Erection Pills over the counter, vitamin, herb and supplement, how to improve
Natural male erection enhancers that work, alternatives to prescription medications, male problem review due to diabetes and impotence
June 26 2017 by
Ray Sahelian, M.D.

Natural way to have a better erection with herbs, supplements, vitamins
An erection problem, or dysfunction, is one of the commonest disorders of male sexuality, especially in older years. Penile erection depends on a complex interaction of psychological, neural, vascular and endocrine factors. Testosterone hormone has an important role in this process. Neurotransmitters are also involved in starting and maintaining a better penis erection including dopamine and nitric oxide. Men who have a weak erection seek an erection ring, pump, vacuum device, cream, or search for an herbal erection pill over the counter or by a doctor's prescription such as Viagra or Cialis. To maintain a strong penis erection, it is best to have a good sleep at night, have low stress, eat a healthy diet with plenty of vegetables and fish, have a moderate amount of exercise, do yoga, meditation, or relaxation techniques, and have an open heart and close intimacy. All these steps can lead to a longer erection time in a man. Before you take any prescription medications or over the counter natural supplements and aphrodisiacs for erection problems, please make sure you read the cautions listed on this impotence page.
Get research information on several studies on various supplements and natural medicine topics -- including ways for a better erection without the need for Viagra, Levitra, Cialis or other pharmaceutical medications.

Passion Rx with Yohimbe -- Medical Doctor formulated for Erection Enhancement
This natural libido and performance booster provides an erection problem solution that are sometimes noticed within a day or two. Various doses and extracts of dozens of herbs from a number or raw material suppliers were tested to determine the ideal dosage and combination for optimal benefit with the fewest side effects. After years of research, a unique proprietary blend with more than a dozen herbal extracts from the best raw material suppliers has been created.


Passion Rx enhances healthy:

The potent herbal extracts in Passion Rx include ashwagandha, catuaba, cnidium, herba cistanches, horny goat weed, maca, muira puama, passion flower, tongkat ali extract and LJ100, tribulus extract and yohimbe bark. A version of Passion Rx without yohimbe is also available.

Q. I have been suffering from venous leak and erection problems for a long time. I have just begun using maca pills. I plan to associate them with horny goat weed or other sex and erection enhancing herbs. I can not maintain an erection, that's my problem. Is there a natural erection pill that works well?
    A. It is not clear when you say venous leak whether that was a diagnosis confirmed by a urologist or perhaps you think that is the problem based on not being able to maintain an erection adequate for sexual activity. Nevertheless, it is possible that sexual herbs such as maca, horny goat weed, tribulus, mucuna pruriens or a combination such as Passion Rx could help with erection problems. It is impossible to predict which sexual herb or which sexual formula will be effective. As a general rule, it is a good idea to use lower dosages when combining since side effects could occur when high amounts are used.

Erection herbs and plants, do they work?
Q. According to your personal experience what herb (other then yohimbe) works best for increasing the erection duration? I don't use yohimbe anymore becasue I don't like the feeling it gives me such as sweating.
   A. I am not aware of any herbs that work as quickly as yohimbe for erection enhancement without causing adverse effects due to the massive doses that need to be taken for a quick effect but tongkat ali could work quickly in high doses with the negative reactions of anxiety and excessive stimulation.

Erection vitamin supplements, herbs and herbal formulas sold over the counter
There are some vitamin or supplement products that offer natural erection help. Most of the regular vitamins, such as vitamins A, B, C, D, and E do not have much of an immediate influence on penile erection and do lead to a harder erection. However, certain vitamin like nutrients, for instance choline, can be considered an erection vitamin.
   Lifestyle changes are important. Stress can certainly inhibit penile engorgement and reduce libido.

Which herbs or dietary supplements should be avoided because they hinder erection function?
   Kava herb and 5-htp could interfere with optimal erection and sensation. 5HTP use could reduce sexual urge and interest.

Do you know how to restore spontaneous erections? Do you have anything that would help me do this? I am 55 years old.
   Eating more fresh garlic, onion, ginger, taking fish oils or eating more fresh fish, sleeping deep at night, exercising a half hour a day or a long walk, having low stress can all help, along with minimal masturbation in order to keep the penis more sensitive. I suggest minimizing alcohol and marijuana use.

Foods, diet, for better erection, stronger and with more blood flow
Eating foods that are rich in certain flavonoids has been associated with a reduced risk of erection problems in men. Of the different flavonoids, anthocyanins (found in blueberries, cherries, blackberries, radishes and blackcurrant), and flavanones and flavones (found in citrus fruits) offer the greatest benefits in preventing the condition. The top sources of anthocyanins, flavones and flavanones are strawberries, blueberries, red wine, apples, pears, and citrus products.

Daily exposure to sunlight early in the morning improves sexual satisfaction and increases testosterone levels in men with reduced libido or erection difficulty.

How an erection happens - control
A complex interaction of neural, vascular, and biomolecular activity results in normal erectile function. Two chambers in the penis, the corpus cavernosa, contain sinusoids, which fill with blood and expand to become rigid when smooth muscle is relaxed. Blood flow out of the penis is temporarily stopped (veno-occlusion) to maintain and keep the erection. Neural control is complex but, in general, the sympathetic nervous system inhibits, and the parasympathetic system excites erection. The central nervous system can induce erections without peripheral stimuli, e.g. in nocturnal erections. In general, there are 5 recognized phases in erectile response: latent, tumescent, full erection, rigid erection, and detumescent. The key biochemical event in erectile function is an increase in levels of cyclic guanosine monophosphate, which causes smooth-muscle relaxation and allows an erection to occur. This process is mediated by nitric oxide, produced by neurons and elsewhere, which acts as a gaseous messenger molecule. Average erection length is about 5 to 6 inches, a large size would be over 7 inches. Small is considered less than 4 inches.

Hormone influence, androgens
Erectile response is centrally and peripherally regulated by androgens. In contrast to younger men, elderly men might require higher levels of testosterone for normal sexual functioning. Several studies have indicated that PDE5 inhibitors are not always sufficient to restore erectile potency in men, and that testosterone improves the therapeutic response to PDE5 inhibitors considerably. The synthesis of PDE5 is upregulated by androgens, and the arterial inflow into the penis is improved by giving androgen. Alternatives to testosterone are DHEA and pregnenolone which are sold over the counter.

Daily exposure to high-intensity light early in the morning improves sexual satisfaction scores and boosts testosterone levels in men with reduced libido or erection difficulty.

Erection problems due to poor blood flow
If hardening of the arteries has made your coronary arteries narrow and stiff, that means arteries elsewhere in your body are probably also affected. Atherosclerosis can prevent enough blood flow from reaching your heart, legs, brain and penis. When atherosclerosis affects blood flow to your penis, the blood can't sufficiently fill the penis to allow a suitable erection.

Prescription medications that work
There is no doubt that Viagra, Cialis, and Levitra improve an erection problem. However, there are risks to these erection pills including optic nerve damage and blindness, along with body aches. I prefer natural erection enhancers such as aphrodisiac herbs.

There are others that are of help:
Urology. 2013. Effect of selective alpha-blocker tamsulosin on erectile function in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Tamsulosin HCl capsules showed a significant statistical improvement in the erectile function, sexual desire, and intercourse satisfaction score in patients with lower urinary tract symptoms because of benign prostatic hyperplasia.

Is alprostadil effective for erection enhancement as a prescription medication?
    Yes. However, alprostadil did not become very popular since it has to be injected into the penis shaft.

Prescription medications that stop or prevent erections
Q.  Have been experiencing erection problem and climaxing difficulties. Recently taken off atenolol 25 mg. On Tildiem Retard 90 mg twice daily. Atorvastatin 80 mg. Ezetimibe 10 mg. Clopidogrel 75 mg. Been on Prozac 20 mg for 17 years and recently been put on Modafinil 400 mg. Can I take 5 mg DHEA and Passion-Rx without Yohimbe.
   A. We don't advise taking Passion Rx if you are on multiple medicines. As to DHEA, that is the decision of your doctor since we can't provide individual advice but it is dangerous taking hormones along with all these medications.

Q. I am 28 years old. I was prescribed beta blockers to help alleviate my constant urination. I do not have a enlarged prostate, After taking this beta blocker for a month I noticed that I could not get an erection impotence, I had lack of libido. I had lack or orgasms, also had less ejaculation. Really a total sexual dysfunction. I stopped taking the medicine immediately after experiencing these sexual side effects. I went to my general practitioner and a urologist. They both told me to give it some time, things should return to normal in a couple of weeks. It did not. That was a year ago and I am still suffering these side effects. I was given a prescription of Viagra, a week after I started experiencing these sexual side effects. It helped a little, but the side effects remained the same really. Apparently doctors/urologist are not aware with these medicines are capable of doing these erectile side effects. They can cause havoc to a man's sexual functioning and it seems to be permanent. My girlfriend (been with me for 2 years) is about to leave me. I have been on the internet a lot, because of that, and Dr Ray Sahelian seems to be one of the few doctors that knows the damage these medicines can do. I ask you to please forward this message to him. I just want to know what can his herbs do for a man like me who has suffered from the side effects from beta blocker medicines for over a year.

Erection pill products, over the counter and in pharmacies
Quite a number of erection pills are available, from the pharmaceutical ones to single erection herb products to combination erection herbal products. Even though the drugs work quicker for erection dysfunction, many of the herbal erection pills, over several days, provide a more natural approach to a hard erection. After several days, a spontaneous erection may occur with erection herbs, including a nocturnal erection and morning erection.

NO erection - NO meaning nitric oxide, a neurotransmitter
Nitric oxide is a chemical in the bloodstream that helps dilate blood vessels, including those in the penis, thus maintaining and improving blood flow.

Morning erection cause
What is the significance of "morning erections", aka "morning wood", or the apparent lack of them? I tend to be under the impression that they're associated with higher testosterone levels in the mornings when a man wakes up; is this correct? Does the absence of these spontaneous erections on waking represent a "dip" in testosterone levels - assuming there is no erectile dysfunction? I'd like to know what should a guy be doing to maintain good healthy testosterone levels and libido when he avidly participates in exercise programs such as martial arts and especially weight-training? Does weight-training decrease libido? I was under the impression that exercise, especially weight-training, actually helped to INCREASE testosterone and growth hormone levels, but sometimes I wonder if they decrease them? Sometimes I swear I feel a bit "less" in terms of sex drive, and I've read suggestions that weight-training can decrease testosterone. Apart from generally eating healthy, avoiding over-training and trying to get adequate rest, what can an exercising male do to keep healthy testosterone and libido levels? Does weight-training decrease libido? I'd like to keep a good healthy high sex drive as part of my overall approach to health.
    I have not studied morning erection causes in any detail but it seems to be related to REM sleep and perhaps testosterone levels. Exercise usually improves libido and sexual health since it promotes deep sleep. Sunlight exposure by being outside can also help with deep sleep. However, too much exercise of physical exertion can reduce sex drive. Occasional use of Passion Rx or other sexual herbal formulas or single herbs can be helpful in maintaining a healthy sex drive.

Getting spontaneous erections
Q. What is associated with regaining getting spontaneous erections during the day. I don't get them any more and I would like to. What causes spontaneous erections to happen? Should I try to increase sensitivity with my penis or lower the SHBG? Would avena sativa help or cacao or would another supplement I can purchase help me?
    A. Not masturbating for many days or longer than a week, getting deep sleep at night, moderate exercise, eating more fish and fish oils, garlic, onion, and ginger all help so do a number of aphrodisiac herbs as listed on this page. Taking a Tantra workshop helps, so does getting a massage.
I just wanted to thank you and commend you on such fine nutritional information from your website. I've shared your site to a myriad of people over the years. Finding someone knowledgeable in regard to nutrition is becoming somewhat of a rarity. I'm a 59-year-old white (married) male, and I seem to have erectile dysfunction (E.D.) for the last several months. I just recently have discovered the many benefits of L-Citrulline in the body, having started taking up to 3 grams on a daily basis. I have strong libido (no problem there!); however, when it comes to an intimate time with my wife in the bedroom, I embarrassingly seem to be either half-limp or just completely limp which certainly is a bad state to be in! I seem to be getting an education through all this, knowing that strong libido is not synonymous with a strong erection! This sounds like a real paradox, but I believe I'm accurate. I'm also taking these supplements, in an attempt to resolve my erection problem : DHEA 50 mg every other day (cycle); Ginko Biloba, L-Argine/L-Ornithine, 500/250 mg. (combo capsule), L-Citrulline, up to 3 grams daily. I've also read that when a man fails to have a normal erection in the morning when waking up (and, I haven't had those for years!) that this may indicate a physical problem, possibly heart disease. I realize anything you tell me in reply to this letter is not to be prescriptive (so please "rest at ease") but, can you give me ANY possible suggestions as to what I can or should do to resolve this erection problem issue?
   A. Firstly one has to make sure there are no heart or vascular problems that are a cause. Sometimes taking too many supplements for too long can be counterproductive and it is a good idea to take a break for 3 days from all supplements. Then one can try specific herbs that help with erections such as tongkat ali or a concentrated form known as LJ100 taken at least a half hour before breakfast two days on, one day off. Eating fresh onions and garlic can help with erectile function, and also fish oils or eating more cold water fish such as salmon and halibut and reducing sugar intake and reducing junk foods. Daily walks and mild exercise, and light sun exposure can help with getting a deeper sleep. Passion Rx with yohimbe is another good option.

Q. I have a 4 inch erection of my penis but I am looking for a huge erection that is rock hard and stronger. Do you recommend a pill for this?
   A. I am not aware of an erection pill that increases your size to more than 4 inches. But, it is possible keeping a big erection with some of the suggestions listed at the top of the page.

Q. Does a circumcision affect erection size? and if not, what natural vitamins and or minerals should i take to enhance my erection? Are there any tools you know of that can make my erection larger, an erection enhancer?
   A. Certain herbs and sexual herbal products can improve blood flow to the penis and make it fuller and lead to stronger erection. We have not studied the topic of erection enhancer tools. Circumcision has only a millimiter or two effect on erection size.

Q. i wanted to know what should i be ordering as far as helping me consistently achieving solid erections. I been ordering individual items like Reishi mushroom, maca, eurycoma longifolia extra powder, yohimbe 2000 mg , tribulus nothing seemed to work. I dont have sex with the wife on a normal basis maybe once a year personal issues ie marital insecurities etc but i notice since i stopped having sex i dont have hard erection like when i was 25-30 yrs old im 39 now gained a few extra pounds I'm working on to loose, any suggestions. Will cordyceps work maybe for erection enhancer.
   A. There are dozens of herbs for sexual health and to improve erection, it is difficult to predict which will work in any particular person. Cordyceps is not a potent erection enhancer like some other sexual herbs.

I have had prostate cancer and the prostate removed by radical surgical procedure. I am 59 years old and in good health, want to have sex but cannot get an erection hard enough for intercourse.
   There are a number of herbs and combinations that can be of benefit. It is impossible to predict in any person which one or which combination will work.

I am very much worried about my sexual life with my wife because I have destroyed my massive erection power by using Viagra too much now I am getting married soon and I am very much worried about that. I can't use Viagra for my whole life.
   Natural herbs for erection enhancement are good options to try.

I'm having trouble maintaining an erection during sex especially in the woman on top position. I have been prescribed Viagra 100 mg. I'm 23 and have taken many sex aphrodiasiac herbs, including Passion Rx (which works well for me but i still cant maintain a full erection in every position in sex). I used to smoke marijuana heavily and I did extasy about 11 times. i haven't done extasy in about 2 yrs and i haven't smoked in 3 months but even with Viagra and herbs i still have erection problems. rarely my penis works the way i like it to, and my testicles don't feel as healthy as they used to even with the testosterone boosting herbs like tongkat ali (and yes i do take breaks). I was wondering if u have any advice on how to help me maintain a strong erection during intercourse, my girlfriend is becoming frustrated.
    Sometimes it's good to go back to basics with eating healthier, eating more fish and taking fish oil capsules, eating ginger herb every day, walking at least a half hour to an hour a day, sleeping well, and reducing stress. It may be a good idea to take a break from all supplements and medications for a couple of weeks and then resume. If one version of Passion Rx was not good enough to lead to a strong erection, the other version may work better. Another option is to try different herbs such as mucuna pruriens, catuaba, or tribulus terrestris.

I have seen websites selling several products for male erection enhancement including Irexis and Orexis. Do the work?
    We have not tried these supplements so we don't know.

I first had sex when I was 21 years that’s like 4 years ago and it kind of freaked me out and that night I lost my erection for the first time in my life, I was scared. But before that, I got addicted to masturbation for years though am clearing that habit out now…..But I feel like since the first time I had sex, my erection has not been like it was before. Now I feel like am not satisfying my gal friend who am planning to wed soon. Is it possible that I can overcome this problem that came up later in my young life? Such herbal sexual enhancement products, do they clear the problem that after 3-4 months, the problem permanently? How can I achieve that mental confidence and physical performance excellence again?
    There are many causes of erectile difficulties. Certain herbal supplements can be helpful but often only work during the time they are used, although it is possible to have some longer lasting benefits.

I have recently had a stroke and am reluctant to take any type of supplement, but, I am experiencing difficulty with performance since the stroke. It seems that an great amount of stimulus is needed to achieve any erection and I have trouble maintaining it. I know this is the result of the stroke as I had no troubles before. Do you have a supplement that is SAFE and effective for someone in my situation?
    A number of factors have to be taken into consideration regarding the use of natural supplements for erectile enhancement in those with heart conditions or those who have had a cardiovascular event such as a stroke. We are not in a position to give specific suggestions since that is the role of your health care provider.

J Sex Med. 2015. Oximes induce erection and are resistant to oxidative stress. Because of their nitric oxide (NO)-donating capacities, oxime derivatives have shown to offer some therapeutic perspective for the treatment of erectile dysfunction (ED) as well as cardiovascular diseases. However, to date the in vivo effect of these oximes on erectile function remains unknown. In many disease states oxidative stress occurs, impairing NO-mediated relaxations. Hence the influence of oxidative stress on oxime-induced effects is also of interest. This study aimed to evaluate the in vivo effect of formaldoxime (FAL) and formamidoxime (FAM) on blood pressure and intracavernosal pressure (ICP); and to examine the role of soluble guanylyl cyclase (sGC) and the influence of oxidative stress on the FAL and FAM responses.