So, in establishing physiology, pharmacology, clinical results and safety, zinc is a good choice when you look at cost and side effect profile as well as ease of availability and interaction profile with other meds and other medical conditions.  Having said all of this, there is no bulletproof evidence out there guaranteeing that increasing your zinc consumption either in food or via a supplement will improve ED or increase libido.  Even if a patient experiences an increase in testosterone from such a supplementation, this is not a certain gateway to resolution of theses symptoms as there is more to it than just one hormone level.  However for those that are experiencing problems in these areas, it is certainly worth a try for them.  The patient should be mindful however that supplements should be treated like any other medication and trying to increase your testosterone shouldn’t be done without consultation with your doctor and pharmacist.  You should also check for any interactions with any meds or medical conditions before trying any supplement as well.
Aside from pelvic floor exercises, it has been found out that aerobic exercises also work in treating erectile dysfunction. This condition is often caused by problems related to blood flow to the penis. Diabetes, obesity, vascular disease as well as high cholesterol may affect blood flow. This results to erectile dysfunction. By adding some aerobic exercises to your routine, you can significantly enhance your overall male sexual health and may even remove the problem totally in the long run.

Erectile dysfunction (ED) is the inability to get an erection or to keep one that's firm enough or that lasts long enough for a man to have a satisfying sexual experience. Occasional bouts of ED aren't unusual. In fact, as many as one in five men deal with erectile dysfunction to some degree. Symptoms, of course, are rather obvious. And while age can be a risk factor, so can medication use, health conditions, lifestyle factors (like smoking), and other concerns. Treatment is available and may involve prescriptions, habit changes, or other options.
Erectile dysfunction (ED) is one of the most common sexual problems that men deal with. There are a host of different causes of ED that range from nutrient deficiencies to clinical depression. It’s important to talk to a medical professional about ED, in order to determine the cause of the issue before exploring treatment options. That said, erectile dysfunction has been found in recent years to be a symptom of zinc deficiency.
It's also important to remember that your mental health plays as much a part of your sexual ability as your physical health. Stress and other mental health concerns can cause or make erectile dysfunction worse. Minor health problems may slow your sexual response, but the accompanying anxiety that comes with the slow sexual response can shut things down entirely.
Since endothelial dysfunction, CVD and ED are closely associated in epidemiological studies, the question for clinicians is whether to recommend the man presenting with ED undergo a cardiovascular (CV) evaluation. Clearly, based on numerous studies, ED can be considered at least a ‘marker’ for possible further vascular disease or CVD.15 In their report, Vlachopoulos and coworkers make the point that the man presenting with ED, the clinician, is offered an opportunity to attempt to improve the health of the man by addressing lifestyle modification, and consider further vascular evaluation owing to the clear relationship between endothelial dysfunction, ED and CVD.19
According to a study conducted by the University of the West of England, Bristol, pelvic floor exercises may be very effective in treating erectile problems. Many participants of the study, all of whom were men who had been experiencing erectile dysfunction for at least six months, reported a significant improvement of their condition within three months of training their pelvic floor. 

"Medications that create blood flow to the penis can't help when an erection is blocked by the fear or anxiety of the fight-or-flight response,” says Feloney. “This type of erectile dysfunction probably has a lot to do with evolution — men didn't need an erection when a dinosaur was chasing them." The best way to treat erectile dysfunction caused by performance anxiety, depression, a poor relationship, or stress may be with a combination of ED drug treatment and sex therapy, individual therapy, or couples therapy from sexual health professionals.


"Erections are good for your penis, and probably good for mental health. Taking medication for erections may also be good for a man's overall health. This is the first study to look at long-term treatment to improve erectile function in men, but the sample is too small to definitively answer the question. We really need a big study with a long follow-up to know the answers." Mulhall, who was not involved in the study, is an associate professor and director of sexual medicine in the departments of urology at Weill Medical College of Cornell University and Memorial Sloan-Kettering Cancer Center in New York.

PDE5 inhibitors, the primary second-line therapy, have been the mainstay of ED treatment since the release of sildenafil (Viagra) in 1998, with the subsequent development of many others, and still more in the development stage. These medications do improve erectile quality for the majority of men, and they work by enhancing blood flow in the corpora cavernosa. These medications are generally used on demand and need to be taken about an hour before sexual intimacy. Tadalafil (Cialis) is longer acting and does come in a daily preparation potentially eliminating the ‘on-demand’ need. The daily dosing of tadalafil, 2.5–5 mg\day, has also been approved by the FDA for treatment of symptoms of BPH.41 PDE5 inhibitors are contraindicated in men taking nitrates, but otherwise PDE5 inhibitors are very safe and effective. When PDE5 inhibitors are coadministered with nitrates, pronounced systemic vasodilation and severe hypotension are possible. Many patients with ED are elderly and have the same risk factors as patients with CAD, so these drug combinations are commonly considered or encountered in clinical practice.42
There have been reports of heart attack, stroke, irregular heartbeat, bleeding in the brain or lungs, high blood pressure, and sudden death in men who took sildenafil for erectile dysfunction. Most, but not all, of these people had heart problems before taking sildenafil. It is not known whether these events were caused by sildenafil, sexual activity, heart disease, or a combination of these and other causes.Talk to your doctor about the risks of taking sildenafil.
Ginseng. Korean red ginseng has long been used to stimulate male sexual function, but few studies have tried systematically to confirm its benefits. In one 2002 study involving 45 men with significant ED, the herb helped alleviate symptoms of erectile dysfunction and brought "enhanced penile tip rigidity." Experts aren't sure how ginseng might work, though it's thought to promote nitric oxide synthesis. "I would recommend ginseng [for men with ED]," says Espinosa. Discuss with your doctor before taking it since ginseng can interact with drugs you may already be taking and cause allergic reactions.
Lower urinary tract symptoms (LUTS) are independent risk factors for sexual dysfunction in older men (Rosen et al 2003). A possible role for PDE5i in the treatment of LUTS has been presented (McVary 2005). Sairam and colleagues (2002) showed that ED treatment with sildenafil improved both sexual function scores (based on IIEF) and LUTS and urinary scores correlated strongly with sexual function scores at 3 months. Mulhall and colleagues (2006), in a group of ED patients treated with sildenafil, similarly noticed that 60% of men improved their IPSS score, and 35% had at least a 4-point improvement in their score. If ongoing clinical research proves these preliminary data, it will open the avenue for innovative therapeutic approaches.
For centuries, men have tried all sorts of natural remedies for erectile dysfunction (ED) -- the repeated inability to get or maintain an erection firm enough for sexual intercourse. But do they really work? It is simply not scientifically known at this point. Furthermore, you take these remedies at your own risk, because their safety profiles have not been established. What follows are commentaries by experts and reviews in the field of alternative treatments that are available over the counter for erectile dysfunction and impotence.
These prescription drugs increase the levels of nitric oxide in your blood. Nitric oxide is a vasodilator, meaning it makes your blood vessels widen to help increase the blood flow. These drugs are especially effective at widening the blood vessels in your penis. More blood in your penis makes it much easier for you to get and maintain an erection when you are sexually aroused.
How common is impotence? According to findings from several studies, including “The Massachusetts Male Aging Study,” overall prevalence for men between 40–70 years old is around 52 percent (or around 30 percent of all men between 18–60 years old). That’s right — nearly half of all men over 40 experience erectile dysfunction symptoms at some point. Not surprisingly, research demonstrates that impotence is increasingly prevalent with age. Around 40 percent of men in their 40s experience sexual dysfunction. Up to 70 percent of men in their 70s experience ED. (1) Every year more than 617,000 new cases of impotence occur in the United States alone.

Andrew McCullough, MD, associate professor of clinical urology and director, male sexual health program, New York University Langone Medical Center. Lecturer: Auxillium. Research grant: Pfizer. Data safety monitoring board: Pfizer. Consultant: Slate Pharmaceuticals. Clinical trials: Warner Chilcott, Vivus, Lilly, Bayer-GSK, ICOS, Timm, Schering Plough, Aeterna.
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.
The more you try not to think about your sex problems, the more these problems consume your thoughts! While it appears that your problem is complicated, my Hard and in Control program provides the complete strategy so you can complete mutually satisfying sexual acts. This will enable you to eliminate performance anxiety and restore enjoyment for your partner.
They found that men who exercised the most were also the most likely to have higher scores in sexual function. Specifically, those who expended 18 METS, or metabolic equivalents, per week were most likely to enjoy sex. METS is a physiological measurement that denotes the amount of energy a person spends on a specific activity, as well as the intensity of it. According to the researchers, 18 METS was equal to about two hours of strenuous exercise like running or swimming, 3.5 hours of moderate-intensity exercise, or six hours of light exercise.   
The availability of phosphodiesterase type 5 inhibitors (PDE5i) has resulted in increasing numbers of patients seeking medical help for erectile function problems, but has also altered dramatically the medical management of ED (Hatzichristou and Pescatori 2001; Lewis et al 2001; Steers et al 2001). More physicians are treating ED, especially in the primary care setting, including minimal patient work-up and prescription of PDE5i due to their proven efficacy and safety profile. The management of ED by non-specialists includes minimal patient work-up and prescription of exclusively first-line treatment options in most cases, mainly due to the lack of time and background knowledge (Hatzichristou 2002). Sildenafil was the first available PDE5i that revolutionized ED treatment (Goldstein et al 1998). More than 30 million of men are treated worldwide with sildenafil accompanied by vast experience and research with more than 2600 papers published in Medline as of July 2006. Furthermore, new data suggest that sildenafil has beneficial effects in several chronic conditions. It has been recently approved for the treatment of idiopathic pulmonary hypertension (Galie et al 2005), and numerous articles have suggested that PDE5i may improve endothelial function (Katz et al 2000; Desouza et al 2002; Halcox et al 2002; Vlachopoulos et al 2003; Vlachopoulos et al 2004; Gori et al 2005; Hirata et al 2005). PDE5i have been also suggested to be beneficial for patients with premature ejaculation (Abdel-Hamid 2004). However, clinical studies have shown controversial results so far (Salonia et al 2002; Chen et al 2003; Atan et al 2006) and it remains uncertain, whether PDE5i act on the physiologic process of ejaculation, or indirectly, improving erectile function and therefore, reducing performance anxiety in men with ED.
Nitric oxide is made internally from L-arginine, which is an amino acid found in red meat, poultry, fish, and dairy products. In other words, L-arginine is the building block for nitric oxide, which is essential for erections. A lack of one can lead to a lack of the other. However, there’s a problem when it comes to treating L-arginine deficiency with supplements.

Your doctor may also choose to lower your dose of certain medications. Or your provider may switch the type of drug you’re taking if it’s interfering with your sex life. Some medicines used for managing blood pressure, insomnia, anxiety, depression, seizures and prostate problems increase the risk for erectile dysfunction. Beta-blockers (for high blood pressure), SSRIs (often used to treat depression) and the class of drugs called benzodiazepines (like Ativan, Xanax, Librium and Valium) are commonly tied to ED. You may want to speak to your doctor about this.


Because Viagra works in a way that's similar to drugs that contain nitrates, however, it isn't recommended for men who take nitrates for heart disease or those with certain other heart conditions. In some men, it causes bad headaches. In others, it just plain doesn't work. In some instances, men may notice they have trouble telling blue and green colors apart when they start taking the drug.

Similar results were presented by other studies. Incorrect administration accounted for 81% of sildenafil failures referred by primary care physicians (Atiemo et al 2003). Reasons included administration after heavy meals, lack of sexual stimulation, short timing to intercourse, and too few attempts for intercourse. The authors were able to salvage 41.5% of nonresponders after reeducation as measured by the General Assessment Question (GAG) and Sexual Health Inventory for Men (SHIM) scores. Gruenwald and colleagues (2006) showed that counseling and dose adjustment were directly influential in achieving an excellent response to a second trial of sildenafil in patients with ED who had previously failed treatment with the drug, and obviated their needing to seek more invasive measures. In this study, 38% of the included patients did not receive any explanations or counseling whatsoever from the prescribing physician. After proper instruction, erectile function domain scores increased significantly and overall 23.6% of the patients had a normal IIEF EF domain score (≥26) at the end of the study.

There is no guaranteed, permanent way to ‘cure’ ED – partly because, age is a factor that affects ED the older you are, the more likely you are to get ED symptoms. This might mean that even if you have successfully kept your erectile dysfunction under control in the past, you may get ED symptoms again as you get older. Also, there are lots of factors that cause ED. So, one factor that doesn’t affect you right now might do in the future. 


Your brain runs on procedures, so you need to apply the correct thought and action sequence to specifically address the problem you are facing. For example, Kegels are one of the most commonly recommended treatments for premature ejaculation. While Kegels (PC exercises) are a good exercise to strengthen the muscles which support your penis, when done during sex Kegels can cause a man to ejaculate early. This is because Kegels increase blood flow which leads to an increased awareness of sensation. This is exactly what you don't want if you suffer from premature ejaculation!
Experts feel that treating erectile dysfunction on your own, without consulting a doctor, is unsafe. "If you have ED, the first thing you need is a diagnosis," says impotence expert Steven Lamm, MD, a New York City internist and the author of The Hardness Factor (Harper Collins) and other books on male sexual health. He says men with severe erectile dysfunction probably need one of the prescription ED drugs, which include Levitra (vardenafil) and Cialis (tadalafil) as well as Viagra. But, he says, mild ED -- including the feeling that "you're not as hard as you could be" -- often responds to natural remedies.
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.
In patients who either fail to respond to first or second-line therapy, or are not interested in the conservative therapies, penile prosthesis implantation is available. Malleable and rigid implants were available for many years, but in 1973 the world of penile prosthetics took a giant leap forward with the advent of the inflatable penile implant. Most implants done nowadays are of the inflatable variety. Adverse events including malfunction and infection are rare, and patient satisfaction is very high.45
What's to know about erectile dysfunction? Erectile dysfunction (ED) is a condition in which a man regularly finds it difficult to get or keep a firm erection. ED can be caused by psychological, physical, and medical reasons. This article looks at many of the causes, symptoms, and treatment options, which include medication, surgery, exercise, and diet. Read now
Lifestyle changes like getting more exercise and adjusting your diet can help. In a study of obese men with E.D. who restricted calories for two years and were advised to be more active, participants not only lost weight but also experienced decreased severity of their E.D. Research also shows aerobic exercise can significantly lower your risk of erectile dysfunction thanks to its ability to boost blood flow and circulation. Eating certain foods can also reduce incidence of E.D.
Vitamin D is primarily known to help bone health and for its role in calcium-phosphorous homeostasis—but a new study found it also improves erectile dysfunction. Men who received vitamin D supplements showed increased testosterone levels and improved erectile function, researchers reported. The trial included only 41 men, so a larger study is needed to confirm the results. But what mechanism might be behind vitamin D's erectile effect? Click here to find out.
In addition to Viagra, other ED drugs available in the United States include avanafil (Stendra), tadalafil (Cialis) and vardenafil (Levitra). These all improve blood supply to the penis. In combination with sexual stimulation, the drugs can produce an erection sufficient to initiate and complete intercourse. There is also a fast-dissolving form of Levitra, called Staxyn, that you put under your tongue.
Although they work in similar ways, each oral medication has a slightly different chemical makeup. These minor differences affect the way each medication works, such as how quickly it takes effect and wears off, and the potential side effects. Your doctor will consider these factors as well as any health problems you have and possible interactions with other medications you take.
Have you heard about the famous Kegel exercises women often turn to for help? Well, these exercises are not for women only. You can perform them also and get the same beneficial effects as women. Kegel exercises for men are often recommended by many doctors to be used in the treatment of erectile dysfunction. Kegel exercises will strengthen your pelvic floor muscles. In order to perform these exercises, you will need to locate your pelvic floor muscles (to do that you will need to stop the process of urinating a couple of times) and squeeze them a couple of times. Start performing these exercises a couple of times a day and see the results for yourself.
Most importantly, herbal supplements are not well regulated in the United States.  Studies have shown that 40-50% of herbal supplements do not even contain the supposed main ingredient, and many contain substances that are not listed which may have dangerous side effects2.  Another study found that over two thirds of the products tested had substituted other plant species for the plants listed on the label, and a third of products also contained other fillers or contaminants3.  A study by the New York State Attorney General of herbal products sold at GNC, Target, Walgreens, and Walmart found that four out of every five products didn’t contain the ingredient they claimed!  Fourteen US states and territories have petitioned Congress to regulate the herbal supplements industry.
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.
Sildenafil has been on the market for more than 8 years. Morales and colleagues (1998) provided summarized safety until 1998 and Padma-Nathan and colleagues (2002) provided long-term safety data (>4 years). The most commonly reported treatment-related adverse events are headache, facial flushing, dyspepsia, dizziness, nasal congestion, abnormal vision, and palpitation (Table ​(Table2).2). Other adverse events uncommonly or rarely reported include back pain, influenza-like syndrome, rash, vomiting, diarrhea, cardiac arrhythmia, and hypersensitivity reactions. Adverse events are dose related, mild in nature, self-limited by continuous use. The drop-out rate due to adverse events is similar to placebo (2% for sildenafil vs 2.3% for placebo). Post-marketing case series reported higher incidence of adverse events, especially for headache (9%–39%), flushing (7%–33%) and abnormal vision (5%–11%) (Zippe et al 1998; Jarow et al 1999; Marks et al 1999; McMahon et al 2000; Moreira et al 2000; Fagelman et al 2001; Guay et al 2001; Martinez-Jabaloyas et al 2001; Palumbo et al 2001). Patients may tolerate sildenafil differently based on existing comorbidities. Ischemic heart disease and hypertension are associated with higher incidence of adverse events than diabetes (3.6%, 2.3%, and 1.9%, respectively) (Padma-Nathan et al 2002). Visual disturbances (blurred vision, flashing lights, blue haze, and change in color perception) occur due to weak inhibition of PDE6 in the retina. They are coincident with peak plasma concentrations of sildenafil and are transient and fully reversible. None persisted 6 hours after taking sildenafil and rarely consist a reason to discontinue treatment.
There is no evidence that mild or even moderate alcohol consumption is bad for erectile function, says Ira Sharlip, MD, a urology professor at the University of California San Francisco School of Medicine. But chronic heavy drinking can cause liver damage, nerve damage, and other conditions -- such as interfering with the normal balance of male sex hormone levels -- that can lead to ED.
The HSE recommends that adults should complete 30 minutes of moderate intensity activity such as brisk walking or gentle cycling at least five days a week. If you’re new to exercising this is a good place to start – particularly if you are in poor health or are overweight. The longer you keep up your exercise plan, the more activity you can add to it; just remember not to put too much strain on yourself too early. For more help, here’s our guide to starting out.
Poor sleep patterns can be a contributing factor for erectile dysfunction, Mucher says. One review published in the journal Brain Research emphasized the intricate relationship between the level of sex hormones like testosterone, sexual function, and sleep, noting that testosterone levels increase with improved sleep, and lower levels are associated with sexual dysfunction. Hormone secretion is controlled by the body’s internal clock, and sleep patterns likely help the body determine when to release certain hormones. 
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