While both Caverject and Muse share the same active ingredient, there are some pros and cons each. Caverject tends to work much faster (<10 mins) as it enters the blood stream quicker, and has been found to work better. The draw back though is that it is an injection that needs to be applied to the base of the penis, and can cause irritation to the surrounding tissue. And let’s be honest, most men don’t want to engage in sex with a bruised member. It has a higher risk of causing priapism (basically an erection lasting for more than 4 hours, which incidentally is name after a Greek God called Priapus).
Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Impotence can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. Incidence rises with age: about 5 percent of men at the age of 40 and between 15 and 25 percent of men at the age of 65 experience impotence. Yet, it is not an inevitable part of aging.
If you suffer from premature ejaculation, erectile dysfunction or are unable to reach orgasm, it’s important that you reach a higher level of fitness than you currently have. This is also a requirement for you to become a healthier human being. These best exercises to improve sexual function are aimed at redeveloping your groups of muscles directly involved in the sexual act. Increasing the health of your sex muscles can naturally increase blood flow and can lead to improving your sexual performance.
“One important danger that men need to know about if they are using ED drugs recreationally is drug dependence. Men who take the drugs for longer and larger erections may find that they actually develop ED without the drugs. This could mean having to use more aggressive treatments like injections or implants to treat ED in the future,” warned DeSouza.
A study from 1990 (eight years before Viagra was introduced) found that sedentary but otherwise healthy middle-aged men who started an intense aerobic exercise program reported higher levels of sexual intimacy, and more reliable sexual function. Men in the study who started a walking program also experienced improvements, though not as dramatic. But the bottom line is, improved physical fitness often improves sexual functioning and satisfaction. Here are 5 exercises that can help with erectile dysfunction.
Penile implants - are generally used if physical damage (like an accident) makes the anatomical parts needed for an erection not work. These are inserted by surgery and can provide a permanent treatment choice if others fail to work. The implants can be semi-rigid or inflatable. They can be pretty expensive and are not usually available on the NHS.

The number of intromissions in the 5 mg/day group was comparable with controls. On the other hand number of penile thrusting was significantly increased with the same dose. These are indications of unimpaired erectile function due to supplemented zinc. Our observations also confirmed the lack of aberrant sexual behavior which is indicative of uninhibited penile tactile sensations.[15] Sexual behavior may also be changed with motor weaknesses and incoordination.[12] Supplementation with zinc did not impair muscle strength or coordination when tested with bar and bridge tests, indicating that prolongation of ejaculation was not mediated through these mechanisms.


The penis contains two chambers, called the corpora cavernosa, which run the length of the organ. Erection begins with sensory and mental stimulation. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the chambers. The inflow of blood creates pressure in the corpora cavernosa chambers, making the penis expand. Erection is reversed when muscles in the penis contract, stopping the inflow of blood and causing the blood in the chambers to flow out.
3. Testosterone replacement. Before oral medications like Viagra, testosterone was routinely used to treat erectile dysfunction as it is central in the male sexual response, including the desire for sex and the process of getting an erection. Testosterone can be administered in a number of ways, for example orally, by means of an injection, skin patch, or subcutaneous (under the skin) pellet. 

If other options sound boring, maybe you should consider a fun, revved-up option like salsa dancing. You and your partner can lose yourself in the music, and it’s an intense exercise that engages the senses, combining cardio, balance, and coordination. Plus salsa dancing is great for keeping weight under control because it burns a lot of calories. Furthermore, it’s an activity that can build self-confidence, and if you’re single, the classes can be terrific for meeting new people. Regular exercise doesn’t have to be drudgery, and there are many types of dance classes that can seriously improve fitness and help you address erectile dysfunction.
I would think the 25% is just an average. Some men never have a problem with erections. Some healthy men in their 60's never have a problem with their erections -- no Viagra needed at all, thank you. And, no, it is NOT completely associated with age. In fact, many men in their 40's and even younger, are already dealing with ED, especially if they smoke, are obese, don't exercise, or are addicted to porn, among other things. In fact, even men in their 20's and 30's can have these problems.
A mineral involved in muscle development, muscle is essential for reproductive function in men of every age and activity level. One study that compared athletes to non-active individuals found that supplementing with 22 mg magnesium per pound of body weight of the course of four weeks raised testosterone levels in both groups. And two separate studies, one on a group of men over the age of 65 and a second on a younger 18-30-year-old cohort, present the same conclusion: levels of testosterone (and muscle strength) are directly correlated to the levels of magnesium in the body. These are the best foods for magnesium!
Zinc therapy (5 mg/day) improves sexual competence by increasing penile thrusting and prolonging ejaculatory latency without disturbing arousability and motivation of male rats. Increase in the T levels observed with zinc supplementation is beneficial in this regard. However, increase in PRL is responsible for the reduced libido index. Further studies on pigs and monkeys are needed to evaluate the possible therapeutic use of zinc in sexual dysfunction.
Take note that you may not be able to complete a series of about 10 kegel exercises on your first try. This is just fine. Just do what you can, and gradually work on more kegel exercises until you reach 10 to 20 kegels, up to three times in a day. When performing these exercises, avoid holding your breath, or pushing your stomach, thigh muscles, or buttocks in. It would be helpful if you relax after every count of five. You may also challenge yourself by alternating between long and short squeezes.
Many men experience E.D. According to UW Health, “Mild and moderate erectile dysfunction affects approximately 10 percent of men per decade of life (i.e., 50 percent of men in their 50s, 60 percent of men in their 60s).” And if you think erectile dysfunction is only a problem for older men, think again. As reported by The Greatist, a 2014 study found a quarter of patients newly diagnosed with E.D. were under 40. Of these men, almost half were experiencing severe E.D., meaning they were unable to get or maintain an erection during sex. If this is happening to you, before ordering Viagra online, check in with your primary care practitioner. It could be an early warning sign of atherosclerosis, so it’s worth getting a full evaluation before simply throwing medications at the problem.
Just because a product claims to be natural doesn't mean it's safe. Many herbal remedies and dietary supplements can cause side effects and dangerous interactions when taken with certain medications. Talk to your doctor before you try an alternative treatment for erectile dysfunction — especially if you're taking medications or you have a chronic health problem such as heart disease or diabetes.

There have been some fishy results on fish oil. It's purported to lower blood pressure, reduce serum triglycerides, decrease the risk of stroke, and ameliorate arthritis. But scientists recently reported that fish oil does something else—it may cause fat to accumulate in the liver and result in nonalcoholic steatohepatitis, a particularly harmful form of fatty liver disease. However, the scientists also found that another type of oil causes the least damage to the liver. Read here to find out more.
“One important danger that men need to know about if they are using ED drugs recreationally is drug dependence. Men who take the drugs for longer and larger erections may find that they actually develop ED without the drugs. This could mean having to use more aggressive treatments like injections or implants to treat ED in the future,” warned DeSouza.
As we mentioned before, there are a lot of treatment options that you could use to treat a condition as erectile dysfunction. A lot of the men diagnosed with erectile dysfunction decide to try some of the natural remedies before they refer to some of the top men enhancement pills. Exercise is one of the most commonly recommended ways as a natural remedy for erectile dysfunction. We all know that exercising has a lot of different beneficial effects on our bodies so why not use it as a part of the treatment for this condition? 
Consider the case of Mr. Jones, a new patient I was helping in an ambulatory cardiac clinic. Most of my patients are on multiple medications for their heart conditions and other complicated issues, so I often review their medications to make sure everything is all right. This includes screening labs, checking vitals, reviewing past reports, and conducting drug interaction checks related to therapy. If there are any concerns, I’ll meet with the patient and make recommendations to the healthcare team.
Ginseng, known as the “herbal Viagra” has also been found to improve performance. The root of ginseng is steamed and then dried, which produces red ginseng. According to this study in 2008, random clinical tests provided evidence of the effectiveness of red ginseng in improving ED. This particular red ginseng has many excellent reviews of improved sexual performance.
Erectile dysfunction (ED) is a highly prevalent disease, as well as a major sexual concern for men (Braun et al 2000; Martin-Morales et al 2001; Papaharitou et al 2006). The prevalence of ED is increasing with age. The Massachusetts Male Aging Study (MMAS) demonstrated a 40% prevalence of ED in men aged 40 years that increased to almost 70% in men aged 70 years (Feldman et al 1994). As the proportion of older people in the population increases, it has been estimated that the worldwide prevalence of ED will double from 152 million men in 1995 to 322 million men in 2025 (Aytac et al 1999). ED is also associated with other conditions such as age, smoking, hypertension, heart disease, diabetes, and as a consequence of radical prostatectomy. Cardiovascular disease (CVD) and ED share common risk factors and reflect endothelial dysfunction (Kostis et al 2005). There is an increasing body of evidence that ED is the first sign of CVD in men with free medical history and may present well before CVD with a mean time-interval of even 3 years (Montorsi et al 2003).
Patients reporting satisfaction with treatment effect on erections and improvement in ability to engage in sexual activity at end of 1 year, 2 years, and 3 years of open-label treatment with sildenafil. Copyright © 2002. Carson CC, Burnett AL, Levine LA, et al. 2002. The efficacy of sildenafil citrate (Viagra) in clinical populations: an update. Urology, 60:12–27.
According to a recent study published in the Journal of Sexual Medicine research at the University of Adelaide Australia showed that men can reverse erectile dysfunction by focusing on lifestyle factors and not solely relying on medication. The major risk factors are typically physical conditions rather than psychological ones such as being overweight overconsumption of alcohol stress age insomnia or obstructive sleep apnea.
One of the best methods that you can do in order to locate your pelvic floor is to stop your urine in mid-stream several times. These muscles that you clench are the ones that you have to exercise on. In order to perform repetition on Kegel exercises, you can squeeze your pelvic muscles, holding the position for 5 seconds, and then relaxing. You may repeat this for about 10 to 20 times, two to three times in a day. You may also want to do this while in different positions such as standing, sitting, lying down, sitting in a chair, as well as standing.
Intracavernosal injections remain an excellent treatment option with proven efficacy and safety over time. Baniel and colleagues (2001) treated sildenafil non-responders after radical prostatectomy with intracavernosal injections of vasoactive drugs with 85% success rate. Shabsigh and colleagues (2000) were able to salvage sildenafil non responders with intracavernosal injections of alprostadil. More than 85% improvement in Q3 and Q4 of the IIEF was recorded (Shabsigh et al 2000). The tri-mix combination (papaverine, phentolamine, alprostadil) is certainly the more efficacious drug treatment for erectile dysfunction and can be used in severe cases of erectile dysfunction when intravernous alprostadil fails or it is not preferable due to side effects.

How soon the drugs start working ranges from 15 to 60 minutes. Neither Viagra nor Levitra will work if you take them after a meal, which blocks their absorption. However, neither Cialis nor Stendra interact with food this way. The onset time determines how soon you can engage in intercourse. Stendra and daily-use Cialis are closest to being an "on demand" erectile drug; using the others requires more planning.
Viagra is eliminated mainly by the cytochrome p450 system in the liver. Elderly men and men with liver or kidney dysfunction have reduced ability to eliminate the drug. Therefore, these patients should start with the lowest dose (25 mg) to avoid problems with toxicity. Medications that interfere with cytochrome p 450 (such as erythromycin, cimetidine, and ketoconazole) can also decrease the elimination of Viagra. These other medications should preferably be stopped when using Viagra, or Viagra should be used cautiously starting with the lowest dose.

Three of the randomized studies (25–27) that contributed to the present study data indicated the positive role of both interval and continuous aerobic training in the dual management of both ED and cardiovascular disorders (hypertension and ischemic heart disease ,respectively); this is not surprising because of the arterogenic interrelationship between ED and several cardiovascular disorders. The physiological basis for the therapeutic role of continuous exercise in the management of both ED and some cardiovascular disorders as reported in the present study, could be related to the biochemical, neural and hormonal changes in the blood vessel walls that induce an acute and long-term blood vessel relaxation. The blood vessels might relax after each exercise session because of body warming effects; local production of certain chemicals, such lactic acid and NO; decreases in nerve activity; and changes in certain hormones and their receptors (32, 33). Over time, as the exercise is repeated, there appears to be a growing evidence of a prolonged effect. Thus, chronic (regular, longterm) physical training might reduce basal concentrations of inflammatory markers.
Red Ginseng — One small randomized trial found evidence that red ginseng may offer modest improvements in ED symptoms (as compared with placebo). A meta-anaylsis published in the British Journal of Clinical Pharmacology states, “Traditionally red ginseng has been used to restore and enhance normal well-being, and is often referred to as an adaptogenic….Possible mechanisms of action of red ginseng include hormonal effects similar to those of testosterone. Others have postulated that red ginseng might induce relaxation of the smooth muscles.”  (5)
What are the alternatives to viagra? Erectile dysfunction, when a man cannot achieve or maintain an erection, is a common condition that causes much distress. Viagra is just one of several drug treatments that can help relieve the problem. Other methods and treatments can help, too, including alternative herbal remedies that people may wish to try. Read now
Clinical trials and post marketing data of sildenafil demonstrated no increase in myocardial infarction rates in patients that received these agents as part of either double blind, placebo controlled trials or open label studies or compared to expected rates in aged matched populations of men (Boshier et al 2004). Sildenafil does not adversely affect total exercise time or time to ischemia during exercise testing in men with stable angina. In fact, it may actually improve exercise tests. Sildenafil does not alter cardiac contractility, cardiac output or myocardial oxygen consumption based on evidence reviewed to date (Gillies et al 2002; Vlachopoulos et al 2003; Kukreja et al 2004; Webster et al 2004).
Erectile dysfunction supplements and other natural remedies have long been used in Chinese, African and other cultures. But unlike prescription medications for erectile dysfunction, such as sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis, Adcirca) and avanafil (Stendra), erectile dysfunction herbs and supplements haven't been well-studied or tested. Some can cause side effects or interact with other medications. And the amount of the active ingredient can vary greatly from product to product.
The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of hims, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.
If you’ve been to the health food store lately, you’ve seen shelves lined with vitamins and “organic” supplements, each claiming to boost immunity, revitalize organ function, or “promote health.” And it’s working. Supplements are currently a $30 billion industry in the US, with more than 90,000 products on the market, and vitamin use is on the rise. In fact, a recent survey in Journal of American Medicine Association showed that “52% of US adults reported use of at least 1 supplement product.”
But, first for those of you who do not know anything on this topic, let’s define erectile dysfunction. Erectile dysfunction is a condition which characterizes itself with the inability to maintain an erection during sexual intercourse. Luckily, although erectile dysfunction is a common condition, this condition seems to be easily treated. You can choose from the variety of natural remedies, including supplements, which claim to increase your stamina, sexual ability, and muscle mass. This article is dedicated to the importance of exercise as a way to treat erectile dysfunction and highlight the best exercises you could use as a part of the treatment. 
For obvious reasons, ED can be a sensitive subject, one that until relatively recently men were more likely to try to hide than to deal with. Fortunately, a deeper understanding of the variety of causes of erectile dysfunction has led to medications, therapies, and other treatments that can be more individualized and more likely to be effective—and more open discussion about addressing the concern.
L-arginine. L-arginine is an essential amino acid that plays a significant role in erectile function by helping form nitric oxide, a vasodilator. Supplementation with L-arginine has been shown to restore erectile quality and increase sexual satisfaction. L-arginine, in combination with Pycnogenol, has also been shown to improve male sexual function.
But the main challenge to finding the best ED drug for you may turn out to be health insurance rules—not biochemistry. It's a common practice among insurers to limit the number of pills you can obtain per month. After you hit your limit, the out-of-pocket cost for a single pill can be as high as $20. "The main obstacle in my practice is the cost," Dr. Liou says. You'll need to work with your doctor to get the pill you need at a price you can afford.

"Nightly treatment may help promote erectile function as the result of this drugs' beneficial effect on endothelial cells," Frank Sommer, MD, said in a news conference. Endothelial cells line the walls of the blood vessels. Erections occur when the blood vessels in the penis dilate and fill with blood. Sommer, chief of andrology in the department of urology at the University of Cologne in Cologne, Germany, presented his findings at a meeting of the American Urological Association.
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Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
As with most other organ system in the human body, changes and loss of function is normal consequence of the ageing process. This is also true of the endocrine system, specifically the levels of testosterone production from the Leydig cells of the testicle. Accompanying the decrease in testosterone is a decrease in erections which also has a component in decrease in the blood supply to the penis making erection not as frequent and not as rigid compared with a young man’s erectile function. Although these changes are in itself not life threatening, they can impact a man’s relationship with his partner, and also ED may be a harbinger of other undiagnosed conditions such as coronary artery disease (CAD), hypercholesterolaemia or diabetes mellitus.6

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 in 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. 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.


The Prostate Cancer Prevention Trial was a landmark study by Thompson et al that prospectively assessed the time to developing CVD after the diagnosis of ED. There were 4247 men with no ED at study entry; 2420 developed incident ED (defined as the first report of ED of any grade) over 5 years. Those men that developed ED had a 1.45-fold higher probability of experiencing a CV event compared with men who did not develop ED.27
Dear David and Aisha, I am a 39-year-old married man who has had type 1 diabetes for 22 years. My A1C levels run around 7.5%. About six years ago, I started having trouble with erections. Now they are very rare, even with ED pills. I know you say that there is more to sex than intercourse, and my wife and I still enjoy ourselves however we can. But we both miss the erections.

There are so many potential reasons a man might develop erectile dysfunction (ED), it's nearly impossible to generalize the best ways to treat it. What works for one man may not work for another simply because they are having problems for different reasons. That said, it may encouraging to hear that there are a variety of options that may be considered, from psychological counseling to lifestyle changes, medications to treatments and devices.


Hunter Wessells, chairman of urology at the University of Washington School of Medicine, says, “Exercise has a set of potential effects that are not strictly related to weight loss.” A recent Italian study in the Journal of Sexual Medicine found that exercise plus a PDE-5 inhibitor drug like sildenafil (Viagra) worked much better than the drug alone. Another Italian report showed that exercise was a major contributor to sexual function and blood vessel condition.
In conceiving the potential solutions to issues around erectile dysfunction, it’s really helpful to understand clearly how an erection is achieved and completed. To achieve an erection, there needs to be some form of stimulation, either from touch or some sort of audiovisual stimuli.  Once the stimulation occurs, chemical messengers are released and blood starts to fill into the penis. In terms of the musculature, the bulbospongiosus and ischiocavernosus muscles need to be relaxed so blood can fill the area completely. Then the bulbospongiosus needs to contract to keep the blood in the penis. The erection ‘completes’ with the rhythmic contraction of the bulbospongiosus muscle.
Erectile dysfunction is a common occurrence in men with diabetes. The incidence of erectile dysfunction increases progressively with age, from 5% in men age 20 to 75% in men over age 65. The cause of erectile dysfunction in men with diabetes is usually related to a decrease in the blood supply to the penis as well as to injury to the nerves that are responsible for the erection mechanism. A decrease in testosterone production has also been identified as the cause in some men with diabetes.
Long-term effectiveness of sildenafil was assessed in 3 open-label, flexible-dose (25 mg to 100 mg) studies. After 12 months of treatment (3 years in one study) or at the time of discontinuation, patients were asked if they were satisfied with the effect of the medication on erections, and if the treatment improved their ability to engage in sexual activity. Satisfaction and improvement in ability to engage in sexual activity reported in 96% and 99% of patients respectively. Of the 11% of patients who discontinued treatment, 2% discontinued for treatment-related reasons (1.6% for insufficient response, 0.4% for adverse events). These satisfaction rates maintained for 3 years in one study. Over the 3-year period, 32% of patients discontinued treatment. Only 6.7% of discontinuations were treatment related (5.7% for insufficient response, 1% for treatment-related adverse events). The remaining 25.3% of patients discontinued for reasons not related to treatment (eg, non–treatment-related adverse events, lost to follow-up evaluation, withdrawn consent, and protocol violations). Most patients were receiving 100 mg sildenafil doses (88% at 3 years) (Carson et al 2002). Similar efficacy rates for sildenafil were reported in clinical practice setting. An improvement in ability to achieve erections was reported by 68% and 71% of patients with ED (Marks et al 1999; McMahon et al 2000). Success with sildenafil, defined as 75% successful intercourse, was reported by 82% of patients with 77% being successful at every attempt (Guay et al 2001).
Sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis) and avanafil (Stendra) are oral medications that reverse erectile dysfunction by enhancing the effects of nitric oxide, a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.
Non-drug approaches to rehab include using a vacuum constriction device. This is a plastic cone that you place over the penis, then pump out the air inside to create a vacuum. The vacuum draws blood into the penis. For intercourse, an elastic band is slid over the penis to keep the blood in. But for rehab, you don’t use the band; the idea is just to keep the erection for 10 to 15 minutes, or as long as possible. According to San Diego Sexual Medicine, doing this three times a week can help restore normal sexual function. This can be combined with a PDE-5 inhibitor.
The research found that most of the men were overcoming erectile dysfunction naturally. The remission rate of those with erectile dysfunction was 29% which is high. This shows that many of these factors affecting men are actionable providing them an opportunity to do something about their condition. "Even when medication to help with erectile function is required it is likely to be considerably more effective if lifestyle factors are also addressed says Dr. Sean Martin lead author of the research paper. 

"Erectile dysfunction can be a very serious issue because it's a marker of underlying cardiovascular disease, and it often occurs before heart conditions become apparent. Therefore, men should consider improving their weight and overall nutrition, exercise more, drink less alcohol and have a better night's sleep, as well as address risk factors such as diabetes, high blood pressure and cholesterol.
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