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Erectile Dysfunction

Also indexed as: Impotence

Illustration

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:

What you need to know

  • 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 certain medications
  • 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 atherosclerosis, diabetes, hypothyroidism, multiple sclerosis, and chronic alcohol abuse.

Product ratings for erectile dysfunction

Science Ratings Nutritional Supplements Herbs
3Stars  

Asian ginseng

Yohimbe

2Stars

Arginine

DHEA

L-carnitine plus acetyl-L-carnitine

Pycnogenol®

Butea superba

Ginkgo biloba (for ED of vascular origin)

Horny goat weed

1Star  

Damiana

See also:  Homeopathic Remedies for ED
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

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.

Medical options

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 benefit.

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 weeks.14

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.

References:

1. Hernández-López C. Drugs do not only relieve male menopause. BMJ 2000;321:451 [letter].

2. Condra M, Morales A, Owen JA, et al. Prevalence and significance of tobacco smoking in impotence. Urology 1986;27:495–8.

3. Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 2004;291:2978–84.

4. Reiter WJ, Pycha A, Schatzl G, et al. Dehydroepiandrosterone in the treatment of erectile dysfunction: a prospective, double-blind randomized, placebo-controlled study. Urology 1999;53:590–5.

5. Zorgniotti AW, Lizza EF. Effect of large doses of the nitric oxide precursor, L-arginine, on erectile dysfunction. Int J Impot Res 1994;6:33–6.

6. Chen J, Wollman Y, Chernichovsky T, et al. Effect of oral administration of high-dose nitric oxide donor L-arginine in men with organic erectile dysfunction: results of a double-blind, randomized study. BJU Int 1999;83:269–73.

7. Cavallini G, Caracciolo S, Vitali G, et al. Carnitine versus androgen administration in the treatment of sexual dysfunction, depressed mood, and fatigue associated with male aging. Urology 2004;63:641–6.

8. Durackova Z, Trebaticky B, Novotny V, et al. Lipid metabolism and erectile function improvement by Pycnogenol®, extract from the bark of Pinus pinaster in patients suffering from erectile dysfunction—a pilot study. Nutr Res 2003;23:1189–98.

9. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: A systematic review and meta-analysis of randomized clinical trials. J Urol 1998;159:433–6.

10. Carey MP, Johnson BT. Effectiveness of yohimbine in the treatment of erectile disorder: Four meta-analytic integrations. Arch Sex Behav 1996;25:341.

11. Kunelius P, Häkkinen J, Lukkarinen O. Is high-dose yohimbine hydrochloride effective in the treatment of mixed-type impotence? A prospective, randomized, controlled double-blind crossover study. Urol 1997;49:441–4.

12. Mann K, Klingler T, Noe S, et al. Effect of yohimbine on sexual experiences and nocturnal tumescence and rigidity in erectile dysfunction. Arch Sex Behav 1996;25:1–16.

13. Choi HK, Seong DH, Rha KH. Clinical efficacy of Korean red ginseng for erectile dysfunction. Int J Impotence Res 1995;7:181–6.

14. Hong B, Ji YH, Hong JH, et al. A double-blind crossover study evaluating the efficacy of Korean red ginseng in patients with erectile dysfunction: a preliminary report. J Urol 2002;168:2070–3.

15. Cherdshewasart W, Nimsakul N. Clinical trial of Butea superba, an alternative herbal treatment for erectile dysfunction. Asian J Androl 2003;5:243–6.

16. Sohn M, Sikora R. Ginkgo biloba extract in the therapy of erectile dysfunction. J Sec Educ Ther 1991;17:53–61.

17. Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther 1998;24:139–43.

18. Liao HJ, Chen XM, Li WG. Effect of Epimedium sagittatum on quality of life and cellular immunity in patients of hemodialysis maintenance. Zhongguo Zhong Xi Yi Jie He Za Zhi 1995;15:202–4 [in Chinese].

19. Aydin S, Ercan M, Çaskurlu T, et al. Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction. Scand J Urol Nephrol 1997;31:271–4.

20. Kho HG, Sweep CG, Chen X, et al. The use of acupuncture in the treatment of erectile dysfunction. Int J Impot Res 1999;11:41–6.

21. Yaman LS, Kilic S, Sarica K, et al. The place of acupuncture in the management of psychogenic impotence. Eur Urol 1994;26:52–5.

22. Aydin S, Ercan M, Caskurlu T, et al. Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction. Scand J Urol Nephrol 1997;31:271–4.

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