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Erectile dysfunction (ED) is often seen as a purely physical condition, but emerging research reveals that the brain also plays a crucial role in both the onset and treatment of ED. Affecting an estimated 30 million men in the United States alone (National Institute of Diabetes and Digestive and Kidney Diseases, 2020), ED can significantly impact not only physical health but mental well-being, interpersonal relationships, and overall quality of life. (Leslie, 2024) While we are still learning about the connection between the brain and body, research shows that many treatments already exist that can target both physical and physiological aspects of ED.
Understanding ED: Symptoms and Causes
Erectile dysfunction is typically defined as the inability to achieve or maintain an erection sufficient for sexual activity (National Institute of Diabetes and Digestive and Kidney Diseases, 2020). ED can be a short or long-term problem and may present as the occasional inability to get or maintain an erection, or it could be a persistent issue.
The more physical causes of ED range greatly, from certain diseases and conditions impacting the endocrine system, cardiovascular system, and nervous system, to physical injury, certain medications, and lifestyle habits. Psychological or emotional issues can also cause ED to develop or worsen. This includes anxiety, depression, low self-esteem, stress, guilt, or fear of failing sexually. (National Institute of Diabetes and Digestive and Kidney Diseases, 2020)
Because these psychological aspects can significantly worsen ED symptoms and cause strain on interpersonal relationships, finding holistic approaches for treating ED is incredibly important.
The Role of the Brain in ED
The brain is an essential part of the sexual response cycle, and dysfunction at the neurological level can directly affect a man’s ability to achieve an erection. (Calabro, 2019) The sexual arousal process actually begins in the brain, due to sensory and mental stimulation. Then the brain sends signals to the penis through the nervous system to trigger the physiological response of an erection. (Cleveland Clinic, 2023) Certain mental conditions, psychological factors, and medications used to treat these conditions can interfere with the brain’s neurotransmitters, which may lead to difficulty feeling aroused, experiencing sexual desire, or fully enjoying pleasurable feelings. (Cleveland Clinic, 2023)
Holistic Treatment Approaches for ED
Given that ED is often a multifaceted condition, many providers recommend finding holistic treatments for managing ED. Targeting the physical effects and causes of ED with medications, devices, or surgery, and the psychological aspects with therapy, counseling, lifestyle changes, and more, may be more effective for the holistic treatment of ED. In fact, one study found that men who paired a pharmacological treatment (PDE5s) with therapy had more favorable results than those using the medication alone. (Khan, 2019)
By combining treatment approaches, you can find what works best for you and your partner. Remember to always consult a healthcare provider before moving forward with any new treatments or major lifestyle changes.
1. Therapy and Counseling
Therapy and counseling options, such as Cognitive Behavioral Therapy (CBT), have shown to be effective in helping men better manage ED linked to psychological factors. (Bilal, 2020) This type of therapy focuses on altering negative thought patterns that contribute to anxiety or stress surrounding sexual performance. By addressing these negative thoughts, CBT helps individuals feel more confident and less anxious about their sexual performance, often leading to improved erectile function. (Bilal, 2020) (Khan, 2019)
Other options for therapy and counseling include couples therapy, speaking with a sex therapist, practicing mindfulness, and more. These options also target negative thought patterns, encourage communication with your partner, and improve self-esteem and self-talk.
2. Pharmacological Treatments
To target more physical symptoms, medications such as phosphodiesterase type 5 inhibitors (PDE5 inhibitors)—which include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra)—are commonly prescribed to treat ED. These medications work by enhancing blood flow to the penis, making it easier to achieve and maintain an erection. (Leslie, 2024)
Rugiet offers a more holistic approach to ED medications with Rugiet Ready, a 3-in-1 sublingual medication that combines sildenafil, tadalafil, and apomorphine, a dopamine promoter that primes the brain for arousal. The addition of apomorphine gives Rugiet Ready an edge, targeting both the physical and mental aspects of arousal.
3. Hormone Replacement Therapy (HRT)
For those who’s ED is related to low testosterone levels, hormone replacement therapy (HRT) may be beneficial. Testosterone is a key hormone involved in sexual function, and deficiencies can contribute to both ED and low libido. (Cleveland Clinic, 2023) Research has shown that testosterone replacement therapy can improve erectile function in men with hypogonadism (low testosterone levels). (Leslie, 2024) HRT should be administered under medical supervision to avoid potential risks, such as prostate issues or cardiovascular complications.
4. Lifestyle Changes
Another holistic treatment option is to improve certain lifestyle habits, such as eating a balanced diet, exercising regularly, quitting smoking and drug use, limiting alcohol, and managing stress. Not only can these lifestyle changes improve your mental health, but research shows that adopting healthy lifestyle habits can have a positive impact on sexual health, erectile function, and overall well-being. (Cleveland Clinic, 2023) (Leslie, 2024)
5. Vacuum Devices
A vacuum constriction device (VCD), commonly known as a penis pump, is an external pump with a band attached that helps the penis become erect. (Cleveland Clinic, 2020) The pump creates a vacuum seal around the penis, which draws blood into the shaft, causing the penis to swell and become erect. A band can then be placed on the lower end of the penis to maintain the erection for sexual intercourse. Using a VCD is fairly simple and in most cases, will start to work immediately, and can be safely left on for about 30 minutes. (Cleveland Clinic, 2020) This is a great option for those who may struggle with both physical and mental ED.
6. Surgery
Surgery is another option for those with severe or long-standing cases of ED. A surgeon can place a penile implant or pump into the penis to help with erections. This is a more invasive treatment and is often reserved for those who have had no success with other treatment options. (Leslie, 2024)
Combining Treatments: A Comprehensive Approach
For some, the most effective treatment for ED will involve a combination of therapies that address both the mind and the body. By targeting both aspects of arousal, patients are more likely to see sustainable results. What is causing your ED also plays a significant role in which treatment option(s) are right for you. Speak with your healthcare provider about your ED to determine what makes the most sense for you and your partner.
Rugiet Ready offers board-certified doctors who are available to discuss our holistic pharmacological approach to ED treatment. Get your 3-in-1 sublingual medication, designed to target the mind and body! Try Rugiet today.
ED is a Multifactorial Condition
Erectile dysfunction is not just a physical problem—it is a condition that often involves the brain and body in intricate ways. As we gain a deeper understanding of how psychological factors like anxiety, depression, and stress contribute to ED, we continue to research the most effective treatment options. For men struggling with ED, taking a holistic approach to treatment may be more beneficial than treatment for physical causes alone. Consider utilizing multiple options, such as lifestyle changes and therapy or counseling, in addition to medications, physical devices, and HRT. As always, speak with a medical provider about your condition and your concerns before making any significant changes to your routine.
Citations
National Institute of Diabetes and Digestive and Kidney Diseases. (July 2017). Erectile Dysfunction. Retrieved from https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction
Leslie SW, Sooriyamoorthy T. Erectile Dysfunction. [Updated 2024 Jan 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562253/
Calabrò, R. S., Cacciola, A., Bruschetta, D., Milardi, D., Quattrini, F., Sciarrone, F., la Rosa, G., Bramanti, P., & Anastasi, G. (2019). Neuroanatomy and function of human sexual behavior: A neglected or unknown issue?. Brain and behavior, 9(12), e01389. https://doi.org/10.1002/brb3.1389
Cleveland Clinic. Erection. April 2023. Retrieved from https://my.clevelandclinic.org/health/articles/10036-erection
Cleveland Clinic. Depression and Sex. December 2020. Retrieved from https://my.clevelandclinic.org/health/diseases/9296-sexual-problems-and-depression/
Bilal, A., & Abbasi, N. U. H. (2020). Cognitive Behavioral Sex Therapy: An Emerging Treatment Option for Nonorganic Erectile Dysfunction in Young Men: A Feasibility Pilot Study. Sexual medicine, 8(3), 396–407. https://doi.org/10.1016/j.esxm.2020.05.005
Khan, S., Amjad, A., & Rowland, D. (2019). Potential for Long-Term Benefit of Cognitive Behavioral Therapy as an Adjunct Treatment for Men with Erectile Dysfunction. The journal of sexual medicine, 16(2), 300–306. https://doi.org/10.1016/j.jsxm.2018.12.014
