Older men (aged ≥65 years) have higher plasma concentrations of sildenafil compared with younger men (18–45 years), with mean maximum concentration (Cmax) 70% greater in older men and mean area under the curve (AUC) 84% higher compared with the younger age group. Due to age-differences in plasma protein binding, the corresponding increase in free sildenafil plasma concentration was approximately 40%. However, no differences in the safety of any dose of sildenafil were observed in older patients compared with younger men. Therefore, dosage adjustments are not required in elderly patients (Seftel 2003). Sildenafil significantly improves erectile function in elderly patients with erectile dysfunction of broad etiology although efficacy rates may be lower compared with younger men due to the normal aging process and age related risk factor accumulation mentioned before (Rendell et al 1999; Wagner et al 2001; Carson et al 2002).

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.
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.
For oral erectile dysfunction medicines to work as desired, they must be used properly in the first place. This means taking the medicine 30–45 minutes before engaging in sexual intimacy; taking the drug on an empty stomach or at least avoiding a heavy or high-fat meal before taking the drug (this is especially important when using sildenafil); and engaging in adequate genital stimulation before attempting intercourse. Drinking small amounts of alcohol (one to two drinks) should not compromise the effectiveness of erectile dysfunction medicines, but larger amounts of alcohol can diminish a man’s ability to have an erection.
Surgery for erectile dysfunction is usually considered only after all other options have failed. The two surgical options include the insertion of a semi-rigid rod or the implantation of a three-piece inflatable prosthesis. Penile prosthesis implantation has low infection, complication, and malfunction rates. However, since placement of an implant requires permanent injury to the erectile tissue of the penis, implant treatment is considered irreversible.

Several studies have shown that erectile dysfunction is somehow linked to problems with cardiovascular health — which one comes first has been the question. It makes sense; the penis becomes erect through a complex system of blood vessels and spongy tissue called the corpora cavernosa — this is where the blood gets trapped, causing the erection. When problems arise through this system, whether they’re caused in the brain or through problems with the blood vessels, the penis can’t get erect.


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.

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.
The sunshine vitamin will brighten things up in the bedroom. In a recent study published in the Journal of Sexual Medicine, Italian researchers found that of 143 men with erectile dysfunction, 80% had less-than-optimal levels of D, and the men with severe ED had, on average, a 24% lower level of D than with a milder condition. They theorize that low levels of D damage blood vessels and lead to a shortage of nitric oxide.
Zinc affects different aspects of mammalian reproduction. Testicular disruption, impaired spermatogenesis and subsequent poor semen parameters are found in males with zinc deficiency. Testicular concentration of zinc was lower in male sheep fed with zinc deficient diets. The same animals showed smaller seminiferous tubules and less lumen development than the controls.[1] Similarly variable degrees of maturation arrest in different stages of spermatogenesis with reduced diameter of seminiferous tubules were noted when rats were fed with zinc deficient diets.[2] Zinc deficiency causes a reduction in the structural parameters of seminiferous tubules influences serum levels of testosterone (T) and prolactin (PRL) in rats.[3,4]
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.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
Many products contain undocumented “fillers” that can cause allergic reactions.  In recent years, the FDA has found over 300 herbal products that contain hidden, deceptively labeled, or dangerous ingredients4. And since 2015, the FDA has released public warnings on more than 160 ED supplements and “male enhancement” products found to contain dangerous ingredients and contaminants5 .   An independent study of FDA data, conducted in 2018, found almost 800 herbal supplements that contained unlisted ingredients6.

Aerobic exercise — which means "with oxygen" — consists of continuous, repetitive movements that increase your heart rate and get healthy oxygen into all your muscles by increasing blood flow that supports the heart and blood vessels (and in turn, prevents ED). In fact, research suggests that regular aerobic exercise can lower the risk for erectile dysfunction by about 40 percent.

I recently treated a young twenty-something man with a primary complaint of erectile dysfunction. When he started to notice this issue, he attempted to treat it by performing lots of kegels. (If you haven’t heard of kegel exercises, they’re done by repeatedly contracting and relaxing the muscles that form part of the pelvic floor, as if you were trying to stop peeing mid-stream.) I found this man’s story interesting because, as we discovered, in his case the kegels actually did more harm than good. We found that once he stopped kegeling and allowed his pelvic muscles to relax, his erections became stronger and he was able to ejaculate without any issues.
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
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).
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

Risk factors for ED include older age, obesity, diabetes, heart disease, and high blood pressure. The problem is that men without issues are using these medications. "We are seeing more and more young men without any risk factors for ED asking for ED drugs. They look a lot like the young men dancing around in the TV advertisements, probably too healthy to have ED,” said Rowena DeSouza, MD, associate professor of surgery at the University of Texas Health Science Center at Houston and director of urology at Lyndon B. Johnson Hospital.

Experiencing ED can also be a reason to try not penetrative sex.  Try planning a sex session with your partner hat isn't focused on your erection at all.  Things like kissing, licking, sucking, foreplay and teasing all are super stimulating and don't focus on penetration.  Feel free to bring each other to orgasm using these ideas and see if you are able to relax and enjoy the experience.  Many men feel like failures when their erections become unreliable.  Having a few successful sexual sessions that lead to orgasm without penetration can put the fun back into having sex.  Many couples find success using this technique and begin to reengage sexually instead of avoiding being sexual for fear of failure.

Dealing with erection problems can be a challenge. However, there are lots of treatments and lifestyle changes which can help. While medications such as Viagra improve symptoms in the short term, pelvic floor exercises can help you improve your sexual function in the long term. Find out why pelvic floor, also known as Kegel exercises, can be used to treat ED and how to perform the exercises correctly.


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. 

A study from the University of the West in the United Kingdom found that pelvic exercises helped 40 percent of men with ED regain normal erectile function. They also helped an additional 33.5 percent significantly improve erectile function. Additional research suggests pelvic muscle training may be helpful for treating ED as well as other pelvic health issues.

Herbal supplements such as ginkgo biloba, saw palmetto, and yohimbe have been touted as sexual enhancers, and some men have been tempted to try them to treat erectile dysfunction. Bennett warns, however, that none has been approved by the FDA or even shown by any reliable studies to prevent, treat, or improve erectile dysfunction. Moreover, supplements are unregulated and can have many side effects or interfere with prescribed medications you’re already taking. Don’t jeopardize your health by taking a supplement to treat erectile dysfunction without first talking with your doctor.
Clinical trials were included if they met all of the following inclusion criteria: study population defined; Men with arteriogenic ED were considered; the present review was concerned with studies that used aerobic exercise on ED; only randomized controlled trials on this topic were selected for review; The main outcome measure was satisfactory intercourse without additional therapy using the International Index of Erectile Dysfunction (IIED) scores. The present review utilized studies that had successfully undergone rigorous peer review (i.e., published peerreviewed journals), were included.
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.
Watts and coworkers, in their review article, make several points about this ED/CAD nexus. Endothelial dysfunction is present in both CVD and ED, and is linked through the NO mechanism. The authors note that PDE5 inhibitors improve endothelial function and have a salutary effect on both CVD and ED. Both ED and cardiac disease respond to modifications in lifestyle as well as pharmacologic manipulation. These authors also report that the presence of ED gives the clinician an opportunity to assess CVD and prevention as well.20
Men can judge themselves pretty harshly when it comes to their performance in between the sheets. The unsettling fear of not being able to rise to the occasion becomes a reccurring nightmare for men that is often equated with failure, loss of dignity, and masculinity. If you suffer from erectile dysfunction (ED), don’t be so hard on yourself, since impotence can almost always be improved with treatment, without having to rely on Viagra or other medications. Whether you suffer from ED, or hope to prevent the condition, here are six tips to overcome impotence without the side effects of the little blue pill.
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