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.
Move a muscle, but we're not talking about your biceps. A strong pelvic floor enhances rigidity during erections and helps keep blood from leaving the penis by pressing on a key vein. In a British trial, three months of twice-daily sets of Kegel exercises (which strengthen these muscles), combined with biofeedback and advice on lifestyle changes — quitting smoking, losing weight, limiting alcohol — worked far better than just advice on lifestyle changes.
Other factors that “stress” the body can also increase your risk for ED. These include: substance abuse, using marijuana, smoking cigarettes, depression, anxiety and low self esteem. Cigarette smoking — or using nicotine — leads to constricted blood vessels, which has negative effects for sexual health. Other mental/emotional obstacles can cause less desire for sex and decrease testosterone. Several ways to help manage stress include:

Yohimbine. This chemical is found in the bark of an African tree called yohimbe. It has been used as a male aphrodisiac in Africa, and under medical supervision it has been used as a prescription drug to treat ED. Supplements made from yohimbe bark are also available without a prescription, but they can be life-threatening if used at high doses, according to the Natural Medicines Comprehensive Database. The supplement can interact in a harmful way with certain drugs, such as blood pressure medications, and should be avoided by anyone with liver, kidney, heart, or diabetes problems or problems with anxiety or depression. Like DHEA, yohimbine should not be taken without a doctor's supervision.
A cold slice of watermelon can do more than just satisfy thirst and hunger during the warm summer months; it can help with bedroom satisfaction. Citrulline, the amino acid found in high concentrations of watermelon, is found to improve blood flow to the penis. A 2011 study revealed men who suffered from mild to moderate ED and took L-citrulline supplementation showed an improvement with their erectile function and were very satisfied. Natural watermelon juice, or “nature’s Viagra,” can also be easier on the stomach, since taking pills like Viagra can cause nausea and diarrhea.
Vitamins and minerals are used in systems all over the body. Everywhere from your cardiovascular to your nervous system. It’s a lot to understand. So to help dispel some of the myths and outlandish claims, we’ll take a look at how five common vitamins and nutrients affect one very specific aspect of men’s health—erections. Turns out, vitamins can do more than just ward off the common cold.
L-arginine. L-arginine is an important amino acid that the body needs to build proteins. Because L-arginine has been shown to improve blood flow, some alternative practitioners have recommended that the supplements be used to treat ED. The Natural Medicines Comprehensive Database, which is a reliable authority on alternative medicines, says L-arginine is possibly effective for treating erectile dysfunction. But Harris warns that "although this supplement could improve blood flow, side effects can be dangerous." L-arginine can cause an allergic reaction or worsen asthma in some people; it can also lower blood pressure.

Wild oats: a study in 1986 by the Institute for Advanced Study of Sexuality in San Francisco reported effects like heightened sexual awareness, increased sexual thoughts, more orgasms (36% in men and 29% in women) and some male subjects showed increased levels of testosterone attributed to unbinding of testosterone from TBG. Oats supply steroidal saponins which modulate hormonal balance (5).
In fact, one common reason many younger men visit their doctor is to get erectile dysfunction medication. Often, men with erectile dysfunction suffer with diabetes or heart disease, or may be sedentary or obese, but they don’t realize the impact of these health conditions on sexual function. Along with erectile dysfunction treatment, the doctor may recommend managing the illness, being more physically active, or losing weight.
Pomegranate juice. Drinking antioxidant-rich pomegranate juice has been shown to have numerous health benefits, including a reduced risk for heart disease and high blood pressure. Does pomegranate juice also protect against ED? No proof exists, but results of a study published in 2007 were promising. The authors of this small-scale pilot study called for additional research, saying that larger-scale studies might prove pomegranate juice's effectiveness against erectile dysfunction. "I tell my patients to drink it," says Espinosa. "It could help ED, and even if it doesn't, it has other health benefits."
Researchers at Johns Hopkins University last year looked at 3,400 healthy Americans and found that men who were vitamin D deficient were 32% more likely to have trouble getting it up than those with sufficient levels, even after adjusting for other ED risk factors. In fact, the connection is so common, Walker says D levels are something he always checks in ED patients. Why? The sunshine vitamin is crucial for keeping the endothelial cells that line blood vessels healthy. Without enough of the stuff, blood flow is inhibited, affecting everything from your heart to your hard-on.
In one study, men with a Vitamin D deficiency were nearly 33% more likely to have ED. But you don’t need that much sun exposure to get a healthy amount of Vitamin D. As little as 15–20 minutes a day is enough. Taking Vitamin D is a good idea, especially if you are over 65. Vitamin D can also help if you’re obese or dark-skinned (dark skin limits the amount of Vitamin D you naturally, produce)

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).

Erectile Dysfunction is extremely common in men and the number one herb to treat and heal erectile dysfunction is no doubt Tongkat Ali. The herb is commonly known as Malaysian Viagra or Natural Viagra even Herbal Viagra is known to be the best natural male herb, making it extremely valuable herb to restore manhood, virility and libido plus erection.  It stood the simple test, most lab evidence and experience from uses attest to its benefits vs Viagra like drugs.
In reality, on a few and proven key herbs that shown to cure and improve on erectile dysfunction. A simple stack of 3 key supplements has proven to treat and cure erectile dysfunction, namely improving and restoring your libido, blood circulation and erectile strength.  As a naturally supplement combo, this 3 herbal combination is proven to reverse or cure erectile dysfunction.
Epimedium extract (Horny Goat Weed) (11), (Figure 9): the Chinese refer to this herb as ‘yin yang huo’, which has been loosely translated as ‘licentious goat plant’; hence, its common name is well known as ‘horny goat weed’ by many Western cultures. Scientifically, studies have shown that Epimedium may restore low levels of both testosterone and thyroid hormone, bringing low levels back to their normal levels (5), which may account for some of its benefits in improving sexual libido. Other benefits to Epimedium involve increased muscle mass. Used for fatigue and aging, And vasodilatation effect; thus, most frequently used in treatment of sexual dysfunction in Traditional Chinese Medicine (12). The active substance from horny goat weed was reported by Xin Zhong Cheng at Beijing Medical University as Icarin—acts by increasing sexual activities and ICP levels in castrated rats after long term oral administration. It has no effects on serum testosterone level in castrated rats after long term oral administration. Instead Icariin increases nNOS and iNOS mRNA and protein expression in the corpus cavernosum after long term oral administration and hence may have long term efficacy on erectile dysfunction after oral administration.
Dadder seed (Tusizi): there are 2 species i.e., (I) Cuscuta chinensis Lam and (II) Cuscuta japonica. The ripe seeds are collected in autumn, and then they are dried in the sun or boiled. Used to treat deficient kidneys manifesting as impotence, nocturnal emissions, premature ejaculation; Dadder seed (Tusizi) can be used with Schisandra fruit (Wuweizi), Cnidium fruit (Shechuangzi), Flattened milkvetch seed (Shayuanzi) and Grossy privet fruit (Nuzhenzi) for impotence.
Classically the neuro-physiology of ejaculation traces the 3 Phases in which ejaculation is a complex event involving the (I) the propulsion of sperm and seminal plasma into the prostatic urethra which is accompanied by (II) bladder neck closure and (III) coordinated contractions of the bulbocavernosus and ischiocavernosus muscles, striated muscles of the pelvic floor, lower limbs and trunk. In the Asian Society of the Aging Male Study [2004] 63% have reduced erection, 68% reduced or absent ejaculation and 19% pain or discomfort at ejaculation. Disorders of ejaculation can be due to: (I) disorders of production of sperm or seminal plasma/prostatic secretions (II) disorders of propulsion. In the case of anejaculation (absence of ejaculatory) which is the ultimate disorder of ejaculation, the causes can be best classified as (I) primary or secondary. After covering psychogenic causes of ejaculation failure, the organic causes due to non-dynamic and obstructive etiologies in the prepubertal and post pubertal male will be highlighted. More details will be given on retarded ejaculation, premature ejaculation, aspermia, painful and weak (poor propulsive force) ejaculation. The evaluation of the patient must include a detailed history taken from the patient and often his partner. Aside from haematologic tests, various forms of radiological and ultrasonic imaging, neurophysiologic studies may be required. For the general practitioner the commonest scenario will be in the ED Clinic with abundant men with performance anxiety presenting with premature ejaculation. In the male aging clinic lack of arousal is the commonest cause of retarded orgasm and ejaculation but this group is plagued by decreased touch sensitivity, the need for more direct stimulation, reduced drive to orgasm, a less intense orgasm, ejaculation being weaker and of reduced quantity and disturbing complaints of a longer recovery period and less number of attainable orgasms per day or week. Thus it is not mere rumor that “by the time a man reaches 55, the refractory period to ‘do it again for a man’ increases to 12 hours or even up to a week”. In the STD clinic, painful or bloody ejaculation is frequently seen. The Condom may cause condom retarded orgasm/ejaculation.

A combination of yohimbine and L-arginine is shown to significantly improve erectile function in people with ED. L-arginine is an amino acid that helps expand blood vessels. It’s regarded as safe and effective for ED but can cause side effects like nausea, diarrhea, and stomach cramps. Avoid taking L-arginine with Viagra, nitrates, or any high blood pressure medications.
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