Introduction
Erectile dysfunction (ED), also known as impotence, is the inability to get and maintain an erection.
Erectile dysfunction is a very common condition, particularly in older men. It is estimated that half of all men between the ages of 40 and 70 will have it to some degree.
When to see your GP
See your GP if you have erectile dysfunction for more than a few weeks. They will assess your general state of health because the condition can be the first sign of more serious health conditions, such as heart disease (when the heart’s blood supply is blocked or interrupted).
Why does erectile dysfunction happen?
Erectile dysfunction can have a range of causes, both physical and psychological. Physical causes include:
- narrowing of the blood vessels going to the penis – commonly associated with high blood pressure (hypertension), high cholesterol or diabetes
- hormonal problems
- surgery or injury
Psychological causes of ED include:
- anxiety
- depression
- relationship problems
Sometimes erectile dysfunction only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection but you are unable to get an erection with your sexual partner.
If this is the case, it is likely the underlying cause of erectile dysfunction is psychological (stress related). If you are unable to get an erection under any circumstances, it is likely that the underlying cause is physical.
Erectile dysfunction can also be a side-effect of using certain medicines.
Read more about the causes of erectile dysfunction.
Diagnosis
Although you may be embarrassed, it's important to get a diagnosis so that the cause can be identified.
Your GP can usually diagnose erectile dysfunction. This will involve answering questions about your symptoms, as well as a physical examination and some simple tests.
Read more about diagnosing erectile dysfunction.
How is erectile dysfunction treated?
Erectile dysfunction is primarily treated by tackling the cause of the problem, whether this is physical or psychological.
The narrowing of the arteries (called atherosclerosis) is one of the most common causes of ED. In these cases your GP may suggest lifestyle changes, such as losing weight, to try to reduce your risk of cardiovascular disease. This may help to relieve your symptoms as well as improving your general health.
You may also be given medication to treat atherosclerosis, such as cholesterol-lowering statins and drugs to reduce your blood pressure.
A number of treatments have been successful in the treatment of erectile dysfunction. Medication, such as sildenafil (sold as Viagra), can be used to manage it in at least two-thirds of cases. Vacuum pumps that encourage blood to flow to the penis and cause an erection are also successful in 90% of cases.
Psychological treatments include cognitive behavioural therapy (CBT) and sex therapy.
Overall, treatments for erectile dysfunction have improved significantly in recent years. Most men are eventually able to have sex again.
Read more about treating erectile dysfunction.
Causes of erectile dysfunction
Erectile dysfunction (ED) can have many causes, such as certain medical conditions, medications and stress.
It's important to identify the cause of erectile dysfunction and treat any underlying conditions.
Erections
When a man becomes sexually excited (aroused), his brain sends signals to the nerves in his penis. The nerves increase the blood flow to the penis, causing the tissue to expand and harden.
Anything that interferes with the nervous system or the blood circulation could lead to erectile dysfunction.
Anything that affects the level of sexual desire (libido) can also cause erectile dysfunction because a reduced libido makes it more difficult for the brain to trigger an erection. Psychological conditions, such as depression, can reduce libido, as can changes in hormone levels (chemicals produced by the body).
Physical causes
There are four main types of health conditions that can cause physical problems resulting in erectile dysfunction. These are:
- conditions affecting the flow of blood to your penis – vasculogenic
- conditions affecting your nervous system, which is made up of your brain, nerves and spinal cord – neurogenic
- conditions affecting your hormone levels – hormonal
- conditions affecting the physical structure of your penis – anatomical
Injuries and surgery
Penis injuries or surgical treatment of the penis, pelvis or surrounding areas can sometimes lead to erectile dysfunction.
Erectile dysfunction is also thought to occur in up to 15-25% of people who experience a severe head injury.
Vasculogenic conditions
Examples of vasculogenic conditions that cause erectile dysfunction include:
- cardiovascular disease – a disease of the heart or blood vessels, such as atherosclerosis (hardening of the arteries)
- high blood pressure (hypertension)
- diabetes – a condition caused by high blood sugar levels. This can affect both the blood supply and the nerve endings in your penis, so it is also a neurogenic condition
Erectile dysfunction is strongly associated with cardiovascular disease. For this reason, it may be one of the first causes your GP considers when making a diagnosis and planning your treatment.
Neurogenic conditions
Examples of neurogenic conditions that cause erectile dysfunction include:
- multiple sclerosis – a condition that affects the body's actions, such as movement and balance
- Parkinson’s disease – a condition that affects the way that the brain coordinates body movements, including walking, talking and writing
- a spinal injury or disorder
- a stroke – a serious condition that occurs when the blood supply to the brain is interrupted
Hormonal conditions
Examples of hormonal conditions that cause erectile dysfunction include:
- hypogonadism – a condition that affects the production of the male sex hormone, testosterone, causing abnormally low levels
- an overactive thyroid gland (hyperthyroidism) – where too much thyroid hormone is produced
- an underactive thyroid gland (hypothyroidism) – where not enough thyroid hormone is produced
- Cushing's syndrome – a condition that affects the production of a hormone called cortisol
Anatomical conditions
Peyronie's disease, which affects the tissue of the penis, is an example of an anatomical condition that can cause erectile dysfunction.
Medicine
In some men, certain medicines can cause erectile dysfunction, including:
- diuretics – these increase the production of urine and are often used to treat high blood pressure (hypertension), heart failure and kidney disease
- antihypertensives – such as beta-blockers, that are used to treat high blood pressure
- fibrates – medicines used to lower cholesterol levels
- antipsychotics – used to treat some mental health conditions, such as schizophrenia
- antidepressants – used to treat depression and some types of pain
- corticosteroids – medication that contains steroids, which are a type of hormone
- H2-antagonists – medicines used to treat stomach ulcers
- anticonvulsants – used to treat epilepsy
- antihistamines – used to treat allergic health conditions, such as hay fever
- anti-androgens – medication that suppresses androgens (male sex hormones)
- cytotoxics – medication used in chemotherapy to prevent cancer cells from dividing and growing
Speak to your GP if you are concerned that a prescribed medicine is causing erectile dysfunction. Alternative medication may be available. However, it is important never to stop taking a prescribed medicine unless you are advised to do so by a qualified healthcare professional who is responsible for your care.
Psychological causes
Possible psychological causes of erectile dysfunction include:
- depression – feelings of extreme sadness that last for a long time
- anxiety – a feeling of unease, such as worry or fear
Erectile dysfunction can often have both physical and psychological causes. For example, if you have diabetes, it may be difficult for you to get an erection, which may cause you to become anxious about the situation. The combination of diabetes and anxiety may lead to an episode of erectile dysfunction.
There are many emotional issues that may also affect your physical ability to get or maintain an erection. These include:
- relationship problems
- lack of sexual knowledge
- past sexual problems
- past sexual abuse
- being in a new relationship
Other causes
Other possible causes of erectile dysfunction include:
- excessive alcohol intake
- tiredness
- using illegal drugs, such as cannabis, heroin or cocaine
Cycling
Men who cycle for more than three hours per week may be recommended to try a period without cycling to see if this helps improve erectile dysfunction.
Riding in the correct position with a properly fitted seat may also help to prevent regular cycling from leading to erectile dysfunction.
Increased risk
There are some things that can make erectile dysfunction more likely. These are very similar to the risks of cardiovascular disease and include:
- lack of exercise or physical activity
- obesity
- smoking
- high cholesterol
Erectile dysfunction itself can also be a sign of cardiovascular disease.
Diagnosing erectile dysfunction
Erectile dysfunction (ED) can often be diagnosed by your GP. They will talk to you about your situation and may carry out a physical examination.
Your GP may ask you about:
- your symptoms
- your overall physical and mental health
- your alcohol consumption
- whether you take drugs
- whether you are currently taking any medication
If you do not want to talk to your GP about erectile dysfunction, you can visit a genitourinary medicine (GUM) clinic. You can find your nearest GUM clinic on the British Association for Sexual Health and HIV (BASHH) website.
Sexual history
You'll also be asked about your sexual history. Try not to be embarrassed because erectile dysfunction is a common problem. You can request a male GP at your surgery if you prefer.
You may be asked about:
- your previous and current sexual relationships
- what your sexual orientation is
- how long you have been experiencing erectile dysfunction
- whether you can get any degree of erection with your partner, on your own or when you wake up in the morning
- whether you have been able to ejaculate or orgasm
- your libido (your level of sexual desire)
Erectile dysfunction that happens all the time may suggest an underlying physical cause.
Erectile dysfunction that only occurs when you are attempting to have sex may suggest an underlying psychological (mental) cause.
Assessing your cardiovascular health
Your GP may assess your cardiovascular health. Narrowed blood vessels are a common cause of erectile dysfunction and linked with cardiovascular disease (conditions that affect the heart and blood flow).
Your GP may:
- measure your blood pressure to see if you have high blood pressure (hypertension)
- listen to your heart rate to check for any abnormalities
- measure your height, weight and waist circumference to see if you are a healthy weight for your height
- ask you about your diet and lifestyle, for example, how much exercise you do
- test a sample of your blood for glucose (sugar) and lipids (fatty substances), as high levels can indicate conditions affecting your heart or blood vessels
Physical examinations and tests
A physical examination of your penis may be carried out to rule out anatomical causes (conditions that affect the physical structure of your penis).
If you have symptoms of an enlarged prostate, such as weak or irregular urination, a digital rectal examination (DRE) may be suggested.
Blood tests can also check for underlying health conditions. For example, measuring the levels of hormones such as testosterone can rule out hormonal conditions, such as hypogonadism (an abnormally low level of testosterone).
Further testing
In some cases you may be referred to a specialist for further testing. This might be the case if you are unusually young to be experiencing erectile dysfunction as it's rare in men under 40 years of age.
Intracavernous injection test
An intracavernous injection test involves injecting a man-made (synthetic) hormone into your penis to increase the blood flow. This helps assess any abnormalities in your penis and plan surgery.
If the injection doesn't result in an erection it may indicate a problem with the blood supply to your penis. In some cases, you may also need an ultrasound scan.
Arteriography and dynamic infusion cavernosometry or cavernosography
These specialised tests involve injecting dye into the blood vessels of your penis and studying the dye on a scanner. These are likely to be used if you are being considered for surgery or if a problem has been detected with your blood vessels.
Psychological assessment
If the cause of your erectile dysfunction is thought to be psychological, you may be reffered for a psychological assessment.
Treating erectile dysfunction
If you have erectile dysfunction (ED), treatment will depend on what's causing it.
Read on to learn about the different treatments you may be offered.
You can also read a summary of the pros and cons of these treatment options, allowing you to compare your treatment options.
Treating underlying conditions
If your erectile dysfunction is caused by an underlying health condition, such as heart disease or diabetes, that condition may need to be treated first. In some cases, treating the underlying cause may also resolve the problem.
If you are taking medication that can cause erectile dysfunction, there may be an alternative. It is important never to stop taking a prescribed medication unless you are advised to do so by your GP or another qualified healthcare professional responsible for your care.
Lifestyle changes
Erectile dysfunction can often be improved by making changes to your lifestyle, such as:
- losing weight if you are overweight
- giving up smoking
- cutting back your alcohol consumption
- not taking illegal drugs
- exercising regularly
- reducing stress
As well as helping to improve your erectile dysfunction, these changes can also improve your general health and may help to reduce your risk of cardiovascular disease (conditions that affect your heart and blood vessels).
Read more about preventing cardiovascular disease.
Phosphodiesterase-5 (PDE-5) inhibitors
Phosphodiesterase-5 (PDE-5) inhibitors are one of the most widely used and effective types of medication for treating erectile dysfunction. They work by temporarily increasing the blood flow to your penis.
In England, four PDE-5 inhibitors are available for treating erectile dysfunction. They are:
- sildenafil – sold under the brand name Viagra
- tadalafil – sold under the brand name Cialis
- vardenafil – sold under the brand name Levitra
- avanafil - sold under the brand name Spedra
Sildenafil, vardenafil and avanafil work for about eight hours and they are designed to work 'on demand'. Tadalafil lasts for up to 36 hours and is more suitable if you require treatment for a longer period of time, for example, over a weekend.
Depending on the type of PDE-5 inhibitor you are taking and the dose, it should take about 30-60 minutes before it starts to work. With sildenafil, vardenafil and avanafil, you should be able to have sex from one to 10 hours after taking the medicine. After taking tadalafil, the effects will last for up to 36 hours.
It may take longer to notice the effects if the tablet is taken with food, so it's best to take it on an empty stomach. You can then eat after an hour without affecting the medicine.
Only take one tablet within a 24-hour period.
Your GP should explain the benefits of each medication and how it works. The choice may depend on:
- how often you are sexually active
- whether you have tried any of the medications before
There have been many studies to test the effectiveness of these medications. In general, at least two-thirds of men report having improved erections after taking one of these medicines.
If you do not find that PDE-5 inhibitors are effective it may be because:
- you have not waited long enough after taking the dose
- you have waited too long after taking the dose
- the dose is not high enough
- you have not had enough sexual stimulation
These medications are triggered by sexual stimulation, so you also need to be aroused for it to work.
Warnings
PDE-5 inhibitors should be used with caution in men who have cardiovascular disease, such as coronary heart disease. However, sexual activity is also likely to be beneficial for your cardiovascular health. You should discuss the risks and benefits with your GP.
PDE-5 inhibitors should also be used with caution in men who have anatomical problems with their penis, such as Peyronie's disease (a condition that affects the tissue of the penis).
PDE-5 inhibitors should also be used with caution in men who:
- are at risk of priapism – a painful erection that lasts for several hours
- are also taking long lasting alpha-blockers – a medication used to treat a number of conditions, such as high blood pressure (hypertension)
Do not take PDE-5 inhibitors if you are also taking medicines or recreational drugs that contain nitrates. The combination of the two substances can have a dangerous effect on your heart.
Organic nitrates are often used to treat angina, and butyl nitrate is a recreational drug that is more commonly known as 'poppers'.
You are also warned not to take PDE-5 inhibitors if you:
- have been advised not to take part in sexual activity or in activities that widen your blood vessels
- have low blood pressure (hypotension)
- have recently had a stroke – a medical emergency that occurs when the blood supply to the brain is interrupted
- have unstable angina – an underlying heart condition that causes symptoms such as chest pain
- have had a heart attack – a medical emergency where the blood supply to the heart is suddenly blocked
- have a history of non-arteritic anterior ischaemic optic neuropathy – an eye condition that causes a sudden loss of vision
Side effects
PDE-5 inhibitors can cause some side effects, including:
- headaches and migraines
- flushing (redness)
- indigestion
- nausea (feeling sick)
- vomiting (being sick)
- a blocked or runny nose
- back pain
- vision disturbances
- muscle pain
See the medicines information for erectile dysfunction.
NHS prescriptions
Your GP can prescribe sildenafil to anyone with erectile dysfunction as long as it is safe to do so (see warnings above). Other PDE-5 inhibitors may only be prescribed based on your individual circumstances.
In some cases you may need to pay the full cost of the medication. The exact price will depend on the dosage and your local pharmacy but four PDE-5 tablets usually cost between £17 and £30.
Read more about help with prescription costs.
Men with the following medical conditions are entitled to NHS prescriptions for PDE-5 inhibitors:
- diabetes
- multiple sclerosis
- Parkinson’s disease
- polio
- prostate cancer
- spina bifida
- certain genetic conditions, such as Huntington's disease
Men who are receiving or have received certain medical treatments may also be entitled to NHS prescriptions for PDE-5 inhibitors. These treatments include:
- pelvic surgery – which is often used to remove tumours (growths) or to treat conditions such as incontinence
- surgical removal of the prostate gland (prostatectomy) – which is often used to treat prostate cancer
- dialysis for kidney failure
- kidney transplant
In certain circumstances, some specialist centres may provide an NHS prescription for PDE-5 inhibitors. For example, if ED is causing you severe distress.
Vacuum pumps
A vacuum pump consists of a clear plastic tube that is connected to a pump, which is either hand or battery operated.
You place your penis in the tube and pump out all of the air. This creates a vacuum that causes the blood to fill your penis, making it erect. You then place a rubber ring around the base of your penis to keep the blood in place, allowing you to maintain an erection for around 30 minutes.
It may take several attempts to learn how to use the pump correctly, but they are usually effective. After using a vacuum pump, nine out of 10 men are able to have sex, regardless of the cause of their ED.
Considerations
You should not use a vacuum pump if you have a bleeding disorder or if you are taking anticoagulant medicines, which reduce the ability of your blood to clot.
Side effects of vacuum pumps include pain or bruising, although these occur in less than a third of men.
Men who qualify for NHS prescriptions for erectile dysfunction treatments may be able to get a vacuum pump on the NHS (see above for more details). However, some men will need to buy one.
The Sexual Advice Association produces a number of factsheets, including one on vacuum pumps that provides details of companies that supply them.
Alprostadil
If your erectile dysfunction doesn't respond to treatment, or you are unable or unwilling to use PDE-5 inhibitors or a vacuum pump, you may be given a medicine called alprostadil. This is a synthetic (man-made) hormone that helps to stimulate blood flow to the penis.
Alprostadil is available as:
- an injection directly into your penis – this is called an intracavernosal injection
- a small pellet placed inside your urethra (the tube that carries urine from your bladder to the tip of your penis) – this is called urethral application
You may be trained to correctly inject or insert alprostadil. If your partner is pregnant, use a condom during sex if you are inserting alprostadil into your urethra.
Alprostadil will usually produce an erection after five to 15 minutes. How long the erection lasts will depend on the dose.
In men who did not respond to PDE-5 inhibitors, alprostadil injections were successful in 85 out of 100 men. Alprostadil inserted into the urethra is successful for up to two-thirds of men.
Warnings
Alprostadil should not be used:
- in men at risk of priapism (a painful erection that lasts for several hours) – for example, those with sickle cell anaemia
- alongside other erectile dysfunction medications
- if you have a penile implant or if you have been advised to avoid sexual activity
Urethral application may also not be used in:
- some men who have anatomical problems with their penis (conditions that affect the physical structure of the penis)
- men who have infections of their penis, such as balanitis (inflammation of the head of the penis)
Side effects
Alprostadil can cause some side effects including:
- changes in your blood pressure
- dizziness
- headache
- pain in your penis
- urethral burning or bleeding
- reactions at the site of the injection, such as swelling
See the Alprostadil medicines information for more information about this medicine.
NHS prescriptions
As with PDE-5 inhibitors, NHS prescriptions for alprostadil may only be available for men with particular health conditions or those receiving some types of medical treatments. If you need to pay the full prescription cost, a single injection of alprostadil costs around £8 to £22, depending on the dose. A single dose of alprostadil for urethral application is around £10.
Hormone therapy
If a hormonal condition is causing erectile dysfunction, you may be referred to an endocrinologist (who specialises in the treatment of hormonal conditions).
Hormones are chemicals produced by the body. Many hormonal conditions can be treated using injections of synthetic (man-made) hormones to restore normal hormone levels.
Surgery
Surgery for erectile dysfunction is usually only recommended if all other treatment methods have failed. It may also be considered in:
- younger men who have experienced serious injury to their pelvic area – for example, in a car accident
- men with a significant anatomical problem with their penis
In the past, surgery was used if there was clear evidence of a blockage to the blood supply of the penis. The surgeon could unblock the blood vessels to restore a normal supply of blood. However, research now suggests that the long-term results of this type of surgery are poor, so it's unlikely to be used.
Penile implants
Penile implants are a type of surgery that may be considered. These can be:
- semi-rigid implants – which may be suitable for older men who do not have sex regularly
- inflatable implants – which consist of two or three parts that can be inflated to give a more natural erection
Penile implants are not usually available on the NHS and inflatable implants may be very expensive. However, around three-quarters of men report being satisfied with the results of this type of surgery.
Complications
As with all types of surgery, having penile implants inserted carries a risk of infection. If you take preventative antibiotics, the rate of infection is around two or three in 100. Mechanical problems with the implants may occur within five years in five per cent of cases.
Psychological treatments
If your erectile dysfunction has an underlying psychological cause then you may benefit from a type of treatment called sensate focus.
If conditions such as anxiety or depression are causing your erectile dysfunction, you may benefit from counselling (a talking therapy).
Sensate focus
Sensate focus is a type of sex therapy that you and your partner complete together. It starts with you both agreeing not to have sex for a number of weeks or months. During this time, you can still touch each other, but not in the genital area (or a woman’s breasts). The idea is to explore your bodies knowing that you will not have sex.
After the agreed period of time has passed, you can gradually begin touching each other’s genital areas. You can also begin to use your mouth to touch your partner, for example, licking or kissing, them. This can build up to include penetrative sex.
You can find out more about sensate focus from the College of Sexual and Relationship Therapists (COSRT).
Psychosexual counselling
Psychosexual counselling is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues that may be contributing to your erectile dysfunction. By talking about the issues, you may be able to reduce any anxiety that you have and overcome your erectile dysfunction.
The counsellor can also provide you with some practical advice about sex, such as how to make effective use of other treatments for erectile dysfunction to improve your sex life.
For information and advice about sexual arousal, read about good sex.
Psychosexual counselling may take time to work and the results achieved have been mixed.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is another form of counselling that may be useful if you have erectile dysfunction. CBT is based on the principle that the way you feel is partly dependent on the way you think about things. CBT helps you realise that your problems are often created by your mindset. It is not the situation itself that is making you unhappy, but how you think about it and react to it.
Your CBT therapist can help you to identify any unhelpful or unrealistic thoughts that may be contributing to your erectile dysfunction – for example, to do with:
- your self-esteem (the way you feel about yourself)
- your sexuality
- your personal relationships
Your CBT therapist will be able to help you to adopt more realistic and helpful thoughts about these issues.
Read more about cognitive behavioural therapy.
Pelvic floor muscle exercises
Some studies have suggested that, in a few cases, it may be beneficial to exercise your pelvic floor muscles. These are a group of muscles around the underside of the bladder and rectum, as well as at the base of the penis.
Pelvic floor muscle exercise involves strengthening and training the muscles used to control the anus (back passage) and urinate. If your GP feels this type of exercise could be beneficial, then you may want to discuss it with a physiotherapist to learn it correctly.
By strengthening and training these muscles, you may be able to reduce the symptoms of erectile dysfunction.
Complementary therapies
Some complementary therapies, such as acupuncture, have claimed to treat erectile dysfunction. However, there is little evidence they are useful.
In some cases, they may even include ingredients that could interact with other medications and cause side effects.
Always speak to your GP before using any complementary therapies.
Counselling may be required if the underlying cause of your erectile dysfunction is psychological
Managing ED on the internet
As erectile dysfunction (ED) can be an embarrassing problem, some men are tempted to look for treatment on their own. It is possible to buy medication over the internet, but you should always exercise caution as there are many sites that offer counterfeit medicines. These medications are not regulated and the amount of active ingredients in them can vary. They could cause unpleasant side effects or they may not be suitable for you.
Always ensure that any online doctor service is registered with the Care Quality Commission (CQC) , that all doctors are registered with the General Medical Council (GMC) and that any prescribed medicines come from a pharmacy which is registered in the UK.
It is also possible that an underlying health condition may be causing your erectile dysfunction and getting this diagnosed and treated may resolve your symptoms. Therefore, always see your GP for a full check-up.

Take a look at a simple guide to the pros and cons of different treatments for erectile dysfunction
Introduction
Ejaculation problems, such as premature ejaculation, are common sexual problems in men.
The three main problems are:
- premature ejaculation
- delayed ejaculation
- retrograde ejaculation
These are described in more detail below.
Premature ejaculation
Premature ejaculation is the most common ejaculation problem. It is where the male ejaculates too quickly during sexual intercourse.
Many men are unsure about how long ‘normal’ sex should last before ejaculation. A study looking at 500 couples from five different countries found the average time between a man putting his penis into his partner’s vagina and ejaculation was around five-and-a-half minutes.
However, it's up to the individual and his partner to decide whether or not they're happy with the time it takes for him to ejaculate. There is no definition of how long intercourse should last.
Occasional episodes of premature ejaculation are common and not a cause for concern. However, if you're finding that around half of your attempts to have intercourse result in premature ejaculation, it might help to get treatment.
Most men with this problem won't have always had it – they'll have previously ejaculated normally. This may be referred to as 'secondary' premature ejaculation.
It's less common for the man to have always experienced premature ejaculation (since becoming sexually active) – this is known as 'primary' or lifelong premature ejaculation. It affects around one in 50 men in England. In most cases of lifelong premature ejaculation:
- there is an inability to delay ejaculation during sex every time or most times
- the condition causes feelings of shame or frustration and impacts on quality of life, causing the man to avoid sexual intimacy
Delayed ejaculation
Delayed ejaculation (male orgasmic disorder) is classed as either:
- experiencing a significant delay before ejaculation is possible
- being unable to ejaculate at all even though the male wants to and his erection is normal
There is no set definition to describe ‘how long is too long’, but a persistent (and unwanted) delay of ejaculation that lasts for 30 to 60 minutes may suggest delayed ejaculation.
Alternatively, if you are unable to achieve ejaculation at least half the times you have sex, you may have delayed ejaculation.
As with premature ejaculation, delayed ejaculation can be either acquired or lifelong. Lifelong delayed ejaculation is less common and affects an estimated one in 1,000 men.
Delayed ejaculation can occur in all sexual situations, or just in certain situations – for example, you may be able to ejaculate normally when masturbating, but not during sex. When delayed ejaculation only happens in certain situations, there's usually a psychological cause.
Retrograde ejaculation
Retrograde ejaculation is a rarer type of ejaculation problem. It happens when sperm travels backwards and enters the bladder instead of coming out of the end of the urethra (the tube through which urine passes).
The main symptoms of retrograde ejaculation include:
- producing no semen, or only a small amount, during ejaculation
- producing cloudy urine (because of the semen in it) when you first go to the toilet after having sex
Men with retrograde ejaculation still experience the feeling of an orgasm and the condition does not pose a danger to health. However, it can affect the ability to father a child (read about infertility).
Treating ejaculation problems
Premature ejaculation can be treated with medication, such as the selective serotonin reuptake inhibitors (SSRIs) type of antidepressant, which can help delay ejaculating.
Couples therapy, a form of counselling, can be useful in coming up with techniques for partners to practice to help delay ejaculation.
Recommended treatments for delayed ejaculation depend on the underlying cause. If it is thought to be a side effect of medication, switching to an alternative medication will help. However, if the cause is thought to be psychological, counselling may be recommended.
Most men do not require treatment for retrograde ejaculation because they are still able to enjoy a healthy sex life and the condition does not affect their health. In some cases, medication may be used to help restore normal ejaculation.
However, if you want to have children, you may need fertility treatment to extract a sample of sperm.
Read more about treating ejaculation problems.
What causes ejaculation problems?
Ejaculation problems are complex and can be caused by a number of things, including:
- stress
- relationship problems
- anxiety – such as a man being anxious that he will lose his erection (erectile dysfunction), causing him to ‘rush’ the intercourse
- previous traumatic sexual experiences
- depression
- some medical conditions or medicines – for example, diabetes can cause delayed ejaculation
Some researchers think certain men are more prone to premature ejaculation because of their biological make-up, such as having an unusually sensitive penis.
Retrograde ejaculation is caused by damage to nerves or muscles that surround the neck of the bladder (the point where the urethra connects to the bladder). This damage can often occur as a complication of prostate or bladder surgery.
Read more about the causes of ejaculation problems.
Who is affected
Premature ejaculation is the most common type of ejaculation problem.
A number of surveys have found around one in three men reported being affected by premature ejaculation. The true figure is probably much higher as many men are reluctant to admit they have this problem.
While less common, delayed ejaculation is probably more of a problem then most people realise. One study found around one in 20 people had problems achieving an orgasm over the course of a month during the past year.
Although retrograde ejaculation is rare, it can be a common complication of some types of surgery, such as prostate surgery, or in men with certain health conditions that can damage the nerves, such as diabetes or multiple sclerosis.
Involve your partner
If you are having problems with your sex life and are seeking treatment, it is usually recommended you involve your partner as much as possible.
Communicating your concerns can often go a long way to helping to resolve them. And in some cases your partner may also have their own problems that are contributing towards problems with your sex life.
For example some women are unable to reach climax during ‘normal’ intercourse and require manual or oral stimulation.
Read more about why talking about sex is important.
Blood in your semen
Finding blood in your semen (haematospermia) can be alarming. However, in most cases it's not serious and will pass within a few days.
The most likely cause is infection of your urethra (urethritis) and prostate (prostatitis).
See your GP if the symptoms persist, or visit your local genito-urinary medicine (GUM) clinic because the causes may be more serious.
Read more about blood in the semen.
Causes of ejaculation problems
Causes of ejaculation problems vary depending on the person and the type of problem.
An ejaculation problem can often have physical and psychological causes. For example, if a man has previously had a health condition that made it difficult to maintain an erection, it may now cause anxiety, leading to premature ejaculation.
Primary (lifelong) premature ejaculation
A number of possible causes are discussed below.
Conditioning
Many doctors believe early sexual experiences can influence future sexual behaviour. For example, if a teenager conditions himself to ejaculate quickly to avoid being caught masturbating, it may later be difficult to break the habit.
Traumatic sexual experiences
A traumatic sexual experience at an early age can sometimes lead to lifelong sexual anxiety and premature ejaculation. Experiences can range from being caught masturbating to sexual abuse.
Upbringing
Men who have had a strict upbringing, where sexual activity is only considered appropriate in certain circumstances, such as after marriage, may find it difficult to relax during sex, or be unable to let go of the belief that sex is wrong or sinful.
Biological reasons
A number of recent studies suggest biology may play a role in some cases of primary premature ejaculation.
Changes to the normal pattern of nerve signals in some men affected by erectile dysfunction could result in their penis being extra sensitive, meaning it takes much less stimulation to cause ejaculation.
Genetic influences
Studies have recently suggested men with a first-degree relative (father, brother or son) who experiences premature ejaculation are more likely to have the problem themselves. But a definite genetic association has not yet been proved.
Secondary (acquired) premature ejaculation
Acquired premature ejaculation (where premature ejaculation develops in a man who has previously had a history of normal ejaculation) can be caused by both psychological and physical factors.
Common physical causes include:
- diabetes
- multiple sclerosis
- prostate disease
- high blood pressure
- thyroid problems – an overactive or underactive thyroid gland
- using recreational drugs
- drinking too much alcohol
The recommended daily levels of alcohol consumption are three to four units of alcohol for men, and two to three units for women.
A unit of alcohol is equal to about half a pint of normal strength lager, a small glass of wine, or a pub measure (25ml) of spirits.
Common psychological causes include:
- depression
- stress
- unresolved problems, conflicts or issues within a sexual and emotional relationship
- anxiety about sexual performance (this is often a contributory factor at the start of a new sexual relationship, or when a man has had previous problems with sexual performance)
Delayed ejaculation
Like premature ejaculation, delayed ejaculation can be caused by psychological and physical factors.
Possible psychological causes of delayed ejaculation are similar to those of premature ejaculation – for example, early sexual trauma, strict upbringing, relationship problems, stress, and depression.
Physical causes of delayed ejaculation include:
- diabetes (usually only type 1 diabetes)
- spinal cord injuries
- multiple sclerosis
- surgery to the bladder or prostate gland
- increasing age
Many medicines are known to cause delayed ejaculation, including:
- antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs)
- medications used to treat high blood pressure (hypertension), such as beta-blockers
- antipsychotics, which are medications used to treat episodes of psychosis
- muscle relaxants, such as balcofen, which is widely used to treat motor neurone disease and multiple sclerosis
- powerful painkillers, such as methadone (which is also widely used to treat people addicted to heroin)
Retrograde ejaculation
Retrograde ejaculation is caused by damage to the nerves or muscles that surround the neck of the bladder (the point where the urethra connects to the bladder).
Usually when you ejaculate, semen is pushed out of your testicles and up through your urethra (the tube that semen and urine pass through). It is prevented from entering your bladder by the muscles around the neck of the bladder, which close tightly at the moment of orgasm.
However, damage to the surrounding muscles or nerves can stop the bladder neck closing, causing the semen to move into the bladder rather than up through the urethra.
Prostate gland or bladder surgery is the most common cause of retrograde ejaculation. Other causes are diabetes, multiple sclerosis, and a class of medicines known as alpha blockers, which are often used to treat high blood pressure (hypertension).
Diagnosing ejaculation problems
If you have an ejaculation problem, you will usually become aware of it through your own sexual behaviour or discussion with your partner. The next step is to visit your GP who will discuss the problem with you and either examine you or refer you to a specialist.
Family and medical history
Depending on the nature of your problem, you may be asked questions about your family medical history and any underlying health conditions you may have, such as:
- diabetes
- heart disease
- high blood pressure (hypertension)
You will also be asked about your sexual and emotional health. While you may find it embarrassing to talk about, answering questions about the type and pattern of your symptoms is an important step towards making sure that you receive the most effective treatment.
Read more about the symptoms associated with ejaculation problems.
Your GP or specialist will want to know if you have had an injury or surgery to your pelvic area, what medications you are taking, and about aspects of your lifestyle, such as how much alcohol you drink.
Further testing
A rectal examination may be carried out in people over 50 years old to check for an enlarged prostate gland. Your blood pressure and heart rate may also be measured.
Blood and urine samples may be taken to check your hormone and cholesterol levels. Your GP, or specialist, may also carry out a visual examination of the pelvic area to check for injury or infection.
Treating ejaculation problems
If you have ejaculation problems caused by physical conditions, your GP should be able to suggest possible treatment options.
Treating ejaculation problems caused by psychological factors can be more challenging, but most men who persevere with treatment have successful outcomes.
Premature ejaculation
Self-help
There are a number of things you can try yourself before seeking medical help, such as:
- masturbating an hour or two before having sex
- using a thick condom to help decrease sensation
- taking a deep breath to briefly shut down the ejaculatory reflex (an automatic reflex of the body during which ejaculation occurs)
- having sex with your partner on top (to allow them to pull away when you are close to ejaculating)
- taking breaks during sex and thinking about something boring
Couples therapy
If you are in a long-term relationship, you may benefit from having couples therapy. The purpose of couples therapy is two-fold.
First, couples are encouraged to explore issues that may be affecting their relationship, and given advice about how to resolve them.
Second, couples are shown techniques that can help the man to ‘unlearn’ the habit of premature ejaculation. The two most popular techniques are the ‘squeeze technique’ and the ‘stop-go technique’.
In the squeeze technique, the woman begins masturbating the man. When the man feels that he is almost at the point of ejaculation, he signals to the woman. The woman stops masturbating him, and squeezes the head of his penis for between 10 to 20 seconds. She then lets go and waits for another 30 seconds before resuming masturbation. This process is carried out several times before ejaculation is allowed to occur.
The stop-go technique is similar to the squeeze technique except that the woman does not squeeze the penis. Once the man feels more confident about delaying ejaculation, the couple can begin to have sexual intercourse, stopping and starting as required.
These techniques may sound simple, but they do require a lot of practice.
Medication to treat premature ejaculation
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are primarily designed to treat depression, but they also have the useful side effect of delaying ejaculation. Although SSRIs are not licensed to treat premature ejaculation, they are increasingly being prescribed for this use.
SSRIs used for this purpose include:
- paroxetine
- sertraline
- fluoxetine
Some men with premature ejaculation may experience an improvement in their symptoms as soon as treatment begins. However, you will usually need to take the medication for one to two weeks before you notice the full effects of the treatment.
Common side effects of SSRIs include:
- fatigue
- feeling sick and being sick
- diarrhoea
- excessive sweating
However, these are usually mild and should improve after two to three weeks.
Dapoxetine
An SSRI, known as dapoxetine, has been specifically designed to treat premature ejaculation.
From November 2013, dapoxetine (Priligy) became the first medication to be licensed for premature ejaculation in the UK and local NHS authorities can choose to prescribe it on the NHS.
Dapoxetine acts much faster than the SSRIs mentioned above and can be used 'on demand'. If you are prescribed dapoxetine, you will usually be advised to take it one to three hours before having sex, but not more than once a day.
Dapoxetine is not suitable for all men diagnosed with premature ejaculation. For example, it is not recommended for some men with heart, kidney and liver problems. Dapoxetine can also interact with other medications, such as other antidepressants.
Common side effects of dapoxetine include headaches, dizziness and feeling sick.
Topical anaesthetics and condoms
The use of topical anaesthetics such as lidocaine or prilocaine can be helpful but can be transferred and absorbed to the vagina, causing decreased sensation. Condoms can also be used and are effective, particularly when combined with local anaesthesia.
Delayed ejaculation
Sex therapy
Sex therapy is a form of counselling that uses a combination of psychotherapy and structured changes in your sex life. This can help to increase your feeling of enjoyment during sex, and help make ejaculation easier.
Some clinical commisioning groups (CCGs) provide a sex therapy service on the NHS, but others do not. Therefore, levels of availability can vary widely depending on where you live.
You can also pay privately for sex therapy. Prices for a single session can vary from around £50 to £80. For information about private sex therapists in your local area you should visit the College of Sexual and Relationship Therapists website.
The relationship counselling service Relate also offers sex therapy at a number of its centres; you would be expected to pay for each session.
During sex therapy, you will have the opportunity to discuss any emotional or psychological issues related to your sexuality and relationship, in a non-judgemental way.
Activities may also be recommended for you to try at home while you are having sex with your partner (you should never be asked to take part in any sexual activities during a session with the therapist).
These may include:
- viewing erotic material before having sex, such as videos and magazines, to increase the feeling of sexual stimulation
- erotic fantasies and ‘sex games’ to make your lovemaking more exciting
- using lubricating creams or gels to make the physical act of sex more comfortable and relaxing
- using sexual aids, such as vibrators, to increase pleasure
Read more information about what a sex therapist can do.
Switching medication
There are a number of medications that can be used if it is thought SSRIs are responsible for causing delayed ejaculation. These include:
- amantadine – a medication originally designed to treat viral infections
- buproprion – a medication originally designed to help people stop smoking
- yohimbine – a medication originally designed to treat erectile dysfunction
These medications help block some of the chemical effects of SSRIs that are thought to contribute towards delayed ejaculation.
Retrograde ejaculation
Most men do not require treatment for retrograde ejaculation because they are still able to enjoy a healthy sex life and the condition does not have adverse effects on their health.
If retrograde ejaculation is caused by using a certain medication then normal ejaculation will usually return once the medication is stopped. Speak to your GP before you stop taking prescibed medication.
If treatment is required (usually because of wanting to father a child), medicines can be used to strengthen the muscles around the bladder neck. Pseudoephedrine (a medicine commonly used as a decongestant) has proved to be effective in treating retrograde ejaculation caused by diabetes or surgery.
However, if the retrograde ejaculation has been caused by significant muscle or nerve damage, treatment may not be possible.
Men who want to have children can have sperm taken from their urine for use in artificial insemination or in-vitro fertilisation (IVF).
Buying medication on the internet
Many medications mentioned here are available from commercial websites on the internet, including medications not licensed for use in the UK. However, using these websites to purchase medication is not recommended.
Medication such as SSRIs can have a wide range of side effects so it is important to take it under the supervision of a healthcare professional. You'll need guidance about whether the medication is suitable for you, the correct dose to take and any interactions with other medicines.
Also, medications ordered on the internet could be out-of-date, diluted or fake, making them dangerous to your health.
The Royal Pharmaceutical Society of Great Britain (RPSGB) has a code of ethics for all online pharmacies to help you ensure a website is reputable.
Page last reviewed: 23/09/2014
Next review due: 23/09/2016
Source: NHS Choices, UK.
Men: The Secret to Better Erections
- Published May 15, 2013
- Publication: Bottom Line Personal
- Source Steven Lamm, MD
If you’re like most middle-aged and older men, you want better erections—erections that are reliable and hard. But better sex is only one of the benefits of better erections…
Surprising fact: A man’s erection is an important barometer of his health. Erectile dysfunction (ED)—when a man can’t get or keep an erection firm enough for sexual intercourse—often is an early warning sign of heart disease. An erection requires healthy blood vessels, nerves and hormones.
Important scientific evidence: A seven-year study of more than 4,000 middle-aged and older men, published in The Journal of the American Medical Association, showed that those who had ED at the beginning of the study or developed it during the study had a 45% higher risk of developing heart disease.
Unfortunately, ED affects roughly half of American men over age 60 (and many younger men)—most of whom have cardiovascular disease or one or more risk factors for developing it, such as high cholesterol, high blood pressure, insulin resistance, diabetes or obesity.
Of course, you can take an ED drug (such as Viagra, Cialis or Levitra) for the problem. But that won’t take care of the underlying health issues. Plus, no man wants to be dependent on ED drugs…they’re not without risk (blindness is a rare but possible side effect)…and they don’t always work.
Here’s what you need to know to preserve or restore your erections—and the health of your body—naturally…
EXERCISE
Erections owe most of their hardness to nitric oxide, a molecule that signals blood vessels to relax, allowing blood to enter and pool in the penis. The body’s most effective way of stimulating nitric oxide formation is exercise—even mild exercise, such as walking.
Scientific evidence: In a study of 180 men ages 40 to 70, published in International Journal of Impotence Research, those who were sedentary were 10 times more likely to develop ED than those who were physically active.
My recommendation: 10,000 steps a day, which you can achieve through everyday physical activity (typically 4,000 to 5,000 steps) and a brisk walk of 4,000 to 6,000 steps (about two to three miles, or 30 to 45 minutes).
Start with 5,000 steps daily for one week. Increase to 6,000 steps daily the second week…and to 7,000 the third week…until you reach 10,000. Maintain that level. You can find an accurate pedometer—typically at a cost of $20 to $30—at your local sporting-goods store or on the Internet at www.DigiWalker.com.
ERECTION-ENHANCING FOODS
Your sexual performance is greatly impacted by the foods you eat. My recommendations…
Reduce the fats in your diet. Fatty foods lead to clogged arteries, which prevent blood flow from reaching the penis. Cut back on saturated fats such as egg yolks, butter, cream, fatty red meats and palm oil.
Eat more fruits and vegetables. They reduce cholesterol and improve blood flow to the penis.
Eat whole grains, nuts and seeds. They provide an important basis for cardiovascular and penile health.
Spice up your foods. Chili peppers stimulate the nervous system, helping with sexual arousal. Ginger has long been considered a sexual stimulant and an overall tonic for general health.
BEST SUPPLEMENTS
Several supplements can help restore erections…
L-arginine and Pycnogenol. The amino acid L-arginine (found in meat, whole grains, fish, nuts and milk) is converted to nitric oxide in the body. But most men don’t get enough in their diets, so I often recommend an L-arginine supplement Caution: Talk to your doctor before you take L-arginine, especially if you have low blood pressure, herpes, gastric ulcer, liver disease or kidney disease.
L-arginine works best when combined with Pycnogenol, a patented amalgam of more than three dozen antioxidants extracted from the bark of the French pine tree. Together, the supplement allows for better nitric oxide production and utilization.
Scientific research: In a study of men with mild-to-moderate ED, published in Phytotherapy Research, taking a supplement with L-arginine and Pycnogenol for eight weeks improved erections and satisfaction with sex.
Typical dose: A daily dose of the supplement Prelox Blue, which contains a blend of Pycnogenol and L-arginine.
Omega-3 fatty acids (fish oil). Found in oily fish such as salmon and sardines, omega-3s can reduce plaque inside artery walls…decrease blood clotting…lower triglyceride (blood fat) levels…and decrease both blood pressure and blood vessel inflammation. Omega-3s are the nutritional building blocks of heart and penis health.
Typical dose: 2,000 milligrams (mg) daily, taken with a meal.
Horny goat weed (Epimedium sagittatum). This Chinese herb perks up sexual desire.
Scientific evidence: I conducted two studies on Exotica H-G-W, a brand of horny goat weed. The first study showed that the supplement enhanced sexual satisfaction in three out of five men. The second study—in which men took horny goat weed capsules one hour before sexual activity—resulted in a significant increase in hardness in two-thirds of the participants.
Typical dose: Two capsules daily, totaling 500 mg of horny goat weed. My patients take it for six weeks and then start to taper off. You can use it intermittently after that.
TESTOSTERONE SELF-CARE
Testosterone—the predominantly male hormone that helps drive sexual desire and performance—declines with age. But most of that decline is caused by lifestyle—poor sleep, relentless stress and belly fat. My recommendations…
Sleep seven to eight hours a night. Going to bed at the same time every night (say, 11:00 pm) and getting up at the same time every morning (say, 6:30 am) is one of the best habits for deep, refreshing sleep.
Add strength-training to your routine. Whether it’s in the gym or at home with resistance bands, building and maintaining muscle are key to producing plenty of testosterone.
Breathe. Take a few slow, deep breaths a few times a day every single day—it does wonders for relieving tension and anxiety.
VISUALIZE FOR SEX SUCCESS
How do you prepare for an upcoming sexual encounter, especially if you didn’t do so well in a previous effort and don’t feel confident?
Sex is a physical act—and just as athletes practice visualization techniques so they can perform optimally, you can use the same techniques to build confidence in your bedroom “performance.”
First, relax—lie on your back on a mat or a rug with your arms at your sides and take a deep breath. Hold it for a moment, then exhale. Lie still, and continue breathing slowly.
Once you are relaxed, picture yourself about to have sex. Patiently go through the step-by-step sequence of events. Imagine every aspect of the session, including the sights, sounds and smells associated with sex. Try to rehearse the action in your mind just as you would actually perform it. It’s all about mental practice. When the time comes for the actual moment, your confidence will be higher.
Source: Steven Lamm, MD, a practicing internist, faculty member at New York University School of Medicine and director of Men’s Health for the NYU Medical Center, both in New York City. He has been named director of NYU’s men’s health center opening in January 2014. Dr. Lamm is author of The Hardness Factor: How to Achieve Your Best Health and Fitness At Any Age (Harper). His most recent book is No Guts, No Glory (Basic). www.DrStevenLamm.com
Natural Treatment Options for Erectile Dysfunction
5 Herbs to Help Erectile Dysfunction
Written by Kimberly Holland | Published on February 7, 2014
Medically Reviewed by George T. Krucik, MD, MBA on February 7, 2014
- Overview
- Traditional Treatments
- Alternative Treatments
- Panax Ginseng
- DHEA
- L-arginine
- Yohimbe
- Pinus pinaster
- Considerations
- Talk to Your Doctor
- Read This Next
Treat ED naturally.
Part 1 of 10: Overview
What Is Erectile Dysfunction?
Erectile dysfunction (ED) is a common male sexual problem. ED occurs when a man has trouble achieving or maintaining an erection long enough to have sexual function.
ED is not as simple as the inability to achieve an erection when aroused. It is a complex multi-system dysfunction. Male sexual arousal involves many body systems including the brain, nervous system, blood vessels, muscles, hormones, and emotions. A problem with one part of the body can cause a problem elsewhere, which could then be the cause of ED.
Part 2 of 10: Traditional Treatments
Traditional Treatments for Erectile Dysfunction
ED is often a symptom and not a condition in itself. If your doctor can diagnose what is causing your ED, it can be treated. Treating the cause should ease the ED.
The most common treatments for ED include:
- prescription medicine
- injections
- penis suppository
- testosterone replacement
- a penis pump (vacuum erection device)
- a penile implant
- blood vessel surgery
Lifestyle treatments include:
- sexual anxiety counseling
- psychological counseling
- reaching and maintaining a healthy weight
- stopping tobacco use
- reducing alcohol use
Part 3 of 10: Alternative Treatments
Alternative Treatments
In addition to prescription medications, traditional treatments and lifestyle changes, alternative treatments provide some helpful and beneficial options for men with ED. However, it’s important that you work with your doctor before beginning any alternative treatments.
These five herbs can be used to treat erectile dysfunction. It’s important to know that researchers and medical professionals believe these treatments need more study before they can be considered truly safe and effective.
Part 4 of 10: Panax Ginseng
Panax Ginseng

The roots of ginseng, also called Korean red ginseng, are used to make medicine for several conditions, including ED. Panax ginseng has been studied as a treatment for ED in humans. The plant is regarded as a safe treatment that is possibly effective for treating ED. However, Panax ginseng should only be taken for a short time due to possible complications.
The most common side effect of Panax ginseng is insomnia or trouble sleeping. Ginseng can interact negatively with alcohol, caffeine, and some medications.
Part 5 of 10: DHEA
Dehydroepiandrosterone (DHEA)

Dehydroepiandrosterone (DHEA) is a hormone produced naturally by the body. It can also be manufactured using wild yam and soy. DHEA has been studied as a treatment for erectile dysfunction in humans. DHEA is regarded as a safe treatment that is possibly effective for treating ED. However, research suggests DHEA may not be effective if a man’s ED is the result of diabetes or a nerve disorder.
DHEA can interact negatively with some medications. The most common side effects include acne, upset stomach, and hair loss.
Part 6 of 10: L-arginine
L-arginine

L-arginine, or arginine, is an amino acid found in red meat, poultry, fish and dairy products. Arginine can also be created in a laboratory. Arginine is a vasodilator, which means that it helps expand blood vessels and increase blood flow. Arginine has been studied as a treatment for erectile dysfunction in humans. Arginine is regarded as a safe treatment that is possibly effective for treating erectile dysfunction.
Arginine can cause several side effects, including nausea, vomiting, diarrhea, and stomach cramps. Arginine should not be taken with Viagra, nitrates, or any high blood pressure medications.
Part 7 of 10: Yohimbe
Yohimbe

Yohimbe is an African evergreen tree. The bark of the tree contains yohimbine, a chemical that is used to make yohimbe. Yohimbe has been studied as a treatment for erectile dysfunction in humans. The tests have shown positive results, but yohimbe is considered possibly unsafe as a treatment for ED in humans.
Serious side effects include kidney failure, seizure and heart attack. Do not take yohimbe without doctor supervision. Do not take yohimbe if you also take antidepressants or stimulant medications.
Part 8 of 10: Pinus pinaster
Pinus pinaster

Pinus pinaster is derived from the bark of a pine tree. Pycnogenol is a trademarked brand name for a supplement that contains the bark. Limited research suggests pycnogenol may help treat ED. However, a patient may need to take it for several months before any benefit is seen.
Side effects of pycnogenol include dizziness, headache, and mouth ulcers. Do not take pycnogenol if you take an immunosuppressant. Because pycnogenol has not had sufficient medical research, your doctor may not recommend you take this alternative medicine for your ED.
Part 9 of 10: Considerations
Be Careful with Supplements
The U.S. Food and Drug Administration (FDA) warns men against purchasing supplements and creams that promise to treat ED. Studies have shown that these drugs can contain prescription medicines or other harmful ingredients. In most cases, these ingredients are not disclosed on the products’ packaging. These undisclosed ingredients might cause severe side effects or interactions. Consult your doctor before purchasing any over-the-counter or online ED treatments.
Part 10 of 10: Talk to Your Doctor
Your Doctor Can Help
You should not feel ashamed or nervous to talk with your doctor about your ED. Think of the conversation as a way to talk about your health in general. Often, ED is a sign of another health problem: treating it may treat your ED, too.
Remember that ED is often easily treated; the sooner you speak with your doctor, the sooner you can return to normal, healthy sexual function.
Source: Healthline, (http://www.healthline.com/health/erectile-dysfunction/herbs#Overview1)
Erectile Dysfunction Treatment: 6 Ways To Naturally Overcome Impotence
May 8, 2014 08:30 AM By Lizette Borreli
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.
1. Walk 2 Miles in Your Own Shoes
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.
2. Move Your Nether Regions
The phrase “use it before you lose it” can be applied when it comes to helping men with ED regain normal erectile function. Pelvic exercises, more commonly known as kegel exercises, are used to promote urinary continence and sexual health. They help to strengthen the bulbocavernosus muscle, which does three things: allows the penis to engorge with blood during erection, it pumps during ejaculation, and it helps empty the urethra after urination, according to Healthline.
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.
3. Get Needled
The art of acupuncture has become the new treatment for everything from back pain, depression, and even ED. Impotence could be more of a state of mind, and acupuncture may help. Through this alternative therapy, fine needles are placed in various parts of the body to relieve pain or stress. Although there are many mixed studies for acupuncture and ED, many tend to confirm positive results. A 1999 study found acupuncture improved the quality of erection and even restored sexual activity in 39 percent of participants.
4. Take Some 'Herbal Viagra'
Ginseng, specifically “red ginseng,” is known as the “herbal Viagra” that helps puts to rest men’s bedroom woes. Red ginseng is when the root has been steamed and then dried. The ginseng root is the part of the plant that is mostly used as a natural remedy when in its supplement form. However, the plant must be grown for a minimum of five years before it can be used. In a 2008 review, seven studies on red ginseng and ED, ranging in dosages from 600 to 1,000 milligrams three times a day, were found to provide evidence for the effectiveness of the herb in ED treatment.
5. Take This Amino Acid Found in Your Body
L-arginine, an amino acid that is naturally present in the body and helps make nitric oxide, supports a successful erection. Nitric oxide is responsible for making the blood vessels relax, which helps sustain an erection for men. A 1999 study, observed the effects of six weeks of high-dose (5 grams/day) orally administered nitric oxide (NO) donor L-arginine on men with organic ED. Thirty-one percent of those who took 5 grams/day of L-arginine experienced significant improvements in sexual function. Burns told Medical Daily, “l-arginine and deer antler velvet” have been the most popular go-to natural treatments for men.
6. Drink Watermelon Juice
A cold slice of watermelon can do more than just satisfy thirst and hunger during the warm summer months; it can help with bedroom satisfaction. Citrulline, the amino acid found in high concentrations of watermelon, is found to improve blood flow to the penis. A 2011 study revealed men who suffered from mild to moderate ED and took L-citrulline supplementation showed an improvement with their erectile function and were very satisfied. Natural watermelon juice, or “nature’s Viagra,” can also be easier on the stomach, since taking pills like Viagra can cause nausea and diarrhea.
Burns cautions men and says, “Not all natural treatments are a safe alternative to Viagra. Like with everything herbs have side effects just like drugs do. Depending on the person there might be drug-herb interaction and sometimes people overdose thinking more is better.”
These six natural ED treatments could potentially help to prevent and fix impotence in men, but it’s always best to check with your doctor first to see if these are safe for you.
Source: Medical News Today
Sexual dysfunction
Introduction
Sexual dysfunction -- having a problem with sexual desire or response -- covers a wide variety of problems. In men, sexual dysfunction may refer to erectile dysfunction (ED) and premature or delayed ejaculation. For women, sexual dysfunction may include spasms of the vagina and pain with sexual intercourse. For both sexes, it can include problems with sexual desire (libido) and response.
Men over age 65 are at higher risk for ED, although ED is not a normal part of aging. Among women with sexual dysfunction, 43% say decreased sexual desire is their No. 1 complaint. The problem may be psychological, physical, or a combination of both.
Signs and Symptoms
- Premature or delayed ejaculation in men
- Erectile dysfunction -- not being able to get or keep an erection
- Pain during sex
- Lack or loss of sexual desire
- Lower urinary tract symptoms
- Difficulty having an orgasm
- Vaginal dryness
What Causes It?
Sexual dysfunction can be temporary or long lasting. Causes vary and may include:
- Being age 65 or over in men
- Childhood sexual abuse
- Taking certain prescription medications, including some antidepressants
- Hormonal imbalances
- Drug abuse
- Depression, anxiety, or other psychological issues
- Stressful life events
- Certain medical conditions, such as diabetes, coronary heart disease, high blood pressure, arthritis, and sleep apnea
- Vaginal infections
- Injury, such as pelvic fracture
What to Expect at Your Provider's Office
Your doctor will do a physical examination. Many times, lab tests and a physical exam may not show a cause. Your doctor may ask about your ethnic, cultural, religious, and social background, which can influence your sexual desires, expectations, and attitudes. Your doctor may test your hormone levels, particularly levels of testosterone, which affects sex drive in both men and women.
Treatment Options
If depression is causing sexual dysfunction, antidepressants may help. Although some antidepressants may cause low libido, others may not. It may take some time for you and your doctor to find the right antidepressant for you.
Erectile dysfunction -- Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) can treat erectile dysfunction, but may have potentially serious side effects in some men. Vasodilators (drugs that dilate blood vessels, improving blood flow) may be injected into the penis. Vacuum devices may also be used. Vascular surgery or an implant in the penis may help if the problem does not get better with other treatment.
Problems related to menopause -- When estrogen levels drop after menopause, women may have vaginal dryness and other changes that may make sex painful. Women who have painful intercourse after menopause may want to ask their doctors about estrogen therapy, as a vaginal ring or cream. Over-the-counter products are available as creams or gels for women who have vaginal dryness. Your doctor may also consider a testosterone patch or cream, although using testosterone for sexual dysfunction is controversial. Women who have pain with intercourse may try taking naproxen or ibuprofen before having sex.
A variety of psychological, behavioral, and interpersonal therapies may also help with sexual disorders. For example, combination therapy, including both sex therapy and medications, may work best for premature ejaculation.
Complementary and Alternative Therapies
Sexual dysfunction caused by decreased circulation, hormonal imbalance, depression, or anxiety may be helped by alternative therapies. Be sure to work with an experienced provider of alternative therapies and tell all of your doctors about the herbs, supplements, and medications you are taking. Many have side effects and can interact with each other. Unless noted, treatments are for both men and women.
Nutrition and Supplements
- Vitamin C may help both men and women, as it increases blood flow. One study suggests vitamin C may increase libido in women.
- Essential fatty acids, found in evening primrose oil, fish oil, and borage oil, help improve blood flow. Essential fatty acids may increase the risk of bleeding, especially if taken with blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. If you have a history of seizures, speak with your physician before taking a fatty acid supplement.
- Dehydroepiandrosterone (DHEA), a hormone made by the body's adrenal glands, has been studied for both men and women. DHEA levels get lower as women grow older. Some studies show DHEA may help restore libido in older women, but doesn't help younger women. And some studies suggest DHEA may help some men with ED, although it doesn't seem to help those with diabetes or neurological problems. DHEA is sold as a supplement, but it is a powerful hormone that can change into other hormones such as estrogen and testosterone once in the body. Do not use DHEA without your doctor's supervision.
- L-arginine may help men with ED, according to one study. A lower dose didn't seem to work by itself. But another study suggested that adding pycnogenol to a lower dose of arginine might help ED. More research is needed. People with high blood pressure, kidney or liver disease, or who take blood thinners or diabetes medications should not take arginine. L-arginine may make herpes worse. It may interact with medications used to treat ED, such as sildenafil (Viagra), and with nitrates used to treat heart disease. People with autoimmune diseases should not take pycnogenol.
- Propionyl-L-carnitine added to Viagra seemed to improve erections more than Viagra alone in men with diabetes and ED, according to one study. More research is needed. Propionyl-L-carnitine can increase the risk of bleeding, especially if you also take blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Propionyl may make an underactive thyroid (hypothyroidism) worse and may raise the risk of seizures in people with a history of seizures.
Herbs
Herbs help strengthen and tone the body's systems. As with any therapy, you should work with your doctor before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.
Chaste tree (Vitex agnus castus) helps your body produce hormones normally, but must be taken long term (12 to 18 months) to work.
For men:
- Ginkgo (Ginkgo biloba) increases circulation and may improve sexual function, although one study found no effect. Ginkgo may increase the effects of certain blood-thinning medications (anticoagulants). Do not take ginkgo if you have a history of seizures. Ask your doctor before taking ginkgo.
- Korean red ginseng (Panax ginseng) helped men with ED improve sexual function, according to one double-blind study. People in the study took 2 weeks off after 8 weeks of treatment. Ginseng is a stimulant and may not be right for people with insomnia, autoimmune diseases, schizophrenia, heart disease, bleeding disorders, and hormone-sensitive cancers such as breast or prostate cancer. Ginseng interacts with a number of medications, including blood thinners and insulin. Ask your doctor before taking it.
- Maca (Lepidium meyenii) may boost sexual desire in men, according to one study. Maca has been grown as a vegetable in Peru for thousands of years. However, more research is needed to see if it works for low libido and whether it is safe.
- Saw palmetto (Serenoa repens) and Pygeum africanum may help if your sexual problems are caused by prostate disease. Saw palmetto can interact with certain medications, including blood thinners and hormonal medications. So do not take it without your doctor's supervision.
- Yohimbe (Pausinystalia yohimbe) contains some yohimbine hydrochloride, a chemical found in a prescription drug used to treat ED. However, the levels vary. Do not take yohimbe without the supervision of your doctor. High doses are dangerous. Yohimbe interacts with several drugs and isn't safe for people with certain medical conditions. Yohimbe may interact with certain antidepressant medications.
For women:
- Arginine, ginseng, ginkgo, and damaina (Turnera diffusa), plus certain vitamins and minerals, in a formulation called Argin-Max, showed effectiveness in one study. People with high blood pressure, kidney or liver disease, or who take blood thinners or diabetes medications should not take arginine. Ginseng is a stimulant and may not be right for people with insomnia, autoimmune diseases, schizophrenia, heart disease, bleeding disorders, and hormone-sensitive cancers such as breast or prostate cancer. Ginseng interacts with a number of medications, including blood thinners and insulin. Ask your doctor before taking ginseng or arginine.
- Korean red ginseng (Panax ginseng) improved sexual arousal in menopausal women, according to one study. Ginseng is a stimulant and may not be right for people with insomnia, autoimmune diseases, schizophrenia, heart disease, bleeding disorders, and hormone-sensitive cancers such as breast or prostate cancer. Ginseng interacts with a number of medications, including blood thinners and insulin. Ask your doctor before taking it.
- Yohimbe combined with arginine may increase arousal. As is true for men, you should not take yohimbe without the supervision of your doctor. Yohimbe interacts with several drugs and isn't safe for people with certain medical conditions. Yohimbe may interact with antidepressant medications.
Acupuncture and Traditional Chinese Medicine
Acupuncture and Traditional Chinese Medicine (TCM) have been used for centuries to treat sexual dysfunction. Studies show that acupuncture may help specific organs, and many people use acupuncture and TCM to address hormonal imbalances.
Yoga and Meditation
Yoga and meditation can reduce the effects of stress and relieve anxiety about sexual dysfunction.
Massage
Therapeutic massage can reduce stress.
Following Up
Some sexual dysfunctions are long term and require professional care.
Special Considerations
Some drugs and herbs used for treating sexual dysfunction may have serious side effects. Marital, psychological, and sexual counseling are also important.
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Alternative Names
Version Info
- Last reviewed on 3/19/2014
- Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
Source: Sexual dysfunction | University of Maryland Medical Center http://umm.edu/health/medical/altmed/condition/sexual-dysfunction#ixzz3cvwqvFRC
University of Maryland Medical Center
Source: University of Maryland