Erectile Dysfunction

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Erectile dysfunction (ED), also referred to as impotence, is the inability to achieve or maintain an erection. ED is extremely prevalent, and may affect over half of men.[1] Although the prevalence of erectile dysfunction increases with age, it is not a natural part of aging. About 4 percent of men in their 50s and nearly 17 percent of men in their 60s experience a total inability to achieve an erection. The incidence jumps to 47 percent for men older than 75.[2]

The underlying causes of erectile dysfunction are variable, and while ED itself can be benign, associated with other conditions or may indicate a serious underlying problem.

Erectile Dysfunction

Erectile Dysfunction
Causes Alcohol, Smoking, Lack of Movement, Environmental Toxins, Stress, Prescription Medications
See Also Men's Health, Diabetes, Hypertension, Atherosclerosis, Thyroid Disorders, Depression
Books Books on Men's Health
Articles Articles on Men's Health

Naturopathic Assessment

Article Nutrients and Botanicals for Erectile Dysfunction: Examining the Evidence , Alt Med; 2004;Vol9(1)

Causal Factors

In order to stimulate the innate ability of the body to heal the causes of disease must be identified and addressed. Although ED is often associated with an underlying disease, there are other factors such as injury or adverse reactions to prescription medications that need to be considered. Any disorder or situation that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED. A detailed assessment is required to determine which factors are contributing to ED in order to properly treat the condition.


  • Body Weight
  • Increased body weight and obesity are risk factors for ED. Men with waistlines measuring more than 42 inches are twice as likely to develop ED when compared to men with waistlines measuring less than 32 inches.[3]
  • Increased physical activity is associated with better sexual function especially in younger men.[5]


  • Cigarette smoking is associated with several conditions linked to ED, and increased the risk of ED in combination with cardiovascular disorders.[6]
  • Recreational drugs such as cocaine, heroin, amphetamines, and marijuana may impair sexual performance and increase the risk of ED.[4]
  • Trauma
  • Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and the fibrous tissues of the corpora cavernosa.[4]


  • Emotional factors
  • Psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure can also cause ED. Even when ED has a physical cause, psychological factors may make the condition worse.[3], [4]
  • Loss of Partner
  • Widower syndrome, or the loss of a partner, may increase the risk of ED. [4]


  • Environmental Chemicals and Toxins
  • There is growing concern, but little evidence, describing the link between environmental chemicals and toxins and erectile dysfunction.
  • There is growing concern that cellphones worn around the waist may contribute to erectile dysfunction.

Medical Interventions

  • Prescription Medications
  • Many widely used medications can lead to erectile dysfunction including: diuretics, beta-blockers, tricyclic antidepressants, monoamine oxidase (MAO) inhibitors, SSRIs, benzodiazepines, antipsychotics, antiandrogens, digoxin, antihistamines, appetite suppressants, hypoglycemics, phenytoin, phenobarbital, and ketoconazole.
  • It is estimated that up to one quarter of ED cases may be attributed to pharmaceutical use. [1]
  • Medical Treatments
  • Surgical interventions, including prostatectomy or bladder surgeries, can increase the risk of ED. [7]

Diagnostic Testing

  • History: A person's medical and sexual histories including an inquiry about sexual desire, erection, ejaculation, or orgasm is the primary means of diagnosing erectile dysfunction.
  • Physical Examination: The physical examination will provide an indication of associated local or systemic conditions. For example, if the penis is not sensitive to physical touch, a problem in the nervous system may be the cause. Abnormal secondary sex characteristics, such as unusual hair pattern or breast enlargement, can point to hormonal problems, which would mean the endocrine system is involved. The doctor might discover a circulatory problem by observing decreased pulses in the wrist or ankles. And unusual characteristics of the penis itself could suggest the source of the problem-for example, a penis that bends or curves when erect could be the result of Peyronie’s disease.
  • Radiology, nocturnal penile rigidity testing, vascular and neurologic functional testing, and ultrasound are not routinely used but may be indicated in specific cases under the guidance of a specialized medical professional.[7]
  • Other Tests
  • If sleep-nocturnal erections occur it may indicate a psychological versus physical cause as healthy men have involuntary erections during sleep. The validity of this test is still questionable.

Related Symptoms and Conditions

Conditions that results in damage to nerves, arteries, smooth muscles, and fibrous tissues are commonly associated with ED. These conditions include:[1]


Because an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

  • Diagnostic criteria for erectile dysfunction according to the DSM-IV-TR are as follows:
  1. Persistent inability to attain an erection or to maintain until completion of an adequate erection.
  2. Marked distress and interpersonal difficulty are associated with the disturbance.
  3. ED is not otherwise attributed to another sexual dysfunction, medication, drug abuse, or medical condition. [8], [4]
  • International Index of Erectile Function (IIEF)
  • The IIEF is a questionnaire that may be used to both diagnose ED and track treatment effectiveness. A modified version known as the Sexual Health Inventory for Men (SHIM) is often commonly used to assess and track ED. [1]

Naturopathic Treatment

Article Treating Erectile Dysfunction: A Multifactorial Approach, NDNR [1], 2011 November

The goal of naturopathic treatment is to support and work in tandem with the healing power of the body and to address the causal factors of disease with individual treatment strategies. The treatment strategy for erectile dysfunction involves addressing the lifestyle and other factors that are contributing. If there are underlying conditions such diabetes or atherosclerosis improvement typically seen as those conditions are addressed.

It is always advisable to work with a naturopathic doctor before engaging in any treatment plan.

Home Care

Home Care strategies include:

  • Eliminate smoking. Studies have demonstrated that smoking cessation can in some cases lead to a full recovery of functional erection status.[9]
  • Work with your doctor to modify or discontinue any prescription medication that is contributing to the problem.
  • Avoid carrying cellphones or other electronic devices on or around the waist or pelvis.
  • Address psychological factors
  • Couples counselling and Cognitive Behavioral Therapy may benefit ED.[4]
  • Strategies to address anxiety are often beneficial.


Lifestyle recommendations include:

  • Exercise aimed at weight reduction and cardiovascular health can help to treat ED.[9]
  • Pelvic floor exercises have been shown effective in the treatment of ED.[11]

Naturopathic Therapies

The prescribing of naturopathic therapies requires the guidance of a naturopathic doctor as it depends on a number of factors including the causal factors, a person's age, prescription medications, other conditions and symptoms and overall health. It is always advisable to work with a naturopathic doctor prior to taking any natural therapies.

Naturopathic Therapies for erectile dysfunction include:

Article Pistachio Nuts and Erectile Dysfunction, NMJ, 2012 February
  • From a TCM perspective erectile dysfunction is associated with the following patterns: deficiency of KI Yang, deficiency of KI Yin, fear, worry and anxiety, damp heat in the lower burner.
  • acupuncture is effective in increasing the flow of Qi to the lower pelvic area.
  • Physical therapies including biofeedback, electrical stimulation, and pelvic floor exercises can effectively treat some patients with erectile dysfunction associated with venous occlusion.[11]


Reviewed by Iva Lloyd, BScH, RPE, ND [2]

  1. 1.0 1.1 1.2 1.3 Diaz VA, Close JD (2010) Male Sexual Dysfunction Prim Care 37(3):473-489
  2. Saigal CS, Wessells H, Wilt T (2006) Predictors and prevalence of erectile dysfunction in a racially diverse population. Archives of Internal Medicine.;166:207-212.
  3. 3.0 3.1 Ward C (2009) Impotence: Case Study Aus J of Med Herb 21(1):15-18
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Ferri (2011) Ferri's Clinical Advisor 2012 1st ed. Sect E - Erectile Dysfunction Mosby
  5. Hsiao W, Shrewsberry AB, Moses KA, Johnson TV, Cai AW, Stuhldreher P, Dusseault B, Ritenour CW (Feb 2012) Exercise is associated with better erectile function in men under 40 as evaluated by the International Index of Erectile Function. J Sex Med.;9(2):524-30. PMID: 22145804.
  6. Goldstein I (2004) Epidemiology of Erectile Dysfunction Sexuality and Disability 22:113-120
  7. 7.0 7.1 7.2 Albersen M, Mwamukonda KB, Shindel AW, Lue TF (2011) Evaluation and Treatment of Erectile Dysfunction Med Clin North Am 95(1):201-212
  8. American Psychiatric Association: Diagnostic and statistical manual of mental disorders. Text Revision DSM-IV-TR4th edition American Psychiatric AssociationWashington, DC2000
  9. 9.0 9.1 Burnett A (2011) Wein: Campbell-Walsh Urology 10th ed Chap 24 Evaluation and Management of Erectile Dysfunction Saunders
  10. Esposito K, Giugliano F, Di Palo C, Giugliano G, Marfella R, D'Andrea F, D'Armiento M, Giugliano D (Jun 2004) Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA.;291(24):2978-84. PMID: 15213209.
  11. 11.0 11.1 Van Kampen M, De Weerdt W et al. (2003) Treatment of erectile dysfunction by perineal exercise, electromyographic biofeedback, and electrical stimulation Phys Ther 83(6):536-43
  12. MacKay D (2004) Nutrients and Botanicals for Erectile Dysfunction: Examining the Evidence Alt Med Rev 9(1):4-16
  13. Hershoff Asa (2000) Homeopathic Remedies, A Quick and Easy Guide to Common Disorders and their Homeopathic Treatments, Avery Publishing Group, New York