"I'm a 26-year-old guy that has trouble 'getting it up' sometimes. I'm not really up for going to the doctor to get Viagra or anything like that, so I'm wondering are there any 'natural' fixes that actually help in that department? And how is it even possible for someone my age to have this kind of problem?" — Conrad S., Buffalo, New York
There's nothing worse than being in the middle of an amorous encounter and "coming up short," so to speak. Erectile dysfunction is a very common problem, affecting a significant fraction of men, especially over 40, but younger men can be affected (as you and millions of your brethren out there can attest). Before just popping off to a health food store for some herbal supplements, it's smart to take a few minutes to try to figure out why you're having the problem in the first place.
When a man gets aroused, the brain goes through an electrical tap dance that results in an increase of blood flow to the penis; there's also a constriction of the veins that carry blood away from the organ. All this causes a net increase of fluid pressure in these spongy tube things running the length of the shaft (called corpora cavernosa) which begin to fill up like manic sausages. Because the outer sheath of the penis doesn't stretch much, the result is an erect member.
It's easy to see that for every step in the process, there's a potential defect that can cause it not to work. Decrease desire, and the genitals never get the signal to come to attention. This "loss of libido" can be caused by medical problems (e.g., low testosterone), psychological problems (e.g., depression, anxiety), and drugs (e.g., antidepressants). If the arteries become inelastic and won't dilate, all the desire in the world won't get you hard; this happens in patients with "hardening of the arteries," otherwise known as atherosclerosis. Diabetes can also damage the small nerves going to your junk and can cause the "happy signal" to never arrive.
There's also the possibility that your problem is psychological. If you can masturbate normally but have difficulties during consensual sex, your problem is likely in your head rather than your penis. Performance anxiety has been the downfall of many otherwise virile young men, and it often starts with a small problem and then snowballs over time. A typical scenario: a man has a little too much to drink one night and can't get an erection during a lovemaking session. He may blame himself or feel "less than a man" so that the next time he has an opportunity for sex he's so distracted from the pressure to perform that he can't perform again. The more he can't perform, the more anxious he gets and the vicious cycle spirals out of control. The treatment of this kind of impotence is centered on regaining confidence, whether it be in couples therapy with an understanding partner, or the placebo effect of simply having a pill to take, more on this later.
One of the first "natural fixes" for erectile dysfunction is quitting smoking, as tobacco use is a very important cause of impotence in young men. Look, I was a three-pack-per-day smoker at one time in my life. Even though I was a doctor and definitely knew better, nothing was scary enough for me to quit. No warnings of heart disease, cancer, or emphysema convinced me, but one day I read that tobacco was the primary reversible cause of impotence in men and I quit smoking the next day. Dipping, smoking, and chewing all have the same effect, so avoid tobacco altogether for a more healthy and happy sex life.
Now, in terms of natural fixes, there are a ton of "herbal" erectile dysfunction aids out there. For some, there is a strong placebo effect. Just the idea of taking a pill is enough for some men to gain confidence and toss off the psychological fetters keeping them from having a satisfying erection. A few of the "herbal" remedies on the market have been known to contain a molecule called acetildenefil, which is a close relative to sildenafil, the active ingredient in Viagra.
Acetildenefil and sildenafil (as well as the other molecules in Levitra and Cialis) work to dilate blood vessels causing increased blood flow to the penis which enhances erectile function. Still others have actually been found to have Viagra as an unlisted ingredient (no wonder they worked so well); when found, these products are rapidly removed from the market. Acetildenafil has not been rigorously tested for safety; in September 2006, a "natural" supplement called Nasutra was recalled when the FDA discovered it contained acetildendafil. It's current status is that of an "unregulated drug." Because it's difficult to detect and because it has potential for serious adverse effects, I would be nervous about buying "natural" erectile dysfunction pills from sources I don't know personally. Recently, a company selling an "all natural Viagra" was shut down and its owners sent to jail for 10 years for selling pills containing acetildenafil-like drugs.
Another over-the-counter remedy that has been used for years is yohimbine. Before Viagra, a number of doctors prescribed yohimbine in its pure form for erectile dysfunction. It had a lot of side effects (nausea, anxiety, rapid heart rate, high blood pressure) but there was little else in pill form available at the time. Yohimbine can still be purchased over the counter and is a component in many of the herbal concoctions (haha, get it?) for erectile dysfunction. At least one case of priapism (an erection that won't go away . . . sounds great, but is actually a medical emergency) has been associated with yohimbine extract, so care should be taken with this, and any other herbal preparation. The truth is, there are tons of natural substances out there that have been recommended for erectile dysfunction, including Horny Goatweed (I kid you not), and Red Ginseng. The problem I have with these right now is the lack of good, rigorous scientific evidence that they work. Studies are being done as we speak on some of these agents and hopefully we'll know more as time goes on.
In the end, at 26, I'd simply recommend biting the bullet and talking to your health care professional about this. This is not something to be embarrassed about; clinicians see so many cases of erectile dysfunction that you will not be judged in any way. If your testosterone is low, they'll replace it. If you have low thyroid hormone, they'll do likewise. If you're depressed, they'll treat you. If you just need a little confidence, a prescription bottle with 5 or 10 "blue diamonds" (Viagra) in it may be all you need. You might not even have to take them; if your problem is psychological, simply knowing they're in your back pocket may be just what the doctor ordered.
**Remember, don't do anything you read here without first consulting with your own health care provider.**
Dr. Steve is the resident medical expert for the Opie and Anthony and Ron and Fez shows, and the host of his own Sirius XM Radio program, Weird Medicine.