It has been suggested that approximately 40% of men experience erectile dysfunction (ED) at least occasionally. The cause can be functional or psychological, and these two types are treated differently.
Proper erectile function involves the brain, hormones, muscles, nerves and blood vessels. It is easy to see that problems could originate at many different levels.
Fatigue, stress, relationship issues, performance anxiety, or alcohol consumption can contribute to erectile problems., especially those of a temporary nature. A diagnosis of erectile dysfunction is only made if the problem lasts more than a few weeks or months. Common underlying causes include: heart disease, diabetes, poor physical health, obesity, multiple sclerosis, smoking Parkinson’s disease, enlarged prostate for prostate surgery. Basically, any disease that damages the nerves or blood vessels can affect erectile function. Treating the underlying cause, when one is identified, can often correct the problem. Dysfunction can also be associated with bicycling, and this is believed to be due to compression of nerves and blood vessels in the groin area.
If normal nighttime or early morning erections occur, this supports a diagnosis of a psychological cause, although there still may be a physiological (or physical) cause. Patients with psychological dysfunction often have a high response to a placebo (or sham medication) – nice to think that the problem might be fixed by simply taking a sugar pill, if you believe it will work!
Standard Treatments
The first line medical therapy is the”PDE5 inhibitor” class of drugs (Viagra, Cialis and others). These drugs block the breakdown of nitric oxide, a substance that dilates blood vessels, resulting in increased blood flow to the penis. Penile injection of vasodilators plus prostaglandin can be highly effective when these drugs fail, or in situations where nerve supply to the area has been damaged (such as in paraplegia).
Penile vacuum pumps (think of the first Austin Myers movie, where he claims “That’s not mine!”) can also be effective when used just before sexual activity. The specially designed pump draws blood into the penis creating an erection, and a special rubber band maintains it for a period of time. These pumps can be obtained through your urologist or can be ordered for you by a pharmacist.
Penile implants or blood vessel surgery are also available and may help in some cases but are more invasive and higher risk.
Natural treatments
Panic ginseng (also known as red ginseng) 600 to 1000 mg three times a day appears to show the most benefit in studies. Ginseng has been noted to raise blood pressure, however, so caution is advised in patients whose blood pressure is elevated.
Rhodiola 150 to 200 mg daily showed evidence in one study and has a long history of use in Russia.
DHEA, a hormone in the androgen class, is more likely to be helpful if the patient is low in hormone production. Although it is non-RX in US, it requires a prescription in Canada, and would need to be obtained from a compounding pharmacy.
L-arginine 3500 to 5000mg (or 3.5 - 5g) taken one hour before needed or in a lower dose taken daily, helps increase production of nitric oxide which relaxes blood vessels (note: Viagra-type drugs reduce breakdown of nitric oxide). L-arginine is reported to work better when combined with pycnogenol, a proprietary extract of pine bark. Tea, grapes,wine, juice and berries contain small amounts of proanthocyanidins similar to those in pycnogenol. L-arginine is an amino acid found in high protein foods, such as turkey (especially the breast meat [16g per breast], pork [14g per rib] and chicken [9g per breast]. So, it sounds like a glass of wine with a nice meal of turkey, chicken or pork just might be helpful for ED!
Acupuncture was found to benefit 20 to 40% of patients in one study. A series of regular treatments would be required to see benefit.
Zinc supplements are reported to help but only if low in zinc.
Yohimbe supplements have shown improvement especially in cases where erectile dysfunction is a side effect of medications (such as SSRI antidepressants, like paroxetine or sertraline). Note that yohimbe can increase blood pressure, heart rate and anxiety. Check with your doctor before taking.
L-citrulline supplements help the body make more l-arginine that, in turn, is metabolized into the vasodilator, nitric oxide. Note that L-citrulline can decrease blood pressure.
A number of “herbal Viagra” treatments marketed in North America have been found to contain unlabeled Viagra-like ingredients. US FDA warns that these contaminants are particularly common in products claiming to be ”as effective as Viagra”. Because of their range of side effects, this class of drug requires prescription and should only be used under a doctor’s supervision. In particular, heart patients who take nitrates are not recommended to use these, as the combination can cause dangerously low blood pressure. One way to detect these products would be to look where it was manufactured. Products made in North America are highly regulated and would be unlikely to contain dangerous contaminants.
And, a fun fact to finish off – In 16th and 17th century France, impotence was actually considered a crime and legal grounds for a divorce. Isn’t it fortunate that we have advanced since then!
References: Healthline.com; Wikipedia; WebMD.com
