Also indexed as: Impotence
Learn more about the cause of erectile dysfunction to overcome
this sensitive condition. According to research or other evidence, the following self-care
steps may be helpful:
- Quit smoking
- Men who smoke have an increased ED risk
- Check out Asian ginseng
- 900 mg of a concentrated herbal extract two or three times a day
may improve libido and ability to maintain erection
- Give ginkgo a go
- Take 240 mg a day of a standardized herbal extract to increase
blood flow to the penis
- Try yohimbe and DHEA
- With the help of a doctor experienced in these treatments, take an
herbal extract of yohimbe containing 15 to 30 mg a day of yohimbine to increase blood flow, or
50 mg a day of the supplement dehydroepiandrosterone to improve hormone levels
- Get a checkup
- ED can be caused by some diseases and may be a side effect of
- Consider counseling
- Psychological issues can be a cause, or an effect, of ED
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full erectile dysfunction
article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and
dietary and lifestyle changes that may be helpful.
About erectile dysfunction
Erectile dysfunction (ED) is the inability of a male to attain or sustain an erection
sufficient for sexual intercourse.
It can be a persistent condition; however, almost half of all men experience ED only
occasionally. ED can have physical, psychological, or drug-induced causes.1
Although some doctors used to believe differently, most researchers and doctors now believe
that physical factors are responsible for the majority of ED cases.
Several conditions may contribute to ED by impairing blood flow to the penis. These include
hypothyroidism, multiple sclerosis, and
chronic alcohol abuse.
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What are the symptoms?
ED is defined by the symptoms listed above. Symptoms may also include loss of sexual desire
(libido), premature ejaculation, or inability to achieve orgasm.
Prescription drug treatments for ED include male hormone replacement therapy, such as
testosterone (Delatestryl® Injection, Depo-Testosterone® Injection, Androderm®
Patch, Testoderm® Patch), and dehydroepiandrosterone (DHEA), as well as inhibitors of phosphodiesterase type
5, such as sildenafil (Viagra®),
tadalafil (Cialis®), and vardenafil (Levitra®). Other treatments include yohimbine
(Yocon®), and alprostadil (Caverject®, Muse®), which is inserted or injected
into the penis.
Depending on the cause, therapy may include psychological and behavioral counseling,
treatment of underlying cardiovascular
disease, and avoidance of medications such as
cimetidine, antihypertensives, and MAO inhibitors. Penile vacuum devices and surgical
options, such as penile implants and vascular repair, are usually limited to those who have
not responded to other treatments.
Lifestyle changes that may be helpful
Men who smoke have been shown to have an increased incidence of ED.2
In a study of obese men with erectile dysfunction, a two-year lifestyle program consisting
of a low-calorie diet plus regular exercise resulted in a significant improvement in erectile
function, which became normal in 31% of the participants.3
Vitamins that may be helpful
Low blood levels of the hormone dehydroepiandrosterone (DHEA) have been reported in some men with ED. In one
double-blind trial, 40 men with low DHEA levels and ED were given 50 mg DHEA per day for six
months.4 Significant improvement in both erectile function and interest in sex
occurred in the men assigned to take DHEA, but not in those assigned to take placebo. No
significant change occurred in testosterone levels or in factors that could affect the
prostate gland. Experts have concerns about the safe use of DHEA, particularly because
long-term safety data do not exist.
Dilation of blood vessels necessary for a normal erection depends on a substance called
nitric oxide, and nitric oxide formation depends on the amino acid arginine. In a preliminary trial, men with ED were
given 2,800 mg of arginine per day for two weeks. Six of the 15 men in the trial were helped,
though none improved while taking placebo.5 In a larger double-blind trial, men
with ED were given 1,670 mg of arginine per day or a matching placebo for six
weeks.6 Arginine supplementation was found to be particularly effective at
improving ED in men with abnormal nitric oxide metabolism. Although little is known about how
effective arginine will be for men with ED or which subset of these men would be helped,
available research looks promising and suggests that at least some men are likely to
In a double-blind study, supplementing with the combination of propionyl-L-carnitine (a
form of L-carnitine) and acetyl-L-carnitine (2 grams of each per day) for six
months significantly improved erectile function in elderly men with erectile dysfunction
associated with low testosterone levels. Propionyl-L-carnitine and acetyl-L-carnitine were
significantly more effective than testosterone treatment.7
In a double-blind study of men with erectile dysfunction, supplementing with 120 mg per day
of Pycnogenol®, an extract of the bark of a certain tree (Pinus pinaster),
improved erectile function, whereas placebo treatment had no effect.8
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
Yohimbine (the primary active constituent in
yohimbe) has been shown in several double-blind trials to help treat men with
ED;9 10 negative results have also been reported, however.11
12 Yohimbe dilates blood vessels and may help, regardless of the cause of ED. A
tincture of yohimbe bark is often used in the amount of 5 to 10 drops three times per day.
Standardized yohimbe extracts are also available. A typical daily amount of yohimbine is 15 to
30 mg. It is best to use yohimbe and yohimbine under the supervision of a physician.
Asian ginseng (Panax ginseng)
has traditionally been used as a supportive herb for male potency. A double-blind trial found
that 1,800 mg per day of Asian ginseng extract for three months helped improve libido and the
ability to maintain an erection in men with ED.13 The benefit of Asian ginseng
confirmed in another double-blind study, in which 900 mg three times a day was given for eight
Butea superba is a Thai plant that has been used traditionally to increase sexual
vigor. In a preliminary trial, 82% of men with erectile dysfunction reported an improvement in
erectile function while taking Butea superba for three months.15 The
amount used was 500 mg per day for the first four days, followed by 1,000 mg per day
thereafter. The response rate in the placebo group could not be evaluated, because none of the
men receiving the placebo returned for their follow-up visit.
Ginkgo biloba may help some men
with ED by increasing blood flow to the penis. One double-blind trial found improvement in men
taking 240 mg per day of a standardized Ginkgo biloba extract (GBE) for nine
months.16 A preliminary trial, involving 30 men who were experiencing ED as a
result of medication use (selective serotonin reuptake inhibitors and other medications),
found that approximately 200 mg per day of GBE had a positive effect on sexual function in 76%
of the men.17
Horny goat weed has long been used in
traditional Asian medicine for people with sexual difficulties. It is almost always prescribed
in conjunction with other herbs to improve its efficacy and to prevent side effects. People
with kidney failure being treated with dialysis had improved sex drive after taking horny goat
weed, compared with a similar group not given horny goat weed.18
Damiana (Turnera diffusa) is
a traditional herbal treatment for men with ED. However, no modern clinical trials have
confirmed its effectiveness.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
Holistic approaches that may be helpful
ED that cannot be linked to physical causes has been successfully treated by hypnosis.19 In one trial, three hypnosis
sessions per week, later decreased to one per month, over a six-month period led to
improvement in 75% of men in the trial.
Acupuncture might be of some benefit for
men with ED. Electroacupuncture, which is acupuncture accompanied by electrical stimulation,
was performed on various acupuncture points in men with ED in a preliminary trial of men with
this condition.20 Two treatments were administered every week for one month. An
improvement in quality of erection was observed in 15% of the participants and an increase in
sexual activity was reported by 31% of the men. Another preliminary trial21 found
good results in over half of the men treated, but the only controlled trial of
electroacupuncture for ED22 found that placebo also produced a large improvement in
sexual function—an effect similar to that of acupuncture. Controlled trials with larger
groups of men are necessary to better test the efficacy of acupuncture therapy for men
suffering from ED.
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