Alternative treatments for erectile dysfunction: A review

This study reviewed several different treatments for erectile dysfunction (ED). Researchers suggested that alternative treatments combined with phosphodiesterase 5 inhibitors (PDE5i) are associated with improved effectiveness.

ED is one of the most frequent sexual health conditions. It affects around 18 million American men and consists of the inability to have and maintain an erection firm enough for sex. ED significantly affects the quality of life of men.

One of the standard treatments for ED is PDE5i medication such as sildenafil (Viagra) or tadalafil (Cialis). However, PD5i are associated with negative side effects and low effectiveness in advanced cases. Other treatments for ED are vacuum erection devices, penile implants, alprostadil (Caverject) suppositories, and penile injections. These treatments vary in invasiveness and necessary commitment. Therefore, many patients may prefer to try natural treatments. However, the effectiveness of these natural therapies is not yet clear.

This article reviewed different alternative therapies for ED.

Low-intensity extracorporeal shockwave therapy (Li-ESWT) applies gentle pulses to specific areas of the body. It speeds up tissue repair and improved blood flow. Despite its shown effectiveness, this therapy lacks standardized protocols and is still considered experimental.

Low-intensity pulsed ultrasound (LIPUS) applies pulsed sound waves with anti-inflammatory effects to induce tissue recovery. Despite its positive outcomes in ED, clinical evidence and treatment methods are still needed.

Intracavernosal injections are given at the base of the penis to deliver medication. Injections can involve stem cells that can repair tissues or platelet-rich plasma. Prior studies with animals and later with ED patients showed the potential effectiveness of this method. However, clear clinical evidence is lacking and it is not known if changes in the source, dose, or repeat injections are beneficial for the patients.    

Amino acids are taken in form of diet supplements. The amino acid L-Arginine starts a reaction in the cells that helps the penis to become swollen. It improves penile function and may be a good option in combination with PDE5i. L-Citrulline may also be used for the same effect. However, there are few studies on this amino acid.

Herbal supplements such as ginseng increase blood flow to the penis. Prior studies suggested increased effectiveness when compared to placebo. Another supplement is yohimbine that works by increasing arousal and sexual function. It has been shown to work together well with L-arginine. However, there is insufficient evidence to make a recommendation. There is no study evaluating the effectiveness of these two supplements in ED patients.

Alprostadil has proven effective when injected into the penis or introduced in the urethra (the tube that passes urine and semen out of the penis) as a suppository. Despite its effectiveness with these methods, side effects can be significant with high drop out rates. An alternative method of delivery being tested is topical (over the skin) application. However, alprostadil cream is currently only available in Europe and Canada.

Hyperbaric oxygen therapy increases the oxygen blood level and the oxygen delivery to the penis which increases penile function. Prior studies showed its effectiveness in ED patients. However, there is no set method, length of treatment, or understanding of who should get the treatment.

Penile vibratory stimulation stimulates erection through vibration. Prior studies suggested its effectiveness, but the results were not statistically significant. It could become an approved treatment alongside PDE5i, but this has not been evaluated yet. 

This study reviewed alternative treatments for ED and suggested that despite their effectiveness more studies are necessary to evaluate these treatments as first-line therapies.