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Erection: The penis (male sexual organ) contains two chambers called the corpora Prostate gland enlargement, such as with benign prostatic hyperplasia .
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Other side effects may include bleeding from the injection, prolonged erection, and formation of fibrous tissue at the injection site. It should not be used more than three times per week, and there must be at least 24 hours one day between each dose. The cost per injection can be expensive. Injecting a mixture of alprostadil and other prescribed drugs including papaverine and phentolamine may be a less expensive and more effective option.

A risk of infection exists at the injection site, especially in immunocompromised individuals such as those with human immunodeficiency virus HIV. It involves using a disposable applicator to insert a tiny suppository, about half the size of a grain of rice, into the tip of the penis. The suppository, placed about two inches into the urethra, is absorbed by erectile tissue in the penis, increasing the blood flow and causing an erection. Although needles are not involved, this method may be painful or uncomfortable.

Side effects may include pain, minor bleeding in the urethra, dizziness, and formation of fibrous scar tissue. Hormone replacement therapy: For the small number of men who have testosterone deficiency, testosterone replacement therapy may be an option. While it is fairly well established that testosterone plays a role in libido sexual desire , its role in ED remains unclear. ED occurs in men with normal or moderately low levels of testosterone, so it cannot be concluded that testosterone is the primary modulator of erectile function.

However, among men diagnosed with hypogonadism, a condition characterized by abnormally low testosterone, erections do improve after testosterone replacement. For these men with ED, testosterone therapy is recommended to restore erectile function. Testosterone replacement therapy has also been recommended as a second-line approach to treatment of ED when prescription medications alone have failed and when prostate cancer has been ruled out.

However, testosterone may increase the growth of prostate cancer and is not used in individuals with this disease or an enlarged prostate benign prostatic hyperplasia or BPH. Yohimbine comes from the bark of the Pausinystalia yohimbe tree. Yohimbine hydrochloride is a standardized form of yohimbine that is available as a prescription drug in the United States, and has been reported in human studies to be effective in the treatment of male impotence. Yohimbine hydrochloride HCL has also been used for the treatment of sexual side effects caused by some antidepressants selective serotonin reuptake inhibitors , female hyposexual low sexual desire disorder, as a blood pressure boosting agent, and xerostomia dry mouth due to lack of saliva.

It stimulates the parasympathetic nervous system, which is linked to erection, and may increase libido sexual desire. It is necessary to take the medication for six to eight weeks before determining whether it will work or not. Yohimbine HCL has a stimulatory effect and side effects include elevated heart rate and blood pressure, mild dizziness, nervousness, and irritability.

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Vacuum devices: This treatment involves the use of an external vacuum and one or more rubber bands tension rings. To begin, a hollow plastic tube is placed over the penis. This tube is available by prescription or through various vendors. Then a hand pump is used to create a vacuum in the tube that pulls blood into the penis. Once an adequate erection is achieved usually one to three minutes , a tension ring is slipped around the base of the penis to maintain the erection. The vacuum device is then removed.

The erection typically lasts long enough for a couple to have sexual intercourse. The ring can be left in place for 25 to 30 minutes. The tension ring is removed after intercourse. Vascular surgery: This treatment is usually reserved for men whose blood flow has been blocked by an injury to the penis or pelvic area. Surgery may also be used to correct erectile dysfunction caused by vascular blockages such as atherosclerosis hardening of the arteries or tumors.

The goal of this treatment is to correct a blockage of blood flow to the penis so that erections can occur naturally; however, long-term success of this surgery is unclear. Abstinence from sexual activity involving the erect penis is recommended for the first six weeks after the operation. Penile implants: This treatment involves surgically placing a device into the two sides of the penis, allowing erection to occur as often and for as long as desired. These implants consist of either an inflatable device or semi-rigid rods made from silicone or polyurethane.

This treatment is often expensive and is usually not recommended until other methods have been considered or tried first. Penile implants are also sometimes used to treat Peyronie's disease, a disorder that causes bent or painful erections. As with any surgery, there is a risk of complications such as infection. Most men go home within 24 hours of surgery. Although new penile implant designs are very reliable and may last a lifetime, they can malfunction.

For example, in some semi-rigid devices, internal parts can break down over time, leading to a prosthesis malfunction. In inflatable devices, fluid can leak or the valve or pump device can fail. Surgery is necessary to repair or replace a broken implant. Penile implants do not usually affect urination, sex drive, orgasm, or ejaculation. A consideration before implanting a device into the penis is that implants cause an erection, but they do not increase sexual desire or sensation.

A penile implant will be shorter than the natural erection. Some partners feel that sexual pleasure is diminished by their lack of involvement in creating an erection. This surgery is permanent. If the implant is removed, the patient will not be able to get an erection. There may be reduced sensation in the head of the penis. Integrative therapies Unclear or conflicting scientific evidence: Acupressure, shiatsu: Additional studies are needed.

With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. Serious long-term complications have not been reported, according to scientific data. Hand nerve injury and herpes zoster "shingles" cases have been reported after shiatsu massage. Forceful acupressure may cause bruising. The practice of acupuncture originated in China 5, years ago.

Today it is widely used throughout the world and is one of the main pillars of Chinese medicine. It involves the insertion of needles in various point of the body to help move the "chi" or energy. A few clinical studies have suggested that acupuncture may help individuals suffering from erectile dysfunction ED. The results found that acupuncture can be an effective treatment option in more than two-thirds of patients with ED caused by psychological factors including stress, anxiety, and depression.

Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, medical conditions of unknown origins, or infections. Acupuncture should not be applied to the chest in patients with lung diseases or on any area that may rely on muscle tone to provide stability.

Avoid use in infants, young children, or in patients with needle phobias. Use cautiously with bleeding disorders, neurological disorders, seizure disorders, or diabetes. Use cautiously in elderly or medically compromised patients. Use cautiously in patients who will drive or operate heavy machinery after acupuncture. Use cautiously if taking anticoagulants. Avoid if pregnant. L-arginine, or arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required.

Early studies found that men with low nitrate levels a cause of erectile dysfunction in their blood or urine may find arginine supplements to be useful for managing erectile dysfunction.

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A randomized, controlled clinical trial reported improvements in patients with ED following use of a combination of L-arginine, glutamate, and yohimbine hydrochloride. Notably, yohimbine hydrochloride is an U. Food and Drug Administration FDA approved drug therapy for ED, and the effects caused by arginine alone in this combination therapy are difficult to determine. It is not clear what doses of arginine may be safe or effective in treating this condition, and comparisons have not been made with other agents used for ED. Larger, high-quality studies are needed. L-arginine is generally safe in recommended dosages, although drug interactions may be seen, especially with drugs to lower high blood pressure.

Avoid if allergic to arginine, or with a history of stroke, or liver or kidney disease. Avoid if pregnant or breastfeeding. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels. A small amount of human research reports that a combination cream with clove and other herbs may be helpful in the treatment of premature ejaculation.

However, well-designed studies of the effectiveness of clove alone are needed before a conclusion can be drawn.

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Avoid if allergic to Balsam of Peru, clove, eugenol, or some licorice and tobacco clove cigarette products. Avoid with bleeding disorders and in pediatric patients. Avoid use of undiluted clove oil on the skin. Use cautiously with seizure disorders and kidney or liver dysfunction. Coenzyme Q There is early evidence that supports the use of CoQ10 for increasing sperm count and motility in patients with idiopathic asthenozoospermia.

Better studies are needed before a conclusion can be made. Allergy associated with Coenzyme Q10 supplements has not been documented in the available literature, although rash and itching have been reported rarely. Use caution with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with anticoagulants blood thinners or antiplatelet drugs like aspirin, warfarin , or blood pressure, blood sugar, cholesterol, or thyroid drugs. Coleus Coleus forskohlii has been used in Asian traditional medicine for over 2, years. A component of coleus, called forskolin, was studied in humans in addition to prostaglandin E1, a drug commonly used in erectile dysfunction.

Positive effects were seen with forskolin and progstaglandin when the prostaglandin alone did not work for erectile dysfunction. Caution is advised when taking coleus supplements, as numerous adverse effects including drug interactions with blood pressure lowering medications are possible. Coleus should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor. Cordyceps sinensis is a fungus found mainly in China, Nepal, and Tibet. There is currently not enough available scientific evidence regarding the use of Cordyceps for sexual dysfunction.

High quality clinical research is needed in this area. Avoid if allergic or hypersensitive to cordyceps, mold, or fungi. Use cautiously with diabetes, prostate conditions, bleeding disorders, or if taking anticoagulant medications, immunosuppressive medications, or if on hormonal replacement therapy or oral contraceptives.

Avoid with myelogenous-type cancers. DHEA dehydroepiandosterone: DHEA is an endogenous hormone made in the human body secreted by the adrenal gland. DHEA serves as forerunner to male sex hormones androgens and female sex hormones estrogens. DHEA levels in the body begin to decrease after age Although some human studies report positive benefits on erectile dysfunction and sexual function while using DHEA in both men and women, better research is necessary before a clear conclusion can be drawn. Preliminary evidence suggests that DHEA may offer some benefit for increasing libido in premenopausal women.

Well designed clinical trials are required before recommendations can be made. Caution is advised when taking DHEA supplements, as numerous adverse effects including drug interactions are possible. Early small studies suggest that ephedra may increase sexual arousal in women. Further well-designed research is needed to confirm these results.

Avoid use in individuals younger than 18 years old. Avoid use for prolonged periods longer than seven days due to risk of abuse or toxicity. Discontinue use at least one week prior to major surgery or diagnostic procedures. Use cautiously with cardiovascular disease, including structural heart disease, arrhythmia, coronary artery disease, high blood pressure, cerebrovascular disease, and a history of stroke or transient ischemic attack. Use cautiously with monoamine oxidase inhibitor MAOI or stimulant use.

Ginkgo Ginkgo biloba has been used medicinally for thousands of years, and is one of the top selling herbs in the United States. Ginkgo is commonly used for decreased blood flow. Ginkgo has been reported in animal and human models as having vascular blood vessel relaxant properties, which may act on corpus cavernosum tissue of the penis and improve penile blood flow in patients with ED. Ginkgo has also been reported to be effective in treating antidepressant-induced decreased libido and erectile dysfunction.

Avoid if allergic or hypersensitive to members of the Ginkgoaceae family. If allergic to mango rind, poison sumac, poison ivy, poison oak, or cashews, then allergy to ginkgo is possible. Ginkgo should be stopped two to three weeks before surgical procedures. Use cautiously with seizures or in children. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or breastfeeding.

Asian ginseng, or Panax ginseng , has been used for more than 2, years in Chinese medicine for various health conditions. Preliminary evidence indicates that ginseng may be effective in improving the signs and symptoms of erectile dysfunction ED. Early studies suggest that applying an herbal combination containing Panax ginseng on the penis may help treat premature ejaculation. However, because ginseng was tested with other herbs, its individual effects on sexual function and libido are unclear.


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Studies with Panax ginseng alone are needed before strong conclusions can be made. Avoid ginseng with known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations. Horny goat weed: Horny goat weed has been traditionally used to increase fertility.

Early study suggests that horny goat weed may be of benefit for sexual dysfunction in renal failure patients. Additional study is needed in this area. Use cautiously with tachyarrhythmia, decreased blood pressure, frequent nosebleeds, musculoskeletal disorders, bipolar disorder, immune function disorders, homocysteine disorders, hypothyroid conditions, and cardiovascular disease.

Use cautiously if taking anticoagulant or antiplatelet blood thinning medications, antihypertensive blood pressure medications, antidepressants MAOIs , interleukins, or cholesterol-lowering medications. Avoid with hormone-sensitive conditions or if taking estrogen or oral contraception. According to traditional Chinese medicine TCM , avoid in patients with "fire from yin deficiency" people with too much "yang" or heat, masculinity, and activity, based on Chinese philosophy. Hypnotherapy, hypnosis: There is inconclusive evidence from preliminary research on the use of hypnotherapy for erectile dysfunction.

Additional study is needed before a firm conclusion can be drawn. Use cautiously with seizure disorders. L-carnitine, carnitine, or acetyl-L-carnitine, is an amino acid building block for proteins. High concentrations of carnitine are found in muscle tissue. However, more rigorous trials should be performed. Caution is advised when taking L-carnitine supplements, as adverse effects including drug interactions are possible. Avoid with known allergy or hypersensitivity to carnitine.

Use cautiously with peripheral vascular disease, hypertension high blood pressure , alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants blood thinners , beta-blockers, or calcium channel blockers.

Maca Lepidium meyenii is a vegetable that has been cultivated as a root crop for at least 2, years. It can be found wild in Peru, Bolivia, Paraguay, and Argentina, but has primarily been cultivated in the highlands of the Peruvian Andes. Traditionally in Peru, maca has been used as a male aphrodisiac to increase sexual desire.

Maca may improve sexual desire in healthy men independent of changes in mood, or serum testosterone male hormone , and estradiol female hormone levels. Higher quality studies are needed in this area, in both men and women. Use cautiously with anticoagulation therapy, hypertension, hormone responsive cancers such as breast cancer, or prostate cancer, and if using oral contraceptives or stimulants. Muira puama: Muira puama Ptychopetalum olacoides has been used historically for enhancement of libido and as a treatment for erectile dysfunction by Brazilian native people. Well-designed human trials of muira puama, as well as safety data, are necessary.

Additional study is also needed regarding the use of muira puama for female sexual dysfunction. Use cautiously with steroidal drug therapy, hormone-sensitive conditions breast cancer, endometriosis, ovarian cancer, prostate cancer , high blood pressure, or heart disease. Use cautiously if taking medications acting on the central nervous system CNS. Pomegranate juice has been studied in the treatment of mild to moderate erectile dysfunction. Early study is unclear, and more studies are needed to make a firm conclusion. Avoid if allergic or hypersensitive to pomegranate. Avoid with diarrhea or high or low blood pressure.

Avoid taking pomegranate fruit husk with oil or fats to treat parasites. Use cautiously with liver damage or disease. Pomegranate supplementation can be unsafe during pregnancy when taken by mouth. The bark, root and fruit rind can cause menstruation or uterine contractions. Avoid if breastfeeding due to a lack of scientific data. Individual, couples, or group psychotherapy may be helpful for men with erectile dysfunction.

However, prescription medication may be needed to alleviate symptoms. Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.

It is not known what effect each of the individual compounds may have directly on this condition. Further research is needed. Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. There is early evidence to support the use of yoga in the treatment of delayed ejaculation in males.

Larger well designed and controlled trials are needed to further assess the effects of yoga for sexual health. Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, cervical spondylitis, or if at risk for blood clots.

Certain yoga breathing techniques should be avoided with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction. However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.

Yohimbe bark extract: Yohimbine hydrochloride is a prescription drug that has been shown in multiple human trials to effectively treat erectile dysfunction. Yohimbine hydrochloride has also been suggested to treat sexual side effects of selective serotonin reuptake inhibitor SSRI antidepressants. However, although yohimbine is present in yohimbe bark extract, levels are variable and often very low. Yohimbine has also been proposed to increase female libido. More study is needed in these areas before a conclusion can be made. Yohimbine is generally well tolerated in recommended doses. However, many side effects have been reported with yohimbine hydrochloride and may apply to yohimbe bark.

Avoid if allergic to yohimbe, any of its components, or yohimbine-containing products. Use cautiously with peptic ulcer disease, kidney disease, high blood pressure, heart disease or if taking drugs that affect blood sugar levels. Avoid with benign prostate hypertrophy enlarged prostate , anxiety, mania, depression, stress disorders, post-traumatic stress disorders, bipolar disorders, or schizophrenia. Avoid use in children or if pregnant or breastfeeding.

Fair negative scientific evidence: Deer velvet: Deer velvet has a reputation as an aphrodisiac that may improve sexual energy by potentially strengthening and balancing the body and restoring overall energy. Natural supplements can offer a leg up on this task.

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The first option often presented is creatine. Research indicates that creatine is both directly and indirectly responsible for increasing fat-free body mass. Working out more, of course, is going to lead to bigger muscles. In addition, increased creatine content in muscles is directly associated with greater body mass 1. This review also explained that not all forms of creatine are correlated with muscle gains because some trials did not involve subjects engaging in weight training while taking the supplements.

The authors conclude that the majority of the evidence indicates creatine can enhance both athletic performance and the size of muscles 2. Stepping outside the creatine box, protein is fundamental for muscle building. But, it is sometimes claimed that whey protein , or other protein sources found in the supplement market, do not necessarily fare better in supporting muscle growth than any other protein.

There is evidence to contradict this, such as one study on older men that found whey protein stimulated muscle protein accretion more effectively than casein or casein hydrolysate 3. Many other supplements have been convincingly linked with muscle gains, when used in conjunction with exercise.

These include other protein sources such as the aforementioned casein, soy protein and egg protein. Plenty of protein powder products combine several protein sources for variety. Branch-chain amino acids BCAAs , beta-alanine and glutamine are also frequently recommended for men aspiring to bulk up. Most people do not need to be told by now that heart disease is the number one killer of men and women.

But it must be emphasized that many statistics suggest men are at an even greater risk.

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Men who die of cardiovascular disease are under 65 years old on average, while the average age for women trails by 6 years. This is why heart health supplements should be on tap for men, especially those with any family history of heart disease, or who struggle with lifestyle-related risk factors. Of course, men should first consult their physicians about their cardiovascular health risk before taking any new supplements. Omega-3s are perhaps the leading candidate in the heart health supplement space.

Fish oil maintains a sizable share of the market, though plant- or other marine-based sources such as krill are also viable ways to get heart-healthy omegas into the bloodstream and tissues. Eicosapentaenoic acid EPA and docosahexaenoic acid DHA are the two omega-3s found in abundance in marine sources; they also happen to lead the way when it comes to heart health benefits.

The primary reason, scientists believe, is that these fatty acids help control excessive inflammation, which is a primary culprit in cardiovascular health issues 7. Cholesterol-managing fiber, blood pressure-regulating garlic , heart-energizing coenzyme Q10 CoQ10 , and overall risk-lowering vitamin D round out a worthy list of top heart health supplements. Loading up on these and other heart-health supplements, depending on the type of risk being dealt with, is more than a good idea for men.

It may be a lifesaver in the long run. A walnut-sized gland specific to men, it rests below the bladder and surrounds the urethra 8.

In BPH, the prostate enlarges, putting pressure on surrounding tissues including the bladder and urethra, which is the cause of the most common symtpoms. BPH crops up mostly in men over age Dietary supplements, particularly herbs and herbal extracts, have been studied for their ability to address or benefit those with prostate problems. Saw palmetto is the most renowned of these, but the evidence is mixed on its effectiveness. A number of small studies indicate saw palmetto could be effective for helping alleviate the urinary symptoms caused by BPH.

But one large study found no difference between saw palmetto and a placebo for those with moderate-to-severe BPH, and there is also a lack of evidence that it can help reduce prostate-specific antigen PSA levels. PSA is produced by prostate cells, and high levels of PSA are correlated with prostate cancer risk 9. Other herbal extracts, notably pygeum Pygeum africanum , are thought to help with the symptoms of BPH. Scientific studies have found pygeum leads to improvements in nocturnia need to urinate at night and urine flow Grass pollen Secale cereale is another contender, as it has been found to help reduce the amount of urine retained in the bladder, another issue faced by those with BPH.

As they age, a significant number of men may go in search of ways to enhance their overall vitality and libido. Some may also be in the market for solutions for erectile dysfunction. Various herbals and other compounds that support testosterone, blood flow and related biological functions can help with these issues. Though their level of effectiveness may not quite stack up, certain natural options can be considered alternatives to male sexual enhancers like Viagra.

Ginseng is one of these options, though there are several types of ginseng to choose from, like Siberian and Asian. In general, ginseng is thought to help the body produce more nitric oxide, which is produced by prescription drugs in this category. The amino acid L-arginine may also boost nitric oxide and has been found to fit the same profile. For enhanced sex drive and a boost to sexual functions, men may want to turn to maca root.

Native to Peru, it has traditionally been used as an aphrodisiac