There's nothing more frustrating: You want to get busy in the bedroom, but can't get an erection. At least you're not alone. "One in two [people assigned male at birth (AMAB)] over the age of 40 complain about erectile dysfunction (ED)," says Vikas Desai, MD, urologist at Northwestern Medicine Delnor Hospital.
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Try these natural treatment options to get back in business.
1. Consider Weight Loss
It's not a quick fix, but for people with overweight or obesity, slimming down is the most effective way to improve your below-the-belt performance if you have erectile dysfunction (ED).
"A person AMAB with a 42-inch waist has a 50 percent higher chance of ED than someone with a 32-inch waist," Dr. Desai says. "What's more, 1 in 2 people AMAB with a waist greater than 40 inches complains about ED."
Why does putting on the pounds make it difficult to get an erection? "Being overweight clogs the arteries leading to the penis, which can reduce blood flow," Dr. Desai says. "You are also more likely to have comorbidities that might cause ED, including diabetes, hypertension and heart disease."
An October 2021 study in Andrologia found that losing weight improved erectile function in people with overweight or obese.
2. Seek Out Foods Rich in Flavonoids
Can certain nibbles be a natural Viagra? Eating at least three servings a week of flavonoid-rich foods (namely fruit, and berries in particular) may reduce the incidence of erectile dysfunction by 10 percent, according to a February 2016 study in the American Journal of Clinical Nutrition.
This may be because flavonoids increase nitric oxide levels. "Nitric oxide is a compound produced by your body that stimulates blood flow to the penis," Dr. Desai says. "It also helps relax the penis to allow the chambers to fill with blood."
Still, while it can't hurt to snack on juicy strawberries, the effect is limited. For people with overweight or medical comorbidities, "you can eat all the fruit in the world and unfortunately it won't make a difference," Dr. Desai says.
3. Avoid Excessive Drinking — Especially Before Sex
Downing more than two alcoholic beverages can interfere with the brain's ability to signal to the penis to fill with blood, according to the Sexual Medicine Society of North America. Drinking can also dehydrate you, reducing the volume of blood flow to the penis.
"It is fine to drink in moderation, but binge drinking in the hour or so leading up to intercourse will hinder an erection," Dr. Desai says.
4. Quit Smoking (Everything)
Need more motivation to kick the smoking habit? Smoking decreases the activity of nitric oxide, making it harder to get hard. Plus, it leads to health issues associated with ED, such as cardiovascular disease, diabetes and atherosclerosis (buildup of plaque on the walls of your arteries).
Smoking a pack or more a day doubles your risk of developing ED, according to a December 2016 study in Andrologia — and the longer you've been smoking for, the greater your risk. And vaping is no better: A November 2021 study in the American Journal of Preventative Medicine found that e-cigarettes also take a toll on your erection.
Meanwhile, a December 2019 analysis in the American Journal of Men's Health concluded that cannabis smokers are twice as likely to report ED as nonusers. "Daily marijuana use can disrupt your brain signaling," Dr. Desai says.
5. Talk to Your Doctor About Your Rx
Certain medications don't play nice with your ability to get and keep an erection. Drug side effects comprise about one-quarter of all cases of ED, according to Harvard Health Publishing. The most common culprits are blood pressure drugs, antidepressants, anti-ulcer meds, tranquilizers and diuretics.
If your ED started after you began taking medication, check in with your provider about whether it could be the cause. They might be able to substitute a different med or adjust the dose.
6. Reduce Stress
ED is associated with stress, anxiety and depression, according to a 2016 study in Nature Reviews Disease Primers.
"An erection is a two-part process: first, your brain signals your penis to become erect," Dr. Desai says. "Next, your body responds to your brain's signals."
Sometimes ED is related to blood flow etiology: "The mindset to have an erection is there, but the blood flow is not getting to the penis to sustain the erection," Dr. Desai says. Other times, the root cause is psychological: "Your mindset isn't there to initiate the erection," Dr. Desai says. This is called "psychogenic ED."
Whether you're having trouble in your romantic relationship or are worried about something unrelated to your love life, stress prevents you from being into the moment.
Addressing the cause of your worries, whether through self-care, counseling or meditation, can help. An October 2016 review in the British Journal of Sports Medicine found that physical activity significantly improved erectile function. Meanwhile, a May 2021 review in the Arab Journal of Urology concluded that talk therapy improved psychogenic ED even more than medical treatment (a combination of therapy and pills had the best results). Mindfulness may also be a promising ED treatment, according to a small October 2018 study in the Journal of Sexual Medicine.
"Moreover, there is often a ripple effect, where the inability to achieve or maintain an erection adds to the stress," Dr. Desai says. "Sometimes I will prescribe a short term of medication in order to bring a patient's confidence back." Just a few doses can be all it takes to get over the hump.
What About Dietary Supplements?
There are supplements galore promising to help you get it up.
"Although some of these can potentially work, I would not recommend taking them," Dr. Desai says. "Especially if you're in your late 40s or older, ED can be a sign of underlying disease; treating it with an over-the-counter supplement can mask these issues instead of solving the root of the problem."
Plus, most of these pills can have negative side effects. "If you do take a natural supplement, be cautious and always look at the warning label on the back," Dr. Desai says.
Here's the scoop on some of the herbs you might have heard buzz about:
- Yohimbine: "Before Viagra and Cialis came out, yohimbine used to be a commonly prescribed herb that actually can improve ED," Dr. Desai says. "But side effects include anxiety and increased heartbeat."
- L-arginine: A February 2019 study in the Journal of Sexual Medicine found that l-arginine significantly improved erectile function, with 8 percent of people experiencing negative side effects (none of which were severe). "This supplement stimulates nitric oxide," Dr. Desai says. "However, it can cause nausea and cramps."
- Ginseng: Ginseng has a trivial effect on ED, and few adverse side effects, per an April 2021 Cochrane Database Systems Review. "Gingseng also promotes nitric acid, but can lead to headaches," Dr. Desai says.
- DHEA: This hormone supplement might be helpful in achieving or maintaining an erection. "It seems to be safe, but can cause acne in some people," Dr. Desai says.
Two supplements should be avoided completely: horny goat weed and gingko biloba.
Not only are they not helpful, but they have potentially dangerous side effects. “Horny goat weed can cause breathing issues, while gingko biloba increases your risk of bleeding,” Dr. Desai says.
What About Kegel Exercises?
Kegel exercises are aimed at toning your pelvic floor muscles, which support your bladder and bowel. In a small BJU International study done in 2005 (the most recent research to date on the topic), three-quarters of participants reported that their ED improved after practicing kegels for six months.
But Dr. Desai is not convinced. "Kegels strengthen your pelvic floor muscles, but they don't have a great track record of improving ED," he says.
What About Prostate Massage?
Your prostate is a gland located at the base of the penis that produces semen.
"The idea behind prostate massage is that your prostate ducts are blocked with semen and by massaging the prostate, you can release the blockage," Dr. Desai says. During the massage, a finger is inserted up your rectum.
Again, Dr. Desai is not sold by this potential remedy. "This method is unreliable," he says.
What About GAINSwave Therapy?
"In this treatment, shock waves are delivered to the penis to help regenerate blood flow," Dr. Desai says. "It doesn't deliver long-term results for the vast majority of people, lasting maybe six months or so." It also takes a bite out of your budget. "It is costly and not covered by insurance," Dr. Desai says.
A final reason to be wary: "Eighty percent of the time it is done by non-urologists," Dr. Desai says.
Is There a Permanent Cure for ED?
Yes, but it requires invasive surgery. "A penile prosthetic is a device that replaces the blood flow and will get you an erection 100 percent of the time," Dr. Desai says. Since surgery is involved, there's a risk of infection, as well as a potential for the implant to malfunction, per the Mayo Clinic.
Here, answers to more common questions you may have:
What Is the Fastest Way to Get Rid of ED?
Injection therapy. "You inject your penis with meds that help stimulate blood flow," Dr. Desai says. "It works within 15-20 minutes."
What Is the Best Treatment for ED?
That depends on your age.
"For young people, focus on lifestyle changes — reducing stressors, improving your diet and exercising," Dr. Desai says. "For older folks, PDE-5i inhibitors like Viagra and Cialis work quite well, whether taken short term or long term, and will give you results within an hour."
How Is ED Diagnosed?
Your doctor will likely ask you questions about your symptoms, health history, emotional wellbeing and lifestyle. "It is a diagnosis of clinical history, where the patient describes what is going on," Dr. Desai says.
Your provider will often give you a physical exam and may order blood tests, According to the American Urological Association.
"There are also medical tests that can be done, such as a penile doppler, which checks for blood flow abnormalities," Dr. Desai says. "This is very rarely done in clinical settings because it doesn't change the overall management of the condition; I wouldn't seek it out."
3 Home Remedies for Premature Ejaculation
Premature ejaculation (PE) happens when you reach orgasm earlier than you’d like to. It can go hand in hand with ED because if you’re worried about your erection flagging, you might rush through intercourse. Of course, finishing too soon can ratchet up stress and make your ED worse. These natural treatments can help:
- Ginseng cream: This acts as a numbing agent to put the brakes on a too-soon O. “Apply it topically about 15 minutes prior to intercourse,” Dr. Desai says. You can also try an over-the-counter (or prescription) lidocaine cream to dull sensation.
- Stop and squeeze: When you feel yourself getting close to the finish line (but not yet at the point of no return), stop what you’re doing. “Firmly squeeze the shaft of the penis firmly to bring your erection back down,” Dr. Desai says.
- Go easy with the lube: “Using a lot of lubrication can over-sensitize the penis,” Dr. Desai says. “Too much stimulation can cause PE.”
- Andrologia: "Effect of weight loss on erectile function in men with overweight or obesity: A meta-analysis of randomised controlled trials"
- Texas A&M University: "Watermelon May Have Viagra-effect"
- American Journal of Clinical Nutrition: "Dietary flavonoid intake and incidence of erectile dysfunction1"
- Sexual Medicine Society of North America: "Alcohol and Temporary Erectile Dysfunction"
- Andrologia: "Effects of cigarette smoking on erectile dysfunction"
- American Journal of Preventative Medicine: "Association of E-Cigarettes With Erectile Dysfunction: The Population Assessment of Tobacco and Health Study"
- American Journal of Men’s Health: "Relationship Between Cannabis Use and Erectile Dysfunction: A Systematic Review and Meta-Analysis "
- Journal of Sexual Medicine : " The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis "
- Cochrane Database Systems Review : "Ginseng for erectile dysfunction"
- Harvard Health Publishing: " Some drugs may cause your erectile dysfunction "
- Nature Reviews Disease Primers: "Erectile dysfunction"
- British Journal of Sports Medicine: " Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis "
- Arab Journal of Urology: "The effectiveness of psychological interventions alone, or in combination with phosphodiesterase-5 inhibitors, for the treatment of erectile dysfunction:A systematic review"
- Journal of Sexual Medicine: " Mindfulness-Based Group Therapy for Men With Situational Erectile Dysfunction: A Mixed-Methods Feasibility Analysis and Pilot Study "
- BJU: " Pelvic floor exercises for erectile dysfunction "
- American Urological Association: " What is Erectile Dysfunction?"
- American Journal of Clinical Nutrition: "Dietary flavonoid intake and incidence of erectile dysfunction "
- Mayo Clinic: "Penile implants"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.