Visit a health food store or pharmacy and you'll see numerous products claiming to be "all natural" remedies for erectile dysfunction, or ED. In contrast to the three oral medications currently approved for the treatment of ED (Viagra, Levitra and Cialis), none of these supplements has been proven effective and safe in well-designed studies.
One all-natural remedy that has passed scientific scrutiny in several small studies is rarely mentioned and virtually unknown. A book describing it is available, but has not become a best seller.
You may have guessed by now that this remedy requires some effort - exercise - on the part of the patient and is so readily available that there is little chance anyone can make huge profits selling it. One study found, however, that results in terms of the percentage of men reporting benefits were comparable to those with Viagra.
Any exercise is generally good for erectile dysfunction because it improves blood circulation and cholesterol, crucial to both sexual and cardiovascular health. Data from the large Health Professionals Follow-Up Study found that men who exercised vigorously at least three hours a week had a 30 percent lower risk of erectile dysfunction compared to men who rarely or never exercised.
Athletes can get ED
Well-trained athletes can and do get erectile dysfunction, of course, as the advertisements imply. Doctors know that nerves, hormones, medications, stress, depression and relationship issues can contribute to erectile dysfunction. Diabetes and prostate surgery are frequent causes.
Erectile dysfunction has been reported in long-distance cyclists, and some doctors believe that this may be due to constriction and damage of nerves and blood vessels in the lower pelvis from the bicycle seat. In studies on cyclists, doctor Frank Sommer, a German physician with dual specialties in urology and sports medicine, found that circulation in the penis was greatly decreased when the rider was seated on the saddle, but not when he was standing or cycling on a recumbent bicycle.
Out of these studies, Dr. Sommer developed an exercise program targeted specifically at improving blood flow into the penis and in the area of the pelvis, buttocks and upper leg muscles. In his book, "VigorRobics: Increased Potency through Specific Fitness Training," he describes specific routines, including various versions of pelvic tilts, squats and leg lifts.
A study at Cologne University in Germany found that 80 percent of subjects following this kind of exercise program reported better erections compared to only 18 percent of subjects in a control group.
Many of these exercises involve the muscles of the pelvic floor, particularly the ischiocavernosus, or IC, and bulbospongiosis, or BS, muscles, located in the perineum, the area between the scrotum and the anus. These muscles become activated during sexual excitement, contracting and closing off the veins leading blood flow out of the penis, thereby causing the buildup of pressure that results in a firm erection. Men who get only partial erections or erections that fade quickly are most likely to benefit from exercises that strengthen these pelvic floor muscles.
The IC and BS muscles also are involved in propelling semen down the urethra during ejaculation, and they play a role in urinary and fecal continence.
As with all muscles, pelvic floor muscles benefit from regular exercise and can become weak because of aging, a sedentary lifestyle, cardiovascular disease, diabetes, liver disease or nerve problems.
Several studies during the past several years have demonstrated the effectiveness of pelvic floor muscle exercises in improving erectile dysfunction. In addition to physiotherapy, some of these studies use biofeedback, and electrical stimulation to help subjects become more aware of these muscles and how they are functioning.
In a recent British study of 55 men with erectile dysfunction, one group of subjects performed five weekly sessions of pelvic floor muscle exercises plus daily home workouts while a control group received lifestyle advice about diet, weight loss, smoking and alcohol moderation.
Researchers pointed out that results were similar to those of a large 1998 study of Viagra. Forty percent of the men doing the pelvic floor exercise regained normal erectile function and 35 percent showed significant improvement. As a bonus, subjects who previously suffered from a small leakage after urination - known as post-voiding drop - reported dramatic improvement in that as well.
The 25 percent who didn't respond had other medical conditions such as diabetes, cardiovascular disease or alcohol abuse. Older men and those taking high blood pressure medication generally did not do as well as other subjects. Other studies have found that subjects with ED associated with psychological causes such as anxiety, depression or relationship issues do not respond to this kind of therapy.
Kegels for men
Exercises include Kegels, which are often recommended for women after child birth or as a treatment for urinary incontinence. These involve tightening the pelvic floor muscles, holding for a slow three count and the relaxing.
• While standing with knees slightly bent, pretend you are holding a coin between the muscles of your buttocks and grip it tightly.
• While seated, imagine you are sitting on a pillow filled with rice and try to suck the grains upwards with the bottom of your pelvis.
• With penis erect, cover it with a wash cloth and try to raise the cloth in the direction of your belly.
• With penis flaccid, try to lift the scrotum and retract the penis by contracting the muscles.
• Use the muscles to stimulate stopping urination and then starting again.
The exercises should be performed as many as 90 times a day, and at least three to four weeks are required to have an affect. The exercises can be done, however, while you are doing other things such as sitting at your desk, washing dishes or standing in line at the grocery store. Most subjects reported the return of a morning erection a few weeks before gaining an erection sufficient for intercourse.
It's still too early to make major claims about "potency" exercises. Although results have been positive, the studies were small. And with erectile dysfunction, there's a placebo response of 25 to 40 percent to just about anything.
The treatment is free, non-invasive and carries no risk. The erection is spontaneous, and reports claim that the complete sexual experience is enhanced. As an initial treatment, either with or without oral medications, it may be a good choice.