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.
Minor side effects associated with erectile dysfunction medications include indigestion, runny nose and skin flushes. Sildenafil may cause temporary changes in your vision, and vardenafil may cause muscle aches and back pain. More serious side effects include hearing loss and erections that last longer than four hours. If you have cardiovascular problems, including a history of heart attacks or strokes, high or low blood pressure or vision problems such as retinitis pigmentosa, it may prove unsafe for you to take sildenafil, vardenafil or tadalafil. These medications may also interact poorly with some antibiotics, blood thinners and medications to prevent seizures and heart rhythm disorders.
Aside from pelvic floor exercises, it has been found out that aerobic exercises also work in treating erectile dysfunction. This condition is often caused by problems related to blood flow to the penis. Diabetes, obesity, vascular disease as well as high cholesterol may affect blood flow. This results to erectile dysfunction. By adding some aerobic exercises to your routine, you can significantly enhance your overall male sexual health and may even remove the problem totally in the long run.

I'll explain the best exercises for sex below. Know that if you suffer from PE or ED you also need to change the way you are thinking about sex to gain full control of yourself. Not just during sex, but in the lead up to sex as well, so you can reprogram your brain to achieve hard and in control. I explain this in the following video which is taken directly from my Sex Mastery program:
The group treated with the lower concentration of zinc (1 mg/day) did not show an alteration in any of the observed parameters. However, supplementation with a dose of 5 mg/day per rat caused substantial prolonged ejaculatory latency and increased in number of penile thrusting. The other parameters studied remained unchanged indicating uninterrupted libido, sex vigor and performance. Majority of male rats (75 %) showed the prominent actions of sexual behaviour (mount, intromission and penile thrusting) and did not ejaculate within the 15-minute observation period.
The RigiScan™ portable home monitor recorded nocturnal penile tumescence and rigidity testing. The monitor's quantitative analysis software quantitates various parameters of tumescence and rigidity, which includes the area under the curve over time slept, reported as tumescence activity units and rigidity activity units. The reproducibility and accuracy of this technique have been reported.28 Baseline normal values were used as previously reported,29 Rigidity had to be at least 60% at the base and 50% at the tip and maintained for at least 10 min. At least half of the episodes had to meet these criteria, with a minimum of three or four episodes per night. Tumescence had to achieve a height of 3 cm at the base and 2 cm at the tip.
Some men say certain alternative medicines taken by mouth can help them get and maintain an erection. However, not all “natural” medicines or supplements are safe. Combinations of certain prescribed and alternative medicines could cause major health problems. To help ensure coordinated and safe care, discuss your use of alternative medicines, including use of vitamin and mineral supplements, with a health care professional. Also, never order a medicine online without talking with your doctor.

In a study with human subjects, Kruger et al. have reported that acute changes in the normal physiological levels of PRL led to a significantly prolonged ejaculatory latency, but minor reductions of sexual drive and function.[19] Although zinc induced elevation of PRL was not an acute effect, findings similar to the human study (prolongation of ejaculation and mild reduction of libido index with medium dose of zinc) were observed in this study. However, the prolongation of ejaculatory latency may not be merely due to effects of elevated PRL because elevated PRL levels are known to be associated with the negative aspects of sexual activities (decreased sexual desire and frequency of sexual intercourse).[20]

Three types of medications to treat erectile dysfunction -- sildenafil, vardenafil and tadalafil -- may cause low blood pressure. Niacin, used to treat conditions such as high cholesterol and hardening of the arteries, can also lower your blood pressure. If you take medications to treat male impotence, ask your doctor before combining it with niacin.
There is no guaranteed, permanent way to ‘cure’ ED – partly because, age is a factor that affects ED the older you are, the more likely you are to get ED symptoms. This might mean that even if you have successfully kept your erectile dysfunction under control in the past, you may get ED symptoms again as you get older. Also, there are lots of factors that cause ED. So, one factor that doesn’t affect you right now might do in the future. 
Clinically I have seen these results in doses of just 20 mg twice daily.   It is important to note that prolonged zinc supplementation can lead to lowered copper levels so it is not advisable to continue this therapy unless it is in a cyclical nature.  For those on long term zinc there are combination products with Zinc and Copper.   In cases where some prescriptions that lower zinc are given, like acid lowering meds, thiazide diuretics and ACE inhibitors, or in renal dialysis patients, this chronic monitoring of zinc may lead to longer term supplementation.

A study published in The American Journal of Cardiology confirmed that aerobic exercises will help you to cure your erectile dysfunction. Erectile dysfunction is most commonly caused by obesity, hypertension, and diabetes, which decrease the blood flow in the penis. Aerobic exercises can and will help you to improve your health in general, improve your blood flow, and ultimately treat your condition.


Yohimbe supplements haven't been tested for safety and keep in mind that the safety of supplements in pregnant women, nursing mothers, children, and those with medical conditions or who are taking medications has not been established. You can get tips on using supplements here, but if you're considering the use of Yohimbe, it is essential that you talk with your physician first. 
Returning to pellagra, Dr. Casal was the first to offer a clinical description of the disease. He called it mal de la rose due to the red rash seen on the hands and feet of sufferers. In fact, his account is now recognized as the first modern pathological description of a syndrome. This was the beginning of a progression of discoveries that led to the isolation of niacin in 1911, and its direct implication as the dietary deficiency factor in pellagra in 1937.
The number of animals ejaculating within 15 minutes was significantly reduced in 5 mg zinc treated group (one out of eight). However, all intromitted rats ejaculated between 20-30 minutes when observation was continued. Ejaculatory latency was significantly high in this group compared to controls; 711.60 Sec (SEM 85.47) vs. 489.50 Sec (SEM 67.66), P < 0.05. Similarly, they showed a significantly higher frequency of penile thrusting compared to controls; 26.50 (SEM 6.17) vs. 52.80 (SEM 11.28), P < 0.05 [Table 1].
In addition, statins had a relatively fast effect on the problem of erectile dysfunction as compared to its role in the reduction of cholesterol, which suggest that Niacin drugs were reaching to deal with root inflammation of the mentioned problems significantly. According to the researcher Howard Hermann, Men consuming Niacin scored better on both self-reported tests associated with the function of erectile and the levels of lipids in blood.
On the other hand, high zinc levels have negative effects on sperm quality. Excessive zinc intake in mice have indicated a negative effect of increasing doses of zinc on sperm count and motility.[5] Although there have been studies focusing on various aspects of zinc related reproductive functions, studies on zinc related sexual behavioral aspects have received scant attention. In one study, intranasal irrigation with zinc sulphate has been reported to completely abolish the sexual behavior of male rats.[6]
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.
Three of the randomized studies (25–27) that contributed to the present study data indicated the positive role of both interval and continuous aerobic training in the dual management of both ED and cardiovascular disorders (hypertension and ischemic heart disease ,respectively); this is not surprising because of the arterogenic interrelationship between ED and several cardiovascular disorders. The physiological basis for the therapeutic role of continuous exercise in the management of both ED and some cardiovascular disorders as reported in the present study, could be related to the biochemical, neural and hormonal changes in the blood vessel walls that induce an acute and long-term blood vessel relaxation. The blood vessels might relax after each exercise session because of body warming effects; local production of certain chemicals, such lactic acid and NO; decreases in nerve activity; and changes in certain hormones and their receptors (32, 33). Over time, as the exercise is repeated, there appears to be a growing evidence of a prolonged effect. Thus, chronic (regular, longterm) physical training might reduce basal concentrations of inflammatory markers.
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.
Despite the name, horny goat weed actually helps improve your erection, not libido.  Botanically known as epimedium, this herb has been used by the Chinese for centuries to treat, among other things, low libido and erectile dysfunction. “A growing body of research shows that isolated icariin—the extract of epimedium—inhibits the enzyme phosphodiesterase-5 (PDE-5) and significantly increases nitric oxide synthase, helping to improve erectile function,” says Fisch. In fact, this is the same mechanism that Viagra works through (but the herb comes with a way better name).
According to a study conducted by the University of the West of England, Bristol, pelvic floor exercises may be very effective in treating erectile problems. Many participants of the study, all of whom were men who had been experiencing erectile dysfunction for at least six months, reported a significant improvement of their condition within three months of training their pelvic floor. 
Science is always on the search for the magic bullet for our sexual health problems – that female Viagra. Most women, however, experience poor sexual desire alongside other issues like PMS and fatigue. The solution requires a holistic approach. I want women to start by feeling good every day, in everything they do, as it’s then that you will find you have the ability to feel great about sex.

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.

Esposito et al (18), in their randomized study investigated the effect of physical activities on 110 obese subjects. They reported significant effect of physical activities on both body mass index and EF. The physiological rationales underlying this hypothesis are that healthy lifestyle factors are associated with maintenance of good erectile function in men (19); obesity has been positively associated with endothelial dysfunction and increased serum concentrations of vascular inflammatory markers (34, 35); and both endothelial and erectile dysfunction may share some common metabolic and vascular pathways that may be influenced by behavioral-related pathways (19, 36). Obese men with erectile dysfunction had evidence of abnormal endothelial function, which was indicated by reduced blood pressure and platelet aggregation responses to L-arginine and elevated serum concentrations of markers of low-grade inflammation, such as IL-6, IL-8, and CRP. It has been shown that there are significant associations between IEEF score and proxy indicators of elevated body fat, the vascular response to L-arginine, and circulating IL-8 and CRP levels. The association we found between IEEF score and indices of endothelial dysfunction supports the presence of common vascular pathways underlying both conditions in obese men. A disturbance in nitric oxide activity linked to reduced nitric oxide availability could provide a unifying explanation for this association. In particular, in isolated corpus cavernosum strips from patients with erectile dysfunction both neurogenic and endothelium-dependent relaxation is impaired (37).
I'll explain the best exercises for sex below. Know that if you suffer from PE or ED you also need to change the way you are thinking about sex to gain full control of yourself. Not just during sex, but in the lead up to sex as well, so you can reprogram your brain to achieve hard and in control. I explain this in the following video which is taken directly from my Sex Mastery program:
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.
Sildenafil, vardenafil and tadalafil increase the amount of nitric oxide in your body. Your body contains nitric oxide naturally, which is a gas that relaxes blood vessels. Medications to treat erectile dysfunction relax blood vessels in a man’s penis to help obtain and maintain an erection. Some medications that treat high blood pressure, high cholesterol and heart disease also relax your blood vessels. If you take niacin while you also take medications to treat erectile dysfunction, your blood pressure could drop drastically. You could faint or develop other health problems.

There are risks to prosthetic surgery and patients are counselled before the procedure. If there is a post-operative infection, the implant will likely be removed. The devices are reliable, but in the case of mechanical malfunction, the device or a part of the device will need to be replaced surgically. If a penile prosthesis is removed, other non-surgical treatments may no longer work.


Take note that you may not be able to complete a series of about 10 kegel exercises on your first try. This is just fine. Just do what you can, and gradually work on more kegel exercises until you reach 10 to 20 kegels, up to three times in a day. When performing these exercises, avoid holding your breath, or pushing your stomach, thigh muscles, or buttocks in. It would be helpful if you relax after every count of five. You may also challenge yourself by alternating between long and short squeezes.
Vidal and her team looked at self-reported physical activity among 300 men, and then categorized them into categories: sedentary, mildly active, moderately active, and highly active. These men also reported their levels of sexual function, including their ability to have an erection and orgasm, as well as the quality and frequency of their erections and overall sexual function.
Researchers in London set out to find out if the claims about Yohimbe were true. Could the bark of a tree actually increase libido and improve impotence? They performed a double-blind trial using yohimbine for the treatment of erection inadequacy. Men, aged 18-70 years, seeking help for the secondary erection inadequacy for 6 months or longer, took part in the trial. None of the participants had any serious psychiatric disease, hypertension or liver insufficiency. Half of the men were given 5.4mg of yohimbine, the other half a placebo, for 8 weeks. Patients were assessed in 4-week intervals. After 8 weeks of treatment, 37 percent said they had good erections, as compared to only 13% in the placebo group. After the 8-week treatment, the placebo group was given the yohimbine as well, results for improved stimulated erection after the second 8-week trial increased to a total of 42 percent overall.
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
Reduction of the libido index was the major disadvantage that we observed with zinc supplementation. Substances that affect libido usually act centrally and may reduce desire by causing sedation or hormonal disturbances.[17] The role of elevated levels of PRL in serum as an inhibitor of sexual drive and gonadal function is well established.[18] This reduction of sex drive may occur through the modification of activity of dopaminergic neurons in the CNS that are regarded as controlling sexual motivation and function.[19] Our study demonstrated a significant increase of serum PRL level (2.9 to 7.22 ng/dl) within two weeks of supplementation of zinc (5 mg/day). This is a possible explanation for the reduced libido with increasing doses of zinc observed in this study.
Disclaimer: The entire contents of this website are based upon the opinions of Dr. Mercola, unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Mercola and his community. Dr. Mercola encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional. If you are pregnant, nursing, taking medication, or have a medical condition, consult your health care professional before using products based on this content.
Suggested intake: “The problem with yohimbine is that you can’t regulate the amount in a dosage,” says Fratellone. “It all depends on what part of the tree it comes from, how it’s cultivated, how it’s exported, and so on. The amount of extract you get will vary.” FDA researchers analyzed a number of over-the-counter yohimbe bark products. They found that the supplements contained only seven percent or less of the amount of yohimbine that would be found in actual yohimbe bark, which suggests that they contained little or no yohimbe. However, the prescription form of yohimbine is strictly regulated by the FDA. It is approved only for the treatment of impotence, and is available in tablets and capsules. For erectile dysfunction, 5.4 to 10 milligrams three times daily has been studied and regarded as generally safe.

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).


Yohimbe is taken by mouth to arouse sexual excitement, for erectile dysfunction (ED), sexual problems caused by medications for depression called selective-serotonin reuptake inhibitors (SSRIs), and general sexual problems in both men and women. It is also used for athletic performance, weight loss, exhaustion, chest pain, high blood pressure, low blood pressure that occurs when standing up, diabetic nerve pain, and for depression along with certain other medications.
While the rationale behind why it would work is airtight, the research on arginine’s actual effect on erectile dysfunction is slim, points out Charles Walker, M.D., assistant professor of urology and cofounder of the Cardiovascular and Sexual Health clinic at Yale University. But given its solid safety profile, minimal side effects, and potential benefit on heart disease, it’s worth a try, he adds, especially when taken in conjunction with other herbs on this list, which studies have shown can be more effective.
L-arginine, or arginine, is an amino acid found in red meat, poultry, fish, and dairy products that helps expand blood vessels and increase blood flow. “The body uses this semi-essential amino acid as the primary building block for nitric oxide,” explains Harry Fisch, M.D., clinical professor of urology and reproductive medicine at Weill Cornell Medical College/New York Presbyterian Hospital.
It promotes the formation of red blood cells, enhances cellular metabolism, supports brain function, improves sexual function in men, and contributes to the healthy sperm production. This is because vitamin B12 is required for the formation and duplication of DNA which, in turn, is responsible for the healthy sperm production. And vitamin B12 deficiency affects genetic material the sperm carries.
Three of the randomized studies (25–27) that contributed to the present study data indicated the positive role of both interval and continuous aerobic training in the dual management of both ED and cardiovascular disorders (hypertension and ischemic heart disease ,respectively); this is not surprising because of the arterogenic interrelationship between ED and several cardiovascular disorders. The physiological basis for the therapeutic role of continuous exercise in the management of both ED and some cardiovascular disorders as reported in the present study, could be related to the biochemical, neural and hormonal changes in the blood vessel walls that induce an acute and long-term blood vessel relaxation. The blood vessels might relax after each exercise session because of body warming effects; local production of certain chemicals, such lactic acid and NO; decreases in nerve activity; and changes in certain hormones and their receptors (32, 33). Over time, as the exercise is repeated, there appears to be a growing evidence of a prolonged effect. Thus, chronic (regular, longterm) physical training might reduce basal concentrations of inflammatory markers.
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.
What it’ll do for you: “Yohimbe dilates the blood vessels and can lower blood pressure,” says Dr. Patrick M. Fratellone, an integrated physician with a practice in Manhattan. “So experts figured, if it can do that, it must give you an erection and treat erectile dysfunction.” Some proponents say that yohimbe extracts are powerful antioxidants that can prevent heart attacks, act as a stimulant and an anti-depressant, and an aid to weight loss. Here, a closer look at the key benefits:
If you have symptoms of ED, it’s important to check with your doctor before trying any treatments on your own. This is because ED can be a sign of other health problems. For instance, heart disease or high cholesterol could cause ED symptoms. With a diagnosis, your doctor could recommend a number of steps that would likely improve both your heart health and your ED. These steps include lowering your cholesterol, reducing your weight, or taking medications to unclog your blood vessels.

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:
Men typically have higher zinc needs than women, which can make them more vulnerable to zinc deficiencies. In men, zinc is also needed to support healthy prostate and penile function. Keep in mind that excessive amounts of zinc can be harmful so it is best to follow package directions on the supplement you choose, should you decide to supplement with the mineral.
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