The quest for a reliable erection is one of the oldest and most universal human pursuits. Every civilization, on every continent, across every era of recorded history has produced its own theory about why erections fail and its own (usually terrible) idea about how to fix them.
What follows is a roughly chronological tour through 10,000 years of humanity's best attempts — from the genuinely dangerous to the accidentally brilliant — ending with the modern era, where science finally caught up with demand.
Crocodile Hearts, Lettuce, and Divine Intervention
The Ebers Papyrus (c. 1550 BCE), one of the oldest surviving medical texts, prescribed a mixture of baby crocodile hearts mixed with wood oil, applied topically to the penis. The logic, to the extent there was any, involved sympathetic magic: crocodiles were associated with the fertility god Sobek.
Egyptian physicians also recommended lettuce — specifically the tall, bolt-going variety that exuded a milky white sap when cut. The resemblance to certain bodily fluids was considered medically significant. The fertility god Min was traditionally depicted holding a head of lettuce.
Did it work? No.
Hippocrates, Aristotle, and Pigeon Dung
Hippocrates, the father of Western medicine, was among the first to recognize that ED could have physical (not just spiritual) causes. He attributed impotence in wealthy Scythian horsemen to excessive time on horseback — an observation about pelvic blood flow compression that modern cycling research has essentially confirmed.
Aristotle, less helpfully, recommended a topical paste of ground pepper and pigeon dung. Neither physician explained their reasoning with the rigor their other work demanded.
Hippocrates was right about the cause. Wrong about the fix.
Gladiator Blood, Goat Testicles, and Wine
Roman remedies were characteristically aggressive. Pliny the Elder recommended drinking the blood of gladiators or consuming roasted wolf penis. Goat testicles — eaten raw or made into a broth — were a popular prescription across the Roman Empire, based on the observation that goats appeared to have vigorous sexual appetites.
The one Roman remedy with any scientific basis? Wine in moderation. Modern research has confirmed that moderate alcohol consumption can reduce performance anxiety and mildly vasodilate blood vessels, though excessive consumption does the opposite.
Mostly horrifying. Wine was directionally correct.
Ginseng, Acupuncture, and Deer Antler Velvet
Traditional Chinese Medicine (TCM) developed the most systematic pre-modern approach to ED, framing it as a deficiency of "kidney qi" or vital energy. Treatments included Panax ginseng (red ginseng), acupuncture, deer antler velvet, seahorse extract, and various herbal formulations.
Interestingly, Panax ginseng has held up better than almost any ancient remedy under modern scrutiny. A 2008 systematic review in the British Journal of Clinical Pharmacology found "suggestive evidence" for the efficacy of red ginseng in treating ED, with the proposed mechanism involving nitric oxide synthesis in the corpus cavernosum — the same pathway that Viagra targets.1
Ginseng: possibly effective. Seahorse: not so much.
Spanish Fly, Mandrake Root, and Witchcraft Accusations
Renaissance Europe added two dangerous substances to the pharmacopoeia. Spanish fly (cantharides) — a powder made from crushed blister beetles — irritated the urinary tract, producing an engorgement that was mistaken for genuine arousal. It was also genuinely toxic and killed a non-trivial number of users. The Marquis de Sade was accused of poisoning prostitutes with it in 1772.
Mandrake root, shaped vaguely like a human body, was steeped in the "doctrine of signatures" — the belief that God designed plants to resemble the body parts they could heal. It contains tropane alkaloids that can produce hallucinations, which may have been interpreted as enhanced virility.
Impotence during this era was also frequently attributed to witchcraft, and men who couldn't perform risked having their wives seek annulment through the Church — or worse, having a suspected witch burned at the stake.
Dangerous. Occasionally fatal. Zero therapeutic value.
Electrical Stimulation, Goat Gland Transplants, and Mail-Order Fraud
The late 19th century brought two competing approaches to ED: genuine (if misguided) medical experimentation, and brazen quackery.
On the medical side, doctors experimented with galvanic electrical stimulation of the genitals, on the theory that erections were fundamentally electrical in nature. Advertisements for battery-powered "electric belts" promised to restore vigor through mild shocks delivered to the pelvic region.
The most infamous quack of the era was Dr. John Brinkley, who performed over 16,000 goat testicle transplant surgeries from his clinic in Milford, Kansas between 1917 and 1941. He claimed that implanting goat gonads into human scrotums would restore virility. It didn't, but Brinkley became a multimillionaire and nearly became governor of Kansas before being shut down by the FCC and AMA.
The golden age of medically sanctioned fraud.
Dr. Brindley's Conference Presentation
In 1983, British neurophysiologist Giles Brindley stood before a packed auditorium at the American Urological Association conference and did something unprecedented: he injected his own penis with papaverine (a smooth muscle relaxant) backstage, then dropped his pants to demonstrate the resulting erection to the audience.
The presentation — described by attendees as either the bravest or most disturbing conference talk in medical history — proved definitively that ED was primarily a vascular problem, not a psychological one. This single demonstration shifted the entire field from Freudian psychoanalysis to vascular physiology and paved the way for penile injection therapy and, eventually, oral PDE5 inhibitors.
Scientifically transformative. Socially traumatizing.
Viagra Changes Everything
When the FDA approved sildenafil (Viagra) on March 27, 1998, it became the fastest-selling drug in pharmaceutical history: $400 million in U.S. sales in the first three months alone. It was, as we've covered in detail, discovered entirely by accident during a failed heart drug trial.
For the first time in 10,000 years of trying, humanity had a pill that worked for the vast majority of men (70–80% success rate on first dose), was relatively safe, and required no crocodile hearts, goat testicles, or public genital displays. Tadalafil (Cialis, 2003), vardenafil (Levitra, 2003), and avanafil (Stendra, 2012) followed.
The first thing that actually works. Took us 10,000 years.
From Doctor's Office to Your Doorstep
The final barrier wasn't pharmacological — it was logistical. Even after Viagra's patent expired and generic sildenafil became available for under $3 per dose, millions of men still didn't seek treatment because they didn't want to have the conversation with a doctor, sit in a waiting room, or hand a pharmacist a prescription with their name on it.
The telehealth revolution eliminated every one of those barriers. A 15-minute confidential online consultation with a licensed physician, followed by a prescription filled through a licensed pharmacy and shipped in discreet packaging to your door. No office visit. No face-to-face conversation. No pharmacy counter.
After 10,000 years of crocodile hearts, pigeon dung, goat transplants, and electrical belts, the solution turned out to be embarrassingly simple: a pill that works, delivered without embarrassment.
We finally got it right.
10,000 Years of Progress, One Click Away
We've compared every modern telehealth provider so you don't have to sort through 10 millennia of bad ideas. Find the right fit in under 5 minutes.
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- Jang, D.J. et al. (2008). "Red ginseng for treating erectile dysfunction: a systematic review." British Journal of Clinical Pharmacology, 66(4), 444–450. Evidence for nitric oxide pathway activation.
- Ebers Papyrus (~1550 BCE). One of the oldest known medical documents; describes various remedies for sexual dysfunction.
- Shah, J. (2002). "Erectile dysfunction through the ages." BJU International, 90(4), 433–441. Comprehensive historical review of ED treatments.
- Brindley, G.S. (1986). "Pilot experiments on the actions of drugs injected into the human corpus cavernosum penis." British Journal of Pharmacology, 87(3), 495–500.
- Goldstein, I. et al. (1998). "Oral sildenafil in the treatment of erectile dysfunction." New England Journal of Medicine, 338(20), 1397–1404. Landmark Viagra efficacy study.