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.
Vidal and her team looked at self-reported physical activity among 300 men, and then categorized them into categories: sedentary, mildly active, moderately active, and highly active. These men also reported their levels of sexual function, including their ability to have an erection and orgasm, as well as the quality and frequency of their erections and overall sexual function.
"Sexual relations are not only an important part of people's wellbeing. From a clinical point of view, the inability of some men to perform sexually can also be linked to a range of other health problems, many of which can be debilitating or potentially fatal," says Professor Gary Wittert, Head of the Discipline of Medicine at the University of Adelaide and Director of the University's Freemasons Foundation Centre for Men's Health.
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. 
Once you get checked out for artery blockage and low T, there are things you can do to help treat ED besides taking medications. Yes, Viagra is now available generically (it’s called sildenafil), but it is still expensive, and many men experience side effects, like heart palpitations or blue-ish vision. Here are a few proven natural ways to help improve E.D.
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.
"Just because there is evidence doesn't mean it's good evidence," says Andrew McCullough, MD, associate professor of clinical urology at New York University Langone Medical Center in New York City, and one of the original clinical investigators for the ED drug Viagra (sildenafil). "And before men with ED start down the naturopathic route, it's smart to make sure that there isn't some underlying medical condition that needs to be corrected." Moreover, it is estimated that 30 million American men have erectile dysfunction, and 70% of cases are a result of a potentially deadly condition like atherosclerosis, kidney disease, vascular disease, neurological disease, or diabetes. Additionally, ED can also be caused by certain medications, surgical injury, and psychological problems.

A variety of personal habits and lifestyle choices have been linked to ED. In some ways, this is a good thing, since habits can be broken and choices reconsidered. What's more, many of the lifestyle factors that contribute to sexual problems are ones that affect overall health and well-being, both physical and mental. Addressing these factors, therefore, can have benefits beyond improving erectile dysfunction.


These drugs can be expensive, but are sometimes covered by insurance. The three most common medications used for injections are papaverine, phentolamine, and prostaglandin E1. According to Dr. Werner, “Two-thirds of men who used the injections on average twice a week recovered erectile function to the point where they could have intercourse without any outside help.”
Though higher doses of zinc reduce libido, supplementation with a medium dose (5 mg/day) has some beneficial effect on the sexual competence of adult male rats. The major significant effects of this dose of zinc are prolongation of ejaculatory latency without disturbing sexual arousability, motivation, penile erection and sex vigor. Also, the partner preference index of the 5 mg/day group was positive and comparable to the controls. A positive partner preference index is indicative of unchanged sexual interest of males.[16] These results confirmed that libido and sexual interest are not affected by zinc supplementation with a 5 mg/day dose. However, mild reduction in percentage of intromission was observed in this group and it is postulated that this may be situational rather than an effect of supplemented zinc. This is based on our observation where mild rejection by the females at the initial phase of the behavior led some males to refrain from sexual activity.
One of the keys to addressing erectile dysfunction is improving the functioning of the endothelium, which is the inner lining of blood vessels. Wayne Hellstrom, MD, urology professor at Tulane University School of Medicine says keeping endothelium healthy can help you improve erectile functioning. Cardio training helps with this, as does resistance training. Adding weight training to cardio training increases muscle mass and bone strength helps your balance and stability (which can help prevent injuries) and can help lower blood pressure as well. Improved muscle definition can also be great for self-esteem, and that can’t hurt.
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.
Pomegranate juice. Drinking antioxidant-rich pomegranate juice has been shown to have numerous health benefits, including a reduced risk for heart disease and high blood pressure. Does pomegranate juice also protect against ED? No proof exists, but results of a study published in 2007 were promising. The authors of this small-scale pilot study called for additional research, saying that larger-scale studies might prove pomegranate juice's effectiveness against erectile dysfunction. "I tell my patients to drink it," says Espinosa. "It could help ED, and even if it doesn't, it has other health benefits."

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. 

In other liver research, investigators recently reported that zinc may be a simple and effective treatment against acute and chronic liver inflammation. In patients with hepatitis C virus (HCV) infection, researchers found that zinc may inhibit the inflammatory and antiviral effects of a protein associated with tissue damage caused by chronic liver disease. But is therapy as simple as giving a patient a zinc supplement? Learn what's involved.
To locate the muscles these exercises engage, try to stop and restart the flow of urine mid-stream. Just do this once, because if you do it too much it can affect the passage of urine. Once you’ve located these muscles, you can tighten and draw the muscles in, feeling them lift upward. Hold for a count of five, then release. It’s recommended that men do 8 to 10 repetitions, resting in between. Ideally, each series of 8 to 10 should be followed by 5 to 10 quick squeezes and releases, and men should work up to doing the whole process four or five times per day for best results.
None of the parameters showed a significant difference between controls and the group treated with 1 mg of zinc. The percentage of males who engaged in intromission (% intromitted), was significantly reduced in 10 mg/day zinc group; only three animals showed the particular behavior. Similarly percentage of rats which ended up with ejaculation significantly decreased with the high dose (two out of eight). Libido index of the highest zinc treated group was significantly low compared to controls; (38 % vs. 88 %, P < 0.05). Number of mounts and intromissions was also significantly decreased in the same group; Number of mounts: 1.58 (SEM 3.16) vs. 11.0 (SEM 1.59) and number of intromissions 2.13 (SEM 4.27) vs. 11.0 (SEM 1.59), P < 0.05).
If you can't take one of these oral medications, your physician may have you try Caverject (alprostadil for injection), a hormone that you inject into your penis using a fine needle, or Muse (alprostadil urogenital), a tiny suppository that you insert into the tip of the penis. Both of these will bring on an erection within five to 15 minutes without sexual stimulation.
Taking zinc in supplement form is just one of many treatments for those looking for help with ED. Many men use supplements either to replace prescription medications like Viagra and Cialis, or to enhance the effectiveness of these medications. Some other natural supplements aimed at relieving ED symptoms include Korean red ginseng, L-Arginine, carnitine, and DHEA.

On the other hand, high zinc levels have negative effects on sperm quality. Excessive zinc intake in mice have indicated a negative effect of increasing doses of zinc on sperm count and motility.[5] Although there have been studies focusing on various aspects of zinc related reproductive functions, studies on zinc related sexual behavioral aspects have received scant attention. In one study, intranasal irrigation with zinc sulphate has been reported to completely abolish the sexual behavior of male rats.[6]
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.
Medical conditions, such as hypertension, diabetes mellitus, and cardiovascular disease (CVD), and psychological conditions, such as depression and anxiety, also contribute to sexual dysfunction in middle-aged or elderly men. CVD and hypertension cause a narrowing and hardening of the arteries, leading to reduced blood flow to the corporal bodies, which is essential for achieving an erection. Diabetes is a common aetiology of sexual dysfunction, because it can affect both the blood vessels and the nerves that supply the penis. Men with diabetes are four times more likely to experience ED, and on average, experience ED 15 years earlier than men without diabetes.7 Obesity is also correlated to the development of several types of dysfunction, including a decrease in sex drive and an increase in episodes of ED.8
So what’s the problem? Well, if you really listen to the advertisements on television for erectile dysfunction (ED) medications, ignoring the blue tinted jazz from Viagra or the bathtubs in the sunset from Cialis, you may have heard the line “Do not take if you take nitrates for chest pain, as it may cause an unsafe drop in blood pressure.” You see Viagra, Cialis, and Levitra belong to the same drug class called Phosphodiesterase 5 Inhibitors (abbreviated as PDE-5 inhibitors), and they all share the same interaction with nitrates. Many patients wonder how bad can a ‘drop in blood pressure’ be. The answer, as we learned after Viagra came out, is this reaction could lead to heart attack in patients and potentially cause death, leading to a black box warning for the whole class of drugs like Viagra.
Although the term ‘treatment failure’ to oral drugs is widely used, there is no precise definition of what exactly means. Treatment failure may be due to medication, clinician and patient issues (Table ​(Table3).3). Based on these issues a definition of a non-responder to oral pharmacotherapy is proposed: “an inadequate erectile response after at least 4 attempts of the highest tolerated drug dose in accordance with manufacturer’s guidelines with respect to timing relative to meals, alcohol ingestion, use of concomitant medications, and adequate sexual stimulation/arousal” (Carson et al 2004).
Research has shown that the same eating patterns that can cause heart attacks due to restricted blood flow in the coronary arteries can also impede blood flow to and within the penis. The blood flow is needed for the penis to become erect. Diets that include very few fruits and vegetables along with lots of fatty, fried, and processed foods can contribute to decreased blood circulation throughout the body.
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.

No matter what erectile dysfunction treatment or treatments (whether herbal remedies or not) a man ultimately decides upon, experts say it's important to eat healthily and to avoid smoking and heavy drinking. Moreover, adequate exercise, stress reduction, and sleep can improve erectile dysfunction in many. In addition, says Lamm, "A loving, receptive, and responsive partner is a home run. After all, this is still a couple's issue."

Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject Impulse, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include papaverine, alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).
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