- 8 Natural Remedies for Erectile Dysfunction (ED, Impotence)
- Causes of erectile dysfunction (impotence)
- Erectile dysfunction drugs
- Natural treatment of erectile dysfunction without drugs
- Lifestyle changes can improve erectile dysfunction
- Treatment for Erectile Dysfunction | NIDDK
- Lifestyle changes
- Go to counseling
- Change your medicines
- Prescribe medicines you take by mouth
- Prescribe injectable medicines and suppositories
- Discuss alternative medicines
- How will side effects of erectile dysfunction medicines affect me?
- Prescribe a vacuum device
- Recommend Surgery
- 8 Natural Cures for Erectile Dysfunction
- How Erectile Dysfunction Is Treated
- Erectile dysfunction: Treatments and causes
- Physical causes
- Psychological causes
- Does riding a bicycle cause ED?
- Prostate disease and ED
- Drug treatments
- Online pharmacies
- Vacuum devices
- Surgical treatments
- Do dietary supplements and alternative treatments work?
8 Natural Remedies for Erectile Dysfunction (ED, Impotence)
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For centuries, men have tried all sorts of natural remedies for erectile dysfunction (ED) — the repeated inability to get or maintain an erection firm enough for sexual intercourse.
But do they really work? It is simply not scientifically known at this point. Furthermore, you take these remedies at your own risk, because their safety profiles have not been established.
What follows are commentaries by experts and reviews in the field of alternative treatments that are available over the counter for erectile dysfunction and impotence.
Causes of erectile dysfunction (impotence)
“Just because there is evidence doesn't mean it's good evidence,” says Andrew McCullough, MD, associate professor of clinical urology at New York University Langone Medical Center in New York City, and one of the original clinical investigators for the ED drug Viagra (sildenafil). “And before men with ED start down the naturopathic route, it's smart to make sure that there isn't some underlying medical condition that needs to be corrected.” Moreover, it is estimated that 30 million American men have erection problems, and 70% of cases are a result of a potentially deadly condition that blocks blood flow, atherosclerosis, kidney disease, vascular disease, neurological disease, or diabetes. Additionally, ED can also be caused by certain medications, surgical injury, and psychological problems.
Erectile dysfunction drugs
Experts feel that treating erectile dysfunction on your own, without consulting a doctor, is unsafe. “If you have ED, the first thing you need is a diagnosis,” says impotence expert Steven Lamm, MD, a New York City internist and the author of The Hardness Factor (Harper Collins) and other books on male sexual health.
He says men with severe erectile dysfunction probably need one of the prescription ED drugs, which include the PDE-5 inhibitors Levitra (vardenafil), Cialis (tadalafil), and Stendra (avanafil), as well as Viagra.
But, he says, mild ED — including the feeling that “you're not as hard as you could be” — often responds to natural remedies.
Natural treatment of erectile dysfunction without drugs
Acupuncture. Though acupuncture has been used to treat male sexual problems for centuries, the scientific evidence to support its use for erectile dysfunction is equivocal at best.
In 2009, South Korean scientists conducted a systematic review of studies on acupuncture for ED.
They found major design flaws in all of the studies, concluding that “the evidence is insufficient to suggest that acupuncture is an effective intervention for treating ED.”
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, increasing blood flow to 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 (a disease that damages blood vessels).
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.
Erectile Dysfunction (ED) Causes and Treatment See Slideshow
DHEA (Dehydroepiandrosterone). Testosterone is essential for a healthy libido and normal sexual function, and erectile dysfunction sufferers known to have low testosterone improve when placed on prescription testosterone replacement therapy.
Similarly, studies have shown that taking over-the-counter supplements containing DHEA, a hormone that the body converts to testosterone and estrogen, can help alleviate some cases of ED.
But DHEA can cause side effects, including suppression of pituitary function, acne, hair loss and its long-term safety is unknown, says McCullough. For this reason, many experts discourage use of the supplements.
Ginseng. Korean red ginseng has long been used to stimulate male sexual function, but few studies have tried systematically to confirm its benefits. In one 2002 study involving 45 men with significant ED, the herb helped alleviate symptoms of erectile dysfunction and brought “enhanced penile tip rigidity.
” Experts aren't sure how red ginseng might work, though it's thought to promote nitric oxide synthesis. “I would recommend ginseng [for men with ED],” says Espinosa. Discuss with your doctor before taking it since ginseng can interact with drugs you may already be taking and cause allergic reactions.
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.
Yohimbe. Before Viagra and the other prescription erectile dysfunction drugs became available, doctors sometimes prescribed a derivative of the herb yohimbe (yohimbine hydrochloride) to their patients suffering from ED.
But experts say the medication is not particularly effective, and it can cause jitteriness and other problems. “It's not a great drug,” says McCullough. “And I suspect the herb is not as potent as the pharmaceutical version.
” What's more, evidence shows that yohimbe is associated with high blood pressure, anxiety, headache, and other health problems. Experts discourage its use.
Horny goat weed. Horny goat weed (Epimedium) and related herbs have purportedly been treatments for sexual dysfunction for years. Italian researchers found that the main compound in horny goat weed, called icariin, acted in a similar way as drugs sildenafil.
Ginkgo biloba. Known primarily as an herbal treatment for cognitive decline, ginkgo has also been used to treat erectile dysfunction — especially cases caused by the use of certain antidepressant medications. But the evidence isn't very convincing. One 1998 study published in the Journal of Sex & Marital Therapy found that it did work.
But a more rigorous study, published in Human Pharmacology in 2002, failed to replicate this finding. “Ginkgo has come fashion in the past few years,” says Ronald Tamler, MD, assistant professor of medicine and codirector of the men's health program at Mount Sinai Medical Center in New York City. “That's because it doesn't do much.
I can say that in my practice, I have not seen ginkgo work — ever.”
There are many unproven herbals, dietary supplements, and natural remedies for ED. These include panax, propionyl-L-carnitine, L-citrulline, pomegranate, rhodiola rosea, golden root, Indian ginseng, zinc supplements, and ashwagandha.
Lifestyle changes can improve erectile dysfunction
No matter what erectile dysfunction treatment or treatments (whether herbal remedies or not) a man ultimately decides upon, experts say it's important to eat healthily and to avoid smoking and heavy drinking.
Moreover, adequate exercise, stress reduction, and sleep can improve erection problems in many. In addition, says Lamm, “A loving, receptive, and responsive partner is a home run.
After all, this is still a couple's issue.”
CONTINUE SCROLLING FOR RELATED SLIDESHOW
Erectile dysfunction (ED) is… See Answer
Reviewed on 12/13/2019
Chen, J. BJU International 83 (1999): 269-273. “Erectile Dysfunction.” National Kidney and Urologic Disease Information Clearinghouse. Espinosa, Geo. Integrative Urological Center, NYU Langone Medical Center.
Lamm, Steven. The Hardness Factor (Harper Collins).
Lee, M.S. BJU International, Feb. 23, 2009.
McCullough, Andrew. NYU Langone Medical Center.
Shabsigh, Ridwan, et al. “A Multicenter, Double-blind, Placebo-controlled Trial to Assess The Efficacy of Sildenafil Citrate in Men With Unrecognized Erectile Dysfunction.” Urology 76.2 Aug. 2010: 373-379. Stanislov, R. Journal of Sex & Marital Therapy 29 (2003): 207-213.
Tamler, Ronal. Men's Health Program, Mount Sinai Medical Center, New York City.
Treatment for Erectile Dysfunction | NIDDK
You can work with a health care professional to treat an underlying cause of your erectile dysfunction (ED). Choosing an ED treatment is a personal decision. However, you also may benefit from talking with your partner about which treatment is best for you as a couple.
Your health care professional may suggest that you make lifestyle changes to help reduce or improve ED. You can
You can seek help from a health professional if you have trouble making these changes on your own.
Go to counseling
Talk with your doctor about going to a counselor if psychological or emotional issues are affecting your ED. A counselor can teach you how to lower your anxiety or stress related to sex.
Your counselor may suggest that you bring your partner to counseling sessions to learn how to support you.
As you work on relieving your anxiety or stress, a doctor can focus on treating the physical causes of ED.
Your counselor may suggest that you bring your partner to counseling sessions to learn how to support you.
Change your medicines
If a medicine you need for another health condition is causing ED, your doctor may suggest a different dose or different medicine. Never stop taking a medicine without speaking with your doctor first. Read about which medicines make it more ly that you’ll develop ED.
Prescribe medicines you take by mouth
A health care professional may prescribe you an oral medicine, or medicine you take by mouth, such as one of the following, to help you get and maintain an erection:
All of these medicines work by relaxing smooth muscles and increasing blood flow in the penis during sexual stimulation.
You should not take any of these medicines to treat ED if you are taking nitrates to treat a heart condition. Nitrates widen and relax your blood vessels.
The combination can lead to a sudden drop in blood pressure, which may cause you to become faint or dizzy, or fall, leading to possible injuries.
Also talk to your health care professional if you are taking alpha-blockers to treat prostate enlargement. The combination of alpha-blockers and ED medicines also could cause a sudden drop in blood pressure.
A health care professional may prescribe testosterone if you have low levels of this hormone in your blood. Although taking testosterone may help your ED, it is often unhelpful if your ED is caused by circulatory or nerve problems. Taking testosterone also may lead to side effects, including a high red blood cell count and problems urinating.
Testosterone treatment also has not been proven to help ED associated with age-related or late-onset hypogonadism. Do not take testosterone therapy that hasn’t been prescribed by your doctor. Testosterone therapy can affect how your other medicines work and can cause serious side effects.
A health care professional may prescribe you an oral medicine to help you get and maintain an erection.
Prescribe injectable medicines and suppositories
Many men get stronger erections by injecting a medicine called alprostadil into the penis, causing it to become filled with blood. Oral medicines can improve your response to sexual stimulation, but they do not trigger an automatic erection injectable medicines do.
Instead of injecting a medicine, some men insert a suppository of alprostadil into the urethra. A suppository is a solid piece of medicine that you insert into your body where it dissolves. A health care professional will prescribe a prefilled applicator for you to insert the pellet about an inch into your urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes.
Discuss alternative medicines
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.
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.
How will side effects of erectile dysfunction medicines affect me?
ED medicines that you take by mouth, through an injection, or as a pellet in the urethra can have side effects, including a lasting erection known as priapism. Call a health care professional right away if an erection lasts 4 hours or longer.
A small number of men have vision or hearing loss after taking oral ED medicines. Call your health care professional right away if you develop these problems.
Prescribe a vacuum device
A vacuum device causes an erection by pulling blood into the penis. The device has three parts:
- a plastic tube, which you put around your penis
- a pump, which draws air the tube, creating a vacuum
- an elastic ring, which you move from the end of the tube to the base of your penis as you remove the tube
The elastic ring maintains the erection during intercourse by preventing blood from flowing back into your body. The elastic ring can remain in place up to 30 minutes. Remove the ring after that time to bring back normal circulation and to prevent skin irritation.
You may find that using a vacuum device requires some practice or adjustment. Using the device may make your penis feel cold or numb and have a purple color. You also may have bruising on your penis. However, the bruises are most often painless and disappear in a few days. Vacuum devices may weaken ejaculation but, in most cases, the devices do not affect the pleasure of climax, or orgasm.
A vacuum device causes an erection by pulling blood into the penis.
For most men, surgery should be a last resort. Talk with your doctor about whether surgery is right for you. A urologist performs surgery at a surgical center or hospital to
- implant a device to make the penis erect
- rebuild arteries to increase blood flow to the penis
Implanted devices. Implanted devices, known as prostheses, can help many men with ED have an erection. Implants are typically placed by a urologist. The two types of devices are
- inflatable implants, which make your penis longer and wider using a pump in the scrotum
- malleable implants, which are rods that allow you to manually adjust the position of your penis
You usually can leave the hospital the day of or day after the surgery. You should be able to use the implant 4 to 6 weeks after the surgery.
Once you have either implant, you must use the device to get an erection. Possible problems with implants include breaking and infection.
Artery reconstruction. Surgery to repair arteries can reverse ED caused by blockages that stop blood flow to the penis. Usually men younger than 30 are the best candidates for this type of surgery.
8 Natural Cures for Erectile Dysfunction
Erectile dysfunction (ED), or impotence, is a major challenge for many men today regardless of their age — young, middle-aged, or old. Because erectile dysfunction may be caused by many factors — a health condition, emotional or relationship problems, some kinds of medication, smoking, drugs, or alcohol — an erectile dysfunction cure is possible.
Though erectile dysfunction treatment options may include ED medication and surgery, there are also noninvasive erectile dysfunction remedies that may help.
According to Mayo Clinic, men with erectile dysfunction may experience some or all of these persistent symptoms:
- Reduced sexual desire
- Trouble getting an erection
- Trouble keeping an erection
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.
The causes of erectile dysfunction are many, including physical problems diabetes, heart disease, obesity, high blood pressure, high cholesterol, and even sleep disorders. Medication taken for health conditions can result in erectile dysfunction, as can alcohol and smoking.
But erectile dysfunction is also caused by mental health problems, such as anxiety, depression, stress, and trouble with relationships. That’s why visiting a medical doctor for erectile dysfunction treatment is so valuable.
If ignored, erectile dysfunction can lead to complications, such as an unsatisfactory sex life, low self-esteem, high anxiety, and relationship problems. Getting a partner pregnant also becomes difficult if a man suffers with erectile dysfunction.
A study published in May 2014 in The Journal of Sexual Medicine found that some men can reverse erectile dysfunction with healthy lifestyle changes, such as exercise, weight loss, a varied diet, and good sleep. The Australian researchers also showed that even if erectile dysfunction medication is required, it's ly to be more effective if you implement these healthy lifestyle changes.
For men searching for ED medication, there are many newer erectile dysfunction treatments (all prescription drugs) that help you get an erection firm enough to have sex, and most have few side effects.
Commonly prescribed erectile dysfunction treatments include:
If you need erectile dysfunction treatment, talk with your doctor today.
“There are many lifestyle changes that are erectile dysfunction remedies, but among them, exercise is the ED treatment that can have the greatest impact,” says Zachary R. Mucher, MD, a urologist in Sugar Land, Texas. “Exercise works on several fronts to combat the development of ED and help reverse it once it has become a problem.”
Exercise improves blood flow, which is vitally important to a strong erection, and improves blood pressure by increasing nitric oxide in blood vessels, which he says is exactly how Viagra works. Weight-bearing exercise can increase the natural production of testosterone, a significant factor in erectile strength and sex drive.
The foods you eat can have a direct impact on erectile dysfunction, Dr. Mucher says. A diet rich in fruit, veggies, whole grains, and fish, and with fewer servings of red meat and refined grains, decreases the risk for ED.
A healthy diet also helps to maintain a healthy body weight, which is important because men who have a 42-inch waist are 50 percent more ly to have ED than men with a 32-inch waist. Also, obesity increases the risk for vascular disease and diabetes, two factors that contribute to ED.
How Erectile Dysfunction Is Treated
Erectile dysfunction (ED) is a common sexual disorder for which there are several treatment options. These range from taking medication or using a device to counseling, lifestyle changes, and natural remedies.
After a careful assessment of the pluses and minuses of each therapy (and often, a trial and error process), you and your doctor can choose the treatment or combination of treatments that is uniquely right for you.
It's important to keep in mind that when ED is a complication of an underlying chronic condition, such as high blood pressure or diabetes, the most effective initial treatment approach will ly involve focusing on the underlying health problem itself.
A variety of personal habits and lifestyle choices have been linked to ED. In some ways, this is a good thing, since habits can be altered and choices reconsidered.
What's more, many of the lifestyle factors that contribute to sexual problems are ones that affect overall health and well-being, both physical and mental. Addressing these factors, therefore, can have benefits beyond improving erectile dysfunction.
Regular physical activity improves blood circulation and decreases the risk of heart disease, diabetes, and obesity, all of which can have an impact on sexual function.
In fact, research shows that men who exercise more in midlife have a 70% lower risk of erectile dysfunction than sedentary men. In addition to preventing ED, physical activity has been found to improve ED.
Excess body fat may play a role in erectile dysfunction by promoting inflammation and converting testosterone to estrogen. According to one study, a third of obese men with erectile dysfunction regained sexual function after participating in a two-year weight loss program.
Smoking affects circulation in ways that can inhibit blood flow to the penis and affect the ability to achieve or sustain an erection. This is why male smokers are at an increased risk of developing ED, regardless of their age or underlying medical conditions.
That said, it remains unclear whether stopping smoking once a person has started will necessarily improve ED. Research suggests this may be only true in younger men who have a limited smoking history.
Regardless, smoking cessation has many other health benefits, such as reducing heart disease and diabetes—two major causes of ED.
People who eat diets rich in whole-grain foods, vegetables, and fruits and low in red meat, full-fat dairy products, and sugary foods and drinks have a reduced risk of ED.
Similar to smoking, adopting healthy eating habits has other health benefits too, especially with regards to improving your heart health.
Research has found that moderate alcohol intake (less than 21 drinks per week) may protect against ED—possibly because, in the long-term, alcohol can raise high-density lipoprotein (HDL or “good cholesterol”). There is still debate about whether excessive alcohol consumption negatively impacts ED.
Perhaps a less obvious lifestyle strategy is to see your dentist for regular teeth care. This is because, according to a review article of five studies involving more than 200,000 men, chronic gum disease (periodontitis) might be associated with a more than twofold increase in the risk of erectile dysfunction.
The oral medications for erectile dysfunction—phosphodiesterase-5 (PDE5) inhibitors—work by enhancing the effects of nitric oxide, a naturally-occurring substance that relaxes blood vessels to allow blood to flow into the penis. With this effect in place, it's possible to get an erection in response to sexual stimulation and to sustain it.
- Viagra (sildenafil): May be effective within 30 to 60 minutes can last up to 12 hours
- Cialis (tadalafil): May be effective within 60 to 120 minutes and may last up to 36 hours
- Levitra or Staxyn (vardenafil): May be effective within 30 to 60 minutes and can last up to 10 hours
- Stendra (avanafil): May be effective within 15 to 30 minutes and can last up to 12 hours
Keep in mind—for Viagra, Levitra, and Stendra—eating a high-fat meal may delay the absorption of the drug, which can prolong the time it takes to get an erection and diminish the drug's overall effectiveness.
In addition, PDE5 inhibitors do have some potential side effects—for example, flushing, headache, dyspepsia, and nasal congestion. They also cannot be taken with nitrates or Adempas (riociguat), a medication used to treat pulmonary hypertension.
Be sure to talk about PDE5 inhibitors with your doctor, making sure that they know your entire medical history and all other medications and supplements that you take.
If a PDE5 inhibitor is ineffective or contraindicated, 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.
Get our printable guide for your next doctor's appointment to help you ask the right questions.
A doctor may prescribe testosterone replacement therapy if a man is found to have a low testosterone level, along with bothersome symptoms, such as low libido and ED.
That said, testosterone deficiency is uncommonly the primary cause of ED. Before you take testosterone, your doctor will have you tested to make sure that you do indeed have a deficiency.
Taking a step back, besides taking a prescription, it's equally if not more important to first review your current list of medications with your doctor. It is very possible that one or more of them may be causing or contributing to your erectile dysfunction.
While you may not necessarily be able to stop that medication, recognizing it as a potential culprit may at least help you and your doctor understand the “why” behind your erectile dysfunction.
Medications that classically cause erectile dysfunction as a side effect are antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), such as Zoloft (sertraline).
Other potential medications linked to erectile dysfunction include certain blood pressure medications and pain medications.
A mechanical device may be worth trying if medication and other interventions don't work.
One option is a vacuum pump, a plastic tube that is placed over the penis. When air is sucked the tube it creates pressure that causes blood to be forced into the penis. A ring can then be temporarily placed at the base of the penis to stop the blood from draining away too quickly.
A penile implant is another option, of which there are two types. One of them, called a semi-rigid penis implant, keeps the penis erect all the time, though it can be bent downward when you aren't having sex. The other type, an inflatable penis implant, includes a pump that's implanted in the scrotum and can be squeezed in order to make the penis erect.
While not a conventional therapy, an emerging treatment for erectile dysfunction is low-intensity shockwave therapy. This treatment entails delivering sound waves to the penis, which is believed to ultimately increase blood flow and, thus, improve erectile dysfunction.
Research suggests that combining a psychological intervention with medication improves sexual satisfaction and symptoms of erectile dysfunction better than either therapy alone.
This makes sense considering that even though ED is most often caused by a medical condition (e.g., heart disease or high blood pressure), stress and mental health problems, such as anxiety and depression, can exacerbate it.
Moreover, suffering from ED often has emotional consequences, which may negatively impact relationships or a person's self-esteem.
If you are considering therapy for ED, be sure to see a certified sexual therapist. You may also consider group psychotherapy, which has been shown to be beneficial for men with ED or going to psychotherapy with a sensate focus with your partner.
Research has found that, to some extent, acupuncture can improve ED. While the precise mechanism remains unclear, experts suspect that acupuncture may help regulate nerve sensitivity and improve blood flow to the penis.
There are lots of herbs and nutritional supplements claiming to improve sexual function in general and to treat ED in particular. However, there's very little research to prove that any of them actually work. Options red Korean ginseng, L-arginine, L-carnitine, zinc, and niacin all have potential side effects when taken in high doses.
In addition, when research has shown a nutrient such as zinc or niacin to improve sexual function, it's usually in people who are deficient in it. So, before you stock up on over-the-counter supplements for ED, speak with your doctor. They can test you for deficiencies and steer you toward the most effective and safest way to treat your erectile dysfunction.
There are obviously a lot of treatment options available for ED, which in no small part is due to the fact that a healthy sex life is important for many people's sense of well-being.
That said, try not to get overwhelmed with all the different choices.
It may take a bit of time and patience on your part, but under the guidance of your doctor, you can find the treatment that works best for you.
Erectile dysfunction: Treatments and causes
A man is considered to have erectile dysfunction if he regularly finds it difficult getting or keeping a firm enough erection to be able to have sex, or if it interferes with other sexual activity.
Most men have occasionally experienced some difficulty with their penis becoming hard or staying firm. However, erectile dysfunction (ED) is only considered a concern if satisfactory sexual performance has been impossible on a number of occasions for some time.
Since the discovery that the drug sildenafil, or Viagra, affected penile erections, most people have become aware that ED is a treatable medical condition.
Men who have a problem with their sexual performance may be reluctant to talk with their doctor, seeing it can be an embarrassing issue.
However, ED is now well understood, and there are various treatments available.
This MNT Knowledge Center article offers helpful information for people experiencing this problem, or those close to them.
- Erectile dysfunction (ED) is defined as persistent difficulty achieving and maintaining an erection sufficient to have sex.
- Causes are usually medical but can also be psychological.
- Organic causes are usually the result of an underlying medical condition affecting the blood vessels or nerves supplying the penis.
- Numerous prescription drugs, recreational drugs, alcohol, and smoking, can all cause ED.
Normal erectile function can be affected by problems with any of the following systems:
- blood flow
- nerve supply
Share on PinterestErectile dysfunction can cause embarrassment.
It is always worth consulting a physician about persistent erection problems, as it could be caused by a serious medical condition.
Whether the cause is simple or serious, a proper diagnosis can help to address any underlying medical issues and help resolve sexual difficulties.
The following list summarizes many of the most common physical or organic causes of ED:
Atherosclerosis is a common cause of blood flow problems. Atherosclerosis causes a narrowing or clogging of arteries in the penis, preventing the necessary blood flow to the penis to produce an erection.
Numerous prescription medications can also cause ED, including those below. Anyone taking prescription medications should consult their doctor before stopping or changing their medications:
- drugs to control high blood pressure
- heart medications such as digoxin
- some diuretics
- drugs that act on the central nervous system, including some sleeping pills and amphetamines
- anxiety treatments
- antidepressants, including monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants
- opioid painkillers
- some cancer drugs, including chemotherapeutic agents
- prostate treatment drugs
- hormone drugs
- the peptic ulcer medication cimetidine
Physical causes account for 90 percent of ED cases, with psychological causes much less common.
In rare cases, a man may always have had ED and may never have achieved an erection. This is called primary ED, and the cause is almost always psychological if there is no obvious anatomical deformity or physiological issue. Such psychological factors can include:
- fear of intimacy
- severe anxiety
Most cases of ED are ‘secondary.’ This means that erectile function has been normal, but becomes problematic. Causes of a new and persistent problem are usually physical.
Less commonly, psychological factors cause or contribute to ED, with factors ranging from treatable mental health illnesses to everyday emotional states that most people experience at some time.
It is important to note that there can be overlap between medical and psychosocial causes. For instance, if a man is obese, blood flow changes can affect his ability to maintain an erection, which is a physical cause. However, he may also have low self-esteem, which can impact erectile function and is a psychosocial cause.
Does riding a bicycle cause ED?
Questions remain about the effects on men’s health of riding a bicycle.
Some research has raised concerns that men who regularly cycle for long hours could have a higher risk of ED, in addition to other men’s health issues such as infertility and prostate cancer.
The most recent study to investigate this found that there was no link between riding a bike and ED, but it did find an association between longer hours of cycling and the risk of prostate cancer.
Prostate disease and ED
Prostate cancer does not cause ED.
However, prostate surgery to remove the cancer and radiation therapy to treat prostate cancer can cause ED.
Treatment of non-cancerous, benign prostate disease can also cause the condition.
The good news is that there are many treatments for ED, and most men will find a solution that works for them. Treatments include:
Men can take a group of drugs called PDE-5 (phosphodiesterase-5) inhibitors.
Most of these pills are taken 30 to 60 minutes before sex – the best known being the blue-colored pill sildenafil (Viagra). Other options are:
- vardenafil (Levitra)
- tadalafil (taken as a once-daily pill called Cialis)
- avanafil (Stendra)
PDE-5 inhibitors are only available on prescription. A doctor will check for heart conditions and ask about other medications being taken before prescribing.
Side-effects associated with PDE-5 inhibitors include:
- visual abnormalities
- hearing loss
Less commonly used drug options include prostaglandin E1, which is applied locally by either injecting it into the penis or inserting it down the opening of the urethra.
Most men prefer a pill, however, so these locally acting drugs tend to be reserved for men who cannot take oral treatment.
It is possible to buy treatment over the internet for ED. However, caution is advised.
The United States (U.S.) Food and Drug Administration (FDA) has a consumer safety guide about this, including a recommendation to check that the online pharmacy:
- is located in the U.S. and licensed
- has a licensed pharmacist to answer questions.
- requires a prescription.
- offers direct contact with a person who can discuss any problems.
You can check whether the pharmacy is licensed using this list of Verified Internet Pharmacy Practice Sites (VIPPS).
The FDA also offers tips for spotting the dangers of an unsafe website, including watching out for the following clues:
- There is no way to contact the website by phone.
- Prices are dramatically lower than those offered by legal online pharmacies.
- Prescription drugs are offered without requiring a prescription – which is illegal.
- Personal information is not protected.
The FDA adds that these illegal sites may send drugs of unknown quality and origin, even sending the wrong drug or a dangerous product.
Vacuum erection devices are a mechanical way of producing an erection for men who do not want or cannot use drug treatments, or find they are not working.
The penis is made rigid by the use of a vacuum pump sealed around it that draws up blood. This is prevented from then leaving the penis by the use of an accompanying band.
The lack of spontaneity with the use of vacuum devices means that many men find other treatments for ED preferable.
There are several surgical treatment options:
- Penile implants: These are a final option reserved for men who have not had any success with drug treatments and other non-invasive options.
- Vascular surgery: Another surgical option for some men is vascular surgery, which attempts to correct some blood vessel causes of ED.
Surgery is a last resort and will only be used in the most extreme cases. Recovery time varies, but success rates are high.
Do dietary supplements and alternative treatments work?
The short answer is “no.”
No guidelines followed by doctors, nor any established sources of evidence, support the use of dietary supplements, such as herbal pills.
In addition to there being no evidence in favor of non-prescription alternatives for ED, the FDA has warned of hidden risks of “treatments” sold online.
Men may not always successfully achieve an erection, and if this rarely happens, it is not considered a medical problem.
However, ED does not only refer to a complete inability to achieve an erect penis. Symptoms can also include struggling to maintain an erection for long enough to complete intercourse or an inability to ejaculate.
There are often also emotional symptoms, such as embarrassment, shame, anxiety, and a reduced interest in sexual intercourse.
A man is considered to have ED when these symptoms occur regularly.
There are exercises a man can carry out to reduce the effects of ED.
The best way to treat erectile dysfunction without medication is by strengthening the pelvic floor muscles with Kegel exercises. These are often associated with women looking to strengthen their pelvic area during pregnancy, but they can be effective for men looking to regain full function of the penis.
Firstly, find the pelvic floor muscles. You can achieve this by stopping mid-stream two or three times the next time you urinate. The muscles you can feel working during this process are the pelvic floor muscles, and they will be the focus of Kegel exercises.
One Kegel exercise consists of tightening and holding these muscles for 5 seconds and then releasing them. Try to do between 10 and 20 repetitions each day. This may not be possible when you first start doing the exercises. However, they should become easier over time.
You should be able to notice an improvement after 6 weeks.
Make sure you are breathing naturally throughout this process and avoid pushing down as if you are forcing urination. Instead, bring the muscles together in a squeezing motion.
Aerobic exercise, such a jog or even a brisk walk, can also help the blood to circulate better and can help improve ED in men who have circulation issues.
The numerous potential causes of ED mean that a doctor will typically ask a lot of questions and arrange for blood tests to be performed. Such tests can check for heart problems, diabetes, and low testosterone, among other things. The doctor will also carry out a physical examination, including of the genitals.
Before considering a diagnosis that requires treatment, a doctor will look for symptoms that have persisted for at least 3 months.
Once a medical history has been established, a doctor will then undertake further investigation. One simple test, known as the ‘postage stamp test,’ can be helpful in determining if the cause is physical rather than psychological.
Men usually have 3 to 5 erections a night. This test checks for the presence of erections at night by seeing if postage stamps applied around the penis before sleep have snapped off overnight. Other tests of nocturnal erection include the Poten test and Snap-Gauge test.
These methods provide limited information but can help guide a doctor’s choice of further tests.