dysfunction at the Lahey Clinic Center for Sexual Function. Patients were screened by history and physical examination and by evaluation of nocturnal penile tumescence and rigidity with the RigiScan™ (Timm Medical Technologies, Inc., Minneapolis, USA). Candidates completed a sexual questionnaire and had morning blood tests for luteinizing hormone (LH), free testosterone, cortisol, dehydroepiandrosterone sulfate and androstenedione. Inclusion criteria included normal initial serum testosterone and prolactin levels and the presence of an organic cause of erectile dysfunction manifested by abnormal nocturnal tumescence and rigidity testing with the RigiScan™ monitor. Active smokers and men with concurrent major psychiatric problems were excluded. No other treatment for erectile dysfunction was permitted during the study. Yohimbine hydrochloride (supplied by Palisades Pharmaceuticals, Palisades, NJ, USA) was started at a dose of 5.4 mg three times a day (tid) for 4 weeks, after which the sex questionnaire was administered again and blood tests, nocturnal penile tumescence and rigidity testing were repeated. The dose of yohimbine then was increased to 10.8 mg tid for 4 additional weeks followed by a third administration of the sex questionnaire and final measurements of hormone levels and nocturnal penile tumescence and rigidity monitoring.
Also to be considered, patients were not using PDE5 inhibitors during the study period. Therefore it wasn’t determined whether the combined use with niacin can enhance the response of PDE5 inhibitors. Another limitation on the study results was the exclusion of the partner’s assessments. This would help to provide a more comprehensive assessment of the efficacy of niacin.

This African tree bark extract sends blood flow to the genitals, said herbalist Ed Smith, a founding member of the American Herbalists Guild, who adds a warning that Yohimbe can cause nervousness and raise already-existing high blood pressure (so avoid taking it if you have heart or kidney disease), and can also negatively interact with antidepressants.


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.

Zinc is vital for the organism and it’s even more important for men because it inhibit the transformation of testosterone into dihydrotestosterone, it has an important role in the prostate health. The urologist recommended my dad to take a supplement that has zinc and after a good research I found him a supplement on amazon named alpharise, it has zinc, vitamin B9, pumpkin seeds (also a good source of zinc). There has been a huge difference between the after and before alpharise in my dad’s health (prostate)
Aerobic exercise — which means "with oxygen" — consists of continuous, repetitive movements that increase your heart rate and get healthy oxygen into all your muscles by increasing blood flow that supports the heart and blood vessels (and in turn, prevents ED). In fact, research suggests that regular aerobic exercise can lower the risk for erectile dysfunction by about 40 percent.
If other options sound boring, maybe you should consider a fun, revved-up option like salsa dancing. You and your partner can lose yourself in the music, and it’s an intense exercise that engages the senses, combining cardio, balance, and coordination. Plus salsa dancing is great for keeping weight under control because it burns a lot of calories. Furthermore, it’s an activity that can build self-confidence, and if you’re single, the classes can be terrific for meeting new people. Regular exercise doesn’t have to be drudgery, and there are many types of dance classes that can seriously improve fitness and help you address erectile dysfunction.
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Does drinking water improve erectile dysfunction? Erectile dysfunction or ED is a common concern for men. Everyday factors, such as hydration levels, may affect a person's ability to get or maintain an erection. Drinking water may, therefore, help some men with ED. In this article, learn about the link between hydration and ED, and other factors that can cause ED. Read now
If ED continues to be a problem even after making certain lifestyle changes, talk with your doctor. ED is an uncomfortable subject for many men to discuss, but it’s treatable in most cases, so there’s no reason to avoid getting help. Doctors see patients every day about ED, so you’re simply one of millions of men dealing with this common condition.
Though higher doses of zinc reduce libido, supplementation with a medium dose (5 mg/day) has some beneficial effect on the sexual competence of adult male rats. The major significant effects of this dose of zinc are prolongation of ejaculatory latency without disturbing sexual arousability, motivation, penile erection and sex vigor. Also, the partner preference index of the 5 mg/day group was positive and comparable to the controls. A positive partner preference index is indicative of unchanged sexual interest of males.[16] These results confirmed that libido and sexual interest are not affected by zinc supplementation with a 5 mg/day dose. However, mild reduction in percentage of intromission was observed in this group and it is postulated that this may be situational rather than an effect of supplemented zinc. This is based on our observation where mild rejection by the females at the initial phase of the behavior led some males to refrain from sexual activity.
In the end, the data from the Hong Kong study suggest that niacin alone can improve the erectile function of subjects with dyslipidemia suffering from ED. This is the first time this conclusion has appeared in the literature. Once again, the effect of niacin is clinically significant in those with moderate to severe ED. Further, because of the close relationship between ED and dyslipidemia, niacin could prove to be an important therapy for managing both conditions. Who knows? There may even be other benefits. Future studies will further refine the indications and benefits of niacin in patients with ED.
Studies of mixed organic causes for erectile dysfunction showed varied results;15,16 thus, certain guidelines recommended that it not be used to treat erectile dysfunction.17 Side effects occurred when a high dose was given.18 Patients with organic erectile dysfunction had mixed results, with positive effects in 26,19 33,20 3421 and 43%,22 respectively. The results were better when the dose was doubled.20,21 Several meta-analyses showed a slight positive effect of yohimbine compared with placebo.23,24
If ED continues to be a problem even after making certain lifestyle changes, talk with your doctor. ED is an uncomfortable subject for many men to discuss, but it’s treatable in most cases, so there’s no reason to avoid getting help. Doctors see patients every day about ED, so you’re simply one of millions of men dealing with this common condition.
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.
Most human studies completed thus-far examine the impact of oral yohimbine consumption on erectile dysfunction (ED) in males. A meta-analysis of seven randomized, placebo-controlled trials found that yohimbine is significantly more effective in treating ED compared to placebo. [11] These findings did not compare yohimbine to prescription medications like Viagra®, which are designed to treat ED.
With an inflatable implant, fluid-filled cylinders are placed lengthwise in the penis. Tubing joins these cylinders to a pump placed inside the scrotum (between the testicles). When the pump is engaged, pressure in the cylinders inflate the penis and makes it stiff. Inflatable implants make a normal looking erection and are natural feeling for your partner. Your surgeon may suggest a lubricant for your partner. With the implant, men can control firmness and, sometimes, the size of the erection. Implants allows a couple to be spontaneously intimate. There is generally no change to a man's feeling or orgasm.
The following parameters were computed using the observed behavioral measures. Copulatory efficiency (proportion of mounts resulting in vaginal penetration relative to the total number of mounts), intromission ratio (number of intromissions/number of intromissions + number of mounts) and intercopulatory intervals (average time between intromissions).[8]

One of the best methods that you can do in order to locate your pelvic floor is to stop your urine in mid-stream several times. These muscles that you clench are the ones that you have to exercise on. In order to perform repetition on Kegel exercises, you can squeeze your pelvic muscles, holding the position for 5 seconds, and then relaxing. You may repeat this for about 10 to 20 times, two to three times in a day. You may also want to do this while in different positions such as standing, sitting, lying down, sitting in a chair, as well as standing.
There was a higher incidence of adverse events in those taking niacin. However, most patients could tolerate it at the maximum dosage (1,500 mg/day). With this in mind, niacin could be an alternative choice of treatment for patients with ED. Despite the success of phosphodiesterase type 5 inhibitors (PDE5 inhibitors), such as sildenafil, only around 60–70% of patients have a satisfactory response to this class of drugs. And there are adverse effects such as headache, flushing, dyspepsia, nasal congestion, and impaired vision, including photophobia and blurred vision. Hence, there is a need to develop other therapeutic agents for those patients who do not respond satisfactorily to PDE5 inhibitors or are contraindicated for those such as sildenafil.
There’s much evidence to suggest that Yohimbine does have a positive effect in men who have erectile dysfunction. Initially, it was considered a failure as a treatment because it doesn’t increase levels of testosterone in the body, the hormone needed for erections. However, recent trials have shown that it works well to increase arousal, help blood flow to the penis, and as a general stimulant.

Though higher doses of zinc reduce libido, supplementation with a medium dose (5 mg/day) has some beneficial effect on the sexual competence of adult male rats. The major significant effects of this dose of zinc are prolongation of ejaculatory latency without disturbing sexual arousability, motivation, penile erection and sex vigor. Also, the partner preference index of the 5 mg/day group was positive and comparable to the controls. A positive partner preference index is indicative of unchanged sexual interest of males.[16] These results confirmed that libido and sexual interest are not affected by zinc supplementation with a 5 mg/day dose. However, mild reduction in percentage of intromission was observed in this group and it is postulated that this may be situational rather than an effect of supplemented zinc. This is based on our observation where mild rejection by the females at the initial phase of the behavior led some males to refrain from sexual activity.


Call this the Marvin Gaye of amino acids: L-arginine converts to nitric oxide (NO), a naturally occuring gas that causes blood vessels to relax and facilitate blood flow, helping you get and stay hard. You can find plenty of the nutrient in oysters, but in supplement form, the Mayo Clinic says that 400-6,000 milligrams is the maximum dose. And these are the best foods for arginine!

The phrase “use it before you lose it” can be applied when it comes to helping men with ED regain normal erectile function. Pelvic exercises, more commonly known as kegel exercises, are used to promote urinary continence and sexual health. They help to strengthen the bulbocavernosus muscle, which does three things: allows the penis to engorge with blood during erection, it pumps during ejaculation, and it helps empty the urethra after urination, according to Healthline.


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.
The vitamin-deficiency disease pellagra was first identified in 1735 by Spanish physician Gaspar Casal. Considered to be Spain’s first epidemiologist, Casal is famous for his clarity and independence of thought, along with his conceptual change in the approach to medicine. Instead of mere observation and reporting, Casal moved to a fact-based induction methodology, presaging the work of John Stuart Mill, the political philosopher, economist, and logician, one hundred years earlier.
Being as of a common condition as it is, there is no reason why you should be ashamed of asking for help to treat erectile dysfunction. It seems as men are still unaware of how common but how easily treatable this condition is. You can choose from the variety of natural remedies, such as changing your diet, routine, habits, exercising or you can choose from the variety of products available on the market to treat this condition. The point of this article is to raise awareness on the topic of erectile dysfunction and the importance and beneficial effects of exercising as a way to treat erectile dysfunction. We understand how overwhelmed you could feel from hearing all those people’s opinions on the topic and sharing their stories. That is why we choose some of the best exercises you can perform in order to improve your health. Do not hesitate to ask for help. A few changes in your diet and routine is all that is separating you from an improving your health in general.
"The good news is, our study also found that a large proportion of men were naturally overcoming erectile dysfunction issues. The remission rate of those with erectile dysfunction was 29%, which is very high. This shows that many of these factors affecting men are modifiable, offering them an opportunity to do something about their condition," Professor Wittert says.

"Erectile dysfunction can be a very serious issue because it's a marker of underlying cardiovascular disease, and it often occurs before heart conditions become apparent. Therefore, men should consider improving their weight and overall nutrition, exercise more, drink less alcohol and have a better night's sleep, as well as address risk factors such as diabetes, high blood pressure and cholesterol.
Even at the higher doses of yohimbine, no changes in blood pressure or pulse were noted. This agent would appear to be safe in men with medically controlled hypertension. There was an increase in the morning cortisol levels in all men; the value was higher but not significantly so in responders. Telöken et al18 reported a high percentage (80%) of adverse events, but these authors administered a large dose (100 mg) of yohimbine. A toxic overdose of 200 mg produced only tachycardia, elevated blood pressure and anxiety of brief duration.33 Even direct intravenous dosing of yohimbine raised the mean arterial blood pressure by 12%,34 Goldstein et al35 systematically administered yohimbine and noted large hemodynamic and norepinephrine responses in both normal and hypertensive men; only the men who had a history of anxiety, depression, or other psychopathologic factors had symptoms. Oral administration of yohimbine at standard doses or even four tablets (21.6 mg) at a time has had no effect on blood pressure.4 Elevated blood pressure and heart rate were recorded when eight tablets (43.2 mg) were given at one time.3
In the present study zinc caused an elevation of T. This showed an increase from 2.39 to 8.21 ng/dl after two weeks of zinc treatment. This elevated T level may have contributed to the increase in number of penile thrusting (from 26.5 to 52.8) observed. Supplementation with 459 μmol/day of zinc for three months, in marginally zinc deficient healthy elderly men, has been shown to increase the levels of serum T from 8.3 to 16 ng/dl.[25] Laboratory experiments indicate that the nitric oxide erectile pathway is T dependent.[26] Many studies using animal models have confirmed that T is important in modulating the central and peripheral regulation of erectile dysfunction. T deprivation has a negative impact on the structure of penile tissues and erectile nerves.[27] Thus, elevated T levels subsequent to zinc supplementation may increase the sexual competence via rigid and sustained erection. This may promote greater tactile stimulation of the penis due to increased contact with vagina.[25]
This no.1 penis strengthening exercise is essential for helping to correct erectile dysfunction problems and can lead to mind-blowing orgasms. The download instructions (see link above) also contain important information regarding a common mistake that men make, especially when doing Kegel exercises. Kegel Exercises are not the best treatment for premature ejaculation! However, a slight modification to a common Kegel exercise can make it become more beneficial in overcoming PE and ED. See the above instructions for detailed explanation.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
None of the parameters showed a significant difference between controls and the group treated with 1 mg of zinc. The percentage of males who engaged in intromission (% intromitted), was significantly reduced in 10 mg/day zinc group; only three animals showed the particular behavior. Similarly percentage of rats which ended up with ejaculation significantly decreased with the high dose (two out of eight). Libido index of the highest zinc treated group was significantly low compared to controls; (38 % vs. 88 %, P < 0.05). Number of mounts and intromissions was also significantly decreased in the same group; Number of mounts: 1.58 (SEM 3.16) vs. 11.0 (SEM 1.59) and number of intromissions 2.13 (SEM 4.27) vs. 11.0 (SEM 1.59), P < 0.05).
Responders tended to have consistently higher scores compared with nonresponders. For nonresponders, none of the scores was significantly different when comparing baseline scores with either of the yohimbine doses. However, a trend toward an improved total questionnaire score was noted from baseline to the 5.4 mg tid dose (P=0.083). For responders, a significant increase in the Florida Sexual History Questionnaire total score was observed from baseline to the time the 5.4-mg tid dose was administered (P=0.021). A trend closely approaching statistical significance (P=0.055) was noted from baseline to the administration of the 10.8 mg tid dose of yohimbine. Inspection of changes in the individual items revealed that responders reported significantly greater frequency of vaginal penetration with both the 5.4- and 10.8-mg doses of yohimbine tid compared with baseline (P=0.010 and P=0.010, respectively). Participants also noted less difficulty obtaining an erection for sexual intercourse while taking 10.8 mg of the drug compared with baseline (P=0.011). Responders reported having significantly less difficulty maintaining an erection for sexual intercourse compared with baseline with both the 5.4-mg tid dose (P=0.049) and the 10.8-mg tid dose (P<0.001). Responders also reported significantly greater penile firmness and rigidity before intercourse or masturbation in both treatment conditions compared with baseline (P=0.02 for the 5.4-mg tid dose and P=0.013 for the 10.8-mg tid dose).
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

There are so many potential reasons a man might develop erectile dysfunction (ED), it's nearly impossible to generalize the best ways to treat it. What works for one man may not work for another simply because they are having problems for different reasons. That said, it may encouraging to hear that there are a variety of options that may be considered, from psychological counseling to lifestyle changes, medications to treatments and devices.
In conceiving the potential solutions to issues around erectile dysfunction, it’s really helpful to understand clearly how an erection is achieved and completed. To achieve an erection, there needs to be some form of stimulation, either from touch or some sort of audiovisual stimuli.  Once the stimulation occurs, chemical messengers are released and blood starts to fill into the penis. In terms of the musculature, the bulbospongiosus and ischiocavernosus muscles need to be relaxed so blood can fill the area completely. Then the bulbospongiosus needs to contract to keep the blood in the penis. The erection ‘completes’ with the rhythmic contraction of the bulbospongiosus muscle.
The vitamin-deficiency disease pellagra was first identified in 1735 by Spanish physician Gaspar Casal. Considered to be Spain’s first epidemiologist, Casal is famous for his clarity and independence of thought, along with his conceptual change in the approach to medicine. Instead of mere observation and reporting, Casal moved to a fact-based induction methodology, presaging the work of John Stuart Mill, the political philosopher, economist, and logician, one hundred years earlier.
We have presented objective evidence that yohimbine has a positive effect in men with organic erectile dysfunction. This is contrary to the blanket statement of the American Urological Association in their clinical guidelines for erectile dysfunction, which states: ‘Based on the data to date, yohimbine does not appear to be effective for erectile dysfunction and, thus, it should not be recommended as treatment for the standard patient.’17 Our data strongly suggest that yohimbine treatment should be revisited. Our study was observational with dose-escalation just to see if there was any rationale to expect any effect in men with organic erectile dysfunction, especially in men who do not have the risk factor of tobacco abuse. The next step would be a double-blind, placebo-controlled study using yohimbine in smokers vs non-smokers to verify the current observation. We believe that our data justify such a trial. Yohimbine will never be a first-line drug for erectile dysfunction, but may be useful in subsets of men with mild disease or few risk factors. Yohimbine might also be useful in combination therapy with other treatment modalities such as sildenafil and intraurethral alprostadil, when they do not produce adequate effects alone, as has already been shown with naloxone39 or trazedone.40
Some medications that are changed by the liver include amitriptyline (Elavil), clozapine (Clozaril), codeine, desipramine (Norpramin), dextromethorphan, donepezil (Aricept), fentanyl (Duragesic), flecainide (Tambocor), fluoxetine (Prozac), meperidine (Demerol), methadone (Dolophine), metoprolol (Lopressor, Toprol XL), olanzapine (Zyprexa), ondansetron (Zofran), tramadol (Ultram), trazodone (Desyrel), and others.
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