Old and New Treatments for ED

By Austin Davis

Witchcraft, homosexuality, self-satisfaction and sexual excess–such historical explanations for erectile dysfunction are stranger than a would-be elevator pitch for a new sci-fi rom-com.

Thankfully, society's understanding of ED has evolved since such views were commonplace. From the ingestion of animal genitalia to today’s holistic solutions, let's take a look at old and new treatments for ED and how they've been influenced by evolving societal perceptions of masculinity.

How the emperor got his groove back

Scholars date the first ED treatment to around 2600 BCE with the publication of the Yellow Emperor's Classic of Internal Medicine, which describes ailments and therapies common during that era–including an elixir made of over 20 ingredients to alleviate erectile dysfunction. Nearly a millennium later, in 1600 BCE, Egyptian scribes noted how a salve of baby crocodile hearts and wood oil lathered on the penis was the favored method of the time.

But the most complete insights into ancient ED treatments come from the Greeks and the Romans, whose societies were "positively fixated with an ideal of the self-controlled, aggressive, virile male," sex historian Angus McLaren writes in 2007's Impotency: A Cultural History.

The ideal Roman or Greek man was strong and active. He needed to be capable of showcasing masculinity in all walks of life–including in the bedroom–and was mocked and ridiculed if he failed to do so.

Such standards for masculinity began at birth, when nurses would tightly swaddle a baby's penis to shape it to the accepted aesthetic of the time. Once sexually active, young men were encouraged to eat certain foods–including the genitalia of animals with high libidos–and drink healthy amounts of wine to boost potency. Balancing the ingestion of these purported remedies with self-restraint was key, however, as overstimulation was thought to drain the body of vitality. Old age, on the other hand, began a period in which "you shall not make love, not even for a thousand drachmas, such is the impotence that awaits you," as the Greek poet Antiphanes wrote.

Enlightened about ED?

The centuries spanning the Enlightenment to the Industrial Revolution sparked an experimental renaissance in ED treatments.

Experimenting on cadavers in 1668, for example, Dutch physician Regnier de Graf began to understand how the penis' complex vascular structure plays a role in erectile function. Later, in 1875, 72-year-old French neurologist Charles-Édouard Brown-Séquard tested a hunch on the link between testosterone production and aging by injecting himself with the testicular fluid of dogs and guinea pigs. Scientists have since debunked the treatment's purported efficacy, but acknowledge that it opened the door to modern androgen therapy. And vacuum erection devices? The original model developed by French physician Vincent Marie Mondat in the early 19th Century is still widely used in today's penis pump designs.

But for all the scientific experimentation of the time, society's perceptions of masculinity and erectile dysfunction remained rigid. Just as in Roman times, jokes and shame about male sexual mishaps exacerbated the pressure to perform and to try any and all advertised cures, no matter how outrageous. Frustrated men reached for the psalms, balms and snake oils peddled by priests and grifters as the quickest remedy for a "lost manhood," McLaren writes, while physicians far from the cutting edge of new treatments continued to point to excess, Christianly sin and masturbation as the primary causes of any sexual misfires.

Jagged little pill

The rapid scientific advancements of the 20th century brought an array of treatments for mild to severe ED–from German biochemist Adolf Butenandt's Nobel Prize-winning synthesis of testosterone in 1935, to Dr. F. Brantley Scott's discrete, three-piece inflatable penile implant in 1973. Popular culture made its own strides, doing away in 1992 with the problematic term "impotence" in favor of the more accurate moniker "erectile dysfunction."

None, however, matched the "major breakthrough" of sildenafil's approval as the first oral treatment for ED in 1998, British urologist Jyoti Shah writes. Commonly known by the brand name Viagra, sildenafil's ability to increase blood flow to the penis by blocking specific hormones has made it the go-to ED treatment preferred by both patients and physicians for the past 25 years.

Sildenafil and its contemporaries have salvaged thousands of relationships and remain cornerstones of modern ED treatments, but new research suggests it works more like a painkiller than a panacea. One in three users report that such medicines aren’t effective in treating their ED, and the dangers for patients with specific comorbidities like heart disease remain too great to ignore.

What's more, writes McLaren in Impotence: A Cultural History, is that "the medicalization of sexuality has displaced, but not entirely banished older beliefs" in cure-all remedies for erectile dysfunction. Pills continue to "advance a model of masculinity that informed men if they were sexual successes, and if not, why not," he writes.

In other words: When prescriptions fail to live up to expectations, it can be just as demoralizing as the failed treatments of yore.

Re-thinking with Regimen–The Latest ED Treatments

So where do men go from here?

Studies point toward a more personalized, holistic path forward that combines existing medicinal treatments with personalized diet and exercise routines. One recent study of four million ED patients, for example, indicated that lifestyle changes–such as quitting smoking, reducing stress and getting enough sleep–had a reliably positive effect on erectile performance. In that same study, physical activity actually resulted in the largest improvement of erectile function when compared to other ED treatments, including sildenafil.

But maintaining long-term lifestyle changes is easier said than done. ED remains a taboo topic for men to discuss with their doctors, and when men actually do speak up, doctors remain prone to only prescribe medicines rather than to incorporate them into a tailored treatment plan.

Enter Regimen. Our personalized program provides information on a variety of factors that could play a role in ED and details possible treatment options. Medications like sildenafil play a role, but so do pelvic floor exercises, vacuum pump training, meditation, or a combination of all of the above. Regimen connects you with the science behind such solutions and helps you track your progress–which play an essential role in the success of long-term, multifaceted therapeutic processes to combat ED.

In doing so, we want to break the chain of historical one-size-fits-all treatments that told men when and how to be "normal" and "masculine" so they can write the history of their own successes without shame or stigma.