In diabetes, vasoconstrictors and vasoactive factors are increased in addition to structural changes and attenuation of relaxation responses in the corpus cavernosum. A shifting of the balance of vasoactive factors occurs such that relaxation factors (eg, nitric oxide [NO]) are inhibited and contractile factors are induced in microvascular disease. With epidemiological predictions suggesting that the incidence of diabetes mellitus will increase to 300 million by 2025, management of diabetes-induced ED is increasingly important.
The causes can be classified into physical (medical) and psychological (mental). As per BBC Health, about 70% of impotence cases are from physical causes (high cholesterol, sexual hormone changes, nutritional deficiencies, hypertension, thyroid, kidney disorders, diabetes, obesity, poor blood circulation, excessive drinking or smoking, certain medications, surgery or injuries, misuse of sexual organs for a long period, enlarged prostate or prostate cancer, etc.) and 30% from psychological causes (anxiety, stress, depression, mental health issues & relationship problems).

One study published in 2013 found that it releases nitric oxide, a feature that may contribute to an erectile response independent of testosterone level. Tribulus also increases testosterone and luteinizing hormone as well as DHEA. Tribulus is a favorite of athletes and body builders, some of whom have reported increased breast tissue at high dosages, due to the conversion of testosterone to estrogen. Although Tribulus has been used for centuries in the East, researchers in the West have yet to document its safety.
A cold slice of watermelon can do more than just satisfy thirst and hunger during the warm summer months; it can help with bedroom satisfaction. Citrulline, the amino acid found in high concentrations of watermelon, is found to improve blood flow to the penis. A 2011 study revealed men who suffered from mild to moderate ED and took L-citrulline supplementation showed an improvement with their erectile function and were very satisfied. Natural watermelon juice, or “nature’s Viagra,” can also be easier on the stomach, since taking pills like Viagra can cause nausea and diarrhea.

Half of the men in the study (50%) were able to complete sexual intercourse in more than 75% of attempts. A comparison of all the above mentioned parameters (NPT, hormone profile and the Florida Sexual Health Questionnaire) before and after yohimbine supplementation clearly showed that men who had milder erectile dysfunction showed improvement while those with severe erectile dysfunction failed to show much improvement.
The phrase “use it before you lose it” can be applied when it comes to helping men with ED regain normal erectile function. Pelvic exercises, more commonly known as kegel exercises, are used to promote urinary continence and sexual health. They help to strengthen the bulbocavernosus muscle, which does three things: allows the penis to engorge with blood during erection, it pumps during ejaculation, and it helps empty the urethra after urination, according to Healthline.
The herb is particularly effective for those whose willy woes are based on other medications: An older study from the University of California found ginkgo biloba is 76% effective in treating sexual dysfunction caused by antidepressants. “Gingko helps counteract sexual dysfunction caused by certain antidepressants called SSRIs by blocking serotonin activity in the erectile centers of the brain, ultimately leading to better synthesis and bioavailability of nitric oxide,” Walker explains.
A plant like Cleome gynandra is a popular vegetable used all over Uganda and is on sale in most markets. Other medicinal plants that are food stuff include Allium cepa (onions), Allium sativum (garlic), Rhus vulgaris, Capsicum frutescens(red pepper) and Zingiber officinale (Ginger) are also on sale in most markets of Uganda and internationally. In addition, the roots of Mondia whiteii are used as an aphrodisiac for males and for improving female sexuality (women's Viagra) in most areas of Uganda11 particularly in urban centres and the Kampala City. To date, Mondia whiteii has been an old traded medicinal plant in most in Kampala. Recently the patented ‘Mulondo Wine’ a drink flavoured by the roots of Mondia whiteii has hit the national and international markets35. The Mulondo Wine is also believed to be an aphrodisiac for both men and women.
Know that you’re not alone.  20 million American men have ED. A study showed that one quarter of men under 40 also experience it. Though this is worrisome, it also means that these issues shouldn’t be solely discussed on the shady forums and message boards in which sketchy elixirs are advertised. If you think you may have ED, just know that you don’t have to go down a internet rabbit-hole to find answers.

By doing Kegels, it’s actually possible to tone up the bulbocavernosus muscle. This muscle is extremely important for men. Thus, it lets the penis to fill with blood in order an erection could occur. The muscle also pumps during the process of ejaculation. In addition, it allows emptying the urethra after you urinate. The study has indicated that it’s necessary to perform Kegel exercises 2 times per day for at least 3 months to achieve considerable results.
With wide-ranging action, ginseng (Panax ginseng), also called Asian ginseng, has been shown in human studies to have an anti-stress effect; improve physical and mental performance, memory, and reaction time; and to enhance mood. Ginseng increases physical working capacity in humans in many ways, including by stimulating the central nervous system, and regulating blood pressure and glucose levels. A 2015 study found that active constituents in ginseng had significant benefit for ED in men with diabetes.

Yohimbe. Before Viagra and the other prescription erectile dysfunction drugs became available, doctors sometimes prescribed a derivative of the herb yohimbe (yohimbine hydrochloride) to their patients suffering from ED. But experts say the medication is not particularly effective, and it can cause jitteriness and other problems. "It's not a great drug," says McCullough. "And I suspect the herb is not as potent as the pharmaceutical version." What's more, evidence shows that yohimbe is associated with high blood pressure, anxiety, headache, and other health problems. Experts discourage its use.

In fact, one common reason many younger men visit their doctor is to get erectile dysfunction medication. Often, men with erectile dysfunction suffer with diabetes or heart disease, or may be sedentary or obese, but they don’t realize the impact of these health conditions on sexual function. Along with erectile dysfunction treatment, the doctor may recommend managing the illness, being more physically active, or losing weight.

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