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Yohimbe is an herbal remedy that comes from the bark of an African tree, Pausinystalia yohimbe. Before Viagra, drugs containing yohimbine hydrochloride, the active ingredient in yohimbe bark extract, were used to treat erectile dysfunction (ED). However, levels of yohimbine in yohimbe bark extract vary considerably and are often very low. Yohimbe bark extract, by itself, never has been shown to work as effectively as drugs containing yohimbine hydrochloride. What's more, yohimbe can have serious side effects including paralysis, fatigue, stomach disorders, even death. I don't recommend it, and harvesting of its bark is driving the yohimbe species to extinction.

Viagra and related drugs are the most effective treatments for ED by far, but you can try the following non-drug approaches if you wish:

• Stop smoking. Nicotine can reduce genital blood flow and impair potency.
• Check your meds. ED is an unfortunate side effect of many drugs. Ask your physician or pharmacist about alternatives.
• See your physician. A general medical examination should be done to rule out physical causes as well as any signs of vascular, hormonal or neurological disorder.
• Limit alcohol consumption. Alcohol's depressive effects can have a negative impact on sexual functioning.
• Shape up. ED is often linked with restricted blood flow to the penis. Keep your heart and arteries in good condition by maintaining a healthy weight, and following a diet high in fruits, vegetables and whole grains. Avoid saturated fats and trans-fats. Regular aerobic exercise can improve blood flow to the genitals and reduce the stress that can contribute to ED.
• Deal with anxiety, depression and stress that may undermine desire and potency. Try breath work, meditation or yoga to reduce stress. Be open and honest with your partner about your mutual needs to help ease any tension or misunderstandings.
• Don't worry about your age. Discard the myth that sexual activity ends with age.

In addition to the measures above, the following supplements may help:

• Ginkgo biloba, which may help by increasing blood flow to the genitals. The usual dose is 120 milligrams a day, in divided doses with food.
• Ashwaganda, an Ayurvedic herbal remedy reputed to act as a mild aphrodisiac, or Asian ginseng (Panax ginseng), a good stimulant and sexual energizer. For either, follow the dosage on the package, and give it six or eight weeks to have an effect. Both ashwaganda and Asian ginseng are generally safe (but Asian ginseng can raise blood pressure and cause irritability and insomnia in some people).

Andrew Weil, M.D.