Erectile dysfunction (ED) affects millions of men globally and can lead to various complications, including relationship issues and low self-esteem. Treatment options range from lifestyle changes, such as exercise and diet, to medication like PDE-5 inhibitors (e.g., Viagra, Cialis), which enhance blood flow to help achieve erections. Traditional remedies, particularly from African medicinal plants, have potential and should be further studied for their efficacy and safety in treating ED.

1. If ignored, erectile dysfunction can lead to complications, such as an
unsatisfactory sex life, low self-esteem, high anxiety, and relationship problems.
Getting a partner pregnant also becomes difficult if a man suffers with erectile
dysfunction.
A study published in May 2014 in The Journal of Sexual Medicine found that
some men can reverse erectile dysfunction with healthy lifestyle changes, such
as exercise, weight loss, a varied diet, and good sleep. The Australian
researchers also showed that even if erectile dysfunction medication is required,
it's likely to be more effective if you implement these healthy lifestyle changes.
For men searching for ED medication, there are many newer erectile dysfunction
treatments (all prescription drugs) that help you get an erection firm enough to
have sex, and most have few side effects.
Commonly prescribed erectile dysfunction treatments include:
Stendra (avanafil)
Viagra (sildenafil)
Cialis (tadalafil)
Levitra or Staxyn (vardenafil)
If you need erectile dysfunction treatment, talk with your doctor today.
1
Exercise Is an Active Erectile Dysfunction Treatment
a person running outside for exercise
Shutterstock
“There are many lifestyle changes that are erectile dysfunction remedies, but
among them, exercise is the ED treatment that can have the greatest impact,”
says Zachary R. Mucher, MD, a urologist in Sugar Land, Texas. “Exercise works
on several fronts to combat the development of ED and help reverse it once it
has become a problem.”
Exercise improves blood flow, which is vitally important to a strong erection, and
improves blood pressure by increasing nitric oxide in blood vessels, which he
says is exactly how Viagra works. Weight-bearing exercise can increase the

2. natural production of testosterone, a significant factor in erectile strength and sex
drive.
2
One Erectile Dysfunction Remedy Is a Healthy Diet
ingredients of a healthy diet for erectile dysfunction
Peter Reali/Corbi
The foods you eat can have a direct impact on erectile dysfunction, Dr. Mucher
says. A diet rich in fruit, veggies, whole grains, and fish, and with fewer servings
of red meat and refined grains, decreases the risk for ED.
A healthy diet also helps to maintain a healthy body weight, which is important
because men who have a 42-inch waist are 50 percent more likely to have ED
than men with a 32-inch waist. Also, obesity increases the risk for vascular
disease and diabetes, two factors that contribute to ED.
3
Sleep Is a Natural Erectile Dysfunction Treatment
a woman reaching for an alarm clock while in bed with her partner
Jamie Grill/Corbis
Poor sleep patterns can be a contributing factor for erectile dysfunction, Mucher
says. One review published in the journal Brain Research emphasized the
intricate relationship between the level of sex hormones like testosterone, sexual
function, and sleep, noting that testosterone levels increase with improved sleep,
and lower levels are associated with sexual dysfunction. Hormone secretion is
controlled by the body’s internal clock, and sleep patterns likely help the body
determine when to release certain hormones.
Adhering to a set sleep schedule is a natural erectile dysfunction remedy, and
can help ensure that those signals are clear and consistent.
4
Quit Smoking to Stop Erectile Dysfunction
a cigarette stubbed out in an ashtray, representing quitting smoking
Peter Dazeley/Getty Images
For many men, stopping smoking is an erectile dysfunction remedy, particularly
when ED is the result of vascular disease, which occurs when blood supply to the

3. penis becomes restricted because of blockage or narrowing of the arteries.
Smoking and even smokeless tobacco can also cause the narrowing of important
blood vessels and have the same negative impact.
If you smoke, talk to your doctor about quitting and whether prescription aids can
help you.
5
Limit Alcohol to Improve ED
an alcoholic drink in a glass
Thinkstock
“Alcohol is a depressant and can cause both temporary and long-term erectile
dysfunction,” Mucher cautions.
The central nervous system is responsible for releasing nitric oxide, an essential
chemical for producing and maintaining an erection, and heavy alcohol
consumption depresses the central nervous system, causing it to function less
efficiently. Not enough nitric oxide translates to erectile dysfunction.
6
Monitor Your Meds to End Erectile Dysfunction
a man holding medication and a glass of water
Corbis
Erectile dysfunction can occur as a side effect of medication taken for another
health condition. Common culprits are high blood pressure meds,
antidepressants, some diuretics, beta-blockers, heart medication, cholesterol
meds, antipsychotic drugs, hormone drugs, corticosteroids, chemotherapy, and
medication for male pattern baldness, among others.
If you think your medication might be causing ED, talk to your doctor, but don't
discontinue using it on your own. Some medication must be tapered off under a
doctor's supervision.
7
Acupuncture May Help With Erectile Dysfunction
a man receiving accupuncture for erectile dysfunction
Getty Images

4. Research is mixed on the effectiveness of acupuncture as an erectile dysfunction
cure, but one study published in November 2013 in the Journal of Alternative and
Complementary Medicine found that acupuncture can be beneficial for men
experiencing erectile dysfunction as a side effect of antidepressants, including
selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline
reuptake inhibitors (SNRIs).
Sexual side effects of these drugs happen to at least half of all people taking
them, and by some counts up to 90 percent.
8
Can Herbal Remedies Help or Hurt Erectile Dysfunction?
a pomegranate cut open, and pomegranate juice
Getty Images
“There are many herbal remedies that tout improvement in erectile function, but
most have little effect and may actually have detrimental side effects,” Mucher
says. Two natural erectile dysfunction treatments that have shown promise are
red ginseng and pomegranate juice.
“Ginseng is thought to increase nitric oxide production, leading to improved blood
flow," he says. "Pomegranate juice is a potent antioxidant and can help prevent
atherosclerosis." Always talk to your doctor before taking any supplements, as
they might interfere with other medication you're taking.
Men's Health
NEWSLETTERS
Sign up for our Men's Health Newsletter!
Enter your email
Enter your email
Subscribe
By subscribing you agree to the Terms of Use and Privacy Policy.
THE LATEST IN ERECTILE DYSFUNCTION
Pornography Habit Is Linked to Erectile Dysfunction, Research Suggests
Survey says more then 50 percent with erectile dysfunction problems during
partnered sex don’t have a problem when watching porn.  

5. By Beth Levine
July 22, 2020
Pfizer Launches Generic Viagra
The little blue pill is about to become a lot more affordable.
By Julie Marks
December 28, 2017
Generic Viagra: What Does It Mean for You?
The little blue pill is expected to go generic in December 2017.
By Julie Marks
December 1, 2017
How Aging Can Make Men Better in Bed (Really)
Aging and ED can slow men's sexual health, but pleasure is not only possible, it
can also improve quality of life in men 60 and older.
By Denise Mann
March 13, 2014
Erection Problems? This Habit May Be Why
Watching porn may extinguish erections in the bedroom. But the brain, not the
penis, is the problem.
By Denise Mann
February 4, 2014
What Happens When You Use Viagra But Don't Have ED
Viagra and other ED drugs are increasingly being misused and even abused.
Learn about the risks of recreational ED drug use.
By Chris Iliades, MD
January 30, 2014
Sexy Men Do Kegels

6. This sneaky, do-anywhere exercise can boost erections, banish leaks.
By Madeline R. Vann, MPH
January 21, 2014
How Women Can Deal With Erectile Dysfunction
Dealing with erectile dysfunction can be awkward and embarrassing, but you can
play an important role in encouraging the man in your life to get checked...
By Kristen Stewart
December 2, 2013
ED and the Sexless Relationship
Erectile dysfunction can lead to relationship problems. Learn why sex is
important in a relationship and for good health and how to restart your sex life...
By Kristen Stewart
November 15, 2013
Ask a Castle Connolly Top Doctor: How Often Are Vasectomy Reversals
Successful and Why?
A renowned urologist and top vasectomy reversal expert, recognized as a Castle
Connolly Top Doctor, discusses what factors influence the success of a ...
By
April 30, 2021
Wellness inspired. Wellness enabled.
FacebookTwitterInstagramPinterest
About Us
Careers
Editorial Policy
Newsletters
Privacy Policy
Health News
Accessibility Statement
Terms of Use

7. Contact Us
Feedback
Do Not Sell My Personal Information
Popular Topics
AdChoiceAdChoice
NEWSLETTERS
Get the best in health and wellness
Enter your email
Enter your email
Subscribe
By subscribing you agree to the Terms of Use and Privacy Policy.
A PROPERTY OFEveryday Health GroupEHGLogo
More From Everyday Health Group:
What to ExpectBabyCenterMedPage TodayCastle Connolly Top DoctorsMigraine
Again
© 1996-2021 Everyday Health, Inc. Everyday Health is among the federally
registered trademarks of Everyday Health, Inc. and may not be used by third
parties without explicit permission.
HON codeBadgesDigital Advertising AllianceBadgesTag SealBadges
Erectile dysfunction (ED) is a common medical condition that affects about 200
million men worldwide,1,2 and as many as 30 million American men.3 Although
ED also afflicts many African men, authentic figures on the incidence and/or
prevalence of the disease are not available in most African countries.
The National Institutes of Health (NIH) has defined erectile dysfunction as ‘a
consistent inability (of the patient) to achieve and maintain erection sufficient for
satisfactory sexual activity’.3 ED is associated with advancing age, with a 39%
prevalence at the age of 40 years and 67% by 70 years of age.4 Erectile
dysfunction is common in men with cardiovascular disorders such as ischaemic
heart disease, hypertension and peripheral vascular diseases.2,5 It is also
common in men with diabetes mellitus,6 probably because of the shared factors
that impair haemodynamic mechanisms in the penile and ischaemic vasculature.
Erectile dysfunction is also caused by spinal cord injury (cord level range,
T6–L5),7 and other factors such as radical prostatectomy, long-term use of
certain medications (eg, antidepressants, antipsychotics, antihypertensives and
diuretics), indices of anger and depression, and cigarette smoking.1,4

8. Clinically known aetiologies of ED include organic, psychogenic and combined
origins.1 Cardiovascular disorders and diabetes mellitus are known to contribute
significantly to erectile dysfunction of organic origin.6,8 Organic causes of
erectile dysfunction are found in 80–90% of ED patients, and these include
vasculogenic (ie, arterial, cavernosal and mixed), neurogenic, anatomical and
endocrine causes.4 Psychogenic forms of ED are usually due to sexual
performance anxiety, depression and inhibited sexual drive.4
Recent studies have shown that vascular endothelial dysfunction is a major
cause of ED, suggesting that ED might be an early manifestation of
cardiovascular disease.2,9,10 Indeed, patients with ED possess many of the risk
factors associated with coronary artery disease (CAD), such as smoking,
hypertension, diabetes and hyperlipidaemia.1,10 The association between ED
and CAD has, therefore, raised concerns regarding the cardiovascular safety of
PDE-5 inhibitors.10
Allopathic medicines for erectile dysfunction
Three synthetic drugs, namely sildenafil citrate (Viagra™), tadalafil (Cialis™) and
vardenafil hydrochloride (Levitra™) are currently available on the pharmaceutical
market for the treatment of ED. As a class, these compounds are mild vasoactive
drugs and they act by selectively inhibiting the enzyme phosphodiesterase type-5
(PDE-5). PDE-5 catalyses the breakdown of the smooth muscle-relaxing agent,
cyclic guanosine monophosphate (cGMP), a second messenger of nitric oxide.10
In the body, inhibition of PDE-5 increases cGMP levels, reduces intracellular
calcium (Ca2+) and induces vasodilation.10,11 The drugs possess identical
mechanisms of action, but differ essentially in their duration of action and in some
aspects of their pharmacokinetic profiles. Recent clinical studies have shown that
the three PDE-5 inhibitors are effective and relatively safe, and that they do not
increase cardiovascular risk in patients with CAD.12-14
The availability of these PDE-5 inhibitors has provided effective and
well-tolerated oral treatments for ED.5,7,15,16 Moreover, these drugs have been
reported to improve endothelial function, 10,14 and are speculated to have
vascular and myocardial protective properties.10,17 As a class, the three drugs
are indicated for the treatment of erectile dysfunction only. They are
contra-indicated in patients undergoing therapy with any form of nitrate, either

9. regularly or intermittently. The common side effects of the three PDE-5 inhibitors
include headache and dyspepsia, back pain, myalgia and non-arteritic anterior
ischaemic optic neuropathy.
Synthetic phosphodiesterase-5 inhibitors
Sildenafil citrate (Viagra™) and related sexual stimulant ‘love’ drugs have been
widely studied for their tolerability, safety and efficacy in the treatment of erectile
dysfunction in a variety of patient populations. In men, oral sildenafil citrate,
tadalafil and vardenafil hydrochloride are generally known to be effective in
erectile dysfunctions of organic, psychogenic or mixed origins. However, the
aetiology of erectile dysfunction has been shown to have a significant impact on
treatment success and satisfaction rates, with neurogenic causes of erectile
dysfunction (eg, diabetes mellitus and prostate surgery) having significantly lower
treatment success rates than psychogenic or vasculogenic erectile
dysfunction.15
The pharmacokinetic characteristics of tadalafil differ significantly from those of
sildenafil citrate and vardenafil hydrochloride. The mean half-life for both
sildenafil and vardenafil is about four hours, whereas the mean half-life of
tadalafil is 17½ hours, and tadalafil has also been shown to improve erectile
dysfunction for up to 36 hours post dosing.12,16
African traditional remedies for erectile dysfunction
In Africa, from ancient times, plants have served as a dependable and
ever-ready source of medicines for the treatment of a plethora of chronic and
acute diseases of mankind. The various communities and societies on the
continent, in addition to ‘owning’ traditional remedies for ailments such as
hypertension, diabetes mellitus, arthritis and other chronic conditions, also ‘own’
remedies for socio-cultural diseases such as erectile dysfunction.
Thousands of African medicinal plants (belonging to several genera and families,
and with diverse chemical constituents) have been reported to possess
aphrodisiac and sexual stimulant properties (Koloko, pers commun). Each
African country has a catalogue of locally made, plant-derived sexual stimulants
under various local trade names such as Impotex™, TigerPower™,
SuperLove™, uBangalala™ and Burantashi™. Hundreds of such traditional,
plant-derived remedies are used in African countries for the effective treatment of

10. ED. For example, the Zulu people of South Africa have, for centuries, used the
roots of Eriosema species as a remedy for the treatment of erectile dysfunction
and/or impotence.
Generally, the genus Eriosema contains plants which fall under the Zulu
indigenous umbrella name of uBangalala, and most of the plant species listed
under this name are used mainly for the purpose of curing or alleviating
impotence..18,19 Hot milk infusions of Eriosema roots and/or pounded boiled
root decoctions of the plant are taken in small doses in the morning and at night
for impotence.18,19 As with oral Viagra™ taken with a fatty meal, oral
administration of an infusion or decoction of Eriosema roots with milk probably
delays or reduces the rate of absorption of the bioactive compounds from the
patient’s gastrointestinal tract, and thereby prolongs the duration of action of the
compounds in the body.
It has been suggested that for maximum benefit, milk infusions and decoctions of
Eriosema kraussianum roots are to be taken two to four hours before any
anticipated sexual intercourse, and the effects (achievement and maintenance of
penile erection sufficient for satisfactory sexual intercourse after penetration) of
the plant extracts have been reported to last for four to six hours following oral
dosing of the milk infusion or decoction of the rootstock extracts (Drewes, pers
commun). Unlike Viagra™, however, the bioavailability, half-life, Tmax, Cmax and
other pharmacokinetic parameters of the bioactive compounds of E kraussianum
are obscure at present. The effects of the extract on the biochemical activities of
cGMP and PDE-5 are also unknown.
Due to economic constraints, providing adequate modern medical care to all the
people in developing, third-world African countries is an elusive dream at
present. Therefore, for the treatment of erectile dysfunction in the rural,
peri-urban and some urban communities of Africa, it is prudent to look for
salvation in herbal medicines and plant-derived products.
Recent studies in our laboratories20-22 have shown that E kraussianum NE Br
(Fabaceae) is one of the promising plant species of South Africa with potential for
use as an effective remedy in the treatment of impotence and/or ED. Drewes et
al.20,21 have shown, in a rabbit experimental model, the plausible therapeutic
beneficial effects of bioactive compounds of E kraussianum in the management

11. of erectile dysfunction. The psycho-social benefits of using such plant-derived
crude remedies in rural African communities cannot be overemphasised. Since
men with ED of organic, psychogenic and mixed aetiologies are known to benefit
from Viagra™ therapy, it is speculated that E kraussianum extractives may also
be used effectively as a Viagra™ substitute in South African men with such
erectile dysfunction.
Conclusion
There is a dire need to develop some of the existing potent, African traditional
remedies for erectile dysfunction into scientifically acceptable natural medicines.
With the financial and goodwill support of governments, non-governmental
organisations and philanthropic individuals, coupled with the cooperation of
multinational pharmaceutical companies such as Pfizer and others, it should be
possible to develop some of the currently available African traditional remedies
for ED into acceptable, potent natural medicines in the foreseeable future. Such
existing remedies should be subjected to rigorous scientific scrutiny
experimentally (in laboratory animals) and clinically (in humans), in order to
establish their safety, efficacy, quality, mechanisms of action, side effects, and
possibly also, their contra-indications.
The goals of medicines, whether allopathic, traditional or complementary, are the
same, namely, to benefit patients therapeutically and improve their quality of life.
Based on these assumptions, one can look forward to a near future of integrated
orthodox and traditional medicines, and hope that experimental and clinical
research in traditional, complementary and alternative medicines will help to
develop affordable, safe and effective natural medicines for erectile dysfunction,
rather than criticising and marginalising unorthodox medicines, ethnomedical
claims and traditional findings.
With traditional health practitioners, pharmacists, orthodox medical practitioners,
nurses, botanists, chemists, pharmacologists, toxicologists and other scientists
working together collaboratively for a common purpose, the future of scientifically
developed, affordable, safe and effective natural medicines for ED will certainly
be in sight. Now is the time to ensure that future availability of scientifically
formulated, safe and effective traditional medicines for the treatment of erectile
dysfunction is not an elusive dream, but an imminent reality.

12. Article information
Cardiovasc J Afr. 2007 Jul-Aug; 18(4): 213–215.
PMCID: PMC4170225
PMID: 17940663
John AO Ojewole, BPharm (Hons), MSc (Clin Pharm), PhD (Pharm)
John AO Ojewole, Department of Pharmacology, School of Pharmacy and
Pharmacology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban;
Copyright © 2010 Clinics Cardive Publishing
This is an open-access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC.
Articles from Cardiovascular Journal of Africa are provided here courtesy of
Clinics Cardive Publishing (Pty) Ltd.
References
1. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB.
Impotence and its medical and psychosocial correlates: results of the
Massachusetts Male Aging Study. J Urol. 1994;151:54–61. [PubMed] [Google
Scholar]
2. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in United States:
prevalence and predictors. J Am Med Assoc. 1999;281:537–544. [PubMed]
[Google Scholar]
3. et al. Impotence. NIH consensus development panel on impotence. J Am Med
Assoc. 1993;270:83–90. [PubMed] [Google Scholar]
4. Golijanin D, Singer E, Davis R, Bhatt S, Seftel A, Dogra V. Doppler evaluation
of erectile dysfunction – Part 1. Int J Impot Res. 2007;19:37–42. [PubMed]
[Google Scholar]
5. Conti CR, Pepine CJ, Sweeney M. Efficacy and safety of sildenafil citrate in
the treatment of erectile dysfunction in patients with ischaemic heart disease. Am
J Cardiol. 1999;83:29C–34C. [PubMed] [Google Scholar]
6. Rendell MS, Rajfer J, Wicker PA, Smith MD. Sildenafil for treatment of erectile
dysfunction in men with diabetes. J Am Med Assoc. 1999;281:421–426.
[PubMed] [Google Scholar]
7. Derry FA, Dinsmore WW, Fraser M. et al. Efficacy and safety of oral sildenafil
(ViagraTM) in men with erectile dysfunction caused by spinal cord injury.
Neurology. 1998;51:1629–1633. [PubMed] [Google Scholar]

13. 8. Zusman RM, Morales A, Glasser DB, Osterloh IH. Overall cardiovascular
profile of sildenafil citrate. Am J Cardiol. 1999;83:35C–44C. [PubMed] [Google
Scholar]
9. Blumentals WA, Gomez-Caminero A, Joo S, Vannappaggari V. Should erectile
dysfunction be considered as a marker for acute myocardial infarction? Results
from a retrospective cohort study. Int J Impot Res. 2004;16:350–353. [PubMed]
[Google Scholar]
10. Sesti C, Florio V, Johnson EG, Kloner RA. The phosphodiesterase-5 inhibitor
tadalafil reduces myocardial infarct size. Int J Impot Res. 2007;19:55–61.
[PubMed] [Google Scholar]
11. Aversa A, Pili M, Fabbri A, Spera E, Spera G. Erectyle dysfunction:
expectations beyond phosphodiesterase type-5 inhibition. J Endoctrinol Invest.
2004;27:192–206. [PubMed] [Google Scholar]
12. Porst H, Padma-Nathan H, Giuliano F, Anglin G, Varanese L, Rosen R.
Efficacy of tadalafil for the treatment of erectile dysfunction at 24 and 36 hours
after dosing: a randomized, controlled trial. Urology. 2003;62:121–125. [PubMed]
[Google Scholar]
13. Kloner RA. Cardiovascular effects of 3 phosphodiesterase-5 inhibitors
approved for the treatment of erectile dysfunction. Circulation.
2004;110:3149–3155. [PubMed] [Google Scholar]
14. Rosano GMC, Aversa A, Vitale C, Fabbri A, Fini M, Spera G. Chronic
treatment with tadalafil improves endothelial function in men with increased
cardiovascular risk. Eur Urol. 2005;47:214–222. [PubMed] [Google Scholar]
15. Jarow JP, Burnett AL, Geringer AM. Clinical efficacy of sildenafil citrate based
on aetiology and response to prior treatment. Am J Urol. 1999;162:722–725.
[PubMed] [Google Scholar]
16. Rajfer J, Aliotta PJ, Steidle CP, Fitch WP, Zhao Y, Yu A. Tadalafil dosed once
a day in men with erectile dysfunction: a randomized, doubleblind,
placebo-controlled study in the US. Int J Impot Res. 2007;19:95–103. [PubMed]
[Google Scholar]
17. Kukrejia RC, Ockaili R, Salloum F, Yin C, Hwakins J, Das A. et al.
Cardioprotection with phosphodiesterase-5 inhibition – a novel preconditioning
strategy. J Mol Cell Cardiol. 2003;36:165–173. [PubMed] [Google Scholar]
18. Bryant AT. Zulu Medicine and Medicine-Men. Cape Town: Centaur Struik;
1966. [Google Scholar]

14. 19. Hutchings A, Scott AH, Lewis G, Cunningham A. Zulu Medicinal Plants: An
Inventory. Pietermaritzburg: University of Natal Press; 1996. pp. 145–146.
[Google Scholar]
20. Drewes SE, Horn MM, Munro OQ, Dhlamini JTB, Meyer JJM, Rakuambo NC.
Pyrano-isoflavones with erectile-dysfunction activity from Eriosema kraussianum.
Phytochemistry. 2002;59:739–747. [PubMed] [Google Scholar]
21. Drewes SE, George J, Khan F. Recent findings on natural products with
erectile-dysfunction activity. Phytochemistry. 2003;62:1019–1025. [PubMed]
[Google Scholar]
22. Ojewole JAO, Drewes SE, Khan F. Vasodilatory and hypoglycaemic effects of
two pyrano-isoflavone extractives from Eriosema kraussianum N.E. Br.
[Fabaceae] rootstock in experimental rat models. Phytochemistry.
2006;67:610–617. [PubMed] [Google Scholar]