Erectile dysfunction (ED) or Impotence is the inability of a male to attain or sustain an erection sufficient for intercourse. Almost half of all men experience impotence once at some point during their life, some experience it occasionally, but it can be a persistent condition as well for many men - some 20 million American men experience some regular form of impotence. That's one in four men over the age of 50. Impotence can have physical, psychological, or both factors as causes. Psychological counseling can be helpful if the impotence is related to emotional factors.
There are several physical contributors to impotence. Atherosclerosis, or hardening of the arteries is one of the more serious - erectile dysfunction may be the first warning sign that other important arteries in your body are clogging with cholesterol - this may signal a future heart attack or stroke! Similarly, diabetes, low thyroid function, a low testosterone level, multiple sclerosis, or what doctors sometimes call "venous leakage" of blood may be the cause of this problem. Regular use of even moderate amounts of alcohol can worsen this condition as can smoking cigarettes, or regular use of marijuana.
Certain medications can also be the culprit - especially in men over 50. More than 200 medications have been identified as problematic and in an American Medical Journal study of 188 men, medications were the problem 25 percent of the time.
CAUTION
Don't just buy supplements or medications on an internet site to fix this problem !
Erectile dysfunction may indicate other serious medical problems (like angina or an impending heart attack) in your future - you should always be evaluated by your primary care doctor before merely embarking on the use of supplements or medications to improve your problem!
Lifestyle changes
 | Alcohol - Limit or omit it. Too much of a "good time" can affect sexual performance. Worse, long-term alcohol use also has been associated with testicular atrophy, which can lead to increased estrogen and decreased testosterone. Studies have also linked alcohol use to benign prostatic hyperplasia (BPH), which can lead to prostate cancer. |
| Cigarettes - Quit smoking. Cigarettes constrict blood vessels everywhere in the body as well as in the penis and cause impotence. Nicotine has the exact opposite effect of L-arginine (below). So if your love life is important to you, ignore advertisements that depict smokers as sexy and desirable - neither is true – they will cause problems and then kill you! Remember that marijuana can do the same thing! |
| Exercise - Do it. Exercise has a tremendous positive impact on your sexual health. Men who exercise at least three to four times a week have sex more often. |
| Weight - Get it off. Excess weight may diminish blood flow to the penis, causing impotence. It also makes your cholesterol worse which causes clogging of the blood vessels and worsens impotence. |
| Cholesterol - Get it Down. Causes hardening of the arteries and increases risk of heart attacks and stroke. You can't have sex if you're under six feet of earth!! |
Nutritional and Natural Therapies
| Dilation of blood vessels necessary for a normal erection depends on a substance called nitric oxide. In turn, the amino acid L-Arginine is needed for nitric oxide formation. This nutrient, which works much like Viagra, is a fantastic alternative for the millions of men who can't take Viagra or who prefer to take a nutrient instead. |
| Low blood levels of the hormone DHEA (dehydroepiandrosterone) have been reported in some men with erectile dysfunction. In one double blind trial, forty men with low DHEA levels and impotence 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 DHEA but not in those assigned to 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. |
| Vitamin E has had a long-term reputation as a "sex vitamin". When male laboratory animals were deprived of vitamin E, their testicles shrank. In pregnant female animals with vitamin E deficiency, the fetuses were reabsorbed into the uterus, preventing the animals from bearing young. Giving the animals even a single drop of vitamin E–rich wheat germ oil restored their fertility. In fact, vitamin E got its scientific name, tocopherol, from this particular ability. It means "to bring forth offspring." A reasonable dosage on natural Vit E would be 400 IU - 200 IU twice daily with meals. More than this can increase bleeding potential, especially if you are taking prescription blood thinners – again, talk to your doctor! |
| Hypnosis has been used to successfully treat Impotence that cannot be linked to physical causes.1 In this trial, three hypnosis sessions per week were used initially, later decreasing to one per month during a six-month period. Three out of every four men in the trial were helped. |
Helpful Herbs
| Yohimbe dilates blood vessels, making this herb useful for treating male impotence and yohimbe has become a prominent herb for promoting sexual desire and performance. Yohimbine (the primary active constituent in yohimbe) has been shown in several double blind studies to help treat men with impotence;5,6 negative studies have also been reported.7,8 Somewhat surprisingly, yohimbe appears to help regardless of the cause of impotence. Today yohimbine is approved by the FDA for treatment of male impotence, whether due to vascular problems, diabetes, or psychogenic causes. The most commonly used forms of yohimbe are standardized products available for the treatment of impotence. A typical daily amount of yohimbine is 15–30 mg. A tincture of yohimbe bark may also be used in the amount of 5–10 drops three times per day. I encourage you to use yohimbine under the supervision of your physician. |
| Ginkgo Biloba may help some men by increasing arterial blood flow.9 The medical benefits of Ginkgo biloba extract (GBE) rely on the proper balance of two groups of active components: the ginkgo flavone glycosides and the terpene lactones. These bioflavonoids are primarily responsible for GBE’s antioxidant activity and ability to inhibit platelet stickiness. Ginkgolides may improve circulation and inhibit platelet-activating factor (PAF). |
| Stinging nettle is another interesting herb. It appears to offer promise for men with symptoms of BPH. One study suggested that stinging nettle reduces the effects of dihydrotestosterone, a hormonal byproduct that increases prostate size |
| Asian ginseng has traditionally been used as a supportive herb for male potency, although there are no studies to support this usage. |
What Western Medicine Offers
The first thing that comes to most men's minds is Viagra due to strong company advertising. It has now been joined by Levitra and Cialis, which all work similarly but have slightly different properties that are mostly related to time of onset and to length of action. Many men have benefited from Viagra, and will benefit from the newer medications, but others may be worse off - even dead - if they took these medications! Viagra can cause a sudden, substantial drop in systolic and diastolic blood pressure, which can lead to death, especially if erectile dysfunction is the first indicator of underlying heart disease!!.
Although these medications have helped many of my male patients I never prescribe them for any man who takes organic nitrates (Nitroglycerine, Isordil, Isosorbide). Similarly, I prescribe these medications with caution in patients using multiple blood pressure medications. Use of HMG co-A reductase inhibitors (Lipitor, Zocor, Mevacor, etc.) gives me pause to prescribe them as well, though this is not an absolute reason not to use them.
Some other modalities and medications that should be considered are: 1) Testosterone hormone replacement if needed (testing should be done), 2) Medications that stimulate an erection - either injected into the penis, or inserted into the urethra (opening of the penis), and last, 3) Vacuum pumps which produce an erection by drawing blood into the penis thus causing an erection.
CAUTION
Don't just buy supplements or medications on an internet site to fix this problem !
Erectile dysfunction may indicate other serious medical problems (like angina or an impending heart attack) in your future - you should always be evaluated by your primary care doctor before merely embarking on the use of supplements to improve your problem!
References:
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2. Moody JA, Vernt D, Laidlaw S, et al. Effects of long-term oral administration of
L-arginine on the rat erectile response. J Urol 1997;158:942–47.
3. Zorgniotti AW, Lizza EF. Effect of large doses of the nitric oxide precursor,
L-arginine, on erectile dysfunction. Int J Impot Res 1994;6:33–36.
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;53:590–95.
5. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: A systematic review and
meta-analysis of randomized clinical trials. J Urol 1998;159:433–36.
6. Carey MP, Johnson BT. Effectiveness of yohimbine in the treatment of erectile disorder:
Four meta-analytic integrations. Arch Sex Behav 1996;25:341.
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in thetreatment of mixed-type impotence? A prospective, randomized, controlled
double-blind crossover study. Urol 1997;49:441–44.
8. 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.
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Educ Ther1991;17:53–61.
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