Sexual dysfunction, including erectile dysfunction (ED), can affect your quality of life, confidence, and relationships. ED is the inability to achieve or maintain an erection sufficient for sexual performance.
Although it can be naturally caused by aging, many other causes of erectile dysfunction exist. It includes psychological factors (stress, depression, and anxiety), hormonal abnormalities (low testosterone), vascular diseases (atherosclerosis), and neurologic causes (multiple sclerosis, spinal, and nerve injuries).
The association between vitamin supplements and erectile dysfunction has been investigated, with some results suggesting that particular vitamins may prevent or alleviate ED symptoms.
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Vitamin D refers to the fat-soluble group of vitamins that are important for calcium metabolism. The vitamin D receptor is expressed in all body tissues, including the penis. Vitamin D binds to its receptor, causing it to relocate from the outer membrane to the nucleus, where specific pathways are switched.
Because vitamin D receptors are found extensively throughout the body, it is well known for playing a pivotal role in many cellular processes, including those related to ED. Some of these ED processes include:
Penile development during gestation
Nitric oxide production
A study¹ investigated the penile morphology of rats with vitamin D restriction. They found that vitamin D was crucial in maintaining the cytoarchitecture of the penis The study concluded that the human body requires vitamin D for the proper formation of the penis during the embryonic stage.
The endothelium² is a thin membrane that lines the inside of blood vessels. Cells release substances to control the relaxation and contraction of vessels. Endothelial dysfunction² results in restricted blood flow and plaque buildup on the blood vessels.
A placebo-controlled trial³ demonstrated that a large dose of vitamin D2 improved endothelial function in patients with type 2 diabetes and vitamin D deficiencies. Since endothelial function improvement is the current treatment target for ED, vitamin D supplementation may benefit ED patients.
Nitric oxide (NO) production⁴ is critical to endothelial cells and vital to controlling blood flow, including to the penis.
One study⁵ demonstrated that vitamin D could stimulate the production of NO in endothelial cells and thus may be helpful in the prevention of ED.
Vitamin B9, or folic acid (FA), has a vital role in NO metabolism. NO is a strong vasodilator⁶ that allows the penile blood vessels to dilate so that blood can flow and create an erection. FA has been shown to improve erectile function in some patients.
In 2020, a study⁷ evaluated homocysteine plasma levels before and after FA administration in patients with erectile dysfunction. Homocysteine is an intermediary amino acid formed by converting methionine to cysteine. High levels of homocysteine are associated with the creation of blood plaques and prothromic properties.
They found that those patients who received FA had significantly reduced homocysteine levels⁸ compared to the beginning of the study.
All research concluded that FA deficiency might be an independent risk factor for ED. The mechanism of action is that FA deficiency may impair NO metabolism⁹ and contribute to endothelial dysfunction and vascular ED.
These results suggest that, although FA shouldn’t be used as a standalone treatment for ED, FA could be used in conjunction with prescribed ED medications.
Atherosclerosis is a buildup of cholesterol in the arterial walls. It can constrict blood flow to the heart muscle if it happens in the coronary arteries and can occlude the penile arteries narrowing and hardening vessels. This makes it difficult for blood to enter the penis before intercourse.
Statins are drugs that reduce lipid levels and possibly stabilize plaques, reverse endothelial dysfunction, decrease thrombogenicity, and help regress atherosclerosis leading to improved blood flow. Some studies have shown that vitamin B3 (niacin) might be a similarly effective treatment in alleviating ED symptoms.
In 2011, a study¹⁰ found that men affected by ED experienced improvements in erectile function after taking niacin for 12 weeks. This was measured using the International Index of Erectile Function (IIEF).
There was no difference in those suffering from mild to moderate symptoms compared to the placebo, but there was a difference in those suffering from moderate to severe ED. This suggests that niacin may be a more effective treatment for those suffering from severe symptoms.
Vitamin B12, or cobalamin, breaks down homocysteine to methionine, a crucial part of DNA synthesis. Although there are limited studies on vitamin B12 affecting ED, there is some evidence that vitamin B12 and homocysteine play an essential role in ED.
One study included 691 men aged 20–69 who identified as having ED through the IIEF-5 questionnaire. The study¹¹ measured plasma homocysteine levels, vitamin B12, and folic acid.
Lifestyle choices were also recorded via face-to-face communication. Their analysis showed that age, homocysteine, and vitamin B12 were associated with ED. Homocysteine levels were increased in men over 45 with ED, while vitamin B12 was decreased in men under 45 with ED.
No scientific studies¹² support the claims that vitamin C supplements can improve ED.
Although there is no concrete evidence that vitamin deficiencies cause ED directly, there is some evidence that vitamin deficiencies may be indirectly associated with ED, most notably, vitamin D.
Vitamin D is connected to many bodily systems, including endothelial function. Vitamin B12 deficiency can also lead to anemia and ED if the anemia is severe.
It has also been shown that deficiencies in NO production can cause ED as NO is necessary to help maintain healthy erectile function. However, vitamin D deficiency is easily treatable with modest sunlight exposure and a healthy balanced diet.
There is growing evidence to support the theory that folic acid (vitamin B9) and niacin (vitamin B3) deficiencies may contribute to the severity of ED in some patients. However, most of this evidence is for severe ED and not the restoration of erectile function. It has not necessarily demonstrated causation beyond association.
There is no sufficient evidence to say that vitamins alone can treat ED. Instead, it is recommended to check your vitamin levels to see if you have a deficiency, then speak to your healthcare professional to discuss supplementation if that is the best course of action.
Getting sufficient vitamins and minerals improves your health, but there is no evidence that they may cure erectile dysfunction. They may, however, help manage the symptoms associated with ED.
There are no recommendations for the dosage of vitamins to treat erectile dysfunction. However, there are recommended daily vitamin doses.
The recommended dietary allowance (RDA)¹³ associated with ED for vitamins for the average adult are:
Vitamin D—10 mcg
Vitamin B9—200 mcg (0.2 mg)
Vitamin B3—16 mg
Vitamin B12—1.5 mcg
Vitamin C—40 mg
Vitamin C is not made endogenously in the body and must be provided daily. However, there is no evidence to suggest that vitamin C improves ED.
Most of these vitamins can be obtained through a healthy daily diet. Supplementation is only recommended when this cannot be achieved, for example, when you’re on a restrictive diet or when a healthcare professional recommends supplementation.
There is limited evidence and a lack of proven clinical trials to support the effectiveness of vitamins for treating erectile dysfunction.
Prescription medications¹⁴ such as sildenafil (Viagra or Revatio), vardenafil (Levitra), tadalafil (Cialis), and avanafil (Stendra) have a scientific basis and are proven to help with ED.
However, vitamins may be used in combination with prescription medication or when a prescription medication is not recommended with other comorbidity medication.
Although some causes of ED are not preventable, such as aging and neurological conditions, lifestyle changes could help prevent ED as there is scientific evidence for their contribution.
These lifestyle changes include smoking and obesity. Smoking damages blood vessels, which impairs their ability to dilate, thus preventing blood from entering the penis during an erection.
Meanwhile, obesity is associated with an increase in cholesterol,¹⁵ which can lead to plaques and thus restrict vessels and reduce blood flow. Obesity is also a risk factor for metabolic diseases such as diabetes, which in and by themselves can cause or put you at risk for erectile dysfunction. In this case, a lifestyle change may help alleviate ED symptoms.
Medications approved for ED treatment may be required if lifestyle factors are not believed to be causing ED. Healthcare professionals can prescribe these depending on your condition.
The most noteworthy ones are sildenafil (Viagra or Revatio), vardenafil (Levitra), tadalafil (Cialis), and avanafil (Stendra). More research on ED is underway, and topical treatments such as creams and ointments (alprostadil)¹⁶ are now being explored as over-the-counter treatment plans.
Some people find it difficult to talk to a health professional about ED. However, it is a very common condition, and understanding its cause will help find the best treatment approach to help.
If you’re struggling to get or maintain an erection regularly, you should speak to your doctor before opting for supplements over medical treatment.
Erectile dysfunction is the inability to achieve or maintain an erection sufficient for sexual performance. ED decreases your quality of life, increases in frequency with age and some lifestyle choices such as smoking and alcohol can put you at increased risk.
However, there are many other causes of ED, including psychological and medical. It is a common issue that affects 50% of men over the age of 40.
Vitamin deficiencies are one of the contributing factors to erectile dysfunction. There is evidence that vitamin D deficiencies contribute to endothelial dysfunction, preventing nitric oxide release and dilating the blood vessels needed to maintain an erection.
Although there is some evidence that supplementation helps, particularly for vitamin D and B9, vitamins are not a “fix-all” miracle drug and should always be discussed with a healthcare professional.
Endothelial function testing | Cedars Sinai
Folic acid supplementation improves erectile function in patients with idiopathic vasculogenic erectile dysfunction by lowering peripheral and penile homocysteine plasma levels: A case-control study (Wiley Online Library: 2019)
Folic acid supplementation improves erectile function in patients with idiopathic vasculogenic erectile dysfunction by lowering peripheral and penile homocysteine plasma levels: a case-control study. (Europe PMC: 2019)
Choosing the right pill to treat ED | Boston University School of Medicine: Sexual Medine
Symptoms & causes of erectile dysfunction | National Institute of Health: National Institute of Diabetes and Digestive and Kidney Diseases