Erectile Dysfunction

The following information is a summary of materials featured in the “Men’s Health” Whole Health overview.  It is meant to be a quick reference for use at the point of care. For more details and a list of references, refer to the overview.

Erectile Dysfunction (ED) is a common condition that many men experience, especially as they age.  A study of U.S. men revealed that 52% of men 40-70 years old suffered some level of erectile dysfunction.

A good tool to measure the severity of ED is the International Index of Erectile Function (IIEF).  This is a self-administered tool that can be used to follow treatment response during follow-up appointments as well.

Studies have demonstrated a relationship between the severity of ED and abdominal circumference.  Having an abdominal circumference over 40 inches increases the risk of ED by two to three times.  Abdominal circumference should be measured using a tape measure at the level of the umbilicus. Abdominal circumference should be measured using a tape measure at the level of the umbilicus.  The pant waist size is not a good measure as many men wear their pants below their true waist.

Maintain Ideal Body Weight

This is probably the most important thing a man can do. As belly fat increases, there is an increase in activity of the enzyme aromatase, which converts testosterone in the adipose cells into estrogen. A study in Italy showed that exercising and losing weight can significantly improve erectile function.  Meeting with a nutritionist or dietician is a good way to start the conversation on better diets and sensible weight-loss plans.

Avoid Xenobiotics

Xenobiotics are compounds from the environment that mimic the body’s hormones. Research has shown that the average testosterone level in men has gradually dropped over the years; this can influence erectile function. This may be in part due to all the environmental toxins that have accumulated over the years. The main toxins are:

  • Bisphenol A (BPA). BPA is found in plastics. To avoid it, don’t microwave food in plastic containers. Avoid plastic containers with the numbers 3, 6, or 7 engraved in the triangle on the product. Buy BPA-free water containers. Drinking water out of containers with the numbers 2, 4, 5, or 7 is OK. Do not drink out of Styrofoam containers.
  • Phthalates. These chemicals are used in plastics, coatings, lubricants, and binders. Many are found in hygiene products such as shampoos and colognes. A useful web site on phthalate-free products is the Guide to Less Toxic Products website
  • Organophosphates. These are mainly found in pesticides and herbicides. Eat organic when able to avoid exposure to them.

Eat Well

Foods to avoid

  • Excessive sugar
  • Excessive caffeine
  • Red meat and other sources of animal fat
  • Excessive dairy products
  • Food dyes
  • Processed foods

Foods to include

  • Green tea
  • Multicolored fruits and vegetables
  • Nuts (particularly Brazil nuts which are rich in selenium—two a day is plenty)
  • Fiber (covered by eating fruits and vegetables)
  • Ground flax seed (1 tablespoon a day)
  • Soy products (soy milk instead of cow’s milk)

Consider Dietary Supplements

Note: Please refer to the Passport to Whole Health, Chapter 15 on Dietary Supplements for more information about how to determine whether or not a specific supplement is appropriate for a given individual. Supplements are not regulated with the same degree of oversight as medications, and it is important that clinicians keep this in mind. Products vary greatly in terms of accuracy of labeling, presence of adulterants, and the legitimacy of claims made by the manufacturer.

Some natural treatments for ED include:

  • L-arginine: 8 gm along with adenosine monophosphate 200 mcg 1-2 hours before intercourse can help. This was found to be effective and well tolerated.
  • Panax ginseng (Korean or red ginseng) has been found in a study to improve erectile function to some degree in two-thirds of men studied. The dose studied was 3,000 mcg daily.
  • Oligomeric proanthocyanidins (OPCs) are substances found in grape seed and pine bark. Small, clinical trials have demonstrated promise.
  • Horny goat weed is not recommended because of lack of research and the challenges of finding a quality product.

Keep In Mind That ED May Be an Indication of Vascular Disease

If ED starts suddenly and there are other risk factors for heart disease, such as diabetes, tobacco use, hypertension, and hyperlipidemia, consider screening for cardiovascular and peripheral vascular disease.

Remember Mind-Body Influences

Finally, it is important to recognize the impact that emotions and mental state have on sexual function.  It can be helpful to explore those connections and be open to discussing issues related to mental health, referring to a professional counselor or psychologist as appropriate.  If Cognitive Therapy is unhelpful, clinical hypnosis or Guided Imagery may be helpful for working with psychological or energetic blocks to healthy sexual function.

Author(s)

“Erectile Dysfunction” was written by Robert Z. Edwards, MD (2014, updated 2020).

This Whole Health tool was made possible through a collaborative effort between the University of Wisconsin Integrative Health Program, VA Office of Patient Centered Care and Cultural Transformation, and Pacific Institute for Research and Evaluation.


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