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It doesn’t matter when it happens, but when a man experiences erectile dysfunction for the first time, countless things go through his head. He might be thinking that there is something seriously wrong or that he has come to that age where an erection isn’t a given anymore.

The truth is that erectile dysfunction is very common and the causes thereof can quickly be determined. However, once you know that you have it, there are many things you can do. If you want to sort it out without having to take a bunch of meds, you could boost your vitamin intake.

Citrulline and L-arginine

Without getting into all the details of what these substances do, the point is that they relax the blood vessels in the penis and enable free blood flow. Watermelon, lemons and pomegranates are some of the best foods to eat as they contain loads of citrulline.

L-arginine is another substance that relaxes the veins and is found in red meat, poultry, dairy and fish. Most men don’t need these supplements though as their diets are packed with protein-rich foods.

Vitamin D

Vitamin D or the lack thereof has been associated with anything from weak bones to heart disease and of course, erectile dysfunction. It was found that men who have a vitamin D deficiency are 33% more likely to suffer from ED.

The best thing to do is to get into the sun for 15-20 minutes a day and you’ll have more than enough vitamin D to get things going again.

Vitamin B3

Niacin or Vitamin B3 has been associated with the improvement of blood flow for a while. It’s only natural that this would then also benefit or improve erectile dysfunction. However, too much of the stuff can cause some serious side effects like strokes, gout and ulcers. Turkey, chicken breasts, tuna and grass-fed beef, are all excellent sources of niacin.

Folic acid (Vitamin B12)

Folic acid helps to produce nitric oxide, which in turn helps blood flow, but a deficiency thereof is catastrophic for your penis. Men with low levels of folic acid were the ones who had mild to severe folic acid deficiencies.

There are many foods that contain folic acid, like oranges, leafy greens, bread, grains, cereals, pasta, beans and rice. Most men should not have a problem in consuming these foods, however.

Panax Ginseng

The Chinese considered Panax Ginseng to be an aphrodisiac, but it turned out to be way more than that. It was found that it improves erectile dysfunction tremendously after consuming it for a couple of weeks.

It improves both the man’s performance in the bedroom by helping him last longer and keeping him harder for longer. It was also found that it increased testosterone and in turn, also libido.

It’s one of those all in one substances that relaxes the soft muscle in the penis, while also increasing the dopamine levels in the brain. Ingesting Ginseng on a regular basis will make you a machine in bed.

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E.D. Couple

Erectile dysfunction can be caused by various issues that can be whittled down to 3 categories. The first category includes physical issues like illnesses and injury. The second category comprises mental problems like anxiety. The third category includes a mix of both mental and physical issues.

Many illnesses that cause erectile dysfunction happens in places that aren't close to your genitalia. This means you'll need to visit the doctor for a proper diagnosis. It’s so because getting the wrong treatment could worsen an erectile problem.


Heart and stress-related diseases

High blood pressure (hypertension) causes erectile dysfunction. It occurs by damaging blood vessels that transport blood to your penis. This damage can make your blood vessels thick, and it may lead to them getting fractured. 

Hypertension can also lead to your endothelium in the arteries getting damaged, and this will result in atherosclerosis. The endothelium is a lining that protects your artery walls. When it's damaged cholesterol, and white blood cells form plaque in the affected area. 

Plaque builds up over the years, and in due time it may slow or prevent blood from flowing into your penis. Also, hypertension medication like beta-blockers and diuretics are reported to cause erectile dysfunction.



Many people with diabetes struggle with keeping their blood sugar levels balanced. It reduces the amount of nitric oxide produced by your body. Nitric oxide is a chemical that's released into your bloodstream when you are sexually aroused. 

This chemical helps muscles and blood vessels in your penis to relax. It allows blood to flow through them. Nitric oxide generation slows down as blood sugar levels increase. That means men who don't monitor their diabetes are at higher risk than those who do. 

Statistics say that around 35% to 50% of diabetic men suffer from erectile dysfunction.


Performance anxiety

Research has shown that being anxious about your sexual performance makes you feel incapable of pleasing your partner when self-imposed expectations aren't met. 

These negative feelings can be exacerbated by low self-esteem issues and a poor body image. These feelings trigger stress hormones that'll make it hard for you to find sexual activity enjoyable. It thus leads to erectile dysfunction.

General stress can also lead to anxiety as stress hormones that are already present in your system will make it hard for you to have an erection.


Body and mind problems

Many men aren't able to get or maintain an erection due to minor and temporary reasons. This, however, could drive men into performance anxiety as they'll put too much pressure on themselves trying to get an erection. 

When this fails, they'll keep stressing themselves, and that'll lead them into getting erectile dysfunction. Another problem that leads to erectile dysfunction is when your brain reacts to sexual stimuli, but due to nerve damage, key organs can't respond to the brain. 

This nerve damage is prevalent in people with multiple sclerosis, diabetes, and spinal cord injuries. Men who have undergone pelvic surgery and heavy drinkers are also at risk.

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Erectile dysfunction is not normal among men aged under 40. Two studies confirmed that less than 5% of men from this age group are affected. These studies were conducted in the years 1999 and 2002. 

In those times, people did not have fast access to various kinds of pornography through the use of tube sites. Ever since tube sites became a popular form of porn, young men tend to suffer from erectile dysfunction. It has become a common problem. 

This has led to new research to ascertain whether porn is a major cause of erectile dysfunction.

What new research shows?

The Global Study of Sexual Attitudes and Behavior (GSSAB) had 2,737 active men aged under 40 from three countries to answer a questionnaire. This questionnaire revealed that 14% to 28% of these men suffered from this erectile dysfunction. 

Another study done by Swiss researchers revealed that 30% of Swiss men aged 18-24 have this condition. Canadian researchers who were looking at sexual problems, in general, found that 53.5% of the Canadian male population aged 16-21 had a sexual problem of some sort in 2014. 

Of that number, 26% suffered from erectile dysfunction and it was the most common sexual problem reported in that study.

Pornography’s role

The findings of the previously mentioned studies clearly show that erectile dysfunction surged with the rise of Internet porn. They do not, however, show how porn could be a possible cause to this, but researchers from the US military have released findings that are based on subjects who admitted to being porn users.

The study from the US military was based on clinical case reports of 3 officers. The first two officers (40 and 24) started having problems with his erections after the heavy use of porn as masturbation stimulant. 

It was the same the other officer 20, but his report also showed that he started watching “softcore” porn before moving on to “hardcore” porn.

This transition is why researchers claim that porn gradually warps the user’s view of sex to the point where a real-life partner doesn't arouse him.

Porn may not be a cause

According to a study done by the neuroscientists Nicole Praus and James Pfaus, excessive porn consumption may not lead to erectile dysfunction. In their study, they used a sample of 280 men who watched a porn clip and answered a questionnaire that was used to determine how porn affects male sexual arousal.

Their findings were that men who regularly watched porn had a higher sex drive. They also found that they had a desire for a partner as much as they desired pornographic stimulation. 

Another finding was that men who view pornography could respond to more sexual stimuli. It lessens their chances of getting erectile dysfunction.

It's all in your mind

Researchers say that men who watch porn but suffer from guilt afterward are the ones who are at risk of getting erectile dysfunction. They say this is due to their brains associating sexual stimulation with negative feelings. The risk rises among men who believe that porn causes erectile dysfunction.

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Erectile dysfunction is not a life sentence

A diagnosis of erectile dysfunction (ED) may sound like the end of the world. It may challenge a man’s perception of his masculinity. ED is defined as being unable to get an erection or maintain an erection for the purposes of having sex. The common term used for ED is impotence.

It isn’t uncommon for a man to have an erection problem from time to time. However, when the condition persists with no other apparent cause, there is a chance that he has ED.

ED is not something men easily discuss as it is a source of embarrassment. The strange thing is that if they did open up to others, they’d be surprised to find out how many others have the same problem. The reason is that ED studies indicate that up to 52% of men experience ED. While it is more common in older men, it is not impossible for younger men to face ED.

Fortunately, ED is no longer as much of a taboo as it used to be. Men are freer to speak about it than they’ve ever been before. This is mainly because, in recent years, effective treatments for ED have become available. 

The erection process and how ED affects it

Getting an erection can happen within seconds, but it is a complex physiological process:

  • A man experiences sexual arousal from sensory or mental stimulation. 
  • Immediately, the brain communicates with the penis, sending it nerve messages.
  • These messages contain an impulse which makes the muscles of the corpora cavernosa to relax. The penis contains two corpora cavernosa chambers which are fed by a vast network of blood vessels. 
  • Nitric oxide in the blood instructs the arteries and blood vessels to dilate to facilitate blood flow. Blood is redirected to the corpora cavernosa to fill the chambers. The increased presence of blood causes the penis to become erect.
  • Membranes around the corpora cavernosa called the tunica albuginea assist by trapping the blood in the chambers which is what sustains an erection.

An inability for the body to perform the steps in the process results in ED. Examples of an interruption to the erection process include:

  • A problem with blood supply to the penis. 
  • An issue with the neurological system which sends the impulse to trigger the erection.
  • Psychological causes which interfere with the brain’s reaction to a sexual stimulus.
  • Injury to the penis which affects the physical capacity to get an erection.

The causes of ED

The leading causes of problems with the blood supply to the penis that could cause ED are physical conditions. They include, but are not limited to:

  • Atherosclerosis

A buildup of plaque in the arteries is called atherosclerosis. The plaque contains fat, cholesterol and calcium. The plaque clogs and blocks the arteries, thereby restricting blood flow to the heart. An interruption of the blood flow to the heart can cause a heart attack. Plaque deposits can also cause clots which have life-threatening implications.

The same blood flow problems to the heart that atherosclerosis causes can also impact a man’s ability to get and maintain an erection. Arteries that are compromised cannot feed the blood vessels that flow into the penis to make it erect.

  • Hypertension

As oxygen-rich blood is pumped around the body, it places pressure on the artery walls. The higher the amount of pressure on the artery walls, the higher your blood pressure. Over an extended period, this constant stress on the arteries causes damage to the artery walls. It results in the narrowing of the arteries which restricts the flow of blood to and from the heart.

High blood pressure is one of the leading causes of ED. It prevents the arteries that supply blood to the penis from opening up as they should. Hypertension also stops the muscles of the penis from relaxing to allow the flow of blood into the corpora cavernosa chambers. Insufficient blood flow to the penis results in a partial erection or no erection at all.

  • Diabetes

Men with type 2 diabetes are more likely to experience ED than their non-diabetic counterparts. Diabetes causes restricted blood flow in the body which can lead to a loss of sensation in the feet and hands. The blood vessels and nerves are damaged which causes circulatory problems. The same blood flow problems may cause ED as insufficient blood is directed into the penis.

Another problem affecting diabetic men is nitric oxide levels in the blood. Nitric oxide is essential for getting and maintaining an erection because it instructs the muscles of the penis to relax. The arteries also dilate which allows for more blood flow into the penis. When blood sugar levels are high such as they are in diabetics, there is less nitric oxide in the blood.

  • Obesity 

Being obese can result in lowered testosterone levels. Low testosterone levels alone are seldom the cause of ED. However, combined with high blood pressure, atherosclerosis, and diabetes which are conditions associated with obesity, they can add to the problem.

  • Smoking and alcohol use

Nicotine raises both blood pressure and heart rate. Smoking damages the body’s blood vessels which can have a direct effect on the blood supply to the penis. Studies suggest that smoking is a significant contributor to ED, especially in younger men. 

Alcohol affects your brain. The brain is an essential part of the erection process as it triggers the body’s physical response. Too much alcohol can result in the brain being unable to instruct the blood vessels to channel blood flow to the penis.

Neurological conditions that can cause ED include:

  • Parkinson’s disease
  • Alzheimer’s disease
  • Multiple Sclerosis (MS)
  • Brain tumors

Psychological conditions like anxiety, stress or depression can cause ED. Low self-esteem because of previous ED episodes can lead to ‘performance anxiety’ which is a fear of sexual failure. This can result in further episodes of ED. 

When to get help for ED

It’s normal for most men to occasionally not be able to get or sustain an erection at some point in their lives. There’s no real cause for concern. However, if it starts happening more frequently and gets worse, there’s likely to be a problem causing it. 

A physical problem predominantly causes ED. Finding out what it is will not only be a solution for ED, but it could also save your life. ED is regarded as a warning sign that something is wrong in the body, often with the heart. Reduced blood flow to the penis causes ED. A struggling circulatory system damages the heart in the long-term.

If you suspect you have ED, it’s advisable to get help as soon as possible. ED can affect your self-confidence and cause conditions like depression. Many antidepressants also cause episodes of ED. This shows that ignoring ED can make the problem more complicated.

Treatments for ED

There have never been more treatment options for ED than there are today. Each man’s ED problems are different, so the same treatment may not work for everyone. 

As part of their treatment, men with ED should make some lifestyle changes:

  • Quitting smoking
  • Reducing alcohol intake and avoiding binge drinking
  • Getting more exercise to stimulate the heart and circulatory system
  • Following a healthy diet to lose weight. Cut out fatty and processed foods which decrease blood circulation.

A doctor might suggest a medical intervention to help a man experiencing ED. The most common treatment is oral medication. There are four main medications used for the treatment of ED:

  • Sildenafil (Viagra)
  • Tadalafil (Cialis)
  • Vardenafil (Levitra, Staxyn)
  • Avanafil (Stendra)

Each medication works in basically the same way. They relax the muscles and improve the blood flow to the penis. Each contains nitric oxide which is essential for blood flow to the penis. As a result, the man can get and maintain an erection. 

Viagra is by far the most well-known ED medication. While it doesn’t work for everyone, the majority of men who have used it have found it to be very effective. Its active ingredient is sildenafil. Today, a generic version of Viagra which includes sildenafil is made under license by Pfizer. 

There are alternative treatments for ED as well. Taking zinc supplements and ginkgo biloba are common alternative treatments. However, their benefits are limited, and few men find them to be useful on their own. 

While there is a place for alternative medicines, they are best used in conjunction with treatments like medication. Not all alternative treatments are FDA approved and could be potentially harmful. Users are encouraged to consult their doctor before using any of them.

You can get ED medication online

There’s no need to go for an awkward face-to-face doctor’s appointment to discuss your ED problems and get a prescription. If you feel that you’d prefer to handle the whole process online, there are convenient options for you to explore. The sites work as platforms for the customer to access the services of the doctors who issue prescriptions.

The process starts with a free online consultation with a U.S.-licensed doctor. Completing a medical survey is the first step. It is essential to provide all the necessary information so that the doctor can decide on your treatment options. This includes the symptoms as well as any other medications being used. The information is kept confidential to encourage users to provide honest, accurate information. 

One of the things doctors insist on is that customers have seen their doctor for a medical exam within the last two years before consulting with them. The doctor may send a message requesting further clarification before coming up with a practical, detailed treatment plan. 

The doctor reviews the initial treatment request within two hours of receiving it during business hours. Outside of business hours, customers should expect to have their treatment request reviewed within 24 hours.

Once the doctor has determined what treatment is needed and discussed it with the patient, they write out a prescription. U.S-based pharmacy packages the medication discreetly and ships it to the patient’s preferred address. Most doctors prescribe 12 doses a month at a rate of $65. The first two weeks’ treatment is free of charge. 

Men who feel they need more than 12 tablets a month are free to discuss this with the doctor. The prescriptions are not covered by health insurance. However, the medication is priced lower than most options provided by insurance plans.

Users of such sites must be over 18 years of age. Underage users will have their information deleted. Anyone who suspects that a minor is using the site’s services must report it immediately for investigation. Users can access the site and undergo an online consultation. Before any prescriptions are written, the doctor will insist on a video call or that a customer upload a live picture of themselves. An uploaded image of government-issued identification is also required. This is done to authenticate the identity of the customer.

Customers are not guaranteed a prescription. Doctors reserve the right to decline a prescription request if they feel there are health risks associated with it. There are also states that by law do not allow the use of such sites. Residents of these states will be excluded from receiving prescriptions and medication deliveries.

Telephonic and email customer support services help users who have queries. Each user has individual login details and can access their information online. Once a prescription has been shipped, customers are kept informed of the process through phone calls and text messages.

The downside of ED medication

Like any medication, ED medicines come with side effects, and there are certain medications with which they should not be combined.

Who should not take ED medication?

Men with these health conditions should not take ED medications:

  • A heart attack or stroke within the last six months
  • An irregular heartbeat with life-threatening potential within the last six months
  • Uncontrolled blood pressure, whether high or low
  • Chest pains experienced during sex

Which medications can prevent the use of ED medication?

There are also certain medications with which ED medications do not interact well. These include:

  • Nitrates prescribed for the treatment of heart conditions
  • Medication for pulmonary hypertension
  • Alpha-blockers
  • Beta-blockers
  • Blood thinners
  • Certain seizure medications

To avoid a dangerous interaction, it is always preferable to share a full list of medication taken for any medical condition with the doctor. This knowledge helps the doctor make an informed decision about a treatment plan and whether ED medications can be used.

Following the dosage instructions for ED medication

Any ED medication comes with instructions for its use. A user should adhere to them strictly. Using more or less of the medicine than prescribed can render it less effective. An overdose is dangerous, and the user should report to an emergency room immediately.

Potential side-effects of ED medication

There are some mild side-effects users can expect. They include:

  • An upset stomach including diarrhea
  • Sleep cycle disruptions
  • Dizziness, nosebleeds, and flushes
  • Headaches and pain in the muscles and back
  • A tingling sensation or complete numbness in the limbs and extremities

Serious side-effects of ED medication include:

  • An erection that lasts longer than what the medication should cause. For example, an erection after taking Sildenafil (Viagra) should last for four hours.
  • Sharp chest pains and shortness of breath.
  • Changes in vision, from blurring to total vision loss
  • Severe headaches
  • Fainting

If a user suspects they are experiencing side-effects from their ED medication, they should stop taking them and speak to a doctor immediately. In the case of severe side-effects, the user should go to their nearest emergency room for assistance.

Talking to a partner about an ED diagnosis and treatment

ED can cause a lot of tensions between couples. When a man has ED, his partner may assume that it’s their fault. The partner feels unattractive and unable to arouse their significant other sexually. 

It can cause a lot of insecurity in the relationship on both sides. It is incorrect to assume that ED affects the self-esteem of the man experiencing it alone. ED can have a considerable impact on their partner as well.

Open lines of communication are essential when a man is diagnosed with ED. Discussing the causes will show his partner it has nothing to do with them. A frank conversation about treatment options is also necessary. The dosage and potential side-effects are important information that a partner would want to know. 

ED is a medical condition like many others, and treatment is available. Couples should discuss the facts and be informed about the condition and what can be done about it. It is a difficult time for both parties in the relationship, but it is better faced together. 

If you’re diagnosed with ED…

  • Don’t let an ED diagnosis make you define yourself as less of a man. Your masculinity has nothing to do with ED. 
  • Explore the possible causes. Identifying the reason that you have ED is the first step in finding the solution. 
  • You’re not alone. Many men experience ED. It’s helpful to talk to other men who are in similar circumstances. You can support each other during this challenging time.
  • Don’t keep it a secret from your partner. ED is a sensitive subject, but your partner deserves to know so that they can support you. 
  • ED is not the end of your sex life. The condition is treatable, and you have several options available to explore.
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There are some things in life you can’t control. Thanks to science, research and Male Excel, erectile dysfunction won't be one of them.

Over 18 million men are affected by erectile dysfunction in the U.S. Only you can choose to regain control of your body and unleash your true, confident self. With our simplified online prescriptions, science has never been this accessible. Whether you need a last-minute boost, or a long-lasting ally, let ME help you.

Male Excel's Lead Physicians

Dr. Peter Fotinos

Dr. Peter Fotinos

Dr. Peter Fotinos is the National Medical Director for Male Excel.

Gary M. Kline

Dr. Gary M. Kline

Dr. Gary Kline is the Head of the Male Excel Medical Advisory Board.

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