In addition to lowering low-density and total cholesterol along with triglycerides, increasing high-density lipoprotein cholesterol (HDL-C) has become one of the principal objectives for treating hyperlipidemia. Considerable evidence has shown that even a minor improvement in HDL-C levels may significantly reduce cardiovascular risk. For example, it has been found that an increase of 1 mg/dl in HDL-C levels results in a parallel reduction in coronary artery disease risk by 2% in men and 3% in women. Moreover, HDL-C helps to transport oxidized cholesterol from peripheral tissues where it instigates atherosclerosis to the liver for excretion. Furthermore, HDL-C has potential anti-inflammatory, anti-thrombotic and anti-oxidant effects.

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).
Guay and Spark observed independently (unpublished data) that yohimbine was associated with a very poor response in cigarette smokers. This is believed to be relevant, because studies several decades ago may have included a large percentage of smokers, which only recently has been recognized as a risk factor for erectile dysfunction. We tested this hypothesis by studying nonsmoking men with documented organic impotence and by judging whether any possible effect might be related to adrenal or testicular hormones, which, to our knowledge, has not been studied.
ICI Alprostadil may be used as a mixture with two other drugs to treat ED. This combination therapy called "bimix or trimix" is stronger than alprostadil alone and has become standard treatment for ED. Only the Alprostadil ingredient is FDA approved for ED. The amount of each drug used can be changed based on the severity of your ED, by an experienced health professional. You will be trained by your health professional on how to inject, how much to inject and how to safely raise the drug's dosage if necessary.

Zinc therapy (5 mg/day) improves sexual competence by increasing penile thrusting and prolonging ejaculatory latency without disturbing arousability and motivation of male rats. Increase in the T levels observed with zinc supplementation is beneficial in this regard. However, increase in PRL is responsible for the reduced libido index. Further studies on pigs and monkeys are needed to evaluate the possible therapeutic use of zinc in sexual dysfunction.
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.

A 2000 study conducted at the Institute of Sexology in Paris found that muira puama, a Brazilian shrub traditionally used in South African folk medicine as an aphrodisiac, increased libido and erection strength in a majority of men who complained of impotence and a lack of sexual desire. Other studies show this happy-making herb also counteracts chronic stress, depression and nervous exhaustion.


Penile implants - are generally used if physical damage (like an accident) makes the anatomical parts needed for an erection not work. These are inserted by surgery and can provide a permanent treatment choice if others fail to work. The implants can be semi-rigid or inflatable. They can be pretty expensive and are not usually available on the NHS.
The positive response in our patients was enhanced with the higher dose of yohimbine, a phenomenon noted previously.20,21 We agree that several weeks of therapy are needed before clinical effects are seen,21,22 and that some responders may be able to take yohimbine only on demand before sexual activity.39 Yohimbine is effective in a subset of men with organic erectile dysfunction, especially nonsmokers, and it deserves a place in our therapeutic armamentarium. When yohimbine is ineffective alone, it may be useful in combination with other treatment modalities, as has been shown with naloxone39 or trazodone.40

Energy-boosting goji berries have been used for thousands of years in Chinese medicine to help increase energy and enhance the release of hormones.”Goji is also beneficial for increasing blood flow, which helps to oxygenate all of the cells and tissues of the body, including the sex organs,” says celebrity nutritionist Dr. Lindsey Duncan. “Which increases libido—that’s why they call goji the ‘Viagra of China.'”
If you’re experiencing psychological ED, you may benefit from talk therapy. Therapy can help you manage your mental health. You’ll likely work with your therapist over several sessions, and your therapist will address things like major stress or anxiety factors, feelings around sex, or subconscious conflicts that could be affecting your sexual well-being.

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.


Yohimbe bark (pronounced yoh-heem-buh) is an herbal supplement associated with anti-aging effects. It is used to naturally treat erectile dysfunction, low libido, hormonal imbalances and symptoms like low energy. Yohimbe has a long history of use in Western Africa, where the plant originates. It’s still grown there today, especially for its apparent aphrodisiac abilities.
The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of hims, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.
Kegel exercises are very effective, simple and affordable methods in enhancing the strength of your muscles. These muscles are the ones that are involved in your sexual function. If you are unsure of the information that you read online, the best option is to talk with your doctor about your condition in order to avail of the best treatment methods for you.

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
One study found that sticking to a Mediterranean diet rich in virgin olive oil, vegetables, fruits, whole grains, nuts, and fish was associated with a lower risk of ED development and improvement in people who already suffered from ED. There is also some evidence that vegetarian and vegan diets may lower the risk of some types of heart disease, which in turn decreases the likelihood of developing ED.
In addition to getting helpful nutrients from your diet, you can also consider supplementing. Many of these are also on my list of top five supplements to increase sex drive, so they’re helpful for overall sexual health. It’s a good idea to check in with a practitioner, particularly one with knowledge of your individual health issues and medications, before taking anything. Here are some I recommend:

Regardless of diet or exercise - to control a sexual act, it's imperative to balance your sexual focus during foreplay, penetration, and intercourse. When you feel safe throughout foreplay it's easy to penetrate and if you're not worried at penetration time then intercourse is easier. A happy and satisfying sex life is knowing when and where to put your attention. How to do this is explained step-by-step in my Sex Mastery Hard AND in Control program for men.
Many people experience occasional erectile dysfunction when they're stressed or preoccupied. This is because stress increases levels of the hormone adrenaline, which actually causes blood vessels to contract. As having a firm erection depends upon a strong supply of blood to and within the penis, feeling chronically stressed can lead to repeated bouts of ED.
A 2000 study conducted at the Institute of Sexology in Paris found that muira puama, a Brazilian shrub traditionally used in South African folk medicine as an aphrodisiac, increased libido and erection strength in a majority of men who complained of impotence and a lack of sexual desire. Other studies show this happy-making herb also counteracts chronic stress, depression and nervous exhaustion.
But in this case, zinc is much harder to absorb. This explains a decrease in testosterone levels in vegetarians. Slippery jack mushrooms, button mushrooms, beef liver, and fish are also rich in zinc. They are followed by breadstuffs, egg yolk, rabbit, chicken, beans, tea, and cocoa. In addition, zinc is found in onions, garlic, and rice. And a very small amount of zinc is available in fruits, vegetables, and milk.
From the overall analysis, the niacin group showed a significant increase in both IIEF-Q3 scores (0.53 ± 1.18, P < 0.001) and IIEF-Q4 scores (0.35 ± 1.17, P = 0.013) compared with baseline values. The placebo group also showed a significant increase in IIEF-Q3 scores (0.30 ± 1.16, P = 0.040) but not IIEF-Q4 scores (0.24 ± 1.13, P = 0.084). However, when patients were stratified according to the baseline severity of ED, the patients with moderate and severe ED who received niacin showed a significant improvement in IIEF-Q3 scores (0.56 ± 0.96 [P = 0.037] and 1.03 ± 1.20 [P < 0.001], respectively) and IIEF-Q4 scores (0.56 ± 1.03 [P = 0.048] and 0.84 ± 1.05 [P < 0.001], respectively] compared with baseline values, but not for the placebo group. The improvement in IIEF-EF domain score for severe and moderate ED patients in the niacin group were 5.28 ± 5.94 (P < 0.001) and 3.31 ± 4.54 (P = 0.014) and in the placebo group were 2.65 ± 5.63 (P < 0.041) and 2.74 ± 5.59 (P = 0.027), respectively. There was no significant improvement in erectile function for patients with mild and mild-to-moderate ED for both groups. For patients not receiving statins treatment, there was a significant improvement in IIEF-Q3 scores (0.47 ± 1.16 [P = 0.004]) for the niacin group, but not for the placebo group.
The researchers noted that "when patients were stratified according to the baseline severity of ED, the patients with moderate and severe ED who received niacin showed a significant improvement in IIEF-Q3 scores (0.56 0.96 [P = 0.037] and 1.03 1.20 [P < 0.001], respectively) and IIEF-Q4 scores (0.56 1.03 [P = 0.048] and 0.84 1.05 [P < 0.001], respectively] compared with baseline values, but not for the placebo group...For patients not receiving statins treatment, there was a significant improvement in IIEF-Q3 scores (0.47 1.16 [P = 0.004]) for the niacin group, but not for the placebo group. Niacin alone can improve the erectile function in patients suffering from moderate to severe ED and dyslipidemia." [3]
Yohimbe supplements often list yohimbe bark extract or yohimbine as the active ingredient. However, some of these products might not provide accurate information about the amount of yohimbine in the supplement. Also, some yohimbe supplements list yohimbine hydrochloride as an active ingredient. Yohimbe products containing man-made yohimbine hydrochloride as an ingredient are not legal to sell as a dietary supplement in the US.
[notice color=’#ebebeb’]Folic acid is very crucial for men since it stimulates the sperm production and improves the function of the cardiovascular system. And this, in turn, contributes to the improvement of sexual function in men. Therefore, if you use vitamin B9 for erectile dysfunction treatment, you will improve your male potency as well.[/notice]
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.
It’s traditionally used by Pygmies and Bushmen as an aphrodisiac and stimulant. In the 19th century, German missionaries brought this herbal plant to Europe, where it became known as the “love tree.” The extract of this herb is clear and odorless with a bitter taste, and is traditionally prepared and consumed as a tea. Nowadays, medicines and supplements that contain yohimbe bark are available in capsule and tablet form.

Oysters are also a great source of zinc, with just 3 ounces providing 493% of your recommended daily intake. In fact, oysters are so rich in zinc that eating too much can cause an accidental zinc overdose, so just be wary of this. Bear in mind as well that oysters are a common source of food poisoning, and they are also very high in cholesterol – might be best to stick to your nuts and seeds!
A number of nonprescription products claim to be herbal forms of Viagra. Some of these products contain unknown amounts of ingredients similar to those in prescription medications, which can cause dangerous side effects. Some actually contain the real drug, which should be given by prescription only. Although the Food and Drug Administration has banned many of these products, some potentially dangerous erectile dysfunction remedies remain on the market.
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.
So, in establishing physiology, pharmacology, clinical results and safety, zinc is a good choice when you look at cost and side effect profile as well as ease of availability and interaction profile with other meds and other medical conditions.  Having said all of this, there is no bulletproof evidence out there guaranteeing that increasing your zinc consumption either in food or via a supplement will improve ED or increase libido.  Even if a patient experiences an increase in testosterone from such a supplementation, this is not a certain gateway to resolution of theses symptoms as there is more to it than just one hormone level.  However for those that are experiencing problems in these areas, it is certainly worth a try for them.  The patient should be mindful however that supplements should be treated like any other medication and trying to increase your testosterone shouldn’t be done without consultation with your doctor and pharmacist.  You should also check for any interactions with any meds or medical conditions before trying any supplement as well.
Dr. Traxler is a University-trained obstetrician/gynecologist, working with patients in Minnesota for over 20 years. She is a professional medical writer; having authored multiple books on pregnancy and childbirth; textbooks and coursework for medical students and other healthcare providers; and has written over 1000 articles on medical, health, and wellness topics.  Dr. Traxler attended the University of Minnesota College of Biological Sciences and University of Minnesota Medical School,  earning a degree in biochemistry with summa cum laude honors in 1981,  and receiving her Medical Doctorate degree (MD) in 1986.
According to the FDA (Food and Drug Administration), many of these products sold on the internet contain potentially harmful compounds. And they aren’t listed on the label. In an investigation, the FDA found that one-third of these online supplements were laced with undisclosed ingredients. This includes sildenafil—the active ingredient in Viagra. Doctors prescribe Viagra to some patients, but it’s not safe for everyone. The drug could interact with other medications and lower your blood pressure to dangerous levels. This makes ordering supplements online risky. You don’t know whether they contain sildenafil or other ingredients that could harm your health. 
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.
The concentration of yohimbine in commercial supplements may vary from one manufacturer to another. A chemical analysis conducted on 26 brands of yohimbe supplement shows that nine products contain no yohimbe extract at all, while eight products contain only small amounts of yohimbine — approximately 0.1 to 1 parts per million (ppm), which is significantly low compared to 7,089 ppm yohimbine in an authentic yohimbe bark.3

If you’re experiencing psychological ED, you may benefit from talk therapy. Therapy can help you manage your mental health. You’ll likely work with your therapist over several sessions, and your therapist will address things like major stress or anxiety factors, feelings around sex, or subconscious conflicts that could be affecting your sexual well-being.
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:
Erectile dysfunction can occur as a side effect of medication taken for another health condition. Common culprits are high blood pressure meds, antidepressants, some diuretics, beta-blockers, heart medication, cholesterol meds, antipsychotic drugs, hormone drugs, corticosteroids, chemotherapy, and medication for male pattern baldness, among others.
A study of 23 individuals found that a dose of 0.4mg/kg of yohimbine not only increased norepinephrine in the blood, blood pressure, and heart rate, but it also increases impulsive response rates. These response rates are measured by the number of impulsive errors, response biases, and reaction times on an immediate memory task. [10] While yohimbine may improve your reaction time it may also encourage you to act irrationally.

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.
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.
A 2000 study conducted at the Institute of Sexology in Paris found that muira puama, a Brazilian shrub traditionally used in South African folk medicine as an aphrodisiac, increased libido and erection strength in a majority of men who complained of impotence and a lack of sexual desire. Other studies show this happy-making herb also counteracts chronic stress, depression and nervous exhaustion.
A study in the Journal of Sexual Medicine found that a large percentage of men with ED also have low levels of vitamin D. If you’re experiencing ED, you may want to have your level of vitamin D checked. Other symptoms of a low vitamin D level may be too subtle to notice. However, if you have serious vitamin D deficiency, you may have bone pain or muscle weakness. Vitamin D levels can be checked with a simple blood test and for most people corrected with a supplement.
The search criteria identified 210 studies from 1972 to 2010; on inserting randomized controlled trials only 26 studies were identified out of which only 5 met the inclusion criteria and 21 studies did not meet the inclusion criteria, hence, were excluded. Five (18, 24–27) randomized controlled trials (RCTs) met the inclusion criteria; studies involved the use of aerobic exercise in the management of ED, the IIEF was the assessment tool for ED and also involved control groups. A total of 385 subjects were involved: Lamina et al (25), n=43; Lamina et al (26), n=43; Esposito et al (18), n= 110; Kalka et al (27), n= 129; Maio, Saraed and Marchiori (24), n= 60.
Although not direct proof of cause and effect, the positive results that we report in half of the men in the current study may reinforce our clinical observation with objective RigiScan™ data that use of yohimbine might be associated with better effects in nonsmokers. We30 reported that cessation of smoking may rapidly improve nocturnal erectile activity and found that nicotine was not the noxious agent in our study. We postulated that carbon monoxide might create a hypoxic environment in the penis. This effect probably was mediated through restoration of nitric oxide activity.31

Pelvic floor exercises are actually good as they can enhance the strength of the pelvic floor muscles. These exercises are commonly called Kegel exercises. These are the types of exercises that women usually perform in order to regain their muscle tone right after childbirth. They are also known to enhance urinary continence and overall male sexual health.
Low levels of zinc can be the cause for a variety of health-related problems. Zinc is a key mineral that cells use to metabolize nutrients. Immune function, DNA and protein production, and cell division are all related to zinc levels in the body. Zinc also enables the male body to produce testosterone. Because of this, your levels of zinc may affect erectile dysfunction.
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