Another common reason for failures of oral therapy is the absence of sexual or genital stimulation prior to attempting sexual intercourse. These medicines facilitate an erection by increasing blood flow to the penis, but they do not act as an aphrodisiac or as an initiator of the erection. A man who is not “in the mood” or does not have adequate physical stimulation will not respond with an erection.
In a 2005 study, three months of twice-daily sets of kegel exercises combined with biofeedback and advice on lifestyle changes, such as quitting smoking, losing weight, and limiting alcohol, worked far better than just giving the participants advice. “Wearing tight pants will affect impotence along with some other medical conditions like diabetes and heart disease,” which can also affect a man’s degree of impotence, Dr. Jennifer Burns, specializing in family practice with an emphasis on gastrointestinal health at the BienEtre Center, told Medical Daily.

Another potential new treatment consists of penile low-intensity shock wave lithotripsy. This consists of 1500 shocks twice a week for 3–6 weeks. The purpose is to stimulate neovascularisation to the corporal bodies with improvement in penile blood flow and endothelial function. The use of low-intensity shock wave lithotripsy may convert PDE5 inhibitor non-responders to responders.47
A study published in The American Journal of Cardiology confirmed that aerobic exercises will help you to cure your erectile dysfunction. Erectile dysfunction is most commonly caused by obesity, hypertension, and diabetes, which decrease the blood flow in the penis. Aerobic exercises can and will help you to improve your health in general, improve your blood flow, and ultimately treat your condition.

Erectile problems can sometimes be linked to cardiovascular issues. If your heart isn't in full health, your sex life maybe suffering as result. Men who suffer with moderate to severe erection problems have significantly lower levels of folic acid than guys without the issue. The B vitamin has been shown to work with nitric oxide which would explain why an absence of it would lead to problems in the manhood. This seems to help with erectile dysfunction more than some medications. Treatment with folic acid resulted in men having an increase in their erectile strength.
According to whom? What's the source of your statistic? Because it sounds astonishingly high, for me to get erections and then lose them. If what you are talking about is men not being able to get erections, why don't you be honest and say that normally this is completely associated with age (say, over-60, and especially over 75), and that the Viagra-class of medications is the simplest and easiest response.
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.

A glass of pomegranate juice a day keeps the oncologist away? Such may be the case if further evidence confirms a recent investigation of the pomegranate's ability to inhibit breast cancer cells. Previous studies have shown that pomegranate juice disrupts metastasis of breast and prostate cancers, but in a new study, researchers found that phytochemicals in pomegranate extract altered breast cancer stem cells, inhibiting cell growth and differentiation. Does this warrant more investigation? Find out here.

*all photos are models and not actual patients.If you are interested in a prescription product, Hims will assist in setting up a visit for you with an independent physician who will evaluate whether or not you are an appropriate candidate for the prescription product and if appropriate, may write you a prescription for the product which you can fill at the pharmacy of your choice.
Some patients experienced a sudden loss of some or all of their vision after they took sildenafil or other medications that are similar to sildenafil. The vision loss was permanent in some cases. It is not known if the vision loss was caused by the medication. If you experience a sudden loss of vision while you are taking sildenafil, call your doctor immediately. Do not take any more doses of sildenafil or similar medications such as tadalafil (Cialis) or vardenafil (Levitra) until you talk to your doctor.

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.
You don’t say how heavy you are, but in heavy men, weight loss has recently been shown to improve erectile function scores rather dramatically. According to an Australian study of men with type 2, published on August 5, 2011, in the Journal of Sexual Medicine, weight loss improved sexual function, sexual desire, urinary function, and inflammation levels. Sexual function continued to improve during a year of follow-up.
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.
Both patients and partners report higher levels of satisfaction (assessed with the Erectile Dysfunction Inventory of Treatment Satisfaction [EDITS] questionnaire) after sildenafil treatment relative to placebo (Lewis et al 2001). Patients receiving sildenafil had significantly higher scores (73.6 ± 3.2) than did those receiving placebo (48.4 ± 3.2, p<0.001). The scores on the partner version of the EDITS were also significantly higher among the partners of men who received sildenafil (63.9 ± 8.1) than among the partners of those who received placebo (33.3 ± 7.5, p<0.001). A high level of treatment satisfaction (65%) reported in another clinical practice study (assessed by 5-item scale) (Jarow et al 1999). Treatment satisfaction was correlated with ED severity (41% in severe, 78% in moderate, and 100% in mild ED) and etiology (56% in neurologic causes, 58% in diabetes, 35% in radical prostatectomy, 89% in psychogenic causes, and 86% in vasculogenic causes). However, no particular characteristic predicted absolute failure with sildenafil. Sildenafil also improved all aspects of health-related quality of life (assessed by SF-36 or Q13 and Q14 of the IIEF) in general ED population or subgroups such as spinal cord injuries (Hultling et al 2000; Giuliano et al 2001; Fujisawa et al 2002). Significant improvements in self-esteem, confidence, sexual relationship satisfaction, and overall relationship satisfaction after treatment of ED with sildenafil were reported by Althof and colleagues (2006) using the self-esteem and relationship questionnaire (SEAR) in a cross-cultural double-blind, placebo controlled, flexible dose study (Althof et al 2006; Cappelleri et al 2006). Treatment satisfaction is also maintained through time (Figure ​(Figure3)3) (Carson et al 2002).
“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.
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.
Nearly every primary care physician, internist and geriatrician now understand that many older men retain an interest in sexual activity as they age. Some primary care physicians think that sexual potency in older men is the norm, and that if it is lacking, it is ‘all in the head.’ This viewpoint has not been supported by current literature. The Massachusetts Male Aging Study (MMAS) found that 52% of men between 40 and 70 years old reported having some form of erectile dysfunction (ED).1 The reality is that ED is a natural part of ageing and that the prevalence increases with age. In the MMAS, they found that roughly 50% of men at 50 years old, 60% of men at 60 years old and 70% of men at 70 years old had ED. Thus, nearly all men who live long enough should develop ED. The myths that surround the problems of impotence or ED confound the attempts of patients to receive treatment and the attempts of physicians to help them.1
For men who do find themselves suffering from ED, the knee-jerk reaction can be to reach for the Viagra but – while ED tablets are an excellent solution in the short term – there are other treatment options to consider incorporating into your lifestyle on a long-term basis, one of the most straightforward being exercise. Below you’ll find four great ways that exercise may help to treat erectile dysfunction.
The idea of using low-energy shock waves to treat erectile dysfunction comes from studies that show that these types of shocks help heart blood vessels regrow, a process called revascularization. Shock wave therapy may also work on the penis, and there have been some promising results, but it’s not currently an approved ED treatment. "It’s similar to the type of shock waves used to break up kidney stones, and it may cause revascularization,” says Bennett. “However, there are not yet any good controlled studies to recommend it to patients."
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.

Erectile dysfunction can be a very serious issue as it is a marker of underlying cardiovascular disease and many times occurs before heart conditions manifest. Men should maintain a healthy weight adhere to good nutrition habits exercise drink alcohol in moderation (if at all) and get quality sleep. It is also important to address risk factors such as diabetes and high blood pressure. Not only will this improve their sexual ability but it will also support their cardiovascular health and help reduce the risk of developing diabetes. 
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.”
At his last visit, Mr. Jones was prescribed Imdur (isosorbide mononitrate) to help with his heart condition. Reading through the notes, it looks like the Imdur worked. He was feeling better, so much better that he wanted to start having sex with his wife again. And here was the problem: Mr. Jone’s doctor had renewed his Cialis prescription. Quickly, I went from a moment of elation to consternation.
After supplementation of 500 milligrams of zinc daily for 30 days, zinc levels improved slightly and sexual dysfunction resolved in 5 of the 22 patients in the group completely.[10] Based on this study, there is enough evidence to highlight a link between zinc levels and sexual function, but it is still too ambiguous to proclaim this to be a "wonder drug" to include as a natural supplement for erectile dysfunction just yet. 
Older age. A man’s risk increases past the age of 40, as age is the variable most strongly associated with impotence. This is due to changing hormones, higher risk for heart problems and those affecting circulation, and decreased sexual desire that often occurs with increasing age. For example, based on findings from the National Health and Social Life Survey, it’s been found that “men between 50–60 years old are more than 3 times as likely to experience erection problems and to report low sexual desire compared to men aged 18 to 29 years.” (3)
It is important that you exercise, not only to combat ED but also to maintain your general health. Any aerobic exercise such as running, cycling or swimming will be great for improving your overall health and fitness. These kinds of exercise improves your cardiovascular health, which is important to help you treat your ED. You may also find it helpful to review your general lifestyle and reduce factors which could be contributing to your ED, such as smoking, drinking alcohol and eating unhealthy foods.

In the present study zinc caused an elevation of T. This showed an increase from 2.39 to 8.21 ng/dl after two weeks of zinc treatment. This elevated T level may have contributed to the increase in number of penile thrusting (from 26.5 to 52.8) observed. Supplementation with 459 μmol/day of zinc for three months, in marginally zinc deficient healthy elderly men, has been shown to increase the levels of serum T from 8.3 to 16 ng/dl.[25] Laboratory experiments indicate that the nitric oxide erectile pathway is T dependent.[26] Many studies using animal models have confirmed that T is important in modulating the central and peripheral regulation of erectile dysfunction. T deprivation has a negative impact on the structure of penile tissues and erectile nerves.[27] Thus, elevated T levels subsequent to zinc supplementation may increase the sexual competence via rigid and sustained erection. This may promote greater tactile stimulation of the penis due to increased contact with vagina.[25]

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.


Vitamins and minerals are used in systems all over the body. Everywhere from your cardiovascular to your nervous system. It’s a lot to understand. So to help dispel some of the myths and outlandish claims, we’ll take a look at how five common vitamins and nutrients affect one very specific aspect of men’s health—erections. Turns out, vitamins can do more than just ward off the common cold.

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.
The number of animals ejaculating within 15 minutes was significantly reduced in 5 mg zinc treated group (one out of eight). However, all intromitted rats ejaculated between 20-30 minutes when observation was continued. Ejaculatory latency was significantly high in this group compared to controls; 711.60 Sec (SEM 85.47) vs. 489.50 Sec (SEM 67.66), P < 0.05. Similarly, they showed a significantly higher frequency of penile thrusting compared to controls; 26.50 (SEM 6.17) vs. 52.80 (SEM 11.28), P < 0.05 [Table 1].
According to the Centers for Disease Control and Prevention, ingesting levels of zinc in excess of the recommended dietary amount will result in diarrhea, vomiting, and stomach cramps. The maximum amount of daily zinc consumption recommended is 40 milligrams per day. Symptoms of too much zinc intake include nausea and headaches. If you have reason to suspect you have ingested too much zinc, contact a medical professional.
Partner preference index in both 5 mg zinc treated group and controls was positive. In the control group, time spent by males, with estrous and diestrous females, was 21.75 sec. (SEM 2.26) and 13.62 sec. (SEM 1.05) respectively. In the zinc treated group they spent 20.87 sec. (2.09 SEM) with estrous and 14.37 sec. (SEM 0.70) with diestrous females. The PPI of controls and zinc treated group was 8.12 Sec. (SEM 2.32) and 6.50 Sec. (SEM 1.76) respectively. There was no significant difference between the two groups, P > 0.05.
It is important to understand that ED is frequently, if not usually, directly related to endothelial dysfunction, and that the release of NO by the vasculature of the penile arteries is directly related to the function of intact, healthy endothelium. In the face of endothelial dysfunction, the process of erection fails to occur in a normal fashion.16
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.
Among the phenomena in the ageing man are a decrease in erectile function and testosterone levels. Add to these, increased risk for CVD, muscle wasting, decrease in bone density and libido, with all of these factors having an interplay with testosterone metabolism.33 Androgens play a key role in maintaining erectile function through four main mechanisms. Androgen deprivation has been shown to result in impairment of NO synthase release, altered PDE5 expression and activity, impaired cavernosal nerve function, and contribution to veno-occlusive disease in the penis.34 The role of testosterone replacement therapy (TRT) as a potential to improve erectile function in the man with ED remains an issue for patient and physicians who are comfortable treating androgen deficiency which include primary care physicians and specialists. Androgens are known to have a significant impact on the function of the smooth musculature within the corpus spongiosum.35
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The bottom line is that nearly all men with diabetes who wish to have an erection adequate for sexual intercourse can do so with the therapies currently available. And with commitment and communication, the experience of erectile dysfunction can be changed from a potential personal tragedy to an opportunity for greater emotional intimacy in a couple.

If you have symptoms of ED, it’s important to check with your doctor before trying any treatments on your own. This is because ED can be a sign of other health problems. For instance, heart disease or high cholesterol could cause ED symptoms. With a diagnosis, your doctor could recommend a number of steps that would likely improve both your heart health and your ED. These steps include lowering your cholesterol, reducing your weight, or taking medications to unclog your blood vessels.
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