Ayurveda defines Erectile dysfunction or ED as follows.

Sankalpapravano nityam priyaam vashyaamapi sthreeyam ||
na yaathi lingashaithilyaath kadaachidyaathi vaa yadi |
Shwaasaarthaha swinnagaatrshcha moghasankalpacheshtitaha ||
mlaanashishnashcha nirbeejaha syodetat klaibyalaxanam |

This means even though a man has a strong desire to perform sexual act with a cooperative partner, he cannot perform sexual act because of looseness (absence of erection) of his phallus (penis). Even if he performs sexual act with his determined efforts he does not get erection and gets afflicted with tiredness, perspiration and frustration to perform sex.

Erectile dysfunction (ED) thus is the inability of a man to achieve or maintain an erection sufficient for his sexual needs or the needs of his partner. Erectile dysfunction may sometimes be even termed as "impotence". The term "erectile dysfunction" can mean the inability to achieve erection, an inconsistent ability to do so, or the ability to achieve only brief erections.

Physiology of Erection

The two chambers of penis (corpora cavernosa,) which run throught the organ are filled with spongy tissue. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and semen runs along underside of the corpora cavernosa ...

Due to sensory or mental stimulation, or both, the erection begins. Due to impulses from brain and local nerves the muscles of corpora cavernosa relax and allow blood to flow in and fill the spaces of spongy tissue. 

The flow of blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the chambers, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection recedes.

In ayurveda physiology of erection and ejaculation is described as follows

Vrishunow basthimedram cha naabhyuuru vankshnow gudam |
Apaanasthaanamantrasthaha shukra mootra shakrunti cha ||

The 'apaanavayu' one of the five types of vayu is located in the testicles, urinary bladder, phallus, umbilicus, thighs, groin, anus and colon. Its functions are ejaculation of semen, voiding of urine and stools. 

Shushruta explains the process of erection and ejaculation as  - When a man has desire (iccha) to have sex, his response to touch increases. (Vayu located in skin causes flow of signals from skin to brain, thus causing sensation of touch). This causes arousal or 'harsha' . Arousal or Harsha intensifies actions of vayu and at this moment highly active vayu liberates the 'teja' or heat of pitta. Thus tejas and vayu increase body temperature, heart beat and blood flow causing erection. 

Causes of ED 

Erection requires a sequence of events. Erectile dysfunction can occur when any of the events is disturbed. Nerve impulses in the brain, spinal column, around the penis and response in muscles, fibrous tissues, veins, and arteries in and around the corpora cavernosa constitute this sequence of events. Injury to any of these parts which are part of this sequence (nerves, arteries, smooth muscles, fibrous tissue) can cause ED. 

Lowered Level of Testosterone Hormone: The primary male hormone is testosterone. After age 40, a man's testosterone level gradually declines. About 5% of men that doctors see for erectile dysfunction have low testosterone levels. In many of these cases, low testosterone causes lower sexual interest, not erectile dysfunction.

The whole male body responds to testosterone. 

Even sushruta has illustrated about this response of body to the element 'Shukra' . He has said

"yatha payasi sarpistu goodashchekshow raso yatha shareereshu tatha shukram nrinaam vidyaadhbishagwara"

This means " The shukra (the element which helps in reproduction) is present all over the body.

This can be explained with the following examples.

1. The ghee is present in milk in an invisible form. This is extracted from milk using many processes.
2. The sugar is present all over the sugarcane. It is extracted by subjecting the sugarcane to number of processes.

Same way shukra is present all over the body. But the cream of shukra (semen) comes out of the body only during the process of ejaculation. But this process of ejaculation needs a joyful union of mind and body.

Decrease in production of 'Shukra' causes erectile dysfunction.

Over Exertion - physically and mentally : Working for long hours in office, mental stress at office and home, short temperedness ,insufficient sleep cause erectile dysfunction. 

These causes are explained in Ayurveda as "shoka, chintaa, bhaya, traasaat .... " which means that erectile dysfunction or Impotence occurs due to grief, fear, anxiety and terror.

Strained relationship with sexual partner: Erectile dysfunction also occurs when there is a disliking towards sexual partner.

Ayurveda describes this as "naarinaamarasamjnatwaat..." means disliking for women.

Diseases that Cause Erectile Dysfunction

Neurological disorders, hypothyroidism, Parkinson's disease, anemia, depression, arthritis, endocrine disorders, diabetes, diseases related to cardiovascular system also become reasons for erectile dysfunction..

According to ayurveda the diseases which cause erectile dysfunction are "Hritpaandurogatamakakaamalashrama..." - Heart diseases , anemia , asthma , liver disorders , tiredness .Apart from these the imbalance in tridoshas also cause impotence or erectile dysfunction.

Consumption of medicines, drugs and tobacco: Using anti-depressants, tranquilizers and antihypertensive medicines for a long time, addiction to tobacco especially smoking, excessive consumption of alcohol, addiction to cocaine, heroin and marijuana cause erectile dysfunction.
 
In Ayurveda texts these causes have been said in brief as "rukshamannapaanam tathoushadham" - "dry food, drinks and medicines" cause impotence or erectile dysfunction.

Trauma to pelvic region: accidental injury to pelvic region and surgeries for the conditions of prostate, bladder, colon, or rectal area may lead to erectile dysfunction.

These causes are mentioned as abhighata (trauma), shastradantanakhakshataha (injury from weapons, teeth and nail.) in Ayurveda.

Other reasons

Obesity, prolonged bicycle riding, past history of sexual abuse and old age also cause Erectile dysfunction.

Ayurveda describes the cause of impotence or erectile dysfunction due to old age as follows. " diminution of - tissue elements, strength, energy, span of life, inability to take nourishing food, physical and mental fatigue lead to impotence"

Remedies for ED

ED is treatable at any age. The total treatment in for impotence is called as Vajikarana therapy in Ayurveda. As this therapy increases the strength of a man to perform sexual act, like a horse, it is called 'Vaajikarana'. (' Vaaji' = Horse.)

Vaajikarana therapy leads to

Happiness.
Good strength.
Potency to produce offspring.
Increased span of erection.

Eligibility for Vajikarana therapy:

1. The vajikarana therapy should be administered to persons who are between 18 to 70 years of age.
2. These therapies should be administered only to a self controlled person. If this therapy is administered to a person who does not have self control, he becomes nuisance to society through his illegitimate sex acts.

Psychotherapy

Decreasing anxiety associated with intercourse, with psychologically based treatment helps to cure ED. The patient's partner can help with the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when ED from physical causes is being treated.

Same treatment is illustrated in Ayurveda. It has been said 'A woman who understands a man and is liked by him, along with erotic environment act as best aphrodisiac.'

Drug Therapy 

Numerous herbal preparations are mentioned in Ayurveda to treat ED or impotence. It has been said that people who have strong sexual urge, who want to enjoy sex regularly have to consume these preparations regularly to replenish the energy, vigor, stamina and strength. These preparations also supply the nutrients which are necessary for production of semen.

Ayurveda tips to overcome ED

Erectile dysfunction which is a very common complaint can be generally rectified by following few simple steps. Here goes the list of simple but effective tips to rectify erectile dysfunction.

• Avoid consumption of alcohol. If you are addicted to alcohol restrict the intake. Alcohol acts on central nervous system and causes erectile dysfunction.
• Keep away from smoking. Men who smoke suffer from erectile dysfunction than men who do not. It is evident from researches. Smoking causes formation of plaques in arteries (atherosclerosis) which obstruct the blood flow.
• Avoid working for long hours. Take a break from regular routine at week ends and spend time with your partner.
• Practice Yoga and meditation regularly to keep away anxiety, depression and stress. Meditation and Yoga are best stress busters.
• Do not have the fear of not getting hard erections or do not doubt your ability to satisfy your partner. It will lead to psychological ED.
• Happy and comfortable atmosphere at home is very essential to stimulate sexual desire and keep sexually healthy.
• Exercise regularly and daily. Brisk walk for 45 minutes is the best exercise which keeps the cardiovascular system healthy. Researches have shown that the incidences of erectile dysfunction are less in men who regularly exercise.
• Weight reduction helps to increase testosterone level and increases sexual energy and stamina. Weight reduction helps to keep hypertension and diabetes in control. Diabetes causes erectile dysfunction and anti hypertensive medications may cause erectile dysfunction.
• Marijuana, heroin, cocaine etc cause erectile dysfunction. Withdrawing from addiction to the above mentioned substances really helps in increasing erections and sexual stamina.
• Reduce the frequency of masturbation. Masturbating twice in a week is ideal. .
• Massage whole body with herbal oil at least once in a week. This increases sexual energy and stamina. Body massage (abhyanga) is mentioned as the best aphrodisiac in Ayurveda.
• Sleep at least for 8 hours a day. Body gets energized with good sleep.
• Do not control natural urges. Empty your bladder before going to bed with your partner.
• Take all steps to prevent indigestion and constipation. Indigestion and constipation vitiate doshas and cause diseases. Hard erections will not occur when body is not healthy.
• Avoid hot, spicy and bitter foods which imbalance vata . According to Ayurveda imbalanced vata causes erectile dysfunction.
• Give a gap of four days between two consecutive intercourses.
• Regularly consume Vajikarana Preparations. Vajikarana preparations always keep men sexually healthy.

Give a gap of four days between two consecutive intercourses.

Dr. Savitha Suri , B.A.M.S is Chief Consultant physician at Chaitanya Integrated Medical Center, Udayagiri, Mysore, Karnataka, India. She is practicing Indian Systems of Medicines since 12 years. By arrangement with http://www.ayurhelp.com

Disclaimer: 
Information provided in this article is for the sole purpose of imparting education on Ayurveda and is not intended to diagnose, treat, cure or prevent any disease. If you have a medical condition, please consult your physician.