Prevalence of erection problems
Blanker, M.H. et al. “Erectile and Ejaculatory Dysfunction in a Community-Based Sample of Men 50 to 78 Years Old: Prevalence, Concern, and Relation to Sexual Activity,” Urology (2001) 57:763.
Corona, G. et al. “Age-Related Changes in General and Sexual Health in Middle-Aged and Older Men: Results from the European Male Aging Study (EMAS),” Journal of Sexual Medicine (2010) 7:1362.
Johannes, C.B. et al. “Incidence of Erectile Dysfunction in Men 40 to 69 Years Old: Longitudinal Results from the Massachusetts Male Aging Study,” Journal of Urology (2000) 163:460.
Laumann, E.O. et al. “Sexual Dysfunction in the United States: Prevalence and Predictors,” Journal of the American Medical Association (1999) 281:537.
Laumann, E.O. et al. “Sexual Dysfunction Among Older Adults: Prevalence and Risk Factors from a Nationally Representative U.S. Probability Sample of Men and Women 57-85 Years of Age,” Journal of Sexual Medicine (2008) 5:2300.
Martin, S. et al. “Clinical and Biopsychosocial Determinants of Sexual Dysfunction in Middle-Aged and Older Australian Men,” Journal of Sexual Medicine (2012) 9:2093.
Martin, S.A. et al. “The Florey Adelaide Male Ageing Study (FAMAS): Design, Procedures and Participants,” BMC Public Health (2007) 7:126.
Pinnock, C.B. et al. “Erectile Dysfunction in the Community: A Prevalence Study,” Medical Journal of Australia (1999) 171:342.
Erections explained
Burnett, A.L. “Erectile Dysfunction: Science and Medicine,” Annual Review of Sex Research (2006) 17:101
Some blood flows out of the erect penis
Udelson, D. “Biomechanics of Male Erectile Function,” Journal of the Royal Society Interface (2007) 4:1031.
Morning erections
https://www.healthline.com/health/mens-health/morning-wood
Van Driel, M.F. “Sleep-Related Erections Throughout the Ages,” Journal of Sexual Medicine (2014) 11:1867.
Giuliano, F. “Neurophysiology of Erection and Ejaculation,” Journal of Sexual Medicine (2011) 8(Suppl 4):310.
Risk factors for erection problems
Allen, M.S. and E.E. Walter. “Erectile Dysfunction: An Umbrella Review of Meta-Analyses of Risk Factors, Treatment, and Prevalence Outcomes,” Journal of Sexual Medicine (2019) 16:531.
Aschka, C et al. “Sexual Problems of Male Patients in Family Practice,” Journal of Family Practice (2001) 50:773.
Bacon, C.G. et al. “A Prospective Study on the Risk Factors for Erectile Dysfunction,” Journal of Urology (2006) 176:217.
Barassi, A. et al. “Vitamin D and Erectile Dysfunction,” Journal of Sexual Medicine (2014) 11:2792.
Baumgartner, M.K. et al. “Patients’ Knowledge About Risk Factors for Erectile Dysfunction is Poor,” Journal of Sexual Medicine (2008) 5:2399.
Biebel, M.G. et al. “Male Sexual Function and Smoking,” Sexual Medicine Review (2016) 4:366.
Boeri, L. “Unrecognized Pre-diabetes is Highly Prevalent in Men With Erectile Dysfunction—Results from the Cross-Sectional Study,” Journal of Sexual Medicine (2018) 15:1117.
Bortolotti, A. et al. “The Epidemiology of Erectile Dysfunction and Its Risk Factors,” International Journal of Andrology (1997) 20:323.
Budweiser, S. et al. “Sleep apnea is an Independent Correlate of Erectile and Sexual Dysfunction,” Journal of Sexual Medicine (2009) 6:3147.
Cao. S. et al. “Association of Quantity and Duration of Smoking with Erectile Dysfunction: A Dose-Response Meta-Analysis,” Journal of Sexual Medicine (2014) 11:2376.
Caretta, N. et al. “Hypovitaminosis D Is Associated with Erectile Dysfunction in Type 2 Diabetes,” Endocrine (2016) 53:831.
Chung, W.S.et al. “Is Obesity an Underlying Factor in Erectile Dysfunction?” European Urology (1999) 36:68.
Corona, G. et al. “Sexual Dysfunction in Subjects Treated with Inhibitors of 5-Alpha-Reductase for Benign Prostatic Hyperplasia: A Comprehensive Review and Meta-Analysis,” Andrology (2017) 5:671.
Corona, G. et al. “Interplay Between Premature Ejaculation and Erectile Dysfunction: A Systematic Review and Meta-Analysis,” Journal of Sexual Medicine (2015) 12:2291.
Derby, CA et al. “Modifiable Risk Factors and Erectile Dysfunction: Can Lifestyle Changes Modify Risk?” Urology (2000) 56:302.
DiFrancesco, S. and R.L. Teneglia. “Mediterranean Diet and Erectile Dysfunction: A Current Perspective,” Central European Journal of Urology (2017) 70:185.
Dunn, K.M. et al. “Systematic Review of Sexual Problems: Epidemiology and Methodology,” Journal of Sex and Marital Therapy (2002) 28:399.
Esposito, K. et al. “Effect of Lifestyle Changes on Erectile Dysfunction in Obese Men: A Randomized Controlled Trial,” Journal of the American Medical Association (2004) 291:2978.
Farag, Y.M. et al. “Vitamin D Deficiency is Independently Associated with Greater Prevalence of Erectile Dysfunction: The National Health and Nutrition Examination Survey (NHANES) 2001-2004,” Atherosclerosis (2016) 252:61.
Francis, M.E. et al. “The Contribution of Common Medical Conditions and Drug Exposures to Erectile Dysfunction in Adult Males,” Journal of Urology (2007) 178:591.
Gacci, M. et al. “Critical Analysis of the Relationship Between Sexual Dysfunctions and Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia,” European Urology (2011) 60:809.
Hanak, V. et al. “Snoring as a Risk Factor for Sexual Dysfunction in Community Men,” Journal of Sexual Medicine (2008) 5:898.
Heiman, JR. “Sexual Dysfunction: Overview of Prevalence, Etiological Factors, and Treatments,” Journal of Sex Research (2002) 39:73.
Hoyos, C.M. et al. “To ED Or Not To ED: Is Erectile Dysfunction in Obstructive Sleep Apnea Related to Endothelial Dysfunction?” Sleep Medicine Review (2015) 20:5.
Irwig, M.S. and S. Kolukula. “Persistent Sexual Side Effects of Finasteride for Mal Pattern Hair Loss,” Journal of Sexual Medicine (2011) 8:1747.
Kalejaiye, O. et al. “Sleep Disorders in Patients with Erectile Dysfunction,” BJU International (2017) epub ahead of print.
Kardasevic, A. and S. Millcevic. “Correlation of Subjective Symptoms in Patients with Benign Prostatic Hyperplasia and Erectile Dysfunction,” Medical Archives (2017) 71:32.
Kardasevic, A. and S. Millcevic. “Correlation Between Prostate Volume in Patients with Benign Prostatic Hyperplasia in Relation to Erectile Dysfunction,” Medical Archives (2016) 70:449.
Kim, SC. “Hyperlipidemia and Erectile Dysfunction,” Asian Journal of Andrology (2000) 2:161.
Laumann, EO. “Sexual Dysfunction in the United States,” Journal of the American Medical Association (1999) 281:537.
Lee, J.H. and S.W. Lee. “Impact of Prostate Volume on Erectile Dysfunction and Premature Ejaculation,” Aging Male (2016) 19:106.
Liu, L. et al. “Effect of 5-Alpha-Reductase Inhibitors on Sexual Function: A Meta-Analysis and Systematic Review of Randomized Controlled Trials,” Journal of Sexual Medicine (2016) 13:1297.
Liu, Q. et al. “Erectile Dysfunction and Depression: A Systematic Review and Meta-Analysis,” Journal of Sexual Medicine (2018) 15:1073.
Mirone, V. et al. “Current Benign Prostatic Hyperplasia Treatment: Impact on Sexual Function and Management of Related Sexual Adverse Events,” International Journal of Clinical Practice (2011) 65:1005.
Nikoobakht, M. et al. “The Relationship Between Lipid Profile and Erectile Dysfunction,” International Journal of Impotence Research (2005) 17:523.
Oguz, F. et al. “Is There a Relationship Between Chronic Periodontitis and Erectile Dysfunction?” Journal of Sexual Medicine (2013) 10:838.
Rao, K. et al. “Correlation Between Abnormal Serum Lipid and Erectile Dysfunction,” Zhonghua Nan Ke Xue [Chinese journal] (2005) 11:112.
Rasmussen, J.J. et al. “Former Abusers of Anabolic Androgenic Steroids Exhibit Decreased Testosterone Levels and Hypogonadal Symptoms Years After Cessation: A Case-Control Study,” PLoS One (2016) 11:e0161208.
Rosen, R.C. et al. “Sexual Dysfunction and Lower Urinary Tract Symptoms (LUTS) Associated with Benign Prostatic Hyperplasia,” European Urology (2005) 47:824.
Rosen, R.C. et al. “Association of Sexual Dysfunction with Lower Urinary Tract Symptoms of BPH and BPH Medical Therapies: Results from the BPH Registry,” Urology (2009) 73:562.
Rosen, R.C. “Update on the Relationship Between Sexual Dysfunction and Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia,” Current Opinion in Urology (2006) 16:11.
Simons, JS and MP Carey. “Prevalence of Sexual Dysfunctions: Results from a Decade of Research,” Archives of Sexual Behavior (2001) 30:177.
Singh, V. et al. “Oral Health and Erectile Dysfunction,” Journal of Human Reproductive Science (2017) 10:162.
Steinke, E. et al. “Determinants of Sexual Dysfunction and Interventions for Patients with Obstructive Sleep Apnea: A Systematic Review,” International Journal of Clinical Practice (2016) 70:5.
Strand, J. et al. “Erectile Dysfunction and Depression: Category or Dimension?” Journal of Sex and Marital Therapy (2002) 28:175.
Symanski, F.M. et al. “The High Risk of Obstructive Sleep Apnea, an Independent Risk Factor for Erectile Dysfunction in ST-Segment Elevation Myocardial Infarction Patients,” Journal of Sexual Medicine (2011) 8:1434.
Thompson, I.M. et al. “Erectile Dysfunction and Subsequent Cardiovascular Disease,” Journal of the American Medical Association (2005) 294:2996.
Verze, P. et al. “The Link Between Cigarette Smoking and Erectile Dysfunction: A Systematic Review,” European Urology Focus (2015) 1:39.
Wang. X. et al. “High Prevalence of Erectile Dysfunction in Diabetic Men with Depressive Symptoms: A Meta-Analysis,” Journal of Sexual Medicine (2018) 15:935.
Wei, M et al. “Total Cholesterol and HDL Cholesterol as Important Predictors of Erectile Dysfunction,” American Journal of Epidemiology (1994) 140:930.
Zadik, Y. et al. “Erectile Dysfunction Might Be Associated with Chronic Periodontal Disease: Two Ends of the Cardiovascular Spectrum,” Journal of Sexual Medicine (2009) 6:1111.
Zhou, X. “Updated Evidence of Association Between Periodontal Disease and Incident Erectile Dysfunction,” Journal of Sexual Medicine (2019) 16:61.
Zuo, Z. et al. “Effect of Periodontitis on Erectile Function and Its Possible Mechanism,” Journal of Sexual Medicine (2011) 8:2598.
Healthy lifestyle helps preserves erection function
Bacon, C.G et al. “Sexual Function in Men Older Than 50: Results from the Health Professionals Follow-Up Study,” Annals of Internal Medicine (2003) 139:161.
Biebel, M.G. et al. “Male Sexual Function and Smoking,” Sexual Medicine Review (2016) 4:366.
Budweiser, S. et al. “Long-Term Changes of Sexual Function in Men with Obstructive Sleep Apnea After Initiation of Continuous Positive Airway Pressure,” Journal of Sexual Medicine (2013) 10:524.
Cassidy, A. et al. “Dietary Flavonoid Intake and Incidence of Erectile Dysfunction,” American Journal of Clinical Nutrition (2016) 103:534.
Chan, S.S. et al. “Smoking-Cessation and Adherence Intervention Among Chinese Patients with Erectile Dysfunction,” American Journal of Preventive Medicine (2010) 39:251.
DellaCamera, P.A. et al. “Sexual Health, Adherence to Mediterranean Diet, Body Weight, Physical Activity and Mental State: Factors Correlated to Each Other,” Urologia (2017) epub ahead of print.
DeLay, K.J. et al. “Modifying Risk Factors in the Management of Erectile Dysfunction,” A Review,” World Journal of Men’s Health (2016) 34:89.
DiFrancesco, S. and R.L. Teneglia. “Mediterranean Diet and Erectile Dysfunction: A Current Perspective,” Central European Journal of Urology (2017) 70:185.
Esposito, K. et al. “Effects of Intensive Lifestyle Changes on Erectile Dysfunction in Men,” Journal of Sexual Medicine (2009) 6:243.
Esposito, K. et al. “Dietary Factors, Mediterranean Diet, and Erectile Dysfunction,” Journal of Sexual Medicine (2010) 7:2338.
Esposito, K. et al. “Effect of Lifestyle Changes on Erectile Dysfunction in Obese Men,” Journal of the American Medical Association (2004) 291:2978.
Giugliano, F. et al. “Adherence to Mediterranean Diet and Erectile Dysfunction in Men with Type-2 Diabetes,” Journal of Sexual Medicine (2010) 7:1911.
Hehemann, M.C. and J.A. Kashanian. “Can Lifestyle Modification Affect Men’s Erectile Function?” Translational Andrology and Urology (2016) 5:187.
Harte, C.B. and C.M. Meston. “Association Between Smoking Cessation and Sexual Health in Men,” BJU International (2012) 109:888.
Hsiao, W. et al. “Tighter Blood Pressure Control is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men,” Journal of Sexual Medicine (2019) 16:410.
Khoo, J. et al. “Comparing Effects of Low- and High-Volume Moderate-Intensity Exercise on Sexual Function and Testosterone in Obese Men,” Journal of Sexual Medicine (2013) 10:1823.
Khoo, J. et al. “Comparing the Effects of Meal Replacements with Reduced-Fat Diet on Weight, Sexual and Endothelial Function, Testosterone, and Quality of Life in Obese Asian Men,” International Journal of Impotence Research (2014) 26:61.
Martin, C.K. et al. “Effect of Calorie Restriction on Mood, Quality of Life, Sleep, and Sexual Function in Healthy Non-Obese Adults: The CALERIE 2 Randomized Clinical Trial,” JAMA Internal Medicine (2016) 176:743.
Meldrum, D.R. et al. “Lifestyle and Metabolic Approaches to Maximizing Erectile and Vascular Health,” International Journal of Impotence Research (2012) 24:61.
Mora, M. et al. “Weight Loss Is a Major Contributor to Improved Sexual Function After Bariatric Surgery,” Surgery and Endoscopy (2013) 27:3197.
Petersen, M. et al. “Long-Term Effects of Continuous Positive Airway Pressure Treatment on Sexuality in Female Patients with Obstructive Sleep Apnea,” Sexual Medicine (2013) 1:62.
Petersen, M. et al. “Sexual Function in Male Patients with Obstructive Sleep Apnea After 1 Year of CPAP Treatment,” Clinical Respiratory Journal (2013) 7:214.
Safavy, S. et al. “Effect of a Smoking Cessation Program on Sexual Function Recovery Following Robotic Prostatectomy at Kaiser Permanente, Southern California,” Permanente Journal (2017) epub ahead of print.
Wang, F. et al. “Erectile Dysfunction and Fruit/Vegetable Consumption Among Canadian Diabetic Men,” Urology (2013) 82:1330.
White, JR. et al. “Enhanced Sexual Behavior in Exercising Men,” Archives of Sexual Behavior (1990) 19:193.
Zhang, X.B. et al. “Erectile Dysfunction and Sexual Hormone Levels in Men with Obstructive Sleep Apnea: Efficacy of Continuous Positive Airway Pressure,” Archives of Sexual Behavior (2016) 45:235.
Cycling on the wrong seat can cause erection trouble
Andersen, K.V. and G. Bovim. “Impotence and Nerve Entrapment in Long-Distance Cyclists,” Acta Neurologica Scandinavia (1997) 95:233.
Blakeslee, S. “Serious Riders, Your Bicycle Seat May Affect Your Love Life,” New York Times, Oct. 4, 2005.
Goldstein, I. “Erectile Dysfunction and Bicycling,” Focus on Sexual Health Medicine, Winter-Spring 2002.
Greenberg, D.R. et al. “Genital Pain and Numbness and Female Sexual Dysfunction in Adult Bicyclists,” Journal of Sexual Medicine (2019) 16:1381.
Marceau, L et al. “Does Bicycling Contribute to Risk of Erectile Dysfunction? Results from the Massachusetts Male Aging Study,” International Journal of Impotence Research (2001) 13:298.
Munarriz, R. et al. “Only the Nose Knows: Penile Hemodynamic Study of the Perineum-Saddle Interface in Men with Erectile Dysfunction Utilizing Bicycle Saddles and Seats With and Without Nose Extensions,” Journal of Sexual Medicine (2005) 2:612.
Randrup, E. and N. Baum. “Bicycle Riding as a Cause of Erectile Dysfunction,” Medical Aspects of Human Sexuality, Nov. 2000, p. 23.
Schrader, S.M. et al. “Cutting Off the Nose to Save the Penis,” Journal of Sexual Medicine (2008) 5:1932.
Solomon, S. and K.G. Cappa. “Impotence and Bicycling: A Seldom-Reported Connection,” Postgraduate Medicine (1987) 81:99.
Sommer, F. et al. “Bicycle Riding and Erectile Dysfunction: A Review,” Journal of Sexual Medicine (2010) 7:2346.
Taylor, K.S. et al. “Using an Experimental Bicycle Seat to Reduce Perineal Numbness,” Physician and Sportsmedicine (2002) 30:27.
Erection problems throughout the lifespan
Carbone, D.J. et al. “Erectile Dysfunction: Diagnosis and Treatment in Older Burnett, A.L. “Erectile Dysfunction: Science and Medicine,” Annual Review of Sex Research (2006) 17:101.
Ludwig, W. and M. Phillip. “Organic Causes of Erectile Dysfunction in Men Under 40,” Urology International (2014) 92:1.
Moore, T.M. et al. “Erectile Dysfunction in Early, Middle, and Late Adulthood: Symptoms Patterns and Psychosocial Correlates,” Journal of Sex and Marital Therapy (2003) 29:381.
Nguyen, H.M.T. et al. “Erectile Dysfunction in Young Men: A Review of Prevalence and Risk Factors,” Sexual Medicine Review (2017) epub ahead of print.
Rastrelli, G. and M. Maggi. “Erectile Dysfunction in Fit, Healthy Young Men: Psychological or Pathological?” Translational Andrology and Urology (2017) 6:79.
VanLankveld, J.J.D.M. and M.A. Van Den Hout. “Increasing Neutral Distraction Inhibits Genital But Not Subjective Sexual Arousal of Sexually Functional and Dysfunctional Men,” Archives of Sexual Behavior (2004) 33:549.
Age demographics of male U.S. porn consumers
https://www.pornhub.com/insights/2018-year-in-review
Testosterone supplementation
Afiadata, A and P. Ellsworth. “Testosterone Replacement Therapy: Who to Evaluate, What to Use, How to Follow, and Who Is At Risk?” Hospital Practice (1995) 42:69.
Basaria, S. et al. “Effects of Testosterone Administration for 3 Years on Subclinical Atherosclerosis Progression in Older Men with Low or Low-Normal Testosterone Levels: A Randomized Clinical Trial,” Journal of the American Medical Association (2015) 314:570.
Corona, G. et al. “Testosterone Supplementation and Sexual Function: A Meta-Analysis Study,” Journal of Sexual Medicine (2014) 11:1577.
Corona, G. and M. Maggi. “The Role of Testosterone in Erectile Dysfunction,” Nature Reviews: Urology (2010) 7:46.
Guay, A.T. “Testosterone and Erectile Physiology,” Aging Male (2006) 9:201.
Jain, P. et al. “Testosterone Supplementation for Erectile Dysfunction: Results of a Meta-Analysis,” Journal of Urology (2000) 164:371.
Kohler. T.S. et al. “Prevalence of Androgen Deficiency in Men with Erectile Dysfunction,” Urology (2008) 71:693.
McBride, J.A. et al. “Diagnosis and Management of Testosterone Deficiency,” Asian Journal of Andrology (2015) 17:177.
Shabsigh, R. “Testosterone Therapy and Erectile Dysfunction,” Aging Male (2004) 7:312.
Snyder, P.J. et al. “Effects of Testosterone Treatment in Older Men,” New England Journal of Medicine (2016) 374:611.
Erection drugs can be taken on a full or empty stomach
Zinner, N. “DO Food and Dose Timing Affect the Efficacy of Sildenafil? A Randomized, Placebo-Controlled Study,” Journal of Sexual Medicine (2007) 4:137.
Erection drugs may be fatal in men taking nitrate medication
Ishikura, F et al. “Effects of Sildenafil Citrate (Viagra) Combined with Nitrate on the Heart,” Circulation (2000) 102:2516.
Mika, M. “Some Men Who Take Viagra Die: Why?” Journal of the American Medical Association (2000) 283:590.
Sales of erection drugs
Berenson, A. “Sales of Drugs for Impotence Are Declining,” New York Times, Dec. 4, 2005.
Stout, H. “Viagra: The Thrill That Was,” New York Times, June 5, 2011.
More than 1,800 men have died while taking erection drugs
Lowe, G. and R.A. Costabile. “10-Year Analysis of Adverse Event Reports to the Food and Drug Administration for Phosphodiesterase Type-5 Inhibitors,” Journal of Sexual Medicine (2011) 9:265.
Mika, M. “Some Men Who Take Viagra Die: Why?” Journal of the American Medical Association (2000) 283:590.
Surprisingly few older men have tried erection medication
May, M. et al. “Erectile Dysfunction, Discrepancy Between High Prevalence and Low Utilization of Treatment Options: Results from the Cottbus Survey,” British Journal of Urology International (2007) 100:1110.
Mulhall, J. et al. “Importance of and Satisfaction with Sex Among Men and Women Worldwide: Results of the Global Better Sex Survey,” Journal of Sexual Medicine (2008) 5:788.
Studies suggesting that erection drug makers have exaggerated effectiveness
Althof, S.E. et al. “Self-Esteem, Confidence, and Relationships in Men Treated with Sildenafil Citrate for Erectile Dysfunction: Results of Two Double-Blind, Placebo-Controlled Trials,” Journal of General Internal Medicine (2006) 21:1069.
Banner, L.L. and R.U. Anderson. “Integrated Sildenafil and Cognitive-Behavior Sex Therapy for Psychgenic Erectile Dysfunction: A Pilot Study,” Journal of Sexual Medicine (2007) 4(4, Pt 2):1117.
Carrier, S. et al. “Treatment Satisfaction with Sildenafil in a Canadian Real-Life Setting. A 6-Month Prospective Observational Study of Primary Care Practices,” Journal of Sexual Medicine (2007) 4:1414.
Chia, S.J. et al. “Clinical Application of Prognostic Factors for Patients with Organic Causes of Erectile Dysfunction on 100 mg of Sildenafil Citrate,” International Journal of Urology (2004) 11:1104.
DeBusk, R.F. et al. “Efficacy and Safety of Sildenafil Citrate in Men with Erectile Dysfunction and Stable Coronary Artery Disease,” American Journal of Cardiology (2004) 93:147.
Fonseca, V. et al. “Impact of Diabetes Mellitus on the Severity of Erectile Dysfunction and Response to Treatment: Analysis of Data from Tardenafil Clinical Trials,” Diabetologia (2004) 47:1914.
Kadioglu, A. et al. “Quality of Erections in Men Treated with Flexible-Dose Sildenafil for Erectile Dysfunction: Multicenter Trial with a Double-Blind Randomized, Placebo-Controlled Phase and an Open Label Phase,” Journal of Sexual Medicine (2007) 5:726.
Lee, J. et al. “Physician-Rated Patient Preference and Patient- and Partner-Rated Preference for Tadalafil or Sildenafil Citrate: Results from the Canadian Treatment of Erectile Dysfunction Observational Study,” British Journal of Urology International (2006) 908:623.
Martin-Morales, A. et al. “Therapeutic Effectiveness and Patient Satisfaction After 6 Months of Treatment with Tadalafil, Sildenafil, and Vardenafil: Results from the Erectile Dysfunction Observational Study (EDOS),” European Urology (2007) 51:541.
Melnik T. and C.H. Abdo. “Psychogenic Erectile Dysfunction: Comparative Study of Three Therapeutic Approaches,” Journal of Sex and Marital Therapy (2005) 31:243.
Mirone, V. et al. “Flexible-Dose Vardenafil in a Community-Based Population of Men Affected by Erectile Dysfunction: A 12-Week Open-Label, Multicenter Trial,” Journal of Sexual Medicine (2005) 2:842.
Ochiai, A. et al. “Efficacy of Sildenafil as the First-Step Therapy Tool for Japanese Patients with Erectile Dysfunction,” International Journal of Impotence Research (2005) 17:339.
Pickering T.G. et al. “Sildenafil Cirate for Erectile Dysfunction in Men Receiving Multiple Antihypertensive Agents: A Randomized Controlled Trial,” American Journal of Hypertension (2004) 17(12 Pt 1):1135.
Skoumal, R. et al. “Efficacy and Treatment Satisfaction with On-demand Tadalafil (Cialis) in Men with Erectile Dysfunction,” European Urology (2004) 46:362.
Studies showing higher rates of side effects than drug company figures
DeBusk, R.F. et al. “Efficacy and Safety of Sildenafil Citrate in Men with Erectile Dysfunction and Stable Coronary Artery Disease,” American Journal of Cardiology (2004) 93:147.
Lowe, G. and R.A. Costabile. “10-Year Analysis of Adverse Event Reports to the Food and Drug Administration for Phosphodiesterase Type-5 Inhibitors,” Journal of Sexual Medicine (2011) 9:265.
Pickering, T.G. et al. “Sildenafil Cittrate for Erectile Dysfunction in Men Receiving Multiple Antihypertensive Agents: A Randomized Controlled Trial,” American Journal of Hypertension 17:1135.
Couples prefer Cialis over other erection drugs
Ahn, TY, et al. “Treatment Preferences in Men with Erectile Dysfunction: An Open Lavbel Study in Korean Men Switching from Sildenafil to Tadalafil,” Asian Journal of Andrology (2007) 9:760.
Brock, G. et al. “The Treatment of Erectile Dysfunction Study: Focus on Treatment Satisfaction of Patients and Partners,” BJU International (2007) 99:376.
Conaglen, H.M. and J.V. Conaglen. “Investigating Women’s Preference for Sildenafil or Tadalafil Use by their Partners with Erectile Dysfunction: The Partner’ Preference Study,” Journal of Sexual Medicine (2008) 5:1198.
Dean, J. et al. “Psychosocial Outcomes and Drug Attributes Affecting Treatment Choice in Men Receiving Sildenafil and Tadalafil for Treatment of Erectile Dysfunction: Results of a Multicenter, Randomized, Open Label, Crossover Study,” Journal of Sexual Medicine (2006) 3:650.
Dzelaludin, J and S. Bajramovic. “Evaluation of Therapeutic Responses of Patients with Erectile Dysfunction,” Medicinski Arhiv [Bosnian journal] (2009) 63:274.
Eardley, I. et al. “Factors Associated with Preference for Sildenafil and Tadalafil for Treating Erectile Dysfunction in Men Naïve to PDE-5 Inhibitor Therapy: Post Hoc Analysis of Data from a Multicenter, Randomized Open-Label, Crossover Study,” BJU International (2007) 100:122.
Eardley, I. et al. “An Open-Label, Multicenter, Randomized, Crossover Study Comparing Sildenafil and Tadalafil for Treating Erectile Dysfunction in Men Naïve to PDE-5 Inhibitor Therapy,” BJU International (2005) 96:1323.
Fusco, F. “Tadalafil Versus Sildenafil in the Treatment of ED: Italian Patients’ Preferences and Explanatory Notes,” Urologia (2008) 75:24.
Gong, B.S. “ED Patients and their Female Partners Prefer Tadalafil,” Zhonghua, Nan Ke Xue [Chinese journal] (2011) 17:571.
Hatzichristou, D. et al. “Patterns of Switching PDE-5 Inhibitors in the Treatment of Erectile Dysfunction: Results from the Erectile Dysfunction Observational Study,” International Journal of Clinical Practice (2007) 61:1850.
Lee, J. et al, “Physician-Rated Patient Preference and Patient- and Partner-Rated Preference for Tadalafil and Sildenafil: Results from the Canadian Treatment of Erectile Dysfunction Observational Study,” BJU International (2006) 98:623.
Melnik T. and C.H. Abdo. “Psychogenic Erectile Dysfunction: Comparative Study of Three Therapeutic Approaches,” Journal of Sex and Marital Therapy (2005) 31:243.
Morales, A.M. et al. “Patients’ Preference in the Treatment of Erectile Dysfunction: A Critical Review of the Literature,” International Journal of Impotence Research (2011) 23:1.
Von Keitz, A. et al. “A Multicenter, Randomized, Double-Blind, Crossover Study to Evaluate Patient Preference Between Tadalafil and Sildenafil,” European Urology (2004) 45:499.
For best results: Drugs plus sex therapy
Aubin, S.et al. “Comparing Sildenafil Along Vs. Sildenafil Plus Brief Couple Sex Therapy on Erectile Dysfunction in Couples’ Sexual and Marital Quality of Life: A Pilot Study,” Journal of Sex & Marital Therapy (2009) 35:122.
Banner, L.L. and R.U. Anderson. “Integrated Sildenafil and Cognitive-Behavior Sex Therapy for Psychogenic Erectile Dysfunction: A Pilot Study,” Journal of Sexual Medicine (2007) 4:1117.
Cost of erection drugs
Mishra, K. et al. “Variability in Prices for Erectile Dysfunction Medications—Are All Pharmacies the Same?” Journal of Sexual Medicine (2018) 15:1785
Don’t buy erection drugs touted on the Internet
Campbell, N. et al. “Internet-Ordered Viagra (Sildenafil citrate) is Rarely Genuine,” Journal of Sexual Medicine (2012) 9:2943.
Viagra-Vation
Conaglen, H.M. and J.V. Conaglen. “Couples’ Reasons for Adherence to or Discontinuation of PDE Type 5 Inhibitors for Men with Erectile Dysfunction at 12 to 24-Month Follow-Up After a 6-Month Free Trial,” Journal of Sexual Medicine (2012) 9:857.
Lamberg, L. “New Drug for Erectile Dysfunction Boon for Many, “Viagravation” for Some,” Journal of the American Medical Association, (1998) 280:867.
Sex therapy helps treat ED
Althof, S.E. “Sexual Therapy in the Age of Pharmacotherapy,” Annual Review of Sex Research (2006) 17:116
Banner, L.L. and R.U. Anderson. “Integrated Sildenafil and Cognitive-Behavioral Sex Therapy for Psychogenic Erectile Dysfunction: A Pilot Study,” Journal of Sex and Marital Therapy (2007) 4(4 Pt 2):1117.
McCabe, M.P. “Evaluation of a Cognitive Behavior Therapy Program for People with Sexual Dysfunction,” Journal of Sex and Marital Therapy (2001) 27:259.
Melnik, T. et al. “Psychosocial Interventions for Erectile Dysfunction,” Cochrane Database Systematic Review (2007) CD004825.
Phelps, J.S. et al. “The PsychoedPlusMed Approach to Erectile Dysfunction Treatment: The Impact of Combining a Psychoeducational Intervention with Sildenafil,” Journal of Sex and Marital Therapy (2004) 30:305.
Vacuum constriction devices
Brison, D. et al. “The Resurgence of the Vacuum Erection Device (VED) for Treatment of Erectile Dysfunction,” Journal of Sexual Medicine (2013) 10:1124.
Cookson, M.S. and P.W. Nadig. “Long-Term Results with the Vacuum Constriction Device,” Journal of Urology (1993) 149:290.
Lin, H. et al. “Application of the Vacuum Erectile Device in Penile Rehabilitation for Erectile Dysfunction After Radical Prostatectomy,” Zhonghua Nan Ke Xue [Chinese journal] (2015) 21:195.
Pajovic, B. et al. “Vacuum Erection Device in Treatment of Organic Erectile Dysfunction and Penile Vascular Differences Between Patients with DM Type 1 and DM Type 2,” Aging Male (2017) 20:49.
Shen, Y.J. et al. “Penile Rehabilitation with Vacuum Erection Device for Erectile Dysfunction After Radical Prostatectomy,” Zhonghua Nan Ke Xue [Chinese journal] (2012) 18:723.
Yuan, J. et al. “Vacuum Therapy in Erectile Dysfunction: Science and Clinical Evidence,” International Journal of Impotence Research (2010) 22:211.
Kegel exercises
Claes, H. and L. Baert. “Pelvic Floor Exercise Versus Surgery in the Treatment of Impotence,” British Journal of Urology (1993) 71:52.
Colpi, G.M. et al. “Perineal Floor Efficiency in Sexually Potent and Impotent Men,” International Journal of Impotence Research (1999) 11:153.
Dorey, G. “Restoring Pelvic Floor Function in Men: Review of RCTs,” British Journal of Nursing (2005) 14:1014.
Dorey, G. et al. “Pelvic Floor Exercises for Erectile Dysfunction,” BJU International (2005) 96:595.
Sighinolfi, M.C. et al. “Potential Effectiveness of Pelvic Floor Rehabilitation Treatment for Post-Radical Prostatectomy Incontinence, Climacturia, and Erectile Dysfunction: A Case Series,” Journal of Sexual Medicine (2009) 6:3496.
Van Kampen, M. et al. “Treatment of Erectile Dysfunction by Perineal Exercise, Electromyographic Biofeedback, and electrical Stimulation,” Physical Therapy (2003) 83:536.
Yohimbe
Carey, M.P. and B.T. Johnson. “Effectiveness of Yohimbine in the Treatment of Erectile Disorder: Four Meta-Analytic Integrations,” Archives of Sexual Behavior (1996) 25:341.
Ernst, E. and M.H. Pittler. “Yohimbe for Erectile Dysfunction: A Systematic Review and Meta-Analysis of Randomized Clinical Trials,” Journal of Urology (1998) 159:433.
Kunelius, P. et al. “Is High-Dose Yohimbine Hydrochloride Effective in the Treatment of Mixed-Type Impotence? A Prospective, Randomized, Controlled, Double-Blind, Crossover Study,” Urology (1997) 49:441.
Lebret, T. et al. “Efficacy and Safety of a Novel Combination of L-arginine Glutamate and Yohimbine Hydrochloride: A New Oral Therapy for Erectile Dysfunction,” European Urololgy (2002) 41:608.
Reid, K. et al. “Double-Blind Trial of Yohimbine in the Treatment of Psychogenic Impotence,” Lancet (1987) 2(8556):421.
Teloken, C. et al. “Therapeutic Effects of High-Dose Yohimbine Hydrochloride on Organic Erectile Dysfunction,” Journal of Urology (1998) 159:122.
L-arginine
Aoki, H. et al. “Clinical Assessment of a Supplement of Pycnogenol and L-arginine in Japanese Patients with Mild to Moderate Erectile Dysfunction,” Phytotherapy Research (2012) 26:204.
Barassi, A. et al. “Levels of L-arginine and L-citruline in Patients with Erectile Dysfunction of Different Etiology,” Andrology (2017) 5:256.
Chen, J. et al. “Effect of Oral Administration of High-Dose Nitric Oxide Donor L-Arginine in Men with Organic Erectile Dysfunction: Results of a Double-Blind, Randomized, Placebo-Controlled Study,” BJU International (1999) 83:269.
DiFrancesco, S. and R.L. Teneglia. “Mediterranean Diet and Erectile Dysfunction: A Current Perspective,” Central European Journal of Urology (2017) 70:185.
Gentile, V. et al. “Effect of Propionyl-L-carnitine, L-Arginine, and Nicotinic Acid on the Efficacy of Vardenafil in the Treatment of Erectile Dysfunction in Diabetes,” Current Medical Research and Opinion (2009) 25:2223.
Gianfrilli, D. et al. “Propionyl-L-carnitine, L-arginine, and Ni9.acin in Sexual Medicine: A Nutraceutical Approach to Erectile Dysfunction,” Andrologia (2012) 44(Suppl 1):600.
Greven, K.M. et al. “Effect of ArginMax on Sexual Functioning and Qualithy of Life Among Female Cancer Survivors: Results of the WFU CCOP Research Base Protocol 97106,” Journal of Community Support and Oncology (2015) 13:87.
Ito, T. et al. “The Effects of ArginMax, a Natural Dietary Supplement, for Enhancement of Male Sexual Function,” Hawaii Medical Journal (1998) 57:741.
Ito, T.Y. et al. “The Enhancement of Female Sexual Function with ArginMax, a Nutritional Supplement, Among Women Differing in Menopausal Status,” Journal of Sex and Marital Therapy (2006) 32:369.
Ito, T.Y. et al. “A Double-Blind Placebo-Controlled Study of ArginMax, a Nutritional Supplement, for Enhancement of Female Sexual Function,” Journal of Sex and Marital Therapy (2001) 27:541.
Lebret, T. et al. “Efficacy and Safety of a Novel Combination of L-arginine Glutamate and Yohimbine Hydrochloride: A New Oral Therapy for Erectile Dysfunction,” European Urololgy (2002) 41:608.
Neuzillet, Y. et al. “A Randomized, Double-Blind, Crossover, Placebo-Controlled Comparative Clinical Trial of Arginine Aspartate Plus Adenosine Monophosphate for the Intermittent Treatment of Male Erectile Dysfunction,” Andrology (2013) 1:223.
Rhim, H.C. et al. “The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis,” Journal of Sexual Medicine (2019) 16:223.
Stanislavov, RT. And V. Nikolova. “Treatment of Erectile Dysfunction with Pycnogenal and L-arginine,” Journal of Sex and Marital Therapy (2003) 29:207.
Zorgniotti, A.W. and E.F. Lizza. “Effect of Large Doses of the Nitric Oxide Precursor, L-Argenine, on Erectile Dysfunction,” International Journal of Impotence Research (1994) 6:33.
Ginseng
Choi, H.K et al. “Clinical Efficacy of Korean Red Ginseng for Erectile Dysfunction,” International Journal of Impotence Research (1995) 7:181.
Choi, Y.D. et al. “Effects of Korean Ginseng Berry Extract on Sexual Function in Men with Erectile Dysfunction: A Multicenter Placebo-Controlled, Double-Blind Clinical Study,” International Journal of Impotence Research (2013) 25:45.
DeAndrade, E. et al. “Study of the Efficacy of Korean Red Ginseng in the Treatment of Erectile Dysfunction,” Asian Journal of Andrology (2007) 9:24.
Gillis, C.N. “Panax Ginseng Pharmacology: A Nitric Oxide Link?” Biochemistry and Pharmacology (1997) 54:1.
Hong, B. et al. “A Double-Blind Crossover Study Evaluating the Efficacy of Korean Red Ginseng in Patients with Erectile Dysfunction: A Preliminary Report,” Journal of Urology (2002) 168:2070.
Jang, D.J. et al. “Red Ginseng for Treating Erectile Dysfunction: A Systematic Review,” British Journal of Clinical Pharmacology (2008) 66:444.
Kim, T.H et al. “Effects of Tissue-Cultured Mountain Ginseng (Panax Ginseng CA Meyer) Extract on Male Patients with Erectile Dysfunction,” Asian Journal of Andrology (2009) 11:356.
Murphy, L.L. and T.J. Lee. “Ginseng, Sex Behavior, and Nitric Oxide,” Annals of the New York Academy of Sciences (2002) 962:372.
Park, S.W. et al. “Effect of SA1, Herbal Formulation, on Sexual Behavior and Penile Erection,” Biology and Pharmacy Bulletin (2006) 29:1386.
Woolven, L. and T. Snider. “Herbs and Erectile Dysfunction: A Review of Traditional Use and Modern Clinical Evidence,” HerbalGram (2013) 99:34.
Ginkgo
Cohen, A.J. and B. Bartlik. “Ginkgo Biloba for Antidepressant-Induced Sexual Dysfunction,” Journal of Sex and Marital Therapy (1998) 24:139.
Kang, B.J. et al. “A Placebo-Controlled, Double-Blind Trial of Ginkgo Biloba for Antidepressant-Induced Sexual Dysfunction,” Human Psychopharmacology (2002) 17:279.
McKay, D. “Nutrients and Botanicals for Erectile Dysfunction: Examining the Evidence,” Alternative Medicine Review (2004) 9:4.
Wheatley, D. “Triple-Blind, Placebo-Controlled Trial of Ginkgo Biloba in Sexual Dysfunction Due to Antidepressant Drugs,” Human Psychopharmacology (2004) 19:545.
Maca
Zenico, T. et al. “Subjective Effects of Lepidium Myeenii (Maca) on Well-Being and Sexual Performance in Patients with Mild to Moderate Erectile Dysfunction: A Randomized, Double-Blind Clinical Trial,” Andrologia (2009) 41:95.
Saffron
Modabbernia, A. et al. “Effect of Saffron on Fluoxetine-Induced Sexual Impairment in Men,” Psychopharmacology (Berlin) (2012) 223:381.
Mohammadzaheh-Moghadam, H. et al. “Effects of a Topical Saffron (Crocus Sativus L) Gel on erectile Dysfunction in Diabetics: A Randomized, Parallel-Group, Double-Blind, Placebo-Controlled Trial,” Journal of Evidence-Based Complementary and Alternative Medicine (2015) 20:283.
Safarinejad, M.R. et al. “An Open Label, Radomized, Fixed-Dose, Crossover Study Comparing Efficacy and Safety of Sildenafile Citrate and Saffron (Crocus Sativus Linn.) for Treating Erectile Dysfunction in Men Naïve to Treatment,” International Journal of Impotence Research (2010) 22:240.
Alprostadil and Intracavernosal injection therapy (ICI)
Belew, D. et al. “Intracavernosal Injection for the Diagnosis, Evaluation, and Treatment of Erectile Dysfunction: A Review,” Sexual Medicine Review (2015) 3:11.
Costa, P. and Potempa, A.J. “Intraurethral Alprostadil for Erectile Dysfunction: A Review of the Literature,” Drugs (2012) 72:2243.
El-Sakka, A.I. “What Is the Current Role of Intracavernosal Injection in Management of Erectile Dysfunction?” International Journal of Impotence Research (2016) 28:88.
Garber, B.B. and C. Lim. “Inflatable Penile Prosthesis Insertion in Men with Severe Intracorporal Fibrosis,” Current Urology (2017) 10:92.
Hanchanale, V. and I. Eardley. “Alprostadil for the Treatment of Impotence,” Expert Opinion in Pharmacotherapy (2014) 15:421.
Hsiao, W. et al. “Satisfaction Profiles in Men Using Intracavernosal Injection Therapy,” Journal of Sexual Medicine (2011) 8:512.
Nelson, C.J. et al. “Injection Anxiety and Pain in Men Using Intracavernosal Injection Therapy After Radical Pelvic Surgery,” Journal of Sexual Medicine (2013) 10:2559.
Sung, H.H. et al. “The Role of Intracavernosal Injection Therapy and the Reasons for Withdrawal from Therapy in Patients with Erectile Dysfunction in the Era of PDE5 Inhibitors,” Andrology (2014) 2:45.
Yiou, R. et al. “Sexual Quality of Life in Women Partnered with Men Using Intracavernosal Alprostadil Injections After Radical Prostatectomy,” Journal of Sexual Medicine (2013) 10:1355.
Low-intensity shockwave therapy (LIST)
Fojecki, G.L. et al. “Effect of Linear Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction: 12-Month Follow-Up of a Randomized, Double Blinded, Sham-Controlled Study,” Sexual Medicine (2018) 6:1.
Fojecki, G.L. et al. “Effect of Low-Energy Linear Shockwave Therapy on Erectile Dysfunction: A Double Blinded, Sham-Controlled, Randomized Clinical Trial,” Journal of Sexual Medicine (2017) 14:106.
Gruenwald, I. et al. “Low-Intensity Extracorporeal Shockwave Therapy:
A Novel Effective Treatment for Erectile Dysfunction in Severe ED Patients who Respond Poorly to PDE5 Inhibitor Therapy,” Journal of Sexual Medicine (2012) 9:259.
Kalyvianakis, D. et al. “Low-Energy Shockwave Therapy for Erectile Dysfunction: A Randomized Clinical Trail Comparing 2 Treatment Protocols and the Impact of Repeating Treatment,” Journal of Sexual Medicine (2018) 15:334.
Kalyvianakis, D. and D. Hatzichristou. “Low-Energy Shockwave Therapy Improves Hemodynamic Parameters in Patients with Vasculogenic Erectile Dysfunction: A Triplex Ultrasonography-Based, Sham-Controlled Trial,” Journal of Sexual Medicine (2017) 14:891.
Kitrey, N.D. et al. “Penile Low-Intensity Shockwave Treatment is Able to Shift PDE5i Nonresponders to Responders: A Double-Blind, Sham-Controlled Study,” Journal of Urology (2016) 195:1550.
Lu, Z. et al. “Low-Intensity Extracorporeal Shockwave Treatment Improves Erectile Function: A Systematic Review and Meta-Analysis,” European Urology (2017) 71:223.
Qi, T. et al. “Comparison of the Effects of Extracorporeal Shockwave Therapy and a Vacuum Erectile Device on Penile Erectile Dysfunction: A Randomized Clinical Trial,” Medicine (Baltimore) (2017) 96:e8414.
Srini, V.S. et al. “Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction: A Study in and Indian Population,” Canadian Journal of Urology (2015) 22:7614.
Vardi, Y. et al. “Can Low-Intensity Extracorporeal Shockwave Therapy Improve Erection Function? A 6-Month Follow-Up Pilot Study in Patients with Organic Erectile Dysfunction,” European Urology (2010) 58:243.
Vardi, Y. et al. “Does Low-Intensity Extracorporeal Shockwave Therapy Have a Physiological Effect on Erectile Function? Short-Term Results of a Randomized, Double-Blind, Sham-Controlled Study,” Journal of Urology (2012) 187:1769.
Yee, C.H. et al. “Extracorporeal Shockwave Therapy in the Treatment of Erectile Dysfunction: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Study,” International Journal of Urology (2014) 21:1041.
Additional surgery to correct problems with penile implants
Mirheydar, H. et al. “Reoperation Rates for Penile Prosthetic Surgery,” Journal of Sexual Medicine (2016) 13:129.
Use of implants has fallen
Lee, D.J. et al. “Trends in the Utilization of Penile Prostheses in the Treatment of Erectile Dysfunction in the United States,” Journal of Sexual Medicine (2015) 12:1638.
