Contributions by Dr. Aimee Paik, Dr. Daniel Lanzer & Jacqui Zyl
Dr. Aimee Paik
Advisor

Dr. Aimee Paik is an experienced dermatologist who is passionate about men’s health and the ability to improve one's quality of life. She completed her dermatology residency at University of California Irvine, where she was elected Chief Resident and received the Resident Teaching Award, and has been in practice for 10 years.

Dr. Daniel Lanzer
Advisor

Dr. Daniel Lanzer is a well known Australian Dermatologist and Cosmetic Surgeon who features prominently on TV and in the media. He has pioneered many new developments in Dermatology and Cosmetic Surgery over the last 30 years.

Jacqui Zyl
Author

Jacqui is an experienced health writer with an academic background in pharmacology and marketing. Jacqui aims to make complex science accessible to consumers and to help people become empowered owners of their health.

Problems getting it up can be a serious downer, and more guys have it going than you think, including younger blokes.

One of the reasons guys let erectile dysfunction (ED) erode their masculinity and ruin their sex lives is that they buy into unrealistic social norms around sex and don’t know much about how their issue can be managed.

Sure, there’s that little blue pill, but that’s not always a silver bullet.

This guide will empower you with all the knowledge you need about ED, how to treat it, and how to get your mojo back.

So let’s dive in, head first.

Chapter 1

Understanding Erectile Dysfunction

In this chapter, we define ED and describe the signs and symptoms. It can be more complicated than you think.

We also look at the stats around ED, its impact on your manhood, and how that little blue pill changed the world.

5 minute read
Key takeaways:
  • ED is when you can't get or keep an erection hard enough for sexual activity with penetration. It can happen to old or young guys and it's normal to experience it occasionally.
  • ED is not a disease, but rather a symptom of another underlying health issue, which can be physical, psychological or both.
  • ED is more common with age, but complaints of ED in younger men is on the rise, with one in four new patients now under 40.

What is Erectile Dysfunction?

ED, also known as impotence, is a man’s inability to get or keep an erection firm enough for sexual activity with penetration.1 Some men are completely unable to get an erection and others may get one that doesn’t remain rigid enough for intercourse.2 That means somewhere between a 1 and 3 on the erection hardness score.

1. Severe ED (Tofu)

Penis is large but not hard.

2. Moderate ED (Peeled banana)

Penis is hard but not hard enough for penetration.

3. Suboptimal erection (Unpeeled banana)

Penis is hard enough for penetration but not completely hard.

4. Optimal erection (Cucumber)

Penis is hard and completely rigid.

Despite the despair you may experience about your 3.5-inch floppy, ED is not a disease, but rather a symptom of another problem. It might be due to a physical problem (such as a heart condition), a psychological issue (such as stress), or a mixture of both.

For simplicity’s sake, think of getting an erection like conducting an orchestra – there are a lot of moving parts. Your brain, nervous system, blood vessels and hormones all have a role to play. If one or more of these parts are out of sync, the whole performance can be ruined.

How common is ED?

  • It is estimated that up to 150 million men worldwide suffer from ED and this figure is likely to double by the year 2025.3
  • ED becomes more common as men age, with approximately 40% of men being affected at age 40 and nearly 70% of men being affected at age 70.4
  • Complaints of ED in younger men is on the rise, with one in four new ED patients now under 40.5
  • About one in ten men are completely unable to have erections.6

ED can undermine your masculinity

Outside of death, nothing worries us blokes more than losing our stiffies.

Erections are an integral part of our identity. Starting with the pleasant sensations experienced in adolescence with masturbation and self-exploration, to our first sexual experience, and then the intimacy of a long-term relationship, getting it up is a key part of our manhood.

Failing in the hard-on department can be a significant blow to both you and your partner. It can trigger a loss of confidence, low self-esteem, anger, anxiety and shame.

If that doesn’t make you want to withdraw from sex altogether, it might make you search for a solution, like the little blue pill.

The era of ED medication

In 1998, a little blue pill for ED was introduced to the world, and it’s fair to say the world hasn’t been the same since.

The availability of ED medication has prompted more blokes than ever to seek medical advice for their hard-on issues and a prescription from their doctors.

As one London-based Cardiologist, Dr Carl Shakespeare, said, it “unlocked the ability of men to communicate with a doctor because it offered them hope.”

Whilst ED medication has helped to break down the stigma associated with sexual dysfunction, it’s also served to make ED, as a sexual issue, become socially unacceptable, which has put a lot of pressure on us guys.

Today’s society would have us believe that a ‘real man’ has sexual prowess, is untiring, masterful and dominant, and can always get it up. But we all know that’s not the case.

Experiencing ED occasionally is normal and nothing to be concerned about. Not every sexual encounter is a '10'. However, if it happens regularly - like more than 50% of the time - you may want to talk to a doctor and consider treatment options.

Does ED last forever?

Having limp dick once – or even several times – doesn’t mean your sex life is over forever.

Most cases of ED are treatable – or at least manageable – no matter what your age.7 So, parking your car in the garage needn’t be a problem forever.

Understanding what’s causing your ED, however, is the first step to treating it, so keep reading.

Chapter 2

Causes of Erectile Dysfunction

ED is usually caused by an underlying health problem, or a combination of problems, which if treated, can reverse your ED.

In this chapter we explore all the possible causes – from physical illnesses to psychological issues, medications and recreational drugs.

5 minute read
Key takeaways:
  • The majority of ED cases have a physical cause, such as a blood cessel or heart condition.
  • Performance anxiety is a common psychological cause of ED, especially in young men. Just one bad experience can trigger an ongoing vicious cycle.
  • Recreational drugs can negatively impact your ability to get an erection, and it gets worse with long term use.
  • Watching too much pornography can desensitise you to sex in real life and eventually cause difficulties with erections.

What is the main cause of ED?

Doctors once thought that ED was primarily in a man’s head, but we now know that physical illness is actually behind most cases of ED,7 with psychological problems causing only one in ten cases of persistent ED.1

Commonly, though, a guy with ED will have a combination of both physical and psychological causes.

Physical causes

These range from heart and blood vessel problems to hormonal issues, obesity and even physical damage to the penis.

Blood vessel and heart conditions

When the erection orchestra plays sweet sexy music and you’re able to get it up, it means blood is flowing freely into the shaft of the penis.

Any condition that affects blood flow to the penis, however, can result in ED.8

Blood vessel and heart conditions are the most common medical causes of ED,7 and are often linked to:

  • Atherosclerosis (a condition that causes clogged vessels)
  • High blood pressure
  • High cholesterol
  • Diabetes (especially type 2)
  • Smoking
  • Obesity
The arteries in the penis are very small, so often doctors will pick up the beginning of arterial hardening and heart disease in the penis before it’s seen in the coronary arteries or the heart. In fact, having ED is as much a risk factor for heart disease as a history of smoking or a family history of heart disease.9
Nerve damage

The nervous system is another key player in the erection orchestra.

When you get turned on – whether by your partner, a sexual thought, or just porn – your brain sends chemical signals to specific nerves near the penis that cause the blood vessel walls to relax, allowing blood to flow into the penis.10 That’s when you get an erection.

Men with conditions that cause nerve damage, such as multiple sclerosis (MS), Alzheimer’s disease, Parkinson’s disease and spinal cord injuries, may often experience ED. It’s because there is an interruption in the transmission of nerve impulses between the brain and the penis.9

Pelvic or prostate surgery and radiation therapy (usually to treat prostate cancer) can also result in the same problem.

And commonly, diabetes can cause nerve and artery damage, making it difficult to get an erection. In fact, between 35% and 50% of men with diabetes experience ED.9

Hormonal problems

If your hormones are out of whack, it can interfere with your libido and your erections.

The hormone that naturally comes to mind is testosterone. But whilst low testosterone may affect your desire for sex, it is less commonly the cause of ED.11

According to the American Urological Association, testosterone treatment has not been shown to improve erections in men with normal testosterone levels. And studies show that it does not help men with low testosterone levels if ED is their only symptom.11

If hormonal imbalance is the cause of ED, it’s most likely to be from:6,12

  • increased prolactin (the hormone that stimulates breast development and milk production in women, but is also found in men)
  • steroid use by bodybuilders
  • too much or too little thyroid hormone
  • too much cortisone (a drug used to help control inflammation)
  • too much growth hormone
  • hormones used to manage prostate cancer
Obesity

Whilst there isn’t any scientific evidence to show that being obese is directly linked to ED, it’s link to heart disease, diabetes, high cholesterol and atherosclerosis – which are all closely linked to ED – make it a major risk factor for ED.13

One Italian study showed that about a third of obese men with ED were able to cure their problem by making lifestyle changes and losing weight,14 and a more recent Australian study14 backed these results, with similar findings.

Not only can weight loss improve your ED, but it'll likely boost your self-esteem and improve your mental health, which can also help in the hard on department.
Penile abnormalities

Penis’ come in all shapes and sizes – big, small, straight, thick and thin – but for men with Peyronie’s disease, it’s curved.

Whilst having a curved erection isn't necessarily a cause for concern, Peyronie's disease causes a significant bend or pain in some men, which can result in trouble having sex.16

The condition is thought to develop after trauma to the penis, such as bending or hitting, which can cause bleeding and scar tissue build-up.17 Peyronie’s can also happen without a prior injury, in which case it’s more likely due to genetics or age.17

Psychological causes

Your mental state holds your penis like a marionette string, so as soon as you start to over analyse things, it can be game over.

Psychological ED is pretty common too, with 90% of teenagers and young men experiencing it at some point, usually due to nervousness and anxiety.18

Note, we said ‘at some point’, which means it’s not likely to be permanent.

Older men can experience psychological ED too, but as men age, it’s is less likely to be from nervousness and more likely to be from professional or relationship stress, loneliness, or loss of a loved one.18

If you're not sure whether your ED issues are physical or psychological, it helps to keep track of when you lose erections. A gradual loss of function over time is more likely a physical issue, but if you're still getting erections spontaneously overnight or in the morning, the problem may be psychological.1
Chronic stress and anxiety

Whether you’re stressed about work, money, or you’re going through a rough patch in your relationship, chronic stress and anxiety will affect not only your libido, but your erections too.

Physiologically, the stress hormones cortisol and adrenaline supress production of the sex hormones making it more difficult to get or sustain an erection.19 Stress and anxiety can also interrupt how your brain sends messages to the penis to allow extra blood flow.18

Performance anxiety

Here’s a scenario that commonly plays out in a man’s life:

You’ve had a stressful day at work and you get home late. You’re tired and still pissed off about the argument you had with a colleague. When you try to have sex it’s really hard to get it up because your mind is elsewhere.

Your partner senses there is something wrong, which only makes you try even harder to get that erection, but it doesn’t work.

The next time things get hot and steamy, you’re reminded of what happened last time and, of course, you fail again. The harder you try the worse it gets, and so begins the vicious cycle of performance anxiety.

For millions of men, ED is nothing more than a stress response that triggers a mind-body phenomenon.18 And because we have no conscious control over our erections, the performance anxiety cycle can be really debilitating and make us want to avoid sex altogether.

We’ll talk about ways to help you manage sexual performance anxiety in the treatment section.

Depression and low self-esteem

It’s common in men with ED to feel angry, sad, frustrated, unsure of themselves or even less ‘manly’. These feelings may lead to lack of self-esteem and, in severe cases, to depression.

On the flipside, a man with depression rooted in other causes is more likely to lose interest in activities, including sex, which can lead to ED.21

Research published in the Journal of Sexual Medicine showed that the risk of ED increases by 39% in patients with depression, and that the incidence of ED is 1.39 times higher in patients with depression than in those without depression.22

Because of the link between the two conditions, doctors commonly screen men for ED when they present with depression, and vice versa.

Sexual attitudes and upbringing

As famous sexuality expert and therapist, Esther Perel says, much of our adult sexuality, our current desires, the way we relate to others and how we perceive our self-worth, is the product of the way we were raised and the environment in which our sexuality developed.23

For many people, sexual education was shaped by moral and religious forces, which means they grew up believing, for example, that sexual desire outside of a monogamous, heterosexual relationship is immoral and that masturbation is a sin.

Men raised in such environments often associate sex and masturbation with shame and may experience sexual dysfunction, such as premature ejaculation and ED.

Childhood abuse and sexual trauma can also be at the root of a man’s ED.

ED associated with other sexual dysfunctions

Some guys can confuse premature ejaculation or loss of libido with ED.

Premature ejaculation is one of the most common sexual dysfunctions in men, affecting up to 30% of Aussie guys.24 More than you thought, right?

If you fear that your hard on won’t last long enough, it may result in premature ejaculation.25 Or, if you’re worried about ejaculating too soon, it can cause you to have ED.

It’s a bit like like a chicken and egg situation – it’s hard to tell what came first

A doctor can help you determine the cause of the issue so you can seek the right treatment.

Medications

Some medications can cause ED or worsen the symptoms of ED.

The common culprits include drugs used to treat:6,26

  • High blood pressure – these drugs can affect blood flow to the penis, making it difficult to get an erection.
  • High cholesterol – Some research27 has found the use of statins to manage high cholesterol may lower testosterone levels in the body, affecting libido.
  • Depression, anxiety and other psychiatric disorders – these drugs alter the chemicals in your brain, which can impact sexual function.
  • Prostate cancer – certain chemotherapy drugs can damage parts of the nervous system, including the nerves involved in controlling erections.
  • Heart failure – certain heart failure drugs can lower the level of testosterone in your body or block it from working, which can reduce your libido.
  • Pain – certain opioids can also lower testosterone levels.

While it’s normal to want to stop a medication that’s getting in the way of your sex life, you should always speak to your doctor first. They’ll help you find a balance between treating your symptoms and managing the side effects.

Recreational drugs

Using alcohol or other recreational drugs for a fun night out could actually be the thing that’s keeping you soft.

Recreational drugs can include illegal drugs but also prescription drugs that are misused.

Here’s how some of the common ones can impact you sexually:

  • Alcohol – If you’ve heard of “whisky dick”, or even experienced it, you’ll know what we mean. Whilst a few alcoholic drinks can help get you in the mood, one too many – and chronic drinking – affects sexual function in several ways. Firstly, alcohol dehydrates, taking away the blood and oxygen flow needed to bring greater sensation to the genitals. Secondly, it lowers testosterone levels, which means it’s hard to get in the mood for sex. Lastly, it’s a nervous system depressant, which means circulation and nerve ending sensitivity are all suppressed, making it harder to get an erection.28
  • Cocaine – This common party drug might boost your sex drive and may even help you last longer in the sack while you’re high. But once the effects wear off – and after long term use – cocaine can cause ED, delayed orgasms, and lower sperm count.29,30 Amongst other effects, the drug causes blood vessels to constrict, decreasing blood flow to the penis.
  • MDMA – Also known as ecstasy, MDMA creates feelings of wellbeing and relaxation because it causes the release of neurotransmitters like serotonin. But whilst you might have a great desire for sex on MDMA, the actual execution can be difficult. MDMA constricts your blood vessels just like cocaine, which means blood flow to the penis – and therefore erections – is more difficult.
  • Dextroamphetamine – Commonly called ‘dexy’, this drug is prescribed to treat symptoms of attention deficit hyperactivity disorder (ADHD) and narcolepsy. Because of its stimulant effects, it’s commonly misused by people to get high. Just like MDMA and cocaine, it causes blood vessels to constrict, making it hard to get a hard on.
  • Marijuana – It might make you feel chilled and even increase sexual desire, but marijuana interferes with erections by preventing the smooth muscle in your penis from relaxing to let enough blood flow in.
  • Nicotine – There is strong evidence that links cigarette smoking with ED, and it’s not just in long term smokers. People exposed to nicotine for even a short while can negatively affect sexual arousal and cause ED. Smoking hampers circulation all over the body, including the genitals, making it harder to get an erection.

Pornography

Watching porn is enjoyable, and based on the stats, we think most of you would agree.

According to Pornhub, Australians rank 7th in the world for visitors to the site, despite our smaller population.

Whilst watching porn might seem harmless, evidence increasingly suggests that watching too much porn can cause problems with sexual performance, such as ED.35

One Italian study that surveyed 28,000 men found that excessive consumption of porn, starting at 14 years of age and continuing daily into their mid-20s, desensitised them to even the most violent images.36

According to the Italian Society of Andrology and Sexual Medicine, these men develop their sexuality largely divorced from real life relationships, leading to “gradual but devastating” consequences.

Symptoms usually start with lower reactions to porn sites, then a general drop in libido and in the end, it becomes very difficult, or impossible, to get an erection.

The type of porn you watch also matters. Unlike the soft-core porn that used to be available in Playboy and Penthouse magazines, online porn depicts more graphic, kinky and even violent behaviour. The more you watch, the more likely you are to develop unrealistic expectations of sex as well an increased tolerance for sex – much like a drug addiction.35

On a neurological level, you decrease your sensitivity to the pleasure-seeking chemical dopamine. This not only desensitises you to real sexual encounters with a partner, but fuels the addiction and makes it difficult to quit porn.37

The good news is that the condition is reversible with proper assistance.

If you find that the only way you can get a hard on and climax is through porn, it might be time to take a break from it and concsult with a doctor or psychologist.
Chapter 3

Myths About Erectile Dysfunction

There’s a lot of good information about ED out there, but there’s also some complete furphies. So, what should you believe?

This chapter will dispel some of the common myths and put your mind at ease about wearing tight underwear!

5 minute read
Key takeaway:
  • It pays to do your research about ED to separate fiction from fact. Talk to your doctor if you have specific concerns.
Myth #1

ED only happens to older guys

False

It’s true that the prevalence of ED increases with age, but that doesn’t mean younger guys are immune to it.

One study published in the Journal of Sexual Medicine found that one in four men seeking medical help for ED is younger than 40 years.38

And whilst it is common for the cause of a young guy’s ED to be psychological – like performance anxiety – another more recent study found that physical causes may be behind more young men’s ED than previously thought.39

So, even if you’re a young, fit guy who is experiencing ED, your doctor will likely assess you for both psychological and physical causes, just to be sure.

Myth #2

If you can’t get it up once, it means you have ED

False

Few guys bat a thousand in the bedroom, and an off night or two is usually nothing to worry about.

Most of the time the reason you can’t get it up can be linked to something temporary, like the fact that you drank too much earlier in the day or you had an exhausting day at work and your mind just wasn’t up to the task.

If, however, you’re experiencing ED over a longer period of time – like several months – it may be a more chronic issue which you should speak to a doctor about.

Myth #3

Men with erectile difficulties can’t achieve orgasm

False

Many people believe if a bloke can’t get it up, he can’t have sex or orgasm. That’s actually not true.

In fact, you don’t need a full erection to be able to ejaculate.7 That’s because two different sets of nerves control erection and orgasm, so if erections aren’t happening, those other nerves can still trigger orgasm.40

Phew!

Myth #4

If a man has ED it means he doesn’t feel desire

False

Erection problems and low desire are actually two very different things.

Low desire means you don’t feel like having sex. This could be because you’re not feeling well, you’re under stress, you don’t fancy your partner or your testosterone levels are low.

Erection problems, however, mean you could want to have sex (which means you feel desire), but your penis won’t get hard – or just not as hard as it used to be. Such cases are usually rooted in a physical issue, such as vascular disease or nerve damage.

Myth #5

Bike riding causes ED

Inconclusive

The research is not conclusive on this one…

Over the last few decades, research has found that some male cyclists develop damage to the main nerve in the perineum (the area between the anus and the penis), which sends blood to the penis.41 Over time, the damage may lead to erectile difficulties.

A 2014 study refuted this, however, finding no link between riding and ED.42

So, whist the jury is still out, it’s worth erring on the side of caution. If you feel any tingling or numbness in your penis after rides, stop riding for a week or two.43

Also, make your ride more comfortable by getting a more padded seat and adjusting the handle bar height. Padded riding shorts could help too.

Myth #6

Wearing tight underwear causes ED

False

If you’re strictly a tight underwear/briefs kind of guy, you needn’t worry about it causing you ED, but there is something else you should keep in mind – your fertility.

Tight underwear has been associated with infertility because it can increase the temperature of the testicles, and therefore the sperm.44 So, switch it up every so often and give boxers a whirl.

Myth #7

Masturbation causes ED

False

Most blokes masturbate – it’s natural! It also has many health benefits, like releasing tension and reducing stress.45

But can it directly cause ED? The answer is no.

There is research suggesting that masturbating to porn can contribute to ED by desensitising you to certain imagery and physical intimacy, but masturbation itself does not physically cause ED.

Myth #8

Your bad habits don’t affect your penis

False

Your vices aren’t just bad for your health overall, but they can affect your erections too.

Lighting up, drinking alcohol and illicit drugs have all been linked to erectile problems, mainly because they affect blood flow to the penis.

If you want to be able to perform, go easy on these activities or don’t do them at all.

Myth #9

Only men feel the impact of ED

False

This certainly isn’t true.

Both a man and his partner can be affected by ED. Whilst it obviously affects a couple’s sex life, it can also carry over into the rest of the relationship.

Often blokes are ashamed to talk about ED and get help. Instead they pull away from their partner, who in turn feels rejected, worries they’re not attractive enough, and may even suspect an affair.

The best policy is honesty. As uncomfortable as it may be, discuss your ED with your partner and get help, both for your health and the success of the relationship.

Chapter 4

Treatments for Erectile Dysfunction

ED is a medical condition like any other, and fortunately, it’s very treatable.

In this chapter we explore all the possible treatment options, from natural and lifestyle changes, to medical and surgical interventions.

5 minute read
Key takeaways:
  • Leading a healthy lifestyle can help manage common underlying causes of ED.
  • Quitting porn can be tough, but there are support communities and tools to help you through your journey.
  • Some herbal supplements may support healthy erections, but in most cases, more research is needed to prove their effectiveness.
  • Orla prescription medicines are available to help treat erectile difficulties, and they're effective in the majority of men. Speak to a doctor about your options.
  • Minimally-invasive treatments or surgery may be an option for men who don't benefit from oral medication.

Is erectile dysfunction curable?

For most men, ED can be effectively treated, especially if there is a reversible underlying cause.

Read on to find out about all the treatment options.

Natural treatments and prevention

Get ahead of the game by looking after your everyday health. Your penis – and your partner – will thank you later.

Get regular exercise

Exercising regularly will give you better stamina and a much better sex life in general.

Firstly, exercise stimulates the release of hormones and boosts libido. Secondly, it stimulates the growth of blood vessels and increases blood flow, which naturally leads to enhanced blood flow to the penis. Thirdly, the awareness of being healthy and fit gives you more confidence overall – and we all know confidence is sexy!19

Eat a heathly diet

When it comes to food, studies show that men who eat a traditional Mediterranean diet have a lower risk of ED.46 That means eating lots of vegetables, fruits, whole grains, nuts, fibres, fish, virgin olive oil and having a moderate wine intake.

Amongst other benefits, these foods are thought to raise nitric oxide levels, which helps blood vessel to relax and widen, helping blood flow to the penis.46

Stop smoking and reduce alcohol

Smoking is a risk factor for heart disease, stroke, vascular disease and type 2 diabetes, which means it’s also a risk factor for ED. If you’re a smoker, research says that quitting can improve your ED, and the earlier you quit, the better.47

And you might like to rethink how many beers you’re consuming. Whilst a few drinks can help you kiss your bedroom nerves goodbye, overdoing the booze can cause you to have erectile difficulties.

One study showed that 33% of alcohol-dependent men experience ED long term, and the more they drank, the more sexual difficulties they had.48

Ideally, cap your intake of alcohol to two standard drinks per day.

Get stress levels under control

Stress and erections don’t go together.

If you’re struggling to get or maintain an erection – or even just get in the mood for sex – consider doing stress-relieving activities such as meditation, breathing exercises and yoga to help improve your mindset and libido.19

In particular, mindfulness-based meditation has been shown to be effective as it helps to focus your thoughts intently on the present moment. Just 10 minutes a day can make a difference.49

Also, don’t be afraid to communicate your fears and desires with your partner. Since a lot of sexual issues start with stress and anxiety, simply sharing your concerns with your partner can help take a load of your mind.19

Get enough sleep

When life gets busy one of the first things we tend to compromise is sleep, but that’s a bad idea for your sex life.

Sleep helps us reduce stress and keeps the immune system healthy, which is essential for energy and a healthy sex drive.19

If you can’t get the normal 7-9 hours of sleep per night, try power napping.

Difficulties sleeping and sleep apnoea (trouble breathing while asleep) can also negatively impact your sex life.50 Speak to a doctor for guidance on how to manage these more serious issues.

Consider psychological therapy

If your erectile difficulties are caused by psychological issues such as performance anxiety or depression, therapy from a trained psychologist, doctor or psychiatrist can help. It can also benefit men who have lost their sexual confidence, even if their ED is caused by physical factors.

Counselling can be done individually or with a partner, but if you’re in a relationship, it’s most beneficial when you include your partner. Studies have shown that for men with stress-related ED, including their partner in therapy resolves the problem 50%-70% of the time.51

Do Kegel exercises

Kegels are usually associated with women looking to strengthen their pelvic floor muscles during pregnancy, but they can also help with erectile difficulties.52

What’s a pelvic floor muscle?

You can find them by stopping mid-stream two or three times when you urinate. The muscles you can feel activating while you do this are the pelvic floor muscles.

Each Kegel squeeze consists of holding these muscles for five seconds and then releasing them. Work up to 10-20 repetitions per day. You should start to notice a difference after six weeks.

Tune out porn

Porn-induced erectile dysfunction is becoming more and more common in young men.

Watching and masturbating to porn too much can desensitise you to sex in real life, leading to erectile difficulties and relationship issues.

Some ways you can tackle the issue include:

  • Go cold turkey – Quit porn for a significant period of time – about 90 days – and stop masturbating for at least 30 days. After 30 days, introduce masturbation again, but limit it to once or twice a week and don’t use porn. Rather focus on physical sensations of pleasure or imagine real life sexual encounters. After a few weeks, practice starting and stopping during masturbation to ensure you can maintain an erection.
  • Join an online support community – Communities like NoFap help participants abstain from porn and masturbation for a period of time. It can help you to have support from other people experiencing the same challenges as you while you go through the change.
  • Install an internet filter or an accountability program on all your viewing devices – Programs like CovenantEyes help people overcome porn by monitoring their screen activity and sending a report to a trusted friend who holds you accountable for your online choices. They also offer a bunch of resources to help you better understand your porn addiction and how to free yourself from it.
Try herbal supplements

If natural medicines are your preference, there are a number of supplements that may support healthy erections, especially if your ED has a physical cause. In all cases, however, more research is needed to prove their safety and effectiveness and they should be taken under the guidance of a health professional.

  • L-arginine and Pycnogenol – L-arginine is an amino acid made naturally in the body and can also be found in certain protein-rich foods such as fish, red meat and poultry.53 Pycnogenol is a plant extract from the pine tree.54 Some evidence shows that in combination, these two ingredients boost the production of nitric-oxide in the body, which helps improve blood flow in men with ED.55
  • Panax ginseng – This is a Korean herbal remedy that has been shown in several studies to be more effective than placebo at improving ED, however more rigorous research is still needed.56 It can also cause side effects such as insomnia, headaches and low blood sugar, and may interact with other medicines.57
  • Yohimbe – There’s some evidence that bark from the African yohimbe tree can help with ED by increasing blood flow.58 It contains a compound called yohimbine, which has been used traditionally in Africa as an aphrodisiac. The amount of yohimbe in dietary supplements varies, however, and it can have side effects such as high blood pressure, tremors and anxiety.
  • Ginkgo biloba – This herb from a Chinese tree may increase blood flow to the penis, but research is still unclear.59 According to Columbia University, it may only be effective in helping treat sexual dysfunction that has been caused by SSRI medicines used to treat depression.60 You should, however, avoid Ginkgo if you take blood-thinning medicines as it can increase your risk of bleeding.
  • Propionyl-L-carnitine – This is an amino acid naturally produced in the body. It is possibly effective for treating symptoms of low levels of testosterone in men and is sometimes used alongside certain prescription ED medications to improve their effectiveness, especially in men whose ED is due to diabetes or poor circulation.61
Just because a supplement is 'natural' or 'herbal' doesn't mean it can't have side effects. Always consult with a health professional before starting any new supplement to determine whether it's safe for you and whether it can interact with any other medicines you are taking.

Non-invasive medical treatments

Australian law prevents us from talking about certain medications for ED until you’ve spoken to a doctor, so our lips are sealed.

What we can say, though, is that there are clinically proven oral medications to treat ED that are effective in the majority of men.1

Curious? Arrange a discreet online consultation with a medical practitioner to determine if this is an option for you.
Beware of counterfeit drugs being sold to treat ED. They're some of the most counterfeited drugs in the world. Only take medications prescribed to you but your doctor, who can advise whether it is suitable to you.
Vacuum devices

Also known as a penis pump, this is a mechanical way of producing an erection for men who can’t (or prefer not to) take medications, or find that they’re not working. It’s best for men diagnosed with moderate ED.62

The pump works by placing a cylindrical tube over the penis. As air is pumped out of the cylinder, the pressure build-up helps to draw blood into the penis, causing the penis to enlarge. A rubber ring is then placed around the base of the penis to keep the erection.

The duration of the erection depends on the individual, but approximately 30-minutes can be expected.62

Whilst it’s a drug-free option, many men prefer other treatments for ED due to the lack of spontaneity involved with using a penis pump as well as possible side effects.

Remember: All medications and medical devices can have side effects. It's important to understand these and discuss them with the doctor before use.

Minimally-invasive medical treatments

These might make you squirm a little, but it’s good to know your options.

Penile injection or suppository

Legally, we can’t name this treatment, but there is a medication that can increase blood flow when injected into the penis or when inserted as a suppository into the opening at the tip of the penis.63 It can give you an erection within 5-10 minutes that lasts up to an hour.

This may be an option for men who find oral ED medications don’t work well.

A doctor’s consultation is needed to determine whether this is a suitable treatment for you.

Shockwave treatment

Low intensity shockwave therapy (LISWT) is a fairly new treatment for men whose ED is caused by blood vessel problems.6 Generally men with mild to moderate ED who have had some response to oral medications are ideal candidates for LISWT.64

During the treatment, non-invasive low-intensity sound waves are passed through the erectile tissue. It is thought that the treatment works by clearing plaque out of blood vessels and encouraging the growth of new blood vessels.65

Studies show that it can significantly improve ED,66 but more research is needed before clear recommendations on its use can be made.

It also costs in the thousands of dollars, so it’s not an option for all candidates.

Surgical treatments

If non-surgical treatments fail to work, surgery may be an option.

Penile prosthetic implant

This involves a device being surgically implanted into the penis. Prostheses are available as either malleable (bendable) rods or an inflatable device.

With the malleable rod implant, the penis will always be semi-rigid and just needs to be lifted or adjusted into the erect position before sex.67

Alternatively, the inflatable implant makes use of saline, which is pumped into cylinders in the penis to get an erection. It is more natural looking than the rod implant and it allows men to have an erection when they choose.67

However, keep in mind, while penile implants can help men get an erection, they don’t increase sexual desire or sensation, nor will they make your penis larger than it naturally is at the time of surgery.68

Vascular surgery

This is a major operation and it is rarely used.

It involves surgery on the veins and arteries that supply blood to the penis and is sometimes recommended for young healthy men who develop ED after trauma in the area around the penis.1

Chapter 5

Next steps

This is the bit where we give ourselves a plug, because, well, we think we’re worth it and we’re sure you’ll think the same if you decide to come on board.

1 minute read
Key takeaway:
  • Mosh connects you with a doctor or psychologist online to help treat your ED. We'll tailor a treatment to meet your budget and needs, and ship it to your door discreetly. Easy as!

The Mosh process


1. Tell us about you

To start answer some simple questions about your health and medical history.


2. Hey Doc

Text, call or video chat with an Australian doctor where they'll figure out the best course of treatment for you.


3. Discreet delivery

Confirm your treatment and partner pharmacy and your prescription will be delivered to your door.

Why we’re different

  • No long-term contracts – We’re confident in our products our service and we think you’ll be happy with the results and want us to continue to help. If you aren’t happy, stop any time. It’s that simple.
  • Discreet, online consultations at times that suits you – our doctors and nurses can evaluate your situation and treatment program without meeting in-person. They also available from 8am-6pm every day of the year and afterhours are an option too, so you don’t have to disrupt your work day.
  • Custom, comprehensive treatment plans – Every person is different so their treatment plans should be too.
  • Continuing support at no additional cost – Your treatment plan includes nurse follow-ups, educational support material, and ongoing medical support at no extra cost.
  • Privacy and discretion – Not only can your consultations be done in the privacy of your home, but your treatments will be delivered to your door every three months in discreet, unmarked packaging.
  • Fast delivery and tracking – We offer guaranteed next-day delivery and online order tracking.
  • Pause deliveries anytime – If you’re going away or want to take a break from your orders, you can pause them anytime. There is no need to cancel altogether.

This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It should never be relied upon for specific medical advice. If you have any questions or concerns, please talk to your doctor.

References

  1. https://www.betterhealth.vic.gov.au/health/healthyliving/erectile-dysfunction
  2. https://healthengine.com.au/info/male-sexual-dysfunction-erectile-dysfunction-impotence
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4467226/
  4. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/erectile-dysfunction/
  5. https://www.ncbi.nlm.nih.gov/pubmed/23651423
  6. https://www.healthymale.org.au/files/resources/erectile_dysfunction_fact_sheet_healthy_male_2019.pdf
  7. https://www.health.harvard.edu/a_to_z/impotence-erectile-dysfunction-a-to-z
  8. https://www.healthline.com/health/erectile-dysfunction/common-causes-impotence#medications
  9. https://my.clevelandclinic.org/health/diseases/15029-heart-disease--erectile-dysfunction
  10. https://study.com/academy/lesson/how-the-central-nervous-system-controls-erection-ejaculation.html
  11. https://www.choosingwisely.org/patient-resources/testosterone-for-erection-problems/
  12. https://www.hopkinsmedicine.org/health/conditions-and-diseases/erectile-dysfunction
  13. https://www.healthline.com/health/erectile-dysfunction/weight-loss-and-ed#obesity
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479584/?report=classic
  15. https://onlinelibrary.wiley.com/doi/abs/10.1111/jsm.12483
  16. https://www.mayoclinic.org/diseases-conditions/peyronies-disease/symptoms-causes/syc-20353468
  17. https://www.healthline.com/health/erectile-dysfunction/peyronies-disease#causes
  18. https://www.healthline.com/health/erectile-dysfunction-anxiety-stress#causes
  19. https://www.psychologytoday.com/au/blog/how-the-mind-heals-the-body/201412/the-stress-sex-connection
  20. https://my.clevelandclinic.org/health/articles/11832-depression-and-erectile-dysfunction
  21. https://www.healthline.com/health/depression/sexual-health#symptoms
  22. https://www.jsm.jsexmed.org/article/S1743-6095(18)31007-5/pdf
  23. https://goop.com/wellness/sexual-health/upbringing-says-bed/
  24. https://www.racgp.org.au/afp/2015/october/premature-ejaculation-a-clinical-review-for-the-general-physician/
  25. https://emedicine.medscape.com/article/435884-overview#a4
  26. https://www.healthline.com/health/erectile-dysfunction/recreational-drugs-linked-to-ed#prescriptions
  27. https://www.webmd.com/erectile-dysfunction/news/20100416/statins_may_lower_testosterone_libido#1
  28. https://drugabuse.com/is-alcohol-wreaking-havoc-on-your-sexual-performance/
  29. https://www.addictioncampuses.com/blog/cocaine-and-sex/
  30. https://sexinfo.soc.ucsb.edu/article/sex-and-cocaine
  31. https://www.sciencedirect.com/topics/neuroscience/mdma
  32. https://www.ncbi.nlm.nih.gov/books/NBK507808/
  33. https://www.healthline.com/health/erectile-dysfunction/recreational-drugs-linked-to-ed#recreational-drugs
  34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2864030/?report=classic
  35. https://www.everydayhealth.com/news/erection-problems-this-habit-may-why/
  36. http://www.ansa.it/web/notizie/rubriche/english/2011/02/24/visualizza_new.html_1583160579.html
  37. https://www.psychologytoday.com/au/blog/therapy-matters/201205/does-porn-contribute-ed
  38. https://www.ncbi.nlm.nih.gov/pubmed/23651423
  39. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5313296/?report=classic
  40. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5340504/
  41. https://www.healthline.com/health/erectile-dysfunction/can-cycling-cause-ed#cycling-and-erections
  42. https://www.liebertpub.com/doi/abs/10.1089/jomh.2014.0012
  43. https://www.health.harvard.edu/staying-healthy/can-cycling-cause-erectile-dysfunction
  44. https://www.groupeproxim.ca/en/article/myths-about-erectile-dysfunction#section4
  45. https://www.medicalnewstoday.com/articles/324068.php#can-masturbation-cause-ed
  46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510347/
  47. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2004.05162.x
  48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917074/
  49. https://www.psychologytoday.com/us/blog/all-about-sex/201905/mindfulness-meditation-helps-resolve-many-sex-problems
  50. https://www.adelaide.edu.au/news/news69602.html
  51. https://www.webmd.com/erectile-dysfunction/guide/sex-therapy-erectile-dysfunction
  52. https://www.medicalnewstoday.com/articles/5702.php#exercises
  53. https://www.mayoclinic.org/drugs-supplements-l-arginine/art-20364681
  54. https://www.healthline.com/nutrition/nitric-oxide-supplements#erectile-dysfunction
  55. https://www.ncbi.nlm.nih.gov/pubmed/12851125
  56. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2561113/
  57. https://www.webmd.com/vitamins/ai/ingredientmono-1000/panax-ginseng
  58. https://nccih.nih.gov/health/yohimbe
  59. https://www.medicalnewstoday.com/articles/316082.php#ginkgo
  60. https://goaskalice.columbia.edu/answered-questions/ginkgo-biloba-and-physiological-impotence
  61. https://www.webmd.com/vitamins/ai/ingredientmono-803/propionyl-l-carnitine
  62. https://www.healthline.com/health/mens-health/how-to-use-a-penis-pump#steps
  63. https://www.webmd.com/erectile-dysfunction/guide/alprostadil-treat-ed#1
  64. https://health.clevelandclinic.org/when-is-low-intensity-shockwave-therapy-a-good-option-for-erectile-dysfunction/
  65. https://www.healthline.com/health-news/shockwave-therapy-for-erectile-dysfunction#2
  66. https://www.ncbi.nlm.nih.gov/pubmed/27321373
  67. https://www.webmd.com/erectile-dysfunction/guide/penile-prosthesis#1
  68. https://www.mayoclinic.org/tests-procedures/penile-implants/about/pac-20384916