Ed fixer: Erectile Dysfunction (ED): Symptoms, Diagnosis & Treatment
5 natural ways to overcome erectile dysfunction
Men’s Health
- Reviewed by
Howard E. LeWine, MD,Chief Medical Editor, Harvard Health Publishing
If you’re a middle aged man, can you run as fast as you did when you were 20 years old? Hit a baseball as far as you once could? Bash a tennis ball with the same speed and spin?
Probably not.
But even as we age, there are still plenty of ways to stay in the game and enjoy it. That’s as true of sex as it is of sports.
What is erectile dysfunction?
Erectile dysfunction, or ED, is trouble attaining and sustaining an erection sufficient for satisfying sexual intercourse. At least 25% of the time, the penis doesn’t get firm enough, or it gets firm but softens too soon.
Causes of erectile dysfunction
Erectile dysfunction can occur for many reasons. Sometimes it is as simple as the side effect of a particular medication. Job stress, relationship problems, or depression can also contribute to ED.
But for roughly 75% of men, the cause is more complex. ED may result from vascular disease, neurological disease, diabetes, or prostate-related treatments or surgeries.
Often, the culprit behind ED is insufficient blood supply to the penis because of clogged arteries (atherosclerosis). In fact, in up to 30% of men who see their doctors about ED, the condition is the first hint that they have cardiovascular disease.
Erectile dysfunction self-care: 5 tips to use today
Whether you currently suffer from ED or are hoping to sidestep this condition, try these tips to overcome ED for better health and a better sex life.
- Start walking. According to one Harvard study, just 30 minutes of walking a day was linked with a 41% drop in risk for ED.
Other research suggests that moderate exercise can help restore sexual performance in obese middle-aged men with ED. - Eat right. In the Massachusetts Male Aging Study, eating a diet rich in natural foods like fruit, vegetables, whole grains, and fish — with less red and processed meat and refined grains — decreased the likelihood of ED.
- Pay attention to your vascular health. High blood pressure, high blood sugar, high cholesterol, and high triglycerides can all damage arteries in the heart (causing heart attack), in the brain (causing stroke), and leading to the penis (causing ED). An expanding waistline also contributes. Check with your doctor to find out whether your vascular system — and thus your heart, brain, and penis — is in good shape or needs a tune-up through lifestyle changes and, if necessary, medications.
- Size matters, so get slim and stay slim. A trim waistline is one good defense — a man with a 42-inch waist is 50% more likely to have ED than one with a 32-inch waist. Losing weight can help fight erectile dysfunction, so getting to a healthy weight and staying there is another good strategy for avoiding or fixing ED. Obesity raises risks for vascular disease and diabetes, two major causes of ED. And excess fat interferes with several hormones that may be part of the problem as well.
- Move a muscle, but we’re not talking about your biceps. A strong pelvic floor enhances rigidity during erections and helps keep blood from leaving the penis by pressing on a key vein. In a British trial, three months of twice-daily sets of Kegel exercises (which strengthen these muscles), combined with biofeedback and advice on lifestyle changes — quitting smoking, losing weight, limiting alcohol — worked far better than just advice on lifestyle changes.
Other research suggests that moderate exercise can help restore sexual performance in obese middle-aged men with ED.
Losing weight can help fight erectile dysfunction, so getting to a healthy weight and staying there is another good strategy for avoiding or fixing ED. Obesity raises risks for vascular disease and diabetes, two major causes of ED. And excess fat interferes with several hormones that may be part of the problem as well.
Image: © Darren Baker | Dreamstime.com
About the Reviewer
Howard E.
LeWine, MD,
Chief Medical Editor, Harvard Health Publishing
Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch.
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9 Popular Ways to Treat Erectile Dysfunction
The number of men diagnosed with erectile dysfunction has skyrocketed ever since the little blue pill made it okay to talk about.
Fortunately, the number of treatment options has increased, too. So, which ones are worth a shot, and which are just hype?
Medically Reviewed
In the 14 years or so since Viagra was introduced in 1998, the number of men diagnosed with erectile dysfunction (ED) has increased by a whopping 250 percent. Men are realizing more and more that they’re not alone and that they have options. Aside from pills like Viagra, Levitra, and Cialis, for example, there are surgical, therapeutic, even do-it-yourself treatments that can bring back that lovin’ feeling. “Some older ED treatments are actually being used more than ever, especially for men who can’t take the pill,” says Michael Feloney, MD, a urologist at the Nebraska Medical Center in Omaha. Read on to find out about nine common remedies for ED, plus the truth about which ones live up to the hype and which fall flat.
Viagra, Levitra, and Cialis
For many of the 30 million Americans affected by erectile dysfunction, Viagra, Levitra, and Cialis are the first line of ED treatment — and they’re successful for about 80 percent of men.
These drugs, called phosphodiesterase-5 inhibitors, are approved by the U.S. Food and Drug Administration (FDA) and work by increasing blood flow to an erection. Common side effects include nasal congestion and headache. Note: If you take nitroglycerin pills for heart disease, you won’t be able to take ED pills, as they can cause a dangerous drop in blood pressure.
Penile Injections
Alprostadil is an FDA-approved erectile dysfunction drug that can be injected directly into the penis to trigger an automatic erection. “Penile injection is the most effective type of ED treatment for men who can’t take oral treatment,” says Nelson Bennett, MD, a urologist at the Lahey Clinic in Burlington, Mass. In fact, it has an 85 percent success rate. Possible side effects include a burning sensation and priapism, an erection that lasts more than four hours and requires medical treatment.
MUSE
“For men who are unwilling or unable to self-inject alprostadil, the FDA has approved this dissolvable pellet that can be inserted directly into the urethra, the opening of the penis,” says Dr.
Feloney. MUSE, with an inspiring name that actually stands for medicated urethral system for erection, will trigger an erection in about 10 minutes that may last as long as an hour. Using MUSE to treat ED can result in somewhat unpleasant side effects, however — including an aching sensation, burning, redness, and minor bleeding.
Vacuum Pump
Can’t or don’t want to take ED drugs? The vacuum pump method is the next most common choice among men with erectile dysfunction who pass on pills, says Dr. Bennett. To create an erection, you place a plastic cylinder over the penis and pump the air out of the cylinder to force blood to flow into the penis. An elastic ring that you slide onto the base of your penis holds the erection. This ED treatment device is effective for about 75 percent of men. Side effects include numbness, bruising, and weak ejaculation — and the ring must be removed after 30 minutes.
Surgical Implants
If you have a neurological disorder or spinal cord injury and other erectile dysfunction treatments aren’t effective, two types of surgical implants could offer solutions to your ED.
“An implantable pump can be used to manually create an erection by pumping fluid into cylinders placed inside the penis,” explains Feloney. “The other option is a malleable prosthesis that works like a gooseneck lamp to direct the penis into position for intercourse.” Risks for these ED treatments include infection and mechanical breakdown.
Sex Therapy
“Medications that create blood flow to the penis can’t help when an erection is blocked by the fear or anxiety of the fight-or-flight response,” says Feloney. “This type of erectile dysfunction probably has a lot to do with evolution — men didn’t need an erection when a dinosaur was chasing them.” The best way to treat erectile dysfunction caused by performance anxiety, depression, a poor relationship, or stress may be with a combination of ED drug treatment and sex therapy, individual therapy, or couples therapy from sexual health professionals.
Male Hormone Therapy
Commercials for drugs to improve “low T,” or testosterone, the male hormone, are now vying for airtime, but they address desire, not performance.
“Male hormone is not an approved treatment for erectile dysfunction,” notes Bennett. “It may be used to increase desire in men who have low testosterone, but it doesn’t improve blood flow to an erection.” A doctor can do a blood test to check you for low testosterone, but it is a rare cause of ED. Hormone therapy with injections, patches, or gels applied to the skin may improve mood and sex drive, but it likely won’t fix any mechanical issues. Also, testosterone drugs should not be used by men with prostate cancer. Side effects include acne, breast enlargement, prostate enlargement, and fluid retention.
Herbal Supplements
Herbal supplements such as ginkgo biloba, saw palmetto, and yohimbe have been touted as sexual enhancers, and some men have been tempted to try them to treat erectile dysfunction. Bennett warns, however, that none has been approved by the FDA or even shown by any reliable studies to prevent, treat, or improve erectile dysfunction. Moreover, supplements are unregulated and can have many side effects or interfere with prescribed medications you’re already taking.
Don’t jeopardize your health by taking a supplement to treat erectile dysfunction without first talking with your doctor.
Shock Wave Therapy
The idea of using low-energy shock waves to treat erectile dysfunction comes from studies that show that these types of shocks help heart blood vessels regrow, a process called revascularization. Shock wave therapy may also work on the penis, and there have been some promising results, but it’s not currently an approved ED treatment. “It’s similar to the type of shock waves used to break up kidney stones, and it may cause revascularization,” says Bennett. “However, there are not yet any good controlled studies to recommend it to patients.”
The Future of ED Treatment
The next new treatments for erectile dysfunction will probably be improvements in some ED drugs already being used. “A dissolvable form of Levitra that you put under your tongue is coming that may work more quickly than the pills we have now,” says Feloney.
A new form of alprostadil may make it possible for you to rub it directly on the penis instead of inserting or injecting it. And newer phosphodiesterase inhibitors that last even longer and cause fewer side effects are being developed. Stay tuned!
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