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Not long ago, doctors and psychologists believed that 90 percent of erection difficulties were psychological and that a stimulating partner was all a man needed. Now authorities agree that most erection impairment has a physical cause: clogged arteries, alcohol or other drugs, diabetes, pelvic injuries, sleep deprivation, smoking or prostate surgery.

But how can a man know if his erection problem is physical or psychological? I like the postage-stamp test mentioned by herb advocate Andrew Weil, M.D., professor at the University of Arizona College of Medicine in Tucson and author of Natural Health, Natural Medicine. It is based on the fact that a normally functioning man has spontaneous erections in his sleep every night.

To take this test, fasten a strip of postage stamps around the shaft of your penis before you go to bed. If the strip is intact in the morning, you have not had any erections during sleep, and there is probably something wrong physically. If, on the other hand, a nighttime erection broke the stamps as you slept, your penis is working okay, and the problem may well be psychological.

This test is not foolproof, but it's a good place to start. The next logical step, of course, is to discuss the results with your doctor.

Impotence is the inability to raise or sustain an erection that is adequate for intercourse and ejaculation. Some 30 million American men experience some form of impotence, with more than a million currently being treated. Some take prescription medication. Others get penile implants. The newest approach involves self-injecting a hormone known as prostaglandin E. Within a few minutes, it produces a 90-minute erection.

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But before you go sticking needles into your penis, you might try some of these herbal approaches.

Velvet bean (Mucuna, various species). Years ago, while working in Panama, I was told by more than one informant that the seeds of the velvet or ox-eye bean (in Spanish, ojo de buey) were aphrodisiac. That was before I knew that these seeds can contain as much L-dopa as velvet beans, and perhaps more. The mucuna is our best food source of the compound L-dopa, which is often used to treat Parkinson's disease. Large amounts of L-dopa may cause priapism, a painful, persistent erection that has nothing to do with sexual arousal.

Ginkgo (Ginkgo biloba). Ginkgo is best known for improving blood flow through the brain. But it also seems to boost blood flow into the penis, thus aiding iffy erections. In several small studies, physicians have obtained very good results with 60 to 240 milligrams daily of a standardized ginkgo extract. In one nine-month study, 78 percent of men with impotence due to atherosclerotic clogging of the penile artery reported significant improvement without side effects.

People normally think of atherosclerosis as a disease that clogs the blood vessels that supply the heart, thereby leading to heart attacks. This same disease can also clog the blood vessels that supply the penis and lead to erection problems. In another six-month study, half of the men being treated with ginkgo regained their erections. The active compounds are too dilute in ginkgo leaves to do much good, so standardized extracts concentrate it: A 50:1 extract means that 50 pounds of leaves were used to produce 1 pound of extract. You can try 60 to 240 milligrams a day, but don't go any higher than that. In large amounts, ginkgo may cause diarrhea, irritability and restlessness. And do give it time to work. In about six months, you'll know whether it's going to do the trick.

Yohimbe (Pausinystalia yohimbe). For at least ten years, I have maintained that if there is a real herbal erection enhancer, yohimbe is it. I based this on centuries of folklore about the African tree bark and a few small clinical trials that showed that the herb produced erections in about half of men with psychological impotence and about 40 percent with physical erection problems.

Unfortunately, the side effects were a little unnerving, including anxiety, increased heart rate, elevated blood pressure, flushing, hallucinations and headache. This is not an herb that you want to mess around with. But then the drug companies got into the act. They figured out how to extract the active compound and eventually won approval for yohimbine hydrochloride (Yocon, Yohimex) as a prescription medication. After one month, 14 percent of men taking it reported restoration of full and sustained erections, 20 percent reported partial responses, and 65 percent reported no improvement. Still, one-third improved, which isn't bad.

Generally, I advocate taking a whole herb rather than a pharmaceutical derivative, but this is an exception to my rule. Compared with the raw herb, the prescription drug causes fewer side effects, and those are generally benign. If I had erection difficulties, I might ask my doctor to put me on yohimbine.

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I do a lot of traveling in Latin America, and the herbal formulas I find there--and people's faith in them--never cease to amaze me.

When it comes to enhancing men's sexual potency, there is a very long list of herbs with a reputation for delivering. I find a couple of alcoholic beverages made from herbal formulas added to a wine or rum base to be particularly intriguing.

One is siete raices. In English this translates to "seven roots," which is rather odd, because the drink is made from seven dried barks. The other is rompe calzon--"bust your britches." The name comes from its folklore reputation for producing erections large enough to strain trouser material. (I'm not making this up.)

There is only anecdotal evidence that rompe calzon stimulates erotic interest, but those anecdotes sure sell a lot of this brew in Latin American countries. I confess that I've tried it myself and haven't found it all that stimulating.

You won't be able to buy either of these formulas in the states, but one ingredient common to both may be available here. Clavohuasca (Tynnanthus panurensis) is an aromatic vine that is often found climbing to the forest canopy in Amazonian Peru, where I lead my Rainforest Pharmacy Workshops.

One traveler in my first Physician's Workshop, an acclaimed herbalist himself, says he has empirical evidence that tincture of clavohuasca, a rather pleasant and warming liqueur, sexually excites both the male and female of the human species--namely him and his wife.

I know of only one herb shop in the United States that carries tincture of clavohuasca, Smile Herb Shop in College Park, Maryland, so I'm assuming that it's imported and can be found in other herb shops. If you're anxious to give it a try, you might have to search for it--but you'd have to work a whole lot harder to get your hands on either siete raices or rompe calzon.

Ginseng (Panax, various species). American Ginseng (P. quinquefolius) is probably North America's most famous--and perhaps most overrated--aphrodisiac. Even though studies have shown that animals increase their sexual activity when they eat ginseng, I'm not entirely convinced that this herb will spark anyone's fire. Still, I grow several varieties--American, Asian (P. ginseng) and Siberian (Eleutherococcus senticosus), which is also known as eleuthero. I'm not currently using any of these herbs, however, as they are expensive. But I am preparing for old age by holding some in reserve just in case the Chinese are correct in saying that ginseng makes an old man young again. America, by the way, exports close to $100 million worth of ginseng annually, mostly to Asians who have great faith in American Ginseng and regard it as the herbal fountain of youth.
Niacin.  Every part of you needs oxygen-rich blood to stay alive, and so does the heart itself. It comes equipped with three special blood vessels that keep it supplied. Shaped like the tubes on a coronet, they're known as coronary arteries.  Normally, the insides of your coronary arteries are slick and even, so blood flows smoothly to your heart. When you have heart disease, though, the inside of the arteries gets clogged with a waxy mixture of cholesterol and other substances, called plaque, that limits blood flow. Now the blood looks as if it's surging through rapids. If the flow gets dammed up altogether, the result is a heart attack.

Your heart isn't the only organ that can be affected by this pernicious clogging. The arteries to your brain and other key body parts, like your legs, can also get clogged with plaque. Cut off the blood flow to your brain, and the result is a stroke. Limit the flow to your legs, and you're almost guaranteed to have chronic cramps and leg pain. In men, too little blood flowing to the penis can cause another related problem—impotence.

Arginnine & Ornithine (amino acid) Current studies support the use of arginine supplements to ensure that nitric oxide secretion is sufficient to keep blood flowing to the penis. Nitric oxide insufficiency can stop the penis from becoming erect. A study published in 1994 showed an 80 percent improvement in the erectile function of men given 2.8 grams of arginine a day for two weeks.
Horny Goat Weed (Epimedium sp.) has a two thousand year history of use as a sex-enhancer. Scientific texts on Chinese herbs and top medical doctors in Shanghai report that horny goat weed boosts libido, improves erectile function, and helps to mitigate menopausal discomfort. The leaves contain a variety of flavonoids, polysaccharides, lignans, sesquiterpenes, phenolic and penethylol glycosides, ionones, sterols, and an alkaloid called magnaflorine. Maca (Lepidium meyennii) has been cultivated for over two thousand years in the Peruvian highlands. MacaPure, the standardized extract used in Horny Goat Weed formula, was the subject of a paper published in the April 2000 issue of the leading medical journal Urology. Maca is widely prescribed by medical doctors in Peru for men with erectile problems, for men and women with low libido, and for women undergoing menopause. Mucuna (Mucuna pruriens), or dopa bean, contains naturally occurring L-dopa—a known libido-booster. In India, we found that mucuna is one of two primary herbal remedies prescribed to men with erectile problems, for men and women with low libido, and for women undergoing menopause. Its long history of use in India's traditional medicinal system of ayurveda testifies to this plant's efficacy.
Saw palmetto (Serenoa repens). This small palm tree native to the Southeast has been shown to help shrink enlarged prostate tissue. But a century ago, it was also considered useful for treating impotence and loss of libido. The main effect of saw palmetto is that it shrinks the prostate, allowing older men to urinate more freely. Prostate enlargement does not necessarily interfere with sexual function, but relieving the condition can only help men feel better about their sexual equipment, which just might be of some help with erection.

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Muira puama (Ptychopetalum, various species). There is one study showing that this little-known Amazonian tree "may be effective in restoring libido and treating erectile dysfunction," according to Melvin Werbach, M.D., assistant clinical professor of psychiatry at the University of California, Los Angeles, School of Medicine, and naturopathic physician Michael Murray, N.D., who cited the study in their book Botanical Influences on Illness. Of 262 men taking 1 to 2.5 grams of muira puama extract a day for two weeks, 51 percent of those with erection problems reported improvement, as did 62 percent of those with loss of libido. I confess I haven't reviewed the original study, but if I had an erection problem, I might try this herb. You can find it in some herb stores. So far I have seen no reports of side effects. (Some men find the Amazonian ladies so attractive as to render the muira puama superfluous.)
Assorted essential oils. For erection problems, aromatherapists often recommend whole-body massage with a combination of a few drops of the essential oils of clary sage, jasmine and rose mixed into a vegetable oil base. (Remember not to ingest the oil, however, as even a small amount can be toxic.) Personally, I've found massage to be a wonderful aphrodisiac, even without the aromatic oils.
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