Can you improve erections naturally?
Lifestyle change can improve erections in some men. Physical activity, particularly aerobic exercise, weight loss and treatment of heart risk factors may improve sexual function, and guidelines recommend starting these changes before or alongside other treatment. Supplements help little, and L-arginine raised erectile function scores by only 2.74 points in one meta-analysis.
Which lifestyle changes can help erections?
Physical activity, particularly aerobic exercise, weight loss, including after bariatric surgery, and treatment of heart risk factors may improve sexual function in men with erectile dysfunction. Statins have also been shown to improve erectile function in meta-analyses.
Conditions such as diabetes and high blood pressure should be well controlled as the first step of any treatment for erectile dysfunction. The American guideline adds that changes in diet and more physical activity improve overall health and may improve erections, and the European guideline notes that lifestyle change can improve erectile dysfunction in specific groups of men.
When should lifestyle change start?
The European guideline makes a strong recommendation to start lifestyle changes and risk factor control before, or at the same time as, treatment for erectile dysfunction. Lifestyle and drug-related risk factors, such as certain medicines, can be changed in the same way.
Education is often the first step. Explaining how sexual response works has been shown to improve sexual satisfaction in men with erectile dysfunction, and the consultation covers the expectations and needs of both the man and his partner.
Do supplements or herbal products work?
The market for herbal and natural supplements has grown fast, but there is very little reliable scientific evidence for their effectiveness or safety. A Cochrane review found that ginseng may have only trivial effects on erections or satisfaction compared with placebo.
In a meta-analysis, L-arginine increased erectile function scores by a mean of 2.74 points, with no difference in sexual satisfaction, and an improvement this small may not be noticeable to men. Similar small effects were reported for other antioxidants, including folic acid, vitamin E, L-carnitine and L-citrulline.
"Use supplements with L-arginine or ginseng daily in men with mild ED who refuse pharmacological treatment after counselling them that the improvement of EF could be mild." Source 1, p. 58
Can psychological approaches help?
Cognitive behavioural therapy (CBT) is recommended, in group or couple format and even when delivered online, and combining it with medical treatment is regarded as best practice. Other psychosocial approaches include sexual skills training, marital therapy and psychosexual education.
The European guideline recommends including the partner in this therapy when it is indicated. The American guideline adds that referral to a mental health professional should be considered, to help men keep using treatment, reduce performance anxiety and bring treatment into the relationship.
What can help erections after prostate surgery?
After prostate cancer surgery, the man's age, his erectile function before surgery and the quality of the nerve-sparing technique are the key factors in keeping erections. There is no evidence that penile rehabilitation itself increases the chance of spontaneous recovery after nerve-sparing surgery.
Early use of a vacuum device has an excellent effect after prostate surgery with no serious side effects. Pelvic floor muscle training combined with biofeedback is a promising alternative to medicines, although larger trials are still needed to draw strong conclusions.