Working Hard or Hardly Working?

Demystifying Erectile Dysfunction

A pair of jeans with a banana emerging from the zipper sits in front of an abstract red background. Hearts are doodled around the image.

by Abby Robinson

As a community sexual health resource, one of the most common concerns brought to us by our customers is difficulty getting or maintaining erections. This topic can be challenging to discuss, and often contains within it a large spectrum of both physical and mental concerns. It is important to note that we here at As You Like It are not medical professionals, but we do have a plethora of educational information, product knowledge, and resources to share when it comes to penile function.

Especially with all of the over-the-counter supplements promising quick fixes, or books promising a cure-all, it can be hard to know where to begin with tackling erectile functionality. Luckily, we are here to demystify erectile dysfunction, including these often confusing and misleading products, and to discuss what other, more realistic options are out there. Because everyone deserves to experience pleasure, and there are many wonderful ways to do so that are safe for you and your body!

Breaking Down Erectile Expectations of Pleasure

Before we dive into the myriad of potentially helpful products and practices for helping increase penile function, let’s first chat for a minute about masculinity, gender roles, and the medicalization of erections. In an article discussing the medicalization of intersex newborns — which are infants with genitals that do not clearly fit in binary male and female categorization — the authors state that according to popular medical opinion, a “healthy man has a penis, and can engage in heterosexual relations, specifically penile-vaginal penetration. Any deviation from this alignment results in a morbid embodiment that is pathologized” (Davis et al 497-498). This belief suggests that a satisfying life without normative penis function is impossible to achieve. The fact that these ideas are frequently regurgitated in discussions of intersex infants is a reflection of society’s expectations for all people with penises, not just intersex folks.

But the truth is that a penis capable of maintaining an erection for the purpose of achieving penetrative sex is not necessary for a satisfying sex life. All bodies are unique, and many do not need not fit into rigid definitions of sexual performance and function. There are so many ways to experience pleasure, and all bodies are capable of accessing pleasure. As explored below, there are plentiful options for addressing erectile concerns, and for achieving pleasure and intimacy without erections, if that is something you desire.

In an alternative perspective to the rigidly medicalized conceptualizations of pleasure, Greta Christina explores the definition of sex itself in “Are We Having Sex Now or What.” Christina reflects on her past method of keeping track of sexual partners: PIV (penis in vagina) intercourse. As she becomes older, and beings engaging in queer sex, this definition blurs significantly (4-5). Christina finds herself unable to nail down a direct definition of sex. If it’s not PIV, what is it? She somewhat humorously explores alternative options, finding plot holes in all of them. She ends the piece by conceding to the concept that she cannot find a straightforward definition of sex, and that’s okay (8)! Christina’s piece embodies our own consensual pleasure-focused approach to sexual activity. Sex is what you make of it — it does not need to be goal-oriented or contain within it a single definitive act. Each person gets to decide their boundaries and desires based on what brings them pleasure, and that is a beautiful and freeing concept!

In the journey to understand erectile functioning, there is a lot of unlearning to be done. Ideas about penis size and function are foundational to many concepts of masculinity. We want to reassure our customers that how their body looks and functions does not determine their validity or worth as a person, or sexual being. Many folks are saddled with the painful task of unlearning harmful rhetoric about their own bodies, or even healing from medical, physical, or psychological trauma. Still others (both with and without penises) are faced with the task of unpacking society’s idea of masculinity as it relates to their own desires for pleasure. Still others do not identify with masculinity at all, and want to understand and enjoy their bodies outside of the rigid expectations of manhood.

No matter your personal situation or desires, we are here to offer support and resources. In the literature department, we recommend UnF*ck Your Intimacy, The Mindful Masculinity Workbook, Sex Without Roles, Naked at Our Age, Pleasure Activism, as well as many more in our expansive book section that did not make this shortlist. 

Understanding Our Unique Experiences

In our store, questions about popular over-the-counter ED supplements usually result in a friendly explanation that none of these supplements meet our body safety standards, and a gentle nudge to some of the body-safe alternatives or literature that we do carry. We can also offer recommendations to local medical and physical therapy providers, if desired by the customers.

The conversation usually ends there, but as pleasure experts, we sense that the desire for these supplements remains. To make matters worse, there is a ton of misinformation out there regarding these supplements, and so we at As You Like It have done the hard work for you and have compiled the most trustworthy research, as well as some fantastic alternative options!

But first, we need to ask ourselves: What does body safety mean? For us, it means committing to thoroughly researching our products to ensure there are no harmful ingredients in anything we carry. The adult industry is completely unregulated, and unfortunately, this means that makers and retailers are not obligated to provide any safety information on the products they sell. In fact, sex toy and product manufacturers are free to use misleading packaging, dangerous chemicals, or to completely abstain from offering any information at all. Thankfully, we are one of many makers and retailers are working against this problem. We firmly believe that our customers have a right to information, and should feel comfortable and safe when purchasing pleasure items! To nurture this trust, we ensure that anything we carry passes our rigorous standards for body-safe ingredients and quality manufacturing. 

So why do we exclude over-the-counter erection supplements? Usually, the packages say reassuring things such as “all-natural,” “safe and effective,” and even “guaranteed results.”  Many boast hundreds of positive reviews from past users. However, because these products are sold as unregulated novelties or dietary supplements, none of these statements are verified, and the companies have no obligation for these kinds of statements to be true. Furthermore, the effectiveness of these supplements are often greatly exaggerated by these companies, despite the wide range of causes of ED. This predatory advertising combined with the stigma or embarrassment often attached to discussing ED creates the perfect cocktail for selling ineffective or harmful supplements (Read & Mati 553-554).But to fully understand why these kinds of supplements can be so dangerous, it is important first to understand what exactly ED is. 

Erectile Dysfunction, or ED, is understood as the inability of a person with a penis to achieve or maintain an erection as part of sexual function. This definition covers a wide spectrum of experiences, with an equally wide array of causes. Research has found causes related to psychosocial, biological, and lifestyle factors. ED is frequently linked to mental health factors, such as anxiety or depression, sexual trauma, or even personal stress. Erectile dysfunction is also often reported as related to circumstantial anxieties, such as becoming intimate with a new person for the first time. Understanding the inherent complexities of experiencing ED is the first step in unpacking the misinformation presented by supplement manufacturers. 

Despite the well-researched range of ED causes, popular culture and even medical understandings still often reverts to biological causes and medication-based treatments. This is likely due to the stigma surrounding the topic. Shame is quickly alleviated by the belief that all ED issues are biological, and can be cured with the right medication. But sexuality professionals and medical professionals know that the reality of ED is more complicated than that. And we see this as a positive! The complex nature of ED means there are plenty of safe and beneficial ways to navigate it: anxiety and stress management, verified herbal supplements, mental healthcare, physical therapy, and even sex toys specifically designed for producing and maintaining an erection or circumventing erection altogether!

Navigating Supplements and Medications

There are several illnesses, including cardiovascular disease, diabetes, metabolic syndrome, hypertension, and hyperlipidemia that correlate with recurrent erectile dysfunction (Chiang et al 15). It is important that a medical provider rules out or addresses these other issues before pursuing medication as an option. If the supplement you are looking at does not mention any of this information, or does not require a medical consultation, that is your first red flag. Remember, there is absolutely no shame in speaking to a medical provider about these options. It is their job to assist with your healthcare needs privately, safely, and in a shame-free manner. Our staff is always happy to offer recommendations for affirming and trustworthy medical resources as well.

So now let’s break down how many popular ED medications work, and why we advise against using unregulated supplements. The prodigal ingredient in prescription erectile dysfunction medications is called Sildenafil. Sildenafil, in a simple definition, is a vasodilator that opens blood vessels and allows for blood flow into the penis when sexually aroused (Mosavi et al 1). This medication does carry its own side effects, including headache, dyspepsia, flushing, myalgia/back pain, visual disturbances, and nasal congestion. But there are more serious side effects associated with underlying medical conditions or medication interactions, too. One well-researched possible side effect is optic nerve damage and vision problems. Because of all these possibilities, researchers strongly support the regulation and prescription status of Sildenafil (Mosavi et al 2). It is extremely important when using a medication such as this to consult with your doctor to hopefully avoid the more dangerous — and in some cases fatal — reactions it could cause. 

Sildenafil is a prescription medication that is heavily regulated by the FDA. However, it is also quite easy to counterfeit. It can be cheaply produced for hefty profit margins and is easily dispersed through the lax rules regarding pleasure items and dietary supplements (Chiang et al 13). Many of the over-the-counter supplements that boast all-natural herbal ingredients and are marked as novelty or dietary items contain counterfeit Sildenafil (Chiang et al 16). One study found that around 60% of the Sildenafil encountered in patients was not obtained with a legal medical prescription (Chiang et al 13). This can be very dangerous when considering the side effects mentioned above. The FDA does its best to watch these manufacturers, but many unregulated supplements are still on the market, and new ones pop up frequently to replace ones that are not. The table at the right shows a list of available brands that have been warned against by the FDA for various contamination (Chiang et al 17). Do you recognize any names on this list? We sure do! This danger only intensifies when you consider there is no regulation on dosing, quality, reactive ingredients, or even basic warnings about patient health history.

Several studies have noted the danger behind this lack of oversight. The research has uncovered varying degrees of counterfeit medications, bacteria, unsafe water, and other toxins and containments in over-the-counter pills (Chiang et al 15-16). In one worst-case scenario, pills were laced with glyburide, a medication to treat diabetes, in addition to counterfeit Sildenafil. This landed 150 people in the hospital and tragically caused the deaths of 7. It took doctors quite a while to find the shared link between patients: an ED supplement from an unidentified online retailer (Chiang et al 16). Although there is limited data on fatalities involving over-the-counter supplements, it is possible the lack of data is related to the underreporting of use and assumed safety. After all, most people do not disclose the use of these supplements to their loved ones. Even at the most basic level, companies often do not provide accurate information to their consumers regarding safety, or things like batch numbers and expiration dates. As a resource committed to the safety of our community, this is the information we believe everyone deserves to know. 

What if the supplement claims to be entirely herbal in formulation? Just like Sildenafil, some things can be safe and effective when properly managed, but dangerous if not. Some herbs have been shown to greatly improve erectile functioning and increase libido. This is a great thing! But there are also plenty of manufacturers that are dishonest about herbal combinations and potency.

One herb, in particular, ginseng, has been shown in studies to be effective. One 2018 systematic review states, “Preparations from the roots of ginseng are claimed to exert antioxidant, antidiabetic, immunomodulating, and aphrodisiac properties. Evidence showed that ginseng was effective in treating ED in all the retrieved studies” (Borelli et al 665). Another study found positive results in alleviating ED and increasing sexual desire with the use of a name-brand herbal blend, which contains primarily red ginseng. The researchers state, “In response to the global efficacy question, 60% of the patients answered that Korean red ginseng improved erection, which is in agreement with the 72% (26 out of 36) patients global response observed in our study." (Shah et. al)

If you are considering the use of an herbal supplement, there are a few important things to keep in mind. The first is finding a reputable manufacturer that is upfront about the contents of their herbal blends. Knowing what you are putting in your body is of the utmost importance for both safety and efficacy. Additionally, it is always good idea to consult a medical professional when adding any herbal supplement to your diet. Some herbs can interact poorly with certain prescription medications, vitamins, or existing medical conditions. If any supplement will not disclose its blend of ingredients, or promises instant results, this is another red flag.  

It's important to remember that the issue is not the customer’s desire, but the lack of information and regulation. While it never hurts to discuss any concerns with a doctor, it is statistically relevant that the majority of people seeking supplements are using them recreationally, and do not report issues consistent with erectile dysfunction as a medical concern (Chiang et al 14). This makes sense considering the ease of access and widespread marketing done by these companies. Supplements are usually sold online or at sex shops over the counter, with no prescription requirements, low costs, little information, and high promises. Customers requesting them are often just looking for a way to have a more pleasurable experience, and these supplements promise to be the answer.

That being said, there are still plenty of customers who are facing difficulty with erection, and there is no shame in this either! There is something crucial that recreational users and medical necessity users have in common: the desire for fun and pleasure-filled experiences. We are here to reassure you that while we do not recommend over-the-counter supplements that promise instant erections or rapid libido enhancement, there are tons of great options we do recommend! 

Arm Yourself With the Right Tools

Education is often our first step when addressing erectile function concerns. There is so little accurate information available to the general public, even on things as simple as how the penis functions with pleasure. Our knowledgeable and trained staff can provide this education in-store, but we also carry several great books if you prefer to learn at your own pace. The Penis Book is a fantastic work by Doctor Aaron Spitz, the  Chief Representative for America’s Urologists. This all-inclusive guide is excellent for both medical professionals and laymen alike to learn about anything from penis size and shape to function. We also highly recommend  S.E.X: The All-You-Need-To-Know Guide, for an all-inclusive sex ed encyclopedia. For a more targeted approach, we recommend Coping with Erectile Dysfunction. We always caution against any books that promise cure-all philosophies, or lack credentialed authorship. Accessible and affirming information about the body and its functioning is often what a person struggling with any kind of sexual dysfunction really needs, rather than a pill. In this case, everyone can move forward with an informed understanding of their desires and concerns.

Returning to the conversation of herbal supplements, there is one herbal manufacturer we do confidently carry in the store. Mountain Rose Herbs is a local Eugene herbal source known for its organic and sustainably sourced products. Specifically for penile function and virility, we stock their Male Care Herbal Supplement, an oral tincture containing all organic herbal ingredients. Like all Mountain Rose products, the Male Care has its ingredients listed directly on the product. There are also clearly stated warnings about the use of these herbs with certain prescription medications, and a note to consult your medical provider before  use. There is also a disclosure statement explaining that this is not intended to cure or treat any illness. These are all green flags. Therefore, we happily recommend this product to all of our penis-bearing customers looking for a supplement.

Aside from literature and medical resources, one of our other go-to recommendations is lubricant and arousal oils infused with CBD. Research has shown that CBD may help alleviate anxiety for some people, and in turn, may help alleviate anxiety-induced ED. CBD-infused lubricants and arousal oils can also help to relax muscle tension and bring blood to the surface of the genitals, increasing sensitivity. And like any product we carry, CBD oils must meet our standards for body safety. One CBD brand our customers have been very pleased with is Foria. Their CBD-infused products are the best option we recommend for ED assistance and boosting arousal and sensitivity “in the moment” rather than over time. Because we cannot legally sell CBD products on our website, Foria's line of CBD-infused oils and lubricants are available exclusively in-store. Stop by and check them out!

Moving into the wonderful world of toys, we have several recommendations! Two popular choices are the Manta by Fun Factory and the Hot Octopus line of stroking toys. Neither of these selections requires an erection for use, and both have been reported to greatly assist with producing and maintaining an erection. When held at the base of the shaft, Manta provides deep, rumbling vibrations to stimulate the pudendal nerve, and can be used to stroke up and down the shaft in whatever manner feels pleasurable. Meanwhile, the Hot Octopus toys use a unique oscillating plate to stimulate the frenulum and shaft, bringing unique pleasure whether the user is erect or not. To read more about either of these unique toys, check out our recent blog, Toys For Two (or Maybe More!): Re-Thinking the Couples' Toy. We’ve dedicated an entire section of this blog to toys for folks who either cannot achieve an erection, or do not desire to engage in penile penetration!

If an erection is achieved, there is one tool that is an excellent help in maintaining it: c-rings!
C-rings come in several different materials, like silicone, elastomer, nitrile, metal, or leather, and can vary widely in their texture, elasticity, and functionality. The basic idea is that once an erection is achieved, a fitted ring is stretched over the shaft and placed at the base and around the testicles if desired. This offers slight compression, allowing bloodflow into the shaft but making it harder to drain back out, resulting in a longer-lasting erection and more intense sensations. Some c-rings vibrate, which offers similar results to the aforementioned toys, with the optional addition of external stimulation for a receiving partner.

It is important when first starting with c-rings to pick something with a soft texture and high elasticity, so that you can try out the sensation of restriction without discomfort or fear of anything getting stuck. Some of our favorites for beginners are listed below!

Another avenue to explore is harness play. In the Couple’s Toy blog we explored the use of alternative harnesses, such as thigh and hand mounts, as tools for penetration.  These are both great options, but what if you want the ability to interchange between toy use and penile penetration? Some folks may want to start play using a toy, and seamlessly transition should an erection develop. This can certainly be achieved by several methods, but there is one innovative tool made exactly for this desire, The Deuce Harness by SpareParts! The Deuce features two separate holes, allowing for both a toy and penis to extend through the openings. This harness can be used to transition between penetrative methods, or even to enjoy dual penetration. The Deuce is structured with plenty of room for the testicles and even features a vibrator pocket for added stimulation. 

In the realm of healing and support resources, our community resource table in-store contains information on a plethora of recommended counselors, medical providers, sexuality coaches, and support groups. We highly recommend the Pelvic Wellness Center for all things related to Pelvic Health and physical therapy, including but not limited to erectile dysfunction. Additionally, one of our beloved community partners, TransPonder, has compiled an incredible Resource Directory for medical, mental health, and community support needs. These listings are all verified and vetted by TransPonder, and are available to all community members seeking inclusive and affirming care. 

The topic of erectile dysfunction is vast and can be quite confusing. We are hopeful that this piece helped to pull the curtain back on what is often a secretive or challenging topic for most to discuss. It is through open discussion and education that we pull ourselves out of shame and stigmatization. Here at As You Like It, we pride ourselves in being a judgment-free safe space for education and community engagement. Whether it is through digital connections like this one, or in-person consultations with our staff, we aim to provide our customers with accurate information and curated guidance on whatever sexuality topic they throw at us. We thank you for entrusting us with your questions, your fears, your hopes, and your desires. Always remember that safe, affirming, fabulous, inclusive pleasure is possible, for everybody and every body!

Cited Works

Chiang, Jason, et al. "The Dangers of Sexual Enhancement Supplements and Counterfeit Drugs to “Treat” Erectile Dysfunction." Translational andrology and urology 6.1 (2017): 12.

Christina, Greta “Are We Having Sex Now or What?” The Erotic Impulse (pp 3-8). Tarcher Press. 1992.

Davis, Georgian et al.“Giving Sex: Deconstructing Intersex and Trans Medicalization” Gender & Society (pp 490-514). Vol. 30 No. 3. 2015.

Mosavi, Seyed Aliasghar, et al. "Bilateral Simultaneous Nonarteritic Anterior Ischemic Optic Neuropathy Associated with The Use of Sildenafil: A Case Report." Razavi International Journal of Medicine 5.1 (2017).

Abby Robinson is a certified Community Sexual Health Resource and Staff Member at As You Like It. Abby has a Bachelor’s degree in Gender and Sexuality Studies and Global Health, and plans to pursue a Master’s of Education and Human Sexuality.

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