Natural Approaches for Erectile Dysfunction

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Sexual health can be a challenging topic of discussion. Men are often unwilling to tell their doctors about problems with sexual functioning. However, there are treatments that can help. In addition, problems with sexual functioning are typically related to other health problems that should also be evaluated. 

For men in the United States, problems achieving or maintaining an erection are common. Research shows increasing prevalence of erectile dysfunction (ED) in men as they get older (Selvin 2007):

  • 5% for ages 20-39
  • 14.8% for ages 40-59
  • 43.8% for ages 60-69
  • 70.2% for over 70

Risk factors for erectile dysfunction include tobacco use, obesity, chronic alcohol consumption and lack of exercise. In addition, having diabetes, high blood pressure, high cholesterol or triglycerides and depression all can increase risks (Irwin 2019).

It’s also worth noting that medication side effects likely account for around 25% of ED (Irwin 2019). Blood pressure medications, antidepressants and antipsychotic medications are the most common culprits (Brock 1993).     

Mental/Emotional Components

Erectile dysfunction can have both physical and mental/emotional aspects. Psychological issues and anxiety can make erectile dysfunction worse, since a person needs to be relaxed for an erection to occur. When treating ED, appropriate counseling with a knowledgeable and supportive therapist can also be important (Hedon 2003). 

ED and Heart Disease

Anyone experiencing recent onset erectile dysfunction should have a work up for heart disease. One of the most common causes of erectile dysfunction is a buildup of plaque in the arteries that feed the penis. Plaque buildup in blood vessels (atherosclerosis) is associated with heart disease. Research suggests that two to three years after onset of erectile dysfunction heart disease commonly follows. Three to five years following the start of ED, men may have a cardiovascular event, either a heart attack or stroke (Katsiki 2015). 

Natural Options for ED

In the published research, there are some natural options for treating ED:

  • Arginine/citrulline
  • Ginseng
  • Pycnogenol (pine bark extract)
  • Maca

Arginine and Citrulline

Arginine is an amino acid found in food. It acts as a precursor to nitric oxide, a compound in the body that relaxes blood vessels. 

A recent meta-analysis looked at studies on arginine for erectile dysfunction. Ten clinical trials were available and the evidence showed significant benefits in multiple areas of sexual function (Rhim 2019). Side effects were more common than placebo, but none were severe. The study concluded that arginine can be recommended for mild to moderate erectile dysfunction.

Citrulline is another precursor to nitric oxide. While research is not robust, there is some data that suggests citrulline may yield better long-term results compared to arginine since it’s not cleared as quickly from the body (Cormio 2011).

Ginseng

Ginseng

Another recent meta-analysis on herbal approaches for ED found significant improvements with Panax ginseng. Five clinical trials all showed benefits. While significant, the authors emphasize the need for larger well done studies to confirm the results (Borelli 2018). 

Ginseng is generally well tolerated. A recent review of clinical trials concluded that ginseng appears “very safe” from the current published clinical trial data (Kim 2015). 

Pycnogenol and Maca

Pine Tree and Bark

Pycnogenol is the trademarked name of a French maritime pine bark extract. The majority of the clinical trials on pycnogenol for ED were combination trials with arginine making it difficult to discern individual effects. However, a recent trial used pycnogenol on its own showing significant benefits. In patients with diabetes and ED, symptoms improved 45% with pycnogenol. In patients with ED alone, symptoms improved 22% (Trebaticky 2019). Obviously, more studies are needed to confirm benefits.

Maca is an herb from South America. The root is often used by the indiginous population to improve stamina. Like pycnogenol, a human trial in mild ED showed significant benefits with its use (Zenico 2009). The effect size was small, but still significant. Again, further research can help clarify the extent of benefits for ED. 

Conclusions

ED is a common problem among men and is often a precursor to heart disease. Any individual presenting with recent onset ED should have a workup for heart health. In addition, dietary and lifestyle factors should be addressed. For those requiring treatment, there are some natural options for ED that appear safe and effective. Among the studies, arginine and ginseng have the strongest research support suggesting benefits. 

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