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Erectile dysfunction is related to the inability to create and maintain penile erection sufficient for sexual satisfaction (1).  For many years erectile dysfunction was considered to be solely a psychological problem (2), but modern studies have demonstrated that there is more to the condition than just psychology.  It is now understood that healthy erections require the combinatorial interaction of vascular, molecular, neurological, hormonal, and psychological elements (3).  Recent publications have even observed correlations between erectile dysfunction and other health conditions, like diabetes and cardiovascular disease (4,5).

Currently, medical doctors categorized erectile dysfunction based on scores from the International Index of Erectile Function questionnaire (IIEF-5) (6):

  • Mild erectile dysfunction (IIEF-5 score of 14-21)
  • Moderate erectile dysfunction (IIEF-5 score of 8-13)
  • Severe erectile dysfunction (IIEF-5 score of 1-7)


Proper categorization of erectile dysfunction can help a physician to identify the cause of the condition and to prescribe the appropriate treatment.  In addition to being categorized by severity level, erectile dysfunction is also categorized into subtypes based on the time of onset:

Lifelong: In which an erection due to sexual desire cannot be achieved throughout one’s life (7).

Acquired: In which the patient had regular erectile function and sexual activity in the past before having erectile dysfunction (7).

For more information about erectile dysfunction: 1. Talk to your doctor or andrologist  2. See the Mayo Clinic article on erectile dysfunction  3. Visit the National Institute of Diabetes and Digestive and Kidney Diseases page for erectile dysfunction


Erectile dysfunction can sometimes be caused by medications.  5α-reductase inhibitors which are commonly prescribed for enlarged prostates may, for example, also can cause erectile dysfunction (8).  Other risk factors include:

  • Vascular and blood sugar problems like hypertension, diabetes, and insulin resistance (9,10,11,12,13)
  • Neurological issues like spinal or brain injuries, Parkinson’s disease, and Multiple Sclerosis
  • Psychological disorders like depression and anxiety (14)
  • Unhealthy lifestyle choices including smoking, excessive alcohol use, drug use, and lack of physical activity (15)


Erectile dysfunction is a common health problem that is currently affecting 10% of males between the ages of 40 to 70 (16).  It is believed that approximately 30 million men in the United States are afflicted with the condition (17).  The existing data also indicate that the severity of erectile dysfunction is age dependent, with the prevalence of moderate and severe dysfunction increasing from 22% in 40-year-old men to 49% in those older than 70 (16).

Statistical trends show an increase in reported cases of erectile dysfunction from year to year.  Based on these trends, scientists estimate that 322 million men worldwide will be suffering from the condition by the year 2025 (18).


Drugs that help facilitate or inhibit the reflex of the cavernous muscle have strong effects on the erection process.  It is known that drugs that raise cytosolic calcium cause contraction of the cavernous muscle and thereby prevent erections from taking place.  Drugs that lower cytosolic calcium levels, on the other hand, facilitate relaxation of these muscles and tend to trigger penile erections (19).  Drugs commonly prescribed for erectile dysfunction include:

  • Sildenafil, marketed as Viagra (20).  Side effects include headache, insomnia, skin rash, and indigestion (21).
  • Vardenafill, marketed as Levitra (22).  Side effects include headache, nausea, runny or stuffy nose, and indigestion.  Less commonly it has been known to cause chest pain (23).
  • Tadalafil, marketed as Cialis (24).  Side effects include headache, muscle pain, indigestion, nausea, high blood pressure, low blood pressure, abnormal ejaculations, and blurred vission (25).
  • Udenafil, marketed as Zydena (26).
  • Avanafil, marketed as Stendra (27).  Side effects include headache, flushing, and dizziness (28).
  • Mirodenafil, marketed as Mvix (29).
  • Lodenafil Carbonate marketed as Helleva (30).


Practices to Support Healthy Penile Function:

  • Lifestyle modification: Reducing the consumption of alcohol and tobacco products (31,32)
  • Diet change: Decreasing sugar consumption and including more whole-grain foods (18)
  • Increasing exercise: Frequent moderate to high-intensity physical activity and healthy weight loss (33,34)

Natural Supplements that Support Healthy Penile Function:


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