3. Testosterone replacement. Before oral medications like Viagra, testosterone was routinely used to treat erectile dysfunction as it is central in the male sexual response, including the desire for sex and the process of getting an erection. Testosterone can be administered in a number of ways, for example orally, by means of an injection, skin patch, or subcutaneous (under the skin) pellet. 
Uses and risks of viagra Viagra treats erectile dysfunction and pulmonary arterial hypertension. For sexual purposes, it helps someone with erectile dysfunction achieve and maintain an erection. However, Viagra can have unpleasant side effects, and an overdose can be serious. We cover everything you need to know about Viagra in this article. Read now

C borivilianum (family Liliaceae) is native to India. Analysis of C borivilianum root revealed a composition of 12% to 17% saponins, 1.9% to 3.5% stigmasterol, 0.79% arabinose, 3.8% galactose, 0.73% glucose and 0.78% rhamnose [31]. For dried root powder, the recommended dose is 5 g and the extract dose is 500 mg. It is used as an aphrodisiac and to cure ED, improve semen quality and volume. It eliminates premature ejaculation, improves general well-being and vitality, and increases stamina and libido. Visavadiya and Narasimhacharya [31] have demonstrated that administration of C borivilianum (0.75 g and 1.5 g root powder per rat per day for four weeks) to hypercholesteremic rats significantly increased highdensity lipoprotein cholesterol levels and decreased plasma and hepatic lipid profiles. Furthermore, the treatments also resulted in increased excretion of fecal cholesterol, sterols and bile and increased superoxide dismutase levels. Kenjale et al [32] evaluated the aphrodisiac and spermatogenic potential of the aqueous extract of dried roots of C borivilianum in rats. C borivilianum was given orally at doses of 125 mg/kg/day and 250 mg/kg/day. Viagra 4 mg/kg/day (sildenafil citrate) was administered as a control. Sexual behaviour was monitored 3 h later using a receptive female. Their sexual behaviour was monitored on days 1, 7, 14, 21 and 28 of treatment by pairing with proestrous female rats. For sperm count, the treatment was continued further in all groups except for the Viagra group for 60 days. At 125 mg/kg, C borivilianum had marked aphrodisiac action, as demonstrated by increased libido, sexual vigour and sexual arousal in the rats. Similarly, at the higher dose (250 mg/kg), all the parameters of sexual behaviour were enhanced, but showed saturation effect after 14 days. On day 60, the sperm count increased significantly in both the C borivilianum-treated groups (125 mg/kg/day and 250 mg/kg/day) in a dose-dependent manner. The administration of C borivilianum extract has been found to be useful for the treatment of premature ejaculation and oligospermia [32]. Supplementation with C borivilianum root 250 mg/kg/day and 500 mg/kg/day to streptozoticin-induced diabetic male rats for 28 consecutive days improved sperm morphology, and reduced oxidative stress and formation of free radicals [33]. In case of streptozotocin- and alloxan-induced hyperglycemia, the aqueus extracts from C borivilianum resulted in improved sexual performance compared with diabetic control [34,35].


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.
If you can't take one of these oral medications, your physician may have you try Caverject (alprostadil for injection), a hormone that you inject into your penis using a fine needle, or Muse (alprostadil urogenital), a tiny suppository that you insert into the tip of the penis. Both of these will bring on an erection within five to 15 minutes without sexual stimulation.
In diabetes, vasoconstrictors and vasoactive factors are increased in addition to structural changes and attenuation of relaxation responses in the corpus cavernosum. A shifting of the balance of vasoactive factors occurs such that relaxation factors (eg, nitric oxide [NO]) are inhibited and contractile factors are induced in microvascular disease. With epidemiological predictions suggesting that the incidence of diabetes mellitus will increase to 300 million by 2025, management of diabetes-induced ED is increasingly important.

If you bike a lot and have a very narrow saddle on your bicycle, consider switching to a "no-nose seat" which is wider at the back than a conventional saddle, allowing more of your weight to be distributed to the sitting bones. Make sure the seat is level or angled slightly downward and at a height that allows your knee to be just slightly bent at the bottom of the pedal cycle. Raising the handlebars on your bike so that you're sitting upright may also help.

The key respondents were mainly old men, male traditional healers, traditional birth attendants and young women and all in total about 160 traditional healers were interviewed. To document male related ailments men are particularly more knowledgeable and most men share their problems with men. In addition, the old men and healers are the ones in charge of administering these herbal remedies. Young women through the informal discussions, interviews and market surveys are particularly more dynamic in the use of herbs for themselves, husbands and children besides being the most active reproductive age group. The medical ethnobotanical data collected has been analysed, medicinal plants from the study areas have been listed and methods of administering the herbal drugs were also documented. In checking for the proper updated naming, spellings and authors of the medicinal plants, besides using voucher specimens in Makerere University Herbarium, several reference books were used1,3,9,15,16,20,22,27.
Pumpkin seed: besides having a pleasant flavor, pumpkin seeds are revered by the Chinese for its antidepressant properties (5). More importantly, pumpkin seed ingestion can impact prostate health, which is very important for male sexual health. It is commonly used to strengthen the prostate gland and promote healthy hormone function in men. Myosin, an amino acid found in pumpkin seeds, is known to be essential for muscular contractions.
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.
Ashwagandha’s reputation as a sexual enhancement herb is supported by research. One animal study showed that extracts of ashwagandha increased production of sex hormones and sperm, presumably by exerting a testosterone-like effect. In another clinical trial, the herb (taken at a dose of 3 gm per day for 1 year) was given to healthy male adults 50–59 years of age. Among benefits noted: serum cholesterol levels decreased, gray hair was reduced, and a vast majority (over 70%) reported improvement in sexual performance.
Tongkat Ali (Eurycoma longiflora) (Figure 7): this native plant found through SE Asia is used as an Aphrodisiac since 1996 (5). It has to be used regularly and works by enhancing the testosterone and cGMP production. Benefits are felt gradually over a period of time, mainly because it enhances the natural biological synthesis of testosterone. When the level is increased, health and vitality are restored. In studies on Mice, Tongkat Ali increases the number of times and duration of sexual performance of the animals under study (8) with testosterone levels increasing up to 440% in some animals. In a recent study on humans, 62% of subjects showed an increase of the free testosterone index indicating it’s biostimulatory effect on steroidogenesis. It has also been shown to increase sperm concentration and motility and increases energy in the individual by enhancing ATP production by 60% thru oxidative phosphorylation.
Physical and emotional stress — whether over-exercising, under-sleeping or just dealing with everyday stressors like work and a busy schedule — causes an increase in “stress hormones,” including cortisol and adrenaline. Stress can lower desire for sex. This is because stress can contribute to fatigue or preoccupation with other tasks. It can also significantly affect blood flow by increasing inflammation.
Deer antlers (Cervi pantotrichum): the most popular of sexual tonics. In the Chinese medical teaching, kidneys control sexual function; hence foods and herbs such as this can invigorate impotency and infertility increasing semen production as well (5). Best quality are from young bucks with new horn still in velvet with blood visible in the cartilage.
According to the Cleveland Clinic, “because erectile dysfunction is caused by a complex set of psychosocial, neurologic, and vascular factors, a specific cause in a patient may remain ambiguous.” The root causes are often related to a blockage or dysfunction of blood vessels. For example, ED can be due to conditions like atherosclerosis or diabetes, hormonal imbalances or problems related to mental health. It’s been found that common causes typically include one or more of the following factors: (2)
Tribulus terrestris (6): this plant has long been used as a folk medicine in Eastern Europe and Bulgaria for sexual deficiency (5). The properties of this powerful ingredient have been associated with an increase in sperm production, sexual endurance, and testosterone levels. Also known as puncture vine, this herb has gained popularity over the past few years. Since testosterone plays a huge role for men, the addition of this herb can prove to be very beneficial. It is not a hormone as some believe. It is said that Tribulus terrestris can also help build muscle and strength, which enhances performance (5,7).
Some studies carried in and outside Uganda show that some of these plants listed in the management of sexual impotence and ED may be potent. Some of these medicinal plants are regarded as traditionally aphrodisiacs, implying that they have ability to increase sexual desires. For instance, Cola acuminata fruits are widely used herbal remedies in ED and are harvested from the forests of Democratic Republic of Congo. The Cola acuminata fruits contain about 2% catechine-coffeine (Colanine)7. The roasted seeds in Europe are used as strong stimulant, in addition to the treatment of migraine, neuralgia, diarrhoea and stimulant or cardiotonic, loss of appetite, antidepressant and melancholy (severe form of depression)7. Coffee is drunk for certain migraine, nausea, resuscitation and diuretic7. Coffee is a famous stimulant used world over as a beverage. However, the wild coffee species are more popular in treating ED and are believed to contain more alkaloids (caffeine). Coffee is further reported to be a nervous system stimulant (Pampalona-Roger, 2000). Cannabis sativa (Marijuana) is smoked by mentally sick and impoverished men7. C. sativa is like morphine, it is an opioid analgesics. Allium sativum (garlic) is used in treatment of diabetes, high blood pressure, prevention of arteriosclerosis (hardening of the arteries and is one of the causes of ED)7. Garlic reduces blood sugar levels and blood cholesterol levels which are the direct causes of ED if not checked. The Zingiber officinalis (ginger) volatile oils from the rhizome are used for stimulating the nerves and making then sensitive7. Capsicum frutescens in many African cultures is a known powerful stimulant and carminative24. Capsicum frutescens (chilli) contains enzyme capsaicine that helps in blood clotting (fibrinolytic) and people who consume C. frutescens seldom suffer from heart attack. In addition, the pharmacological tests showed that the capsaicin chemical compound from Capsicum frutescens acted like powerful stimulant of the receptors participating in circulatory and respiratory reflexes24.
Maca root (Lepedium meyenii W): this native Peruvian root has been cultivated for thousands of years. Considered an integral part of the diet, the Incans found maca root so potent (14), it was restricted to royal use only. Known for its energy enhancing abilities, maca root enjoys a special place amongst herbalists and health seekers. Like ginseng, this plant is employed to increase strength, libido and sexual function (14). Clinically its effects have been proved with experimental animals (5,15).

Derived from the bark of a West African evergreen tree, yohimbe was the go-to ‘script for a wonky willy prior to the advent of wonder drugs like Viagra, Walker says. “Yohimbe enhances sexual performance both by blocking certain neurotransmitters in the brain and by increasing the release of nitric oxide in the cavernosal nerves of the penis,” he explains. And it pairs well with other erection-friendly tablets: A 2010 study in the Iranian Journal of Psychiatry found that a combination of yohimbe and L-arginine successfully helps guys get it up. However, yohimbe also has a handful of side effects, including elevated blood pressure and anxiety, so definitely talk to your doctor before you start on the supp.
E longifolia is a medicinal plant (family Simaroubaceae) native to Indonesia, Malaysia, Thailand, Vietnam and Laos. The root extract has been found to be the most powerful herbal aphrodisiac [17]. Tongkat ali extracts contain many alkaloids, quassinoids, phenolic compounds, tannins, high-molecular-weight glycoproteins and mucopolysaccharides. The main bioactive compounds are eurycomaoside, eurycolactone, eurycomalactone, eurycomanone and pasakbumin-B. It is considered to be natural ‘Viagra’. It increases sexual desire, and enhances performance and general well-being [17- 19]. In addition to its aphrodisiac effect, other medicinal effects, such as antimalarial, antibacterial, antipyretic, antiulcer and antitumour effects, have been reported [20,21]. Root decoction has been used as a general tonic (18,22]. Laboratory animal studies show that root extract enhances sexual characteristics and performance in rodents [22-25]. In a study involving a boar model, it was found that E longifolia root extract-treated boars increased sperm counts and semen volume; the effect was attributed to increased level of plasma testosterone [26]. Reports also suggest that E longifolia extract reverses the inhibitory effects of estrogen on testosterone production and spermatogenesis in rats [27]. Oral administration of E longifolia extract to inexperienced castrated male rats produced dose-dependent increases in sexual performance [28]. Zakaria et al [29] found that eurycomanone, a potential bioactive compound in the root extract of E longifolia, induced apoptosis in hepatocarcinoma (Hep G2) cells. Furthermore, their work suggested that eurycomanone was cytotoxic to Hep G2 cells and less toxic to normal Chang’s liver and WLR-68 cells. Tambi and Imran [19] investigated the effects of water-soluble extract of the root of E longifolia Jack and found that the extract increased semen volume, sperm concentration, percent of normal sperm morphology and sperm motility in male partners of subfertile couples with idiopathic infertility. Supplementation with E longifolia elevated the testosterone levels and upregulated osteoprotegerin gene expression in male Sprague-Dawley rats [30].
Erectile dysfunction (ED) or male impotence is defined as inability of a man to achieve or maintain penile erection sufficient for sexual activity. It is primarily a neuronal and endothelial dysfunction of the corpus cavernosum of penile tissue, and is partly characterized by reduced production of nitric oxide (NO). Other factors that may contribute to the pathogenesis of ED include androgen deficiency in aging men, hypertension, high cholesterol levels, atherosclerosis, diabetes mellitus, diseases of the prostate and heart, and anatomical deformity of the penis. ED may also be caused by some medications, prostate surgery and spinal cord injury. Psychological and social conditions such as stress, depression and unhappy marital relationship may contribute to the problem. Chronic infections and inflammation can also contribute to the disease process. ED is linked to an increased risk for cardiovascular diseases and stroke. Several orally active drugs (sildenafil, vardenafil, tadalafil, avanafil) are currently prescribed for treating ED to improve the arterial blood flow to the penile tissue. Medicinal plants and their extracts have been used in traditional medicine in southwest Asia and other countries to treat ED. The current review focuses on four medicinal plants that have been used as aphrodisiacs for enhancing sexual performance and for the treatment of ED. These plants include Eurycoma longifolia Jack (tongkat ali); Chlorophytum borivilianum (safed musli); Withania somnifera (ashwagandha); and Pausinystalia johimbe (formerly known as Corynanthe johimbe). Suggested mechanisms of action for each of the plant extracts will be discussed.
The art of acupuncture has become the new treatment for everything from back pain, depression, and even ED. Impotence could be more of a state of mind, and acupuncture may help. Through this alternative therapy, fine needles are placed in various parts of the body to relieve pain or stress. Although there are many mixed studies for acupuncture and ED, many tend to confirm positive results. A 1999 study found acupuncture improved the quality of erection and even restored sexual activity in 39 percent of participants.

The art of acupuncture has become the new treatment for everything from back pain, depression, and even ED. Impotence could be more of a state of mind, and acupuncture may help. Through this alternative therapy, fine needles are placed in various parts of the body to relieve pain or stress. Although there are many mixed studies for acupuncture and ED, many tend to confirm positive results. A 1999 study found acupuncture improved the quality of erection and even restored sexual activity in 39 percent of participants.


These three versatile herbs, used for centuries in Chinese and Ayurvedic medicine, have a variety of health benefits for both men and women. However, they work in several ways to address health issues of top concern to men, such as erectile dysfunction (ED) and high blood pressure, and I believe they should be a part of every man’s long-term plan for overall health.
Arginine. The amino acid L-arginine, which occurs naturally in food, boosts the body's production of nitric oxide, a compound that facilitates erections by dilating blood vessels in the penis. Studies examining L-arginine's effectiveness against impotence have yielded mixed results. A 1999 trial published in the online journal BJU International found that high doses of L-arginine can help improve sexual function, but only in men with abnormal nitric oxide metabolism, such as that associated with cardiovascular disease. In another study, published in 2003 in the Journal of Sex & Marital Therapy, Bulgarian scientists reported that ED sufferers who took L-arginine along with the pine extract pycnogenol saw major improvements in sexual function with no side effects. Arginine can be helpful, says Geo Espinosa, ND, director of the Integrative Urological Center at NYU Langone Medical Center. Espinosa says that men with known cardiovascular problems should take it only with a doctor's supervision; L-arginine can interact with some medications.
Ginkgo biloba may increase blood flow to the penis. Researchers discovered the effect of gingko on ED when male participants in a memory enhancement study reported improved erections. Another trial saw improvement in sexual function in 76 percent of the men who were on antidepressant medication. This is why researchers believe that ginkgo may be effective for men who are experiencing ED due to medication.
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