Drug interactions. Some medications can change how long the effects of Viagra last. This includes medications like the antibiotic ‘rifampicin’ (used to treat tuberculosis). When you’re getting assessed for treatment with Viagra, always give as much information as you can about your medications so the doctor can make sure it’s safe for you, this includes any treatments that were not prescribed by a doctor
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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.


It’s important to note that high levels of zinc can reduce available copper in the body and affect iron levels. High levels of zinc can also interfere with different kinds of medications. Though it is estimated that 40 milligrams of zinc supplement are safe for men to take daily, there is no long-term research into the effects that this practice could yield.
I was impressed with the questionnaire to make sure the meds I requested were right for me and the follow up email from the prescribing doctor to see if I needed any support. The meds came promptly, were well packaged and are comfortably in date - I thought they might be very near their sell by date but I was wrong to be suspicious. If I ever need this service again I wouldn't hesitate.
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.
Medicines like I-Arginine and viagra, can fix your problems for hours but vitamins and amino acids will cure erection problems for long term. Remember, not to take vitamins and medications (I-Arginine) at the same time as it can react in your body. Discuss your doctor before adding any vitamin to your routine. Apart for I-Arginine and other pills, here we have given some vitamins to quick fix your problem and have a better sex life.
Magnesium helps regulate levels of calcium, zinc, and other vitamins and minerals. It also helps the body produce energy and contributes to proper organ function. Most people don’t develop a genuine magnesium deficiency, even if they don’t get enough of the mineral in their diets, according to the University of Maryland Medical Center. A true magnesium deficiency, however, may increase the risk of erectile dysfunction.
Low levels of zinc can be the cause for a variety of health-related problems. Zinc is a key mineral that cells use to metabolize nutrients. Immune function, DNA and protein production, and cell division are all related to zinc levels in the body. Zinc also enables the male body to produce testosterone. Because of this, your levels of zinc may affect erectile dysfunction.
Some men opt for penile implants, which involve the placement of tubes in the penis and a pump in the scrotal sac. The pump (usually the size and shape of a testicle) enables men to obtain an erection whenever and for as long as they desire by pumping a saline solution from a reservoir into the penis. Implants are a last resort, however, says Beam. "Once a prosthesis is implanted, a patient cannot respond to anything else because it alters the natural anatomy."
Much of the evidence shows high rates of vitamin D deficiency in patients with erectile dysfunction. In fact, one study of 3,400 participants found that men with vitamin D deficiency were 32% more likely to have trouble with erections when all other risk factors were controlled for. It’s a little on the nose that you need vitamin D for your “D,” but hey—science can be funny too.
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? 
This study was designed to test the hypothesis that hydrochlorothiazide a diuretic used to treat hypertension depletes body zinc and thereby cause sexual dysfunction. Serum zinc and sexual dysfunction were measured in 39 middle aged hypertensive men who had been taking hydrochlorothiazide in average daily doses of between 25 and 50 mg daily for at least six months, and a control group of 27 unmedicated middle aged normotensive men. The medicated group had a higher incidence of sexual dysfunction (56 pc) as compared to 11 pc in the control group. The use of hydrochlorothiazide did affect serum zinc levels significantly in 20 patients. Sexual dysfunction occurred more often in older and overweight patients (p < 0.004). Three of the normotensive men experienced sexual dysfunction probably related to old age. Twenty two of the 39 on hydrochlorothiazide and experiencing sexual dysfunction were divided into two groups of 11 patients. Bloods were taken from the 27 normotensive and 22 hypertensive men receiving hydrochlorothiazide for the analyses of zinc. Subsequently one group of the patients were supplemented with zinc 500 mg daily for 30 days while the other group was supplemented with magnesium chloride 1 g daily for 30 days. The normotensive men were not treated. After 30 days, bloods were again taken from the three groups of analyses for zinc and magnesium. Serum zinc was significantly decreased (p < 0.05) by hydrochlorothiazide and a non significant decrease in serum magnesium (p = ns) was observed. After supplementation with zinc, the serum zinc levels returned to normal only in eight patients. There was improvement in the symptoms of sexual dysfunction in five patients. Two patients gained weight. Hydrochlorothiazide decreased serum zinc levels (p < 0.05) and was unchanged with magnesium supplementation but the serum magnesium returned to normal values. Improvement of symptoms of sexual dysfunction was positive in one patient. This study shows that low serum zinc levels may be associated with sexual dysfunction but the definitive role of zinc in the pathogenesis of sexual dysfunction will remain controversial.

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.

In the end, open and honest communication with your therapist will yield the best course of action. If you do decide to try pelvic floor PT, a comprehensive evaluation will determine what exactly is going on with your muscles. They may be tight and weak or they could have poor coordination. So my advice for those suffering from erectile dysfunction is this: before you try kegels, make an appointment with your pelvic floor therapist.


Erectile dysfunction (ED) is a highly prevalent disease associated with aging as well as with several risk factors including hypertension, heart disease, obesity, dyslipidemia, diabetes, hypogonadism, drugs-related, and pelvic surgery. Many of these factors are components of the metabolic syndrome, a multiplex risk factor for cardiovascular disease (CVD). ED shares common risk factors with CVD. Endothelial dysfunction seems to be the early underlying pathophysiology across both conditions. The efficacy, tolerability and cardiovascular safety of sildenafil has been evaluated in numerous large, randomized, double-blind, placebo-controlled clinical studies in the broad population of men with ED including men with several co-morbid conditions. Sildenafil is effective in several specific patient populations including the difficult-to-treat subpopulations such as diabetes mellitus and after radical prostatectomy. It is associated with rapid onset of action – within 14 minutes for some men – and an extended duration of action for up to 12 hours. Sildenafil improves quality of life and satisfaction for treated men and is well tolerated with a favorable safety profile. New data suggest that sildenafil has beneficial effects in several chronic conditions. It has been approved for the treatment of idiopathic pulmonary hypertension. Numerous articles have suggested that it improves endothelial function and a possible role on premature ejaculation or treatment of lower urinary tract symptoms has been suggested.
The time to maximum plasma concentration is about 1 h while the plasma half-life is about 4–5 h. It is administered orally on demand in 25 mg, 50 mg, and 100 mg doses. The recommended starting dose is 50 mg and adapted according to efficacy and tolerability. Patients are instructed to take sildenafil approximately 1 h before sexual intercourse with a maximum dosing frequency of once daily. Sexual stimulation is a prerequisite for sildenafil as well as for the other PDE5i. The window of opportunity to engage in sexual intercourse is maintained from 30 min to 4–5 h from administration. However, the onset of action can be 14 min for about 35% of patients (Figure ​(Figure1)1) (Padma-Nathan et al 2003) and efficacy may be maintained for up to 12 h (Moncada et al 2004). A heavy fatty meal results in reduced and prolonged absorption. Alcohol does not have an impact on absorption in regular doses. Contraindications for the use of sildenafil and need for dose adjustments are summarized in Table ​Table11 (Langtry and Markham 1999).
Kegel exercises can help improve bladder control, and according to the Mayo Clinic may improve sexual performance. These exercises are simple to do, and can be done anywhere – even while driving or sitting on the couch watching TV.  According to a study in 2005, three months of kegel exercises twice daily, combined with such things as losing weight, reducing alcohol intake, and quitting smoking, significantly improved performance for men with ED.
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, when research has shown a nutrient such as zinc or niacin to improve sexual function, it's usually in people who are deficient in it. So, before you stock up on over-the-counter nutritional supplements for ED, speak with your doctor. He can test you for deficiencies and steer you toward the most effective and safest way to treat your erectile dysfunction. 
Counselling or sex therapy (58% of people find this works for them) –mind-related causes of erectile dysfunction can affect anyone. They are more likely if you experience erectile dysfunction at a younger age. Talking to a counsellor or therapist can help some people overcome erectile dysfunction related to these problems, possibly for good. They can also help you if your erectile dysfunction is causing you stress, as this can make matters worse.

A review of 46 articles on phosphodiesterase type 5 inhibitor abuse was published in the journal Current Drug Abuse Reviews in 2011. One reason cited for abuse was easy access to ED drugs. A search for Internet drug stores found over six million hits at 7,000 Internet pharmacies. Only 4 percent of the sites were in proper compliance, according to the Verified Internet Pharmacy Practice Sites program.
When Viagra (sildenafil) hit the market in 1998, some men thought it was the long-awaited answer to their problems. Many rushed to doctor's offices to give it a try. According to the Grey Clinic in Indianapolis, which specializes in erectile dysfunction, 17% of men between 18 and 55 experience occasional impotence, while 6% have regular erectile difficulties. For men over 55, that number jumps to about one in three. Some common causes of impotence are diabetes, heart disease, and psychological problems. It also frequently occurs after prostate cancer surgery.

Other factors that “stress” the body can also increase your risk for ED. These include: substance abuse, using marijuana, smoking cigarettes, depression, anxiety and low self esteem. Cigarette smoking — or using nicotine — leads to constricted blood vessels, which has negative effects for sexual health. Other mental/emotional obstacles can cause less desire for sex and decrease testosterone. Several ways to help manage stress include:
Most patients with multiple sclerosis (MS) report an interest in using dietary supplements to potentially reduce the severity and symptoms of the disease, and more than half of MS patients are already taking them. But which supplements have evidence of a beneficial effect? Researchers reviewed studies on more than 20 vitamin and dietary supplements—including vitamins A, C, D, E, and many B vitamins, as well as caffeine, lipoic acid, probiotics, and other supplements—but found that only one had sufficient evidence to recommend routine supplementation. Click here to find out which one.

Along with promoting overall health, a sufficient daily magnesium intake can help significantly if you take zinc to promote healthy erectile function or to help alleviate ED. Zinc is often recommended as a natural ED remedy, particularly for men who have a zinc deficiency, according to MayoClinic.com. Magnesium helps regulate zinc levels in the body to support healthy erectile function. Herbs, vitamins and minerals, including magnesium, haven’t been widely studied in terms of their true benefits for men with ED or other erectile problems, but maintaining adequate levels of essential vitamins and minerals may help a doctor narrow down the cause of such problems.
I am so grateful Jacqui, I am seeing my girlfriend tomorrow and feel like the problem is pretty much gone! I can't believe it I thought I was broken!!! I have searched on sooo many sites and got so much bad advice and feel like posting the link of your site on all of those others. As this is a horrible problem and your method will work for me - so guys need to know this! Many, many thanks for the help.

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.
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.
Despite the proven long-term efficacy of PDE5i, it has been suggested that tachyphylaxis to this therapy may develop. Long-term treatment with PDE5i and excessive cGMP accumulation may up-regulate PDE5 (El-Galley et al 2001). Such hypothesis however, has not been proven in the existing clinical trials with chronic PDE5i therapy (Behr-Roussel et al 2005; Musicki et al 2005). Currently, there are no evidence-based data to support tachyphylaxis in patients treated with sildenafil or any other PDE5i.
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.
The Reality: Viagra is a brand name for sildenafil, a prescription drug developed by Pfizer scientists looking for ways to treat cardiovascular disease. It's been on the market since 1998 and works by increasing blood flow to the penis so that people with erectile dysfunction—an inability to achieve and/or maintain an erection—can be hard enough for sex.
Getting too little zinc in your diet may result in a deficiency, which can cause hair loss, impaired immune function, poor would healing and impotence in men, according to the Office of Dietary Supplements. Low zinc levels in men are linked to low sperm and male infertility, according to a study published in the journal Scientific Reports in March 2016. Due to the high number of elderly people who are deficient in zinc, Oregon State University suggests elderly men take a daily zinc supplement containing the zinc RDA, or 11 milligrams of zinc, daily.
Does diabetes cause erectile dysfunction? Diabetes can lead to lower levels of testosterone, and this can result in erectile dysfunction. Controlling blood sugar levels, maintaining a healthy weight, getting exercise, and reducing stress are all ways of reducing this problem. Hormone therapy, Viagra, and counseling are some ways that medicine can help. Read now
Alprostadil is an FDA-approved erectile dysfunction drug that can be injected directly into the penis to trigger an automatic erection. "Penile injection is the most effective type of ED treatment for men who can't take oral treatment," says Nelson Bennett, MD, a urologist at the Lahey Clinic in Burlington, Mass. In fact, it has an 85 percent success rate. Possible side effects include a burning sensation and priapism, an erection that lasts more than four hours and requires medical treatment.
A drug called Alprostadil, either alone or sometimes in conjunction with others such as papaverine and/or phentolamine, can be injected directly into the penis to dilate the arteries, experts say. The drug produces an erection in about 10 minutes that can last up to an hour. But there are several disadvantages, says Teresa Beam, MD, a urologist with the Grey Clinic. Some patients are averse to using a needle, which is why many men abandon the therapy. Those who give it a try may experience pain at the injection site or priapism (a painful erection lasting too long).
Penile erection is a hemodynamic process involving increased arterial inflow and restricted venous outflow, coordinated with corpus cavernosum and penile arterial smooth muscle relaxation. Any problem in this mechanism results in Erectile Dysfunction and its etiology is generally multifactorial. This study is aimed at determining the objective outcome of aerobic training in the management of Erectile Dysfunction of arterogenic origin using Meta analysis.
A meta-analysis of 36 744 men with ED in 12 prospective cohort studies found that the presence of ED significantly increased the risk of CVD, CAD, stroke and all-cause mortality, and the presence of ED was an independent risk factor for CVD. Ponholzer et al found that men with moderate to severe ED had a 65% increased relative risk for developing symptomatic CAD compared with men who did not have ED.26

Several studies (15–17) have shown an inverse relationship between physical activity levels and biomarkers of inflammation in both the healthy individuals and subjects with cardiovascular condition. Studies (18–21) have also reported the role of exercise in the management of erectile dysfunction. The majority of these studies are subjective, retrospective case series and non randomized non controlled studies. However, randomized controlled trials (RCTs) are generally accepted as the most valid method for determining the efficacy of a therapeutic intervention, because the biases associated with other experimental designs can be avoided (22). Therefore, the purpose of the present Meta analysis study was to determine the role and effect of aerobic exercise in the management of erectile dysfunction in randomized controlled trials.
Does diabetes cause erectile dysfunction? Diabetes can lead to lower levels of testosterone, and this can result in erectile dysfunction. Controlling blood sugar levels, maintaining a healthy weight, getting exercise, and reducing stress are all ways of reducing this problem. Hormone therapy, Viagra, and counseling are some ways that medicine can help. Read now
There have been some studies to suggest that a placebo effect that improves ED may work for some men. One study found that men taking an oral placebo pill showed as much improvement in ED symptoms as men who took actual medication to improve ED. Conversely, men who were given therapeutic suggestions to improve ED did not see signs of symptom improvement.

When it comes to boosting sexual performance, many men will walk all over God’s green earth looking for ways to maintain a good sex life. Luckily men, all you have to do is walk — not run — 2 miles a day. This, along with other healthier lifestyle interventions can help obese men reduce their risk of ED, or even “reverse” current impotence, according to a 2005 study. This comes of importance, since maintaining a trim waistline is a good defense for ED, as men with a 42-inch waist are 50 percent more likely to have ED than those with a 32-inch waist. Getting to a healthy weight and maintaining it is a good strategy for preventing and treating ED.

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