A very haqrd question to ask, but I'd like your insight into the question of what are the best and most effective alternatives for treating recurring ED caused by known physiological factors?

Dear donquixote145,

I am not a physician, nor have I examined you or had you under medical supervision. Hence, I can only defer to the ED meds that are available in this country - Viagra, Levitra, Cialis.

You will need to visit with your doctor to get prescriptions and then try the meds one by one. There's daily dosing of Cialis - that may work better for you? Who knows?

If your ED is caused by "known physiological factors," then your doctor should be up on what's ailing you. If you're on diabetes meds, BP meds, cholesterol meds, BPH meds, antidepression meds, then you've got an issue for sure. And among those drugs, there are also several to choose from. Your doc will be able to help you switch.

Impossible to make recommendations in individual cases like these,
The Love Goddess

Besides the now famous ED pills, there are herbals like "horny Goat Weed" which apparently is not a joke.  There is the caverject, there are vacume devices.  Even penile implants.  Any and all should be udertaken under doctor knowledge & supervision.  ED is or can be a sign of a number of diseases which should be fully investigated before swallowing a pill.
I happen to have nerve damage from a Neurological Disease.  Yes, it can have sexual effects.  There is no "best"...  treatment alturnatives must be tailored to the individual's circumstances.

I suggest you seek out a Urologist or Men's Health Medical Practice.

Best Wishes,
jtp

I've been having problems myself along these lines for a couple of years.  I have neurological problems as well as diabetes, and high blood pressure and I'm on medications for all of it.  

Unfortunately, medical science has not resolved my issues.  Here is a little of what I've discovered working with my doctor:

 - Herbal remedies don't work.  They conflict with the medicines I have to take for diabetes and high blood pressure and actually caused my diabetes to spike when I was taking herbal remedies.

  - Viagra works... but I get major headaches that prevent me from doing anything.  It's sort of like being dressed with no place to go.

  - Levitra works... but I get severe nausea that lasts for about 3 days.  Really.  I can barely keep down food.

  - Cialis works.. but I get both the nausea and the headaches.  While neither are as disabling as with the other drugs, they last longer.  So, the headache lasts for about 12 hours and the nausea has lasted up to 9 days.  My doctor doesn't think the daily cialis will be much better.

Your results will probably vary since everyone's body is unique.  But, I'm very disappointed in science.  

Personally, I think the best and most effective way of treating ED is to find and correct whatever is causing the problem in the first place if that's possible.  In my case, it isn't possible since my spinal damage is permanent and so is diabetes.

I still manage to have fun though... it just takes a lot more mental energy, and sometimes I never actually orgasm.  But, I keep trying.

I'll be the first to admit that I would have called this lame 20 years ago, but 20 years ago, I was a stud.  Now, I'm a guy that can't have vaginal intercourse with a condom because I go soft within a couple minutes.  So I've had to make all sorts of accommodations as a result, and I don't think I'm alone in that regard.

You've got a lot of health issues to deal with, but you've got the right attitude.  By staying positive, you can still find ways to have fun.  We can only do what we can do and there's no benefit to wishing we could turn back the clock.

I recently had a session with a woman I'd seen once before, and liked, but didn't really have time to talk much in the rushed hour we had.  On my second visit, we laid on the bed naked and enjoyed getting to know each other so much that 90 minutes went by on a one-hour session.  We never did the deed.  She had to rush me out because another client was scheduled, so she returned part of the fee and apologized.  I told her I enjoyed every minute and no apology was necessary.

Of course, I wouldn't want to do that all the time, but it did illustrate to me that it's always pleasurable to be in the company of an attractive woman you like.  Maybe it's lame, but like I said, I'm not the young stud I used to be, and I'm learning to accept that.

You have some very good responses here.  I post mine only to show that there are many kinds of disability and the only option is find out what works best for you.  In my case I was diagnosed with prostate cancer 12 years ago and had to choose surgery or radiation to save my life.  The good news is that I'm still here and healty; the bad is that I had some permanent damage from the radiation, but never missed a day of work or experienced any pain.  I'm still glad I chose it because it is less invasive and a number of men I know who chose surgery had severe inconvenience, dysfunction, and even recurrences.  I've tried viagra, levitra, cialis, muse and herbal stimulants.  They all help, and I have no side effects, but I can't sustain an erection.  Guess what?  A loving session with an affectionate provider culminating in BBBJ or HJTC (after I've also pleasured her) is still sublime. As several said, "find out what you can do, and then do it!"

How does one find a good doctor?

Anyone having any experience with massaging creams?

But here are my general thoughts.

Overall health = sexual health. So anything that is good for your overall health will likely benefit ED.

The following are not medical recommendations because I am NOT an MD. Run anything I say in this post by competent medical authorities.

Even if a person is not diabetic, he can benefit from eating as though he were and monitoring glycemic load carefully. Even if a person has no autoimmune issues, he can benefit from eating an overall anti-inflammatory diet. Even if a person doesn't have celiac disease; many benefit from a gluten-free diet rich in vegetables. Even if a person doesn't have lung cancer, many benefit from smoking cessation.

And, of course, frequent vigorous aerobic exercise and progressive resistance exercise as well.

These things can all help address the underlying issues of ED; or help prevent those underlying issues for those who do not have ED.

Another thing that can help that is natural is -- believe it or not -- Kegel exercises. They can improve the firmness of erections and more.

For more on Kegel for men: http://www.askmen.com/dating/love_tip_60/67_love_tip.html

May the schwartz be with you.