Erections

Last Updated: May 11, 2023

Erections occur when the penis fills with blood, making it rigid, longer, and thicker. While erectile dysfunction (ED) has many possible causes, from the neurological to the physical, the ones nutrition can address are vasodilation — the widening of blood vessels to allow greater blood flow — and hormonal imbalances caused by nutritional deficiencies.

Overview

The ability to achieve and maintain erections when aroused is a common health issue for many men.[1] While women don’t experience the phenomenon in the same way, inadequate blood flow to female genitalia is also common — and sometimes related to the same phenomena.

Aging is the biggest risk factor for ED, but there are a host of other contributing factors,[2] such as diabetes, vascular disease, low testosterone,[3] and hypothyroidism.[4]

The potential causes of ED generally revolve around vasodilation — the widening of blood vessels — which allows the penis to accommodate more fluid, thus allowing it to become erect. Nitric oxide is a chemical messenger that tells blood vessels to dilate; a breakdown in signaling is a common reason for ED and high blood pressure.

Nitric oxide precursors and substances that lead to greater nitric oxide synthesis are commonly found in drugs and supplements aiming to improve erections. Sex hormones are involved in nitric oxide synthesis, and men with low testosterone are more likely to have ED. Anything that leads to dysfunction in the walls of the blood vessels, such as smoking, inactivity, and excessive body fat, can increase ED risk as well.

Sometimes ED isn’t a breakdown in vasodilation or a hormonal problem but secondary to psychological issues of anxiety and anhedonia — a diminished ability to feel pleasure. In this case, while some libido-enhancing supplements may be useful, the answer may not be found in supplements or dietary modification.

How are erections assessed?

A urologist, who specializes in urinary and sexual issues, is best and can assess ED through a series of medical and sexual history questions. They may also perform a mental health screening and physical exam.

During the exam, your urologist may ask you some of the following questions.

  • How would you rate your confidence that you can get and keep an erection?
  • How often is your penis firm enough for intercourse?
  • How often are you able to maintain an erection during sexual intercourse?
  • Do you have an erection when you wake up in the morning?
  • Do you use illegal drugs, drink alcohol, or smoke?

While it can be uncomfortable, the more accurate your answers, the better medical care your physician can provide.

What affects erections?
Examine Database: Erections
What works and what doesn't?

Unlock the full potential of Examine

Get started

Don't miss out on the latest research

References
  1. ^The content of this page was partially adapted from MedlinePlus of the National Library of Medicine
  2. ^Selvin E, Burnett AL, Platz EAPrevalence and risk factors for erectile dysfunction in the USAm J Med.(2007 Feb)
  3. ^Rastrelli G, Corona G, Maggi MTestosterone and sexual function in menMaturitas.(2018 Jun)
  4. ^Chen D, Yan Y, Huang H, Dong Q, Tian HThe association between subclinical hypothyroidism and erectile dysfunctionPak J Med Sci.(2018 May-Jun)
  5. ^J Cartledge, S Minhas, I EardleyThe role of nitric oxide in penile erectionExpert Opin Pharmacother.(2001 Jan)
  6. ^Biljana Musicki, Tongyun Liu, Gwen A Lagoda, Trinity J Bivalacqua, Travis D Strong, Arthur L BurnettEndothelial nitric oxide synthase regulation in female genital tract structuresJ Sex Med.(2009 Mar)
  7. ^V Dishy, G Sofowora, P A Harris, M Kandcer, F Zhan, A J Wood, C M SteinThe effect of sildenafil on nitric oxide-mediated vasodilation in healthy menClin Pharmacol Ther.(2001 Sep)
  8. ^Christoph A Schmitt, Verena M DirschModulation of endothelial nitric oxide by plant-derived productsNitric Oxide.(2009 Sep)
  9. ^Jackson J, Patterson AJ, MacDonald-Wicks L, McEvoy MThe role of inorganic nitrate and nitrite in CVDNutr Res Rev.(2017 Dec)
  10. ^Hord NG, Tang Y, Bryan NSFood sources of nitrates and nitrites: the physiologic context for potential health benefitsAm J Clin Nutr.(2009 Jul)
  11. ^Jones AMDietary nitrate supplementation and exercise performanceSports Med.(2014 May)
  12. ^Gilbert DG, Hagen RL, D'Agostino JAThe effects of cigarette smoking on human sexual potencyAddict Behav.(1986)
  13. ^Harte CB, Meston CMAcute effects of nicotine on physiological and subjective sexual arousal in nonsmoking men: a randomized, double-blind, placebo-controlled trialJ Sex Med.(2008 Jan)
  14. ^Harte CB, Meston CMThe inhibitory effects of nicotine on physiological sexual arousal in nonsmoking women: results from a randomized, double-blind, placebo-controlled, cross-over trialJ Sex Med.(2008 May)
  15. ^J Peugh, S BelenkoAlcohol, drugs and sexual function: a reviewJ Psychoactive Drugs.(Jul-Sep 2001)
  16. ^Mark G Biebel, Arthur L Burnett, Hossein Sadeghi-NejadMale Sexual Function and SmokingSex Med Rev.(2016 Oct)
  17. ^G Corona, A Sansone, F Pallotti, A Ferlin, R Pivonello, A M Isidori, M Maggi, E A JanniniPeople smoke for nicotine, but lose sexual and reproductive health for tar: a narrative review on the effect of cigarette smoking on male sexuality and reproductionJ Endocrinol Invest.(2020 Apr 22)
  18. ^Angela Castela, Pedro Vendeira, Carla CostaTestosterone, endothelial health, and erectile functionISRN Endocrinol.(2011)
  19. ^Fui MN, Dupuis P, Grossmann MLowered testosterone in male obesity: mechanisms, morbidity and managementAsian J Androl.(2014 Mar-Apr)
  20. ^Ückert S, Kuczyk MA, Oelke MPhosphodiesterase inhibitors in clinical urologyExpert Rev Clin Pharmacol.(2013 May)
  21. ^Friedman JM, Friedman AJDevelopment and therapeutic applications of nitric oxide-releasing materialsFuture Sci OA.(2015 Aug 1)
Examine Database References
  1. Tribulus Terrestris - GamalEl Din SF, Abdel Salam MA, Mohamed MS, Ahmed AR, Motawaa AT, Saadeldin OA, Elnabarway RRTribulus terrestris versus placebo in the treatment of erectile dysfunction and lower urinary tract symptoms in patients with late-onset hypogonadism: A placebo-controlled studyUrologia.(2018 Sep 25)
  2. Panax Ginseng (Korean Ginseng) - Hong B, Ji YH, Hong JH, Nam KY, Ahn TYA double-blind crossover study evaluating the efficacy of korean red ginseng in patients with erectile dysfunction: a preliminary reportJ Urol.(2002 Nov)
  3. Tribulus Terrestris - Roaiah MF, El Khayat YI, GamalEl Din SF, Abd El Salam MAPilot Study on the Effect of Botanical Medicine (Tribulus terrestris) on Serum Testosterone Level and Erectile Function in Aging Males With Partial Androgen Deficiency (PADAM)J Sex Marital Ther.(2016 May 18)
  4. Curcumin - Choi YH, Han DH, Kim SW, Kim MJ, Sung HH, Jeon HG, Jeong BC, Seo SI, Jeon SS, Lee HM, Choi HYA randomized, double-blind, placebo-controlled trial to evaluate the role of curcumin in prostate cancer patients with intermittent androgen deprivationProstate.(2019 May)
  5. Grape Juice - Spettel S, Chughtai B, Feustel P, Kaufman A, Levin RM, De EA prospective randomized double-blind trial of grape juice antioxidants in men with lower urinary tract symptomsNeurourol Urodyn.(2013 Mar)
  6. Saffron - Modabbernia A, Sohrabi H, Nasehi AA, Raisi F, Saroukhani S, Jamshidi A, Tabrizi M, Ashrafi M, Akhondzadeh SEffect of saffron on fluoxetine-induced sexual impairment in men: randomized double-blind placebo-controlled trialPsychopharmacology (Berl).(2012 Oct)
  7. Panax Ginseng (Korean Ginseng) - Kim TH, Jeon SH, Hahn EJ, Paek KY, Park JK, Youn NY, Lee HLEffects of tissue-cultured mountain ginseng (Panax ginseng CA Meyer) extract on male patients with erectile dysfunctionAsian J Androl.(2009 May)
  8. L-Carnitine - Giorgio Cavallini, Fabio Modenini, Giovanni Vitali, Aleardo KoverechAcetyl-L-carnitine plus propionyl-L-carnitine improve efficacy of sildenafil in treatment of erectile dysfunction after bilateral nerve-sparing radical retropubic prostatectomyUrology.(2005 Nov)
  9. L-Carnitine - G Cavallini, S Caracciolo, G Vitali, F Modenini, G BiagiottiCarnitine versus androgen administration in the treatment of sexual dysfunction, depressed mood, and fatigue associated with male agingUrology.(2004 Apr)
  10. Coenzyme Q10 - Safarinejad MRSafety and efficacy of coenzyme Q10 supplementation in early chronic Peyronie's disease: a double-blind, placebo-controlled randomized studyInt J Impot Res.(2010 Sep-Oct)
  11. Pycnogenol - R Stanislavov, V NikolovaTreatment of erectile dysfunction with pycnogenol and L-arginineJ Sex Marital Ther.(May-Jun 2003)
  12. Saffron - Ali Shamsa, Hossein Hosseinzadeh, Mahmood Molaei, Mohammad Taghi Shakeri, Omid RajabiEvaluation of Crocus sativus L. (saffron) on male erectile dysfunction: a pilot studyPhytomedicine.(2009 Aug)
  13. Tongkat Ali - Ismail SB, Wan Mohammad WM, George A, Nik Hussain NH, Musthapa Kamal ZM, Liske ERandomized Clinical Trial on the Use of PHYSTA Freeze-Dried Water Extract of Eurycoma longifolia for the Improvement of Quality of Life and Sexual Well-Being in MenEvid Based Complement Alternat Med.(2012)
  14. Saffron - Hossein Mohammadzadeh-Moghadam, Seyed Mohammad Nazari, Ali Shamsa, Mohammad Kamalinejad, Habibollah Esmaeeli, Amir Abbas Asadpour, Abdoljavad KhajaviEffects of a Topical Saffron (Crocus sativus L) Gel on Erectile Dysfunction in Diabetics: A Randomized, Parallel-Group, Double-Blind, Placebo-Controlled TrialJ Evid Based Complementary Altern Med.(2015 Oct)
  15. Yohimbine - Ernst E, Pittler MHYohimbine for erectile dysfunction: a systematic review and meta-analysis of randomized clinical trialsJ Urol.(1998 Feb)
  16. L-Carnitine - V Gentile, P Vicini, G Prigiotti, A Koverech, F Di SilverioPreliminary observations on the use of propionyl-L-carnitine in combination with sildenafil in patients with erectile dysfunction and diabetesCurr Med Res Opin.(2004 Sep)
  17. DHEA - Morales A, Black A, Emerson L, Barkin J, Kuzmarov I, Day AAndrogens and sexual function: a placebo-controlled, randomized, double-blind study of testosterone vs. dehydroepiandrosterone in men with sexual dysfunction and androgen deficiencyAging Male.(2009 Dec)
  18. Saffron - Safarinejad MR, Shafiei N, Safarinejad SAn open label, randomized, fixed-dose, crossover study comparing efficacy and safety of sildenafil citrate and saffron (Crocus sativus Linn.) for treating erectile dysfunction in men naïve to treatmentInt J Impot Res.(2010 Jul-Aug)
  19. Citrulline - Luigi Cormio, Mario De Siati, Fabrizio Lorusso, Oscar Selvaggio, Lucia Mirabella, Francesca Sanguedolce, Giuseppe CarrieriOral L-citrulline supplementation improves erection hardness in men with mild erectile dysfunctionUrology.(2011 Jan)
  20. Panax Ginseng (Korean Ginseng) - Choi HK, Seong DH, Rha KHClinical efficacy of Korean red ginseng for erectile dysfunctionInt J Impot Res.(1995 Sep)
  21. Panax Ginseng (Korean Ginseng) - de Andrade E, de Mesquita AA, Claro Jde A, de Andrade PM, Ortiz V, Paranhos M, Srougi MStudy of the efficacy of Korean Red Ginseng in the treatment of erectile dysfunctionAsian J Androl.(2007 Mar)
  22. Ashwagandha - Mamidi P, Thakar ABEfficacy of Ashwagandha (Withania somnifera Dunal. Linn.) in the management of psychogenic erectile dysfunctionAyu.(2011 Jul)
  23. Tribulus Terrestris - Sellandi TM, Thakar AB, Baghel MSClinical study of Tribulus terrestris Linn. in Oligozoospermia: A double blind studyAyu.(2012 Jul)
  24. Maca - Zenico T, Cicero AF, Valmorri L, Mercuriali M, Bercovich ESubjective effects of Lepidium meyenii (Maca) extract on well-being and sexual performances in patients with mild erectile dysfunction: a randomised, double-blind clinical trialAndrologia.(2009 Apr)
  25. Tribulus Terrestris - Kamenov Z, Fileva S, Kalinov K, Jannini EAEvaluation of the efficacy and safety of Tribulus terrestris in male sexual dysfunction-A prospective, randomized, double-blind, placebo-controlled clinical trialMaturitas.(2017 May)
  26. Butea Superba - W Cherdshewasart, N NimsakulClinical trial of Butea superba, an alternative herbal treatment for erectile dysfunctionAsian J Androl.(2003 Sep)
  27. L-Carnitine - D Gianfrilli, R Lauretta, C Di Dato, C Graziadio, C Pozza, J De Larichaudy, E Giannetta, A M Isidori, A LenziPropionyl-L-carnitine, L-arginine and niacin in sexual medicine: a nutraceutical approach to erectile dysfunctionAndrologia.(2012 May)
  28. Butea Superba - Cortés-González JR, Arratia-Maqueo JA, Gómez-Guerra LS, Holmberg ARThe use of Butea superba (Roxb.) compared to sildenafil for treating erectile dysfunctionBJU Int.(2010 Jan)
  29. Tongkat Ali - Kotirum S, Ismail SB, Chaiyakunapruk NEfficacy of Tongkat Ali (Eurycoma longifolia) on erectile function improvement: systematic review and meta-analysis of randomized controlled trials.Complement Ther Med.(2015-Oct)
  30. DHEA - Giovanni Corona, Giulia Rastrelli, Vito A Giagulli, Annamaria Sila, Alessandra Sforza, Gianni Forti, Edoardo Mannucci, Mario MaggiDehydroepiandrosterone supplementation in elderly men: a meta-analysis study of placebo-controlled trialsJ Clin Endocrinol Metab.(2013 Sep)
  31. Folic Acid (Vitamin B9) - Zhang Y, Zhang W, Dai Y, Jiang H, Zhang XSerum Folic Acid and Erectile Dysfunction: A Systematic Review and Meta-Analysis.Sex Med.(2021-Jun)
  32. Saffron - Maleki-Saghooni N, Mirzaeii K, Hosseinzadeh H, Sadeghi R, Irani MA systematic review and meta-analysis of clinical trials on saffron () effectiveness and safety on erectile dysfunction and semen parameters.Avicenna J Phytomed.(2018)