I’m a relatively healthy guy in my late 40s with a pretty vigorous libido, but I’m a flop in the sack because of erectile dysfunction. Do you have any alternatives to the little blue pill?
A mere 25 years ago the medical profession believed that psychological problems caused more than 75 percent of erectile dysfunction cases (ED)—that the problem was located between the ears, not below the belt. Current thinking reverses that notion, believing instead that as much as 90 percent of ED has a physical origin. In addition, since so many men’s health issues such as cases of ED stem from inadequate blood flow as a result of blocked arteries, cardiologists now feel ED may be an early warning sign for coronary artery disease. And they say men with ED should be evaluated for coronary atherosclerosis.
Erection of the penis occurs in two stages. The first stage, tumescence, is characterized by the increased length and diameter of the gland. As a result of sexual stimulation, nitric oxide (NO) levels build up in the walls of the arteries supplying blood flow to the penis. NO causes the arteries to dilate and the increased blood flow fills two hollow chambers (the corpus cavernosa) lying on either side of the urethra. As these chambers expand, they compress the walls of the thinner-walled veins that carry blood out of the penis. With increased blood flow in and decreased blood flow out, the chambers quickly become engorged, resulting in the second stage—full erection. Viagra and the other ED drugs work by increasing levels of NO.
NO forms naturally in the body from the amino acid arginine. Some men find that taking supplemental arginine 30 minutes before sexual activity can enhance the strength of their erections. You can begin with 1 to 3 g and move up to 5 to 9 g if needed. Taking arginine on an empty stomach enhances absorption—it’s available in capsules and powder—but individuals with a history of herpes infections and ulcers should avoid taking it. In addition there are many foods that can help improve your libido.
Another botanical, ginkgo biloba, has a long history in treating ED. The medical literature contains conflicting studies on the herb’s effectiveness, but most individuals take a dose of 40 to 120 mg one to three times daily. If you want to cover all your bases, you can safely take it along with arginine.
By Terry Grossman, MD