Viagra, Levitra, Cialis — turn on your TV or flip though a magazine, and you will undoubtedly see ads extolling new potency and pleasures reaped by couples using one of these drugs.
If you are experiencing symptoms of ED, seeing your doctor is much more important than you might think. The good news is that many men can ease, or even reverse, ED by making simple lifestyle changes that also are likely to boost their overall health and reduce their chances of developing diabetes, cardiovascular disease, and metabolic syndrome. When neither lifestyle changes nor the widely available ED drugs are effective, however, several other options described in this Special Health Report may fill the bill. Although ED is a troubling issue that can stress relationships, sap self-esteem, and steal some of the joy from life, the odds of finding a solution that works for you are greater than ever.
Simply put, ED is trouble attaining and sustaining an erection sufficient for sexual intercourse. Failing to have an erection one night after you’ve had several drinks — or even for a week or more during a time of intense emotional stress — is not ED.
Often, the culprit behind ED is clogged arteries (atherosclerosis), which can affect not only the heart but also other parts of the body. Other possible causes of ED include medications and prostate surgery, as well as illnesses and accidents. The National Institutes of Health estimates that ED affects as many as 30 million American men.
Source: National Kidney and Urologic Diseases Information Clearinghouse and Saigal CS, et al. Still, these numbers don’t mean that ED is something that a man simply has to live with as he gets older. Often erectile difficulties are the result of an illness that becomes more prevalent with age. Data mined from the Massachusetts Male Aging Study for a 2007 Journal of Urology article revealed how important lifestyle choices are.
Intriguing findings from the Massachusetts study also suggest that there may be a natural ebb and flow to ED — that is, for some men, trouble with erections may occur, last for a significant amount of time, and then partly or fully disappear without treatment. Directly stimulating the genitals can also prompt an erection, though different nerve pathways are involved.
The penis is made up of three cylindrical bodies: the corpus spongiosum (spongy body) — which contains the urethra and includes the glans (head) of the penis — and two corpora cavernosa (erectile bodies), which extend from within the body out to the end of the penis to support an erection.
As the arteries relax, the thousands of tiny caverns, or spaces, inside these cylinders fill with blood. When a man is sexually stimulated, chemical signals from the brain cause the penile arteries to widen, allowing more blood to enter the erectile bodies known as the corpora cavernosa. In the past, most cases of ED were thought to be psychological in origin, the result of such demons as performance anxiety or more generalized stress. Since erections depend on the blood vessels that serve the penis, it’s not surprising that vascular disease is the leading cause of ED. Another vascular problem that can cause ED is a venous leak, in which blood seeps out of the penis during an erection instead of remaining trapped inside.
An abdominal aortic aneurysm, or a ballooning of the aorta, is another vascular problem associated with ED.
Damage to any of the nerves that produce sensation or relay messages to arteries in the penis can also cause problems.
Likewise, ED can result from a spinal cord injury or as a side effect of various kinds of surgery. The unhealthy quintet of excess abdominal fat (a waistline larger than 40 inches in men), high triglycerides, low HDL (good) cholesterol, high blood pressure, and glucose intolerance or high blood sugar is known as metabolic syndrome. Men with diabetes are two to three times more likely to experience ED as men without the disease, making diabetes one of the most common causes of ED. Diabetes can cause ED in at least two ways: it can harm the nerves that instruct the arteries in the penis to dilate, and it can restrict blood flow to the penis by damaging blood vessels.
Carefully controlling blood sugar can help prevent the vascular and neurological complications that contribute to ED.
Want one more reason to work at boosting your HDL cholesterol, which sponges up excess cholesterol that might otherwise damage and narrow blood vessel walls? Surgery for prostate cancer can sever some of the nerves or arteries needed for an erection. Sometimes, ED is a side effect of certain hormone therapy medications prescribed for men with prostate cancer that has spread beyond the prostate. Estimates of how many men will experience ED after being treated for prostate cancer vary widely, and the type of treatment chosen influences your chances of experiencing erectile problems.
Many men who have benign prostatic hyperplasia (BPH), a noncancerous enlargement of the prostate, also experience ED. It’s uncertain whether transurethral resection of the prostate (TURP), a surgical technique often used when medication fails, also causes ED. Penile rehabilitation is an umbrella term for a variety of evolving therapies intended to preserve sexual ability after prostate cancer treatments. Nerve damage following radical prostatectomy can derail the impulses that trigger erections. While less is known about how radiation causes ED, experts speculate that there are similarities. By stepping in early, often within one to three months of surgery, penile rehabilitation may help restore erectile function by regularly enhancing blood flow to the penis, thus possibly avoiding the buildup of scar tissue.
One reason ED becomes more common with age is that older men are more likely to be on medication. Many drugs can produce erectile difficulties, especially antihypertensives, antidepressants, and tranquilizers, as well as the prostate drug finasteride. Even familiar painkillers like aspirin, naproxen, and ibuprofen (part of a group of medications known as nonsteroidal anti-inflammatory drugs, or NSAIDs) or acetaminophen may make it harder for some men to have and maintain erections sufficient for intercourse.
When you see a doctor about ED, it’s important that you report all prescription and over-the-counter medications that you take on a regular basis. Because testosterone helps spark sexual interest, one might assume that low levels of the hormone are to blame for ED. The most common hormonal cause of ED is hypogonadism, in which the testicles don’t produce enough testosterone. Data from the Massachusetts Male Aging Study point to an intriguing interplay among sex hormones.
Diseases of the adrenal glands (which produce a steroid hormone that is converted to testosterone) or the thyroid gland can also lead to ED. Men with ED are about 38% more likely to have high blood pressure than those without ED, according to a study that examined the medical records of more than 1.9 million men.
Complicating matters is the fact that some drugs used to treat high blood pressure — especially beta blockers — can cause ED.
Although all types of blood pressure medications can cause ED, the problem seems to be greater with diuretics and beta blockers than with ACE inhibitors (see Table 1 for common examples). Keep in mind, though, that psychological factors play a contributing role in most cases of ED.
Given that excess weight is a major risk factor for vascular disease, it’s perhaps not surprising that close to 80% of men with ED are overweight or obese. Other studies have found that encouraging healthier lifestyle choices among overweight men can improve their sex lives. In 2006, the same researchers found that men without ED were more likely to follow a diet rich in fruit, vegetables, whole grains, and fish, and low in red and processed meat and refined grains (the so-called Mediterranean diet). Two findings from the Harvard Health Professionals Follow-up Study, a long-term study involving nearly 32,000 men, lend further support for keeping trim and fit. One small study conducted in Italy suggests that combining exercise with medication for ED may yield better results than medication alone. The more cigarettes you smoke per day, the higher your risk of ED, according to several studies. Data from the Massachusetts Male Aging Study reported in The Journal of Urology in 2007 showed that smoking doubled the likelihood of experiencing progressive problems over time in having erections. If testosterone is the engine of sex drive, what will a blood test for this hormone tell you? Thus, boosting testosterone levels through hormone treatments is likely to solve erectile problems only in a relatively small number of men. If you’ve been having difficulty getting or sustaining erections, talk about it with your doctor. While therapy often involves medication, ED is sometimes a symptom of an underlying condition that requires its own treatment. Have you ever planned to ask your doctor about ED, only to leave the exam room without starting the conversation? As part of this health history, be prepared to tell your doctor specific details about the symptoms that brought you to the office and when they began.
If the cause is clear — a recent operation for prostate cancer, for example — the conversation may move directly to your treatment options.
Assesses the history of the problem, especially whether it started suddenly and if nocturnal erections are affected. Your check-up will probably include tests for cholesterol and triglyceride levels (to assess your risk of cardiovascular disease) and blood sugar levels (to check for diabetes). Some men find that even though they have trouble with erections, they can still experience orgasm. Now that medication can successfully treat most men with ED, many once-routine diagnostic tests are used only when the doctor suspects the patient has an underlying problem requiring additional treatment. Your doctor also may want to check your blood levels of prolactin (a pituitary hormone that can block the action of testosterone) or thyroid-stimulating hormone (a good indicator of an underactive or overactive thyroid gland). Your doctor or other health professional may use this questionnaire or one like it to evaluate ED.
Ejaculation: The ejection of semen from the penis or the feeling of semen ejecting from the penis. Sexual desire: Wanting to have a sexual experience (for example, masturbation or intercourse), thinking about having sex, or feeling frustrated from lack of sex. Sexual stimulation: Situations such as foreplay with a partner, looking at erotic pictures, erotic fantasies, or other erotic stimuli.
It’s natural to remember the zest of younger days and nights, but remember, too, that changes occur in practically all physical realms as years pass. Sometimes a medical exam reveals a straightforward explanation for ED, such as a side effect of medication or of discord between the man and his partner.
During these discussions, you may be surprised to discover that your partner has interpreted your difficulty as an insult — a sign that you no longer find your mate sexually attractive or that you have fallen out of love.
As ED begins, the couple experiences repeated, disappointing attempts at sexual intercourse. The partner’s self-esteem suffers because of an assumption that the man has lost interest.
Above all, couples need to make lovemaking a priority, not something that may or may not happen at the end of a long, tiring day.
If you have not had intercourse for months or years because of ED, you may encounter some physical difficulties once you seek treatment and attempt to resume sexual relations. Please note: If you have a promotional code you'll be prompted to enter it prior to confirming your order. If you subscribe to any of our print newsletters and have never activated your online account, please activate your account below for online access. When it comes to preventing and treating high blood pressure, one often-overlooked strategy is managing stress. Low back pain has many different causes, including the normal wear and tear that comes with aging.
Mobility — the ability to move purposefully around your environment — is vitally important to health and well-being. If a growth or mole looks like a melanoma, the doctor will take a biopsy to confirm the diagnosis.
An overactive bladder (also known as urge incontinence) causes a sudden urge to urinate, even when your bladder isn't full.
It might seem like retirement is a time to take it easy and devote yourself to gardening, golfing, and napping.
Sleep shortfalls can lead to a range of health problems, from being more likely to catch a cold or gain weight to increased risk of developing heart disease or diabetes. One of major roadblock in finding an effective treatment is that we are middle age men with a dick problem. Largely because of this advertising blitz, the topic of erectile dysfunction (ED) has burst into public awareness, encouraging men of several generations to talk more openly about ED and seek their doctors’ advice.
Research increasingly indicates that erections, which rely on robust blood vessels, serve as a barometer for overall vascular health.
Better sex and better health truly is a win-win proposition, and one that is within reach in many cases. You’ll also find a special section on creating a better sex life that offers tips for addressing intimacy issues that couples may face when dealing with ED.
I hope the information that follows proves helpful in improving both your erectile function and your general health.
Five years later, men concerned about ED could ask their doctors for prescriptions for Levitra or Cialis as well.
In fact, a study of men ages 50 and older who went to a urologist for other, unrelated problems found that 74% of those who later admitted to having ED were too embarrassed to discuss the problem with their physician.
At least 25% of the time, the penis doesn’t get firm enough, or it gets firm but softens too soon. 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. In the Massachusetts Male Aging Study, which involved more than 1,700 men between the ages of 40 and 70 living near Boston, researchers found that about 43% of the men had some degree of ED (see Figure 1). While roughly 1% of men ages 40 to 49 have complete ED (meaning they aren’t ever able to achieve an erection that is sufficient for intercourse), nearly 17% of those in their 60s have this condition.
Or it may reflect the treatment of such an illness — erectile difficulties are a potential side effect of many medications.
Study participants were observed at three points in time: when they joined the study in the late 1980s and again approximately nine and 15 years afterward. Research bears out that the majority of healthy older couples can — and do — have an active sex life.
Whether this is true, and which men need treatment versus tincture of time, may be resolved through further long-term studies in other populations.
A sight, a touch, a smell, or perhaps just a memory sparks intense activity in the hypothalamus, an area near the base of the brain. Here, sexual sensation is carried by the pudendal nerve, which runs from the penis to the sacral nerves in the lower spine. These messengers boost the production of other important chemicals, including cyclic guanosine monophosphate, prostaglandins, and vasoactive intestinal polypeptide. Blood floods the penis through two central arteries, which run through the corpora cavernosa and branch off into smaller arteries.
Some signal — usually an orgasm, but possibly a distraction, interruption, or even cold temperature — brings an erection to an end. The length of the interval between erections varies, depending on a man’s age, his health, and whether he is sexually active on a regular basis. Some research suggests that when the penis is flaccid for long periods of time — and therefore deprived of a lot of oxygen-rich blood — the low oxygen level causes some muscle cells to lose their flexibility and gradually change into something akin to scar tissue. While these factors can cause ED, doctors now think that 70% of the time the problem can be traced to physical conditions that restrict blood flow, hamper nerve functioning, or both.


The most common type of vascular disease is atherosclerosis, which occurs when fatty deposits build up on artery walls, narrowing and clogging them (see Figure 5). An aneurysm forms when a blood vessel, weakened by a disease like atherosclerosis or hypertension, balloons outward under the pressure of blood flowing through it.
Because the nerve pathways to the penis travel near the prostate, bladder, and rectum, removing any of these organs to treat cancer can sever some of these nerves, leading to problems. It afflicts just under 35% of adults in the United States, according to the American Heart Association. Diabetic men also confront this problem at younger ages than men in the general population.
People with diabetes often have not only high blood sugar but also high blood pressure and high cholesterol — all conditions that can further impair blood vessels and blood flow. One study of men with diabetes and erection problems found that the worse their blood sugar control, the more their sex lives suffered. Early studies found that these medications seemed to be less effective when ED was diabetes-related than when it had other causes.
Sixteen percent of men in the Massachusetts Male Aging Study with low levels of HDL cholesterol had ED.
For men who undergo a radical prostatectomy (removal of the prostate gland), the estimates of how many will regain their ability to have erections vary widely, from 25% to 80% (see Figure 6). The likelihood of experiencing ED is 30% to 70% among men treated with external beam radiation and 30% to 50% among men who had radiation-emitting seeds implanted in the prostate (brachytherapy).
Among such hormone-based medications are leuprolide (Lupron), goserelin (Zoladex), flutamide (Eulexin), and bicalutamide (Casodex).
Although BPH does not itself cause this condition, some of the treatments used for BPH can do so. A 2007 prospective study of 1,014 European men concluded that TURP did not affect self-assessed quality of erections, although it can cause semen to back up into the bladder rather than exiting the tip of the penis through the urethra (a phenomenon called retrograde ejaculation).
First introduced by European physicians in 1997, the strategies usually involve frequent use of oral or injected medications, alone or in addition to interventions like the vacuum pump. When the damage is temporary — a condition called neuropraxia — the nerves may recover enough to enable a man to have spontaneous erections. Research suggests that when the penis is flaccid for long periods, the low oxygen level causes a loss of flexibility in some muscle cells of the corpora cavernosa, the two columns of erectile tissue flanking the sides of the penis. Radiation harms the lining of small blood vessels, though the damage may take months or years to manifest. Propecia, a low-dose preparation of finasteride used to counteract baldness, is reported to cause ED in 1.3% of men who use it. A 2006 study of Finnish men ages 50 to 70 found that those who regularly took these drugs to ease pain from joint disorders were more likely than nonusers to have ED. Among the blood pressure medications, for example, ED is an occasional side effect of thiazide diuretics, loop diuretics, and beta blockers, but rarely results from use of alpha blockers, ACE inhibitors, and angiotensin-receptor blockers (see Table 1). If your doctor suspects that a medication is to blame, he or she may be able to substitute another one. It’s true that when hormone deficiency is a factor in ED, sexual desire also suffers. More rarely, an abnormally high level of prolactin, a hormone that can lower testosterone levels, is to blame. Luteinizing hormone, made in the pituitary gland, controls testosterone levels in the body by prompting its production in the testes. This finding supports observations that ED often occurs in men who smoke or are overweight — both common risk factors for high blood pressure. If you experience ED shortly after starting treatment with any of these drugs, it may make sense to ask your doctor if you can try a different medication. Even if the cause is purely physical or medical, erectile difficulty is almost certain to have an emotional and psychological impact. If either partner is unhappy with the other, it can dampen sexual desire, an important component of erectile function. Erections rely on healthy blood flow to the penis, and clogged or damaged blood vessels prevent this. During that time, gains and losses in body mass index (a measure of body fat based on height and weight) were tied to progression and remission of ED, respectively.
After two years, almost a third of those who received detailed advice reported improvement in sexual function, compared with just a few in the other group. Researchers found that men who exercised 30 minutes a day were 41% less likely to have ED compared with sedentary men.
The study of 60 men with ED found that those who did several hours of aerobic exercise per week in addition to taking an ED medication over a three-month period showed greater erectile functioning than men who took only the medication and did not exercise. One study suggests that in certain circumstances, bike riding can damage nerves and compress arteries in the penis, possibly leading to erectile problems.
Make sure the seat is not so high that your legs are fully extended at the bottom of your pedal stroke. One, which involved more than 4,700 Chinese men, found that smoking a pack a day (20 cigarettes) increased the risk of ED by 60%.
Unfortunately, quitting smoking did not seem to reverse that trend, possibly because damage to delicate blood vessels had already occurred. In fact, light to moderate drinkers (men who average one to two drinks a day) are 33% less likely to have ED than nondrinkers, according to the Harvard Health Professionals Follow-up Study. A blood test can measure free testosterone — how much is circulating in the bloodstream — and testosterone bound to sex hormone–binding globulin (SHBG). After reviewing data on 1,475 men ages 30 to 79 who had enrolled in the Boston Area Community Health Survey, researchers reported nearly 24% had low total testosterone, 11% had low free testosterone, and 9% were low on both markers. And since it can damage the liver as well as cause problems with the prostate, this isn’t a treatment to undertake lightly. This inflammation of the prostate gland can be either acute (sometimes caused by a bacterial infection) or chronic (usually not caused by an infectious agent). In this relatively uncommon disorder, some of the connective tissue inside the penis thickens, causing the penis to bend at an angle when erect. This is not simply a matter of walking into the doctor’s office, emerging with a prescription, and regaining your erections. Appointments these days can be short, so coming prepared with a list of your questions can increase the likelihood that you will get the answers you need.
After you initiate a conversation about ED with your doctor, he or she will probably ask you some questions in order to form a complete picture of your specific issues. However, some doctors may feel embarrassed discussing certain topics that have to do with sex, even if the topic is medical. Your doctor might want to know how often you had sex before the problem started and if there have been weeks or months in the past when you’ve had ED. Otherwise, you may need to answer more questions to help the doctor narrow down the possible causes and avoid unnecessary testing.
The doctor will listen to your heart for signs of a murmur and other abnormalities that can affect blood flow. Abnormally small testicles and enlarged breasts are sometimes signs of inadequate testosterone. The doctor might also ask for a urine specimen because the presence of blood could be a sign of a urologic disease, such as bladder cancer. That’s because erections and orgasms involve some different muscles and nerve pathways. Checking testosterone levels used to be one of the first tests ordered for men with erectile difficulty, but that was before doctors realized that testosterone deficiency was rarely the source of the problem. These tests also used to be commonplace, but are now done only if your doctor thinks you might have a hormonal deficiency or imbalance. Color duplex Doppler ultrasound, an imaging technique, can reveal problems with blood flow through the arteries or veins of the penis, such as venous leakage.
If it’s unclear whether your erectile difficulties have a psychological or a physical cause, your doctor may suggest a nocturnal penile tumescence test.
The test is usually given before treatment begins and at appropriate intervals during and after care to gauge the treatment’s effectiveness. Over the past four weeks, how often were you able to get an erection during sexual activity? Over the past four weeks, when you had erections with sexual stimulation, how often were your erections hard enough for penetration?
Over the past four weeks, when you attempted sexual intercourse, how often were you able to penetrate (enter) your partner? Over the past four weeks, during sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner? Over the past four weeks, during sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? Over the past four weeks, when you attempted sexual intercourse, how often was it satisfactory for you? Over the past four weeks, when you had sexual stimulation or intercourse, how often did you ejaculate? Over the past four weeks, when you had sexual stimulation or intercourse, how often did you have an orgasm (with or without ejaculation)? Over the past four weeks, how satisfied have you been with your sexual relationship with your partner?
Over the past four weeks, how would you rate your confidence that you could get and keep your erection? Compare your total scores before and after treatment to help determine the treatment’s success. If the problem is a medication, sometimes the drug can be discontinued or a new one substituted. It may be vascular disease, neurological disease, or diabetes, or it may be the result of prostate surgery or radiation.
Just 30 minutes of walking a day was linked with a 41% drop in risk for ED, according to one Harvard study, while a separate trial reported that moderate exercise can help restore sexual performance in obese middle-aged men with ED. Go bullish on fruit, vegetables, whole grains, and fish, while downplaying red and processed meat and refined grains, a diet that lessened the likelihood of ED in the Massachusetts Male Aging Study. 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.
Actually, move several muscles of the pelvic floor, including the ischiocavernosus, which enhances rigidity during erections, and the bulbocavernosus, which helps keep blood from leaving the penis by pressing on a key vein.
It can allow you to address any anxieties or inhibitions that may be causing or contributing to your erectile difficulties. But poor communication between partners often makes sexual issues worse by leading to hurt feelings, anger, and withdrawal.
Or you may discover that your partner has stopped initiating sexual contact for fear of embarrassing you.
Even if you already recognize elements of this pattern taking hold in your relationship, you can reverse the damage by improving communication. Make sure to discuss ED as an issue for both of you to resolve rather than as one person’s problem. Partners who explore other ways of making love — including massage and oral sex (which don’t depend on erection) — often find that their sex lives become more passionate and fulfilling. This openness has eroded some of the stigma associated with ED, making it easier and more acceptable to discuss this very personal issue. In other words, ED may be an early warning sign for a more serious problem — like heart disease or high blood pressure — because it sometimes appears before other symptoms do. The phenomenal response to these pharmaceutical solutions for ED has been dubbed a second sexual revolution, the first occurring with the advent of birth control pills. Nearly every man occasionally has trouble getting an erection, and most partners understand that. Technically, ED can strike any man old enough to have an erection, but it becomes increasingly common with age. Although testosterone, a male sex hormone that plays a role in sexual performance, tends to decline with age, it remains within normal limits in most men.
But many of these illnesses, such as cardiovascular disease or diabetes, can be prevented through good health habits. Investigators found that smoking doubled the likelihood of experiencing progressive problems in having erections. In surveys, 50% to 80% of healthy couples over age 70 say they have sex regularly; half say they have intercourse once a week. Electrical signals of sexual arousal travel from the brain down to the lower part of the spinal cord. These chemicals initiate the erection by relaxing the smooth muscle cells lining the tiny arteries that lead to the corpora cavernosa, a pair of flexible cylinders that run the length of the penis (see Figure 3). Pumped out mainly by the testes and in small amounts by the adrenal glands, levels of this male sex hormone decline with age.
At the same time, the blood-engorged tissues compress the veins, keeping blood in the penis and maintaining the erection.
This process, called detumescence, occurs when the chemical messengers that started and maintained the erection stop being produced, and other chemicals, such as the enzyme phosphodiesterase 5 (PDE5), destroy the remaining messengers. A young, sexually active man in good health may be able to get an erection after just a few minutes, whereas a man in his 50s or older may have to wait 24 hours. Such conditions include diabetes, kidney disease, multiple sclerosis, atherosclerosis, and vascular disease.
In fact, more than 80% of men who have erectile difficulties as a reaction to an underlying physical illness go on to develop psychological issues that further hamper erections. The aorta, which delivers blood from the heart to the abdomen, is the body’s main artery. But degenerative diseases of the nervous system (such as multiple sclerosis or Parkinson’s disease) and substance abuse can also harm the nerves involved in erections. In addition, vitamin B12 deficiency, which is a cause of anemia, can damage the spinal cord, causing neurological problems throughout the body.
Metabolic syndrome doubles your odds for heart attack or stroke and multiplies your risk for developing type 2 diabetes by five. Both forms of diabetes increase the risk, although animal research offers early clues that the pathway to ED may differ depending on whether a man has type 1 or type 2 diabetes.
Even prostate cancer itself, in its advanced stages, can spread to the nerves and arteries that are necessary for an erection. While harmless — the semen simply mixes with urine in the bladder before leaving the body — this can impair fertility. Gradually, these cells change into something akin to scar tissue that seems to block expansion even when the penis swells with blood.
It can take anywhere from several days to several weeks after stopping a medication for erections to return. Elevated prolactin is usually caused by a tumor of the pituitary gland, which lies at the base of the brain. Most of the testosterone in a man’s body is bound to sex hormone–binding globulin (SHBG). In fact, ED might serve as a warning sign that a man has high blood pressure or heart disease. In addition, being aware of possible side effects may make a person more likely to recognize them as abnormal. Stress, relationship problems, or psychological illnesses can impair the signals from the brain that initiate the chain of biological events needed for an erection.
These emotional consequences can lead to the kind of performance anxiety that triggers more severe ED.


And it’s likely to occur with just one partner, often because of tension in the relationship.
Inhibitions that result from undisclosed sexual fantasies or preferences can also be at the root of the problem.
Obesity also triggers complex changes in hormone levels that may have ripple effects on a person’s sex life.
And a man with a 42-inch waist was 50% more likely to have ED than a man with a 32-inch waist. The Massachusetts Male Aging Study found that the risk was highest among men who cycled more than three hours a week. The effect of smoking remained significant even after researchers considered other risk factors such as age, blood pressure, and body mass index.
Partly, this is because large epidemiological studies are only beginning to capture data describing the normal ranges for testosterone at different ages.
Yet only about 6% of the subjects experienced low libido, ED, lethargy, or other symptoms of low levels of male hormones (also known as androgen deficiency). One approach to raising testosterone more likely to prove healthful than harmful is suggested by a 2008 study in The Journal of Clinical Endocrinology and Metabolism, which found that age and waist circumference were independent risk factors for lagging testosterone levels and symptoms of androgen deficiency. Symptoms include pain during urination, more frequent urination, and possibly a fever or discharge from the penis. A pelvic fracture can cause these kinds of injuries because many nerves and arteries run along the pelvic bones. Your doctor must diagnose the cause of your ED in order to recommend an effective treatment. Your list will also help you stay on track if you feel nervous or uncomfortable during the appointment.
You can make the most of your discussion by writing down the details of your experiences before your appointment.
If you sense your doctor is uncomfortable talking about ED, ask for a referral to a urologist — a specialist trained to treat conditions related to the urinary tract and male reproductive system. On the other hand, a sudden loss of sexual desire or the ability to have erections usually suggests that a medication or psychological difficulty, such as depression or stress, may be to blame.
He or she will also take your blood pressure; both high and low blood pressure can impair blood flow. Even if there is a breakdown along the paths to an erection, orgasm is usually still possible. During sexual arousal, local nerves tell muscles in the testes and the prostate to contract, propelling semen forward.
Now, hormone testing is done for men whose medical exams and histories suggest an endocrine problem and for those who have experienced a loss of sexual desire. Psychological factors come into play when you’re trying to achieve or maintain an erection.
Another tip: chronic deficiencies in vitamin B12 — found in clams, salmon, trout, beef, fortified cereals, and yogurt — may harm the spinal cord, potentially short-circuiting nerves responsible for sensation as well as for relaying messages to arteries in the penis. 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. And if you are seeking medical help, be sure to tell your partner and discuss the options and treatments together.
Even if erectile impairment is initially caused by a medical problem such as diabetes, lack of communication can exacerbate the problem.
If a couple isn’t communicating, simply getting a prescription from a doctor and hoping for the best often fails. Women may particularly appreciate this approach because it lengthens foreplay and often improves intimacy between couples. This can make a man anxious, which, in turn, can further inhibit his ability to maintain an erection.
You may feel ashamed or even abnormal because of the sexual difficulties in your relationship. Confront any concerns you may have about erectile difficulties by discussing your feelings and telling your partner that you care. Using the tips from this report on talking to your doctor can help you start this conversation. Both types of medications fostered major changes in sexual behavior and the ways in which people think about and talk about sexuality. If these steps aren’t effective for you, a number of other options, including injections and vacuum devices, are available.
Roughly 1% of men in their 40s, 17% of men in their 60s, and 48% of men 75 or older have complete ED (meaning they are never able to achieve an erection sufficient for intercourse), according to the National Kidney and Urologic Diseases Information Clearinghouse (see Figure 2). Gains and losses in body mass index were also associated with progression and remission of ED, respectively — giving men one more compelling reason to battle the bulge.
Nerves in this area signal nerves in the pelvis, which tell arteries to let blood into the penis and cause an erection.
During sexual activity, both of these nerve pathways are involved in producing an erection. The blood filling the corpora cavernosa compresses and then closes off the openings to the veins that normally drain blood away from the penis (see Figure 4).
Current thinking is that testosterone stokes the engine of sex drive, helping to trigger and sustain an erection. For example, a man may develop ED as a side effect of a drug, and then become so anxious about his sexual performance that he continues to have trouble with erections even after he stops using the drug. Much like those ailments, several key markers of metabolic syndrome harm the vascular system and thus may prompt ED.
If this proves true in human studies, it could be a step toward better-tailored treatments. In any case, other therapies — including drugs in injection or suppository form, vacuum erection devices, and penile prostheses — work well in men with diabetes.
Heart-healthy eating with DASH or Mediterranean-style diets, weight loss if needed, and daily exercise will help. But alpha blockers such as terazosin (Hytrin), tamsulosin (Flomax), and doxazosin (Cardura) can improve the symptoms of BPH with a lower risk of sexual side effects.
And, in fact, blood may drain away from the penis rather than fill it, according to some imaging studies. Larger, randomized trials are needed to determine how effective different approaches are, along with optimal timing for starting therapy.
For this study, the researchers examined data from more than 80,000 men, ages 45 to 69, who are enrolled in the California Men’s Health Study and found that those who used NSAIDs regularly were 38% more likely to have some level of ED, after the researchers adjusted the data for other possible factors such as age, diabetes, and smoking. A much smaller amount of free, or bioavailable, testosterone circulates in the bloodstream to reach cells throughout the body. One study looked at men newly diagnosed with heart disease but without ED who started treatment with the beta blocker atenolol (Tenormin). When this happens, a man may begin to avoid his partner or make excuses for not having sex — actions that can perpetuate anxiety or depression. Another sign that the problem is mainly psychological is the ability to achieve an erection with masturbation and, perhaps most importantly, while sleeping.
If a man feels too embarrassed to tell his spouse or sexual partner about his preferences, he may have trouble becoming aroused.
Now, growing evidence shows that lifestyle changes — namely, losing weight and exercising — can improve ED, just as they lower the risk of vascular disease. That 2008 study enrolled nearly 100 severely overweight men ages 19 to 75 who were scheduled to undergo gastric bypass surgery. The reason avid bikers sometimes get ED is that the seat puts pressure on the perineum, the area between the genitals and anus. A study, published in 2011, of 2,686 men confirmed these findings and also revealed a greater risk for ED in men who had smoked for over 23 years.
A man can’t change his age, but tightening his belt by ridding himself of excess abdominal fat might be a safe — and overall healthy — strategy. In addition, injury to the brain, spinal cord, abdomen, or, of course, the penis can impair nerves or blood vessels involved in erections.
It may be easiest to use the questionnaire to evaluate ED (see next section) to help you record your symptoms and relevant information. Don’t be embarrassed if the doctor asks you about early morning erections or whether you can achieve an erection if you masturbate.
Nerve impulses also tighten muscles at the neck of the bladder in order to keep semen from backing up into the bladder channel and flowing out through the urethra. But the psyche doesn’t affect nocturnal erections, which occur involuntarily during sleep. For help in evaluating the success of the treatment, discuss your scores with your doctor or health care professional. Multivitamins and fortified foods are the best bets for those who absorb B12 poorly, including many older adults and anyone with atrophic gastritis, a condition that may affect nearly one in three people ages 50 and older. During the next three months, the control group also practiced Kegels and experienced similar improvements in erections. To begin, phrase your discussion in a way that doesn’t accuse or alienate your partner. Women need to know that it’s possible for men to reach orgasm without an erect penis and that manual stimulation can bring a man to climax even without a full erection.
Often it’s best to talk at a time and place where both people will feel less vulnerable — that is, not while in bed with your clothes off.
Given the variety of options, the possibility of finding the right solution is now greater than ever before. A hitch in any one of these elements can diminish the quality of an erection or prevent it from happening altogether. When an aneurysm occurs in the aorta, the expanding vessel can squeeze and damage these nerves and blood vessels, causing ED. Even when the nerves are not permanently impaired, it can still take six to 18 months for the tiny nerve fibers to recover from the trauma of surgery and for sexual function to return. Among those who were told about the drug’s sexual side effects, almost a third reported ED.
At this stage, the role of the psychological difficulties may in fact overshadow the original medical or physical cause.
The men filled out a questionnaire called the Brief Male Sexual Function Inventory before the procedure and two years afterward. This pressure can harm nerves and temporarily impede blood flow, causing tingling or numbness in the penis and, eventually, ED. Drinking large amounts of alcohol over a long period of time can also damage the liver, leading to a hormonal imbalance (in this case, raising levels of estrogen, a female sex hormone normally present in small amounts in men). In milder forms, the condition can produce painful ejaculation, which can certainly interfere with sexual pleasure and may lead to ED. Many treatments — including verapamil injections, vitamin E supplementation, and ultrasound — have been tried, but their effectiveness is uncertain, in part because the problem sometimes improves on its own. Your doctor is also likely to ask about your psychological well-being and lifestyle: Do you suffer (or have you ever suffered) from depression?
The ability to do so is an important clue in determining whether the problem is psychologically or physically based (see Table 2).
Low pulse in any of these areas can mean that not enough blood is reaching tissues in the extremities, including the penis. Your doctor may also test for neurological problems by checking the reflexes in your legs, groin, and anus. The pressure of the semen buildup or the muscle contractions experienced during ejaculation are believed to stimulate the pudendal nerve, producing the pleasurable sensation of orgasm.
At six months, 40% of all the subjects had regained normal erectile function and nearly 36% had improved.
You may need to use lubricated fingers or dilators to gradually stretch the vaginal tissues. Since atherosclerosis also raises the risk of having a heart attack, ED can be an early warning sign of possible heart and cardiovascular problems.
An analysis of data drawn from 625 subjects showed ED was not associated with below-normal levels of total testosterone, free testosterone, or SHBG. In contrast, of those who were not told the drug’s name or its side effects, only 3% said they experienced ED. In some cases, untreated depression is to blame, while in others the medications used to treat depression cause sexual difficulties. To cure the problem, you’ll need to address both the physical problem and the psychological one.
Nocturnal erections are impaired by physical problems, like disease or nerve damage, but not by psychological disorders. Before the operation, unhappiness with sex drive, erectile function, sexual satisfaction, and related issues was high.
However, a different type of bike may help: a German study found that riding a conventional bicycle caused a dramatic (though temporary) drop in oxygen supply to the penis, but that riding a recumbent bicycle did not.
Your doctor may prescribe antibiotics or other medications to treat the problem, but it can take several weeks for the symptoms to clear and for normal sexual function to return. To test for nocturnal erections, medical devices may be attached to the penis to monitor its circumference or its rigidity throughout the night. When there is a report about penis research it is reported in a joking way and the comments are even more mocking. The researchers wrote that being very obese added 20 years to a man’s age, at least as far as sexual function was concerned.
Illegal drugs such as marijuana, cocaine, heroin, barbiturates, and amphetamines can trigger problems by acting on the central nervous system in the same way that alcohol does. When the problem is severe enough to cause pain during intercourse or prevent penetration, surgery may be needed to straighten the penis. In many cases, cutting back on such forms of exercise or switching to a softer, wider bicycle seat will solve the problem. Discussing your ED frankly with your partner can help relieve the anxiety and improve your relationship both emotionally and sexually. So, despite all the talk about hormones and virility, doctors currently don’t know exactly what role sex hormones play in normal libido or the ability to have erections. As their weight plummeted, their sexual satisfaction rose significantly, becoming comparable to matched controls.
You can see any number of these articles in the main press.Why am I bringing this up, do I just want to do some additional typing? The composite biomaterial includes a cell-viable hydrogel, such as alginate, surrounded by an outer protective layer. As the scaffolding and stem cells are applied, the BioPen cures and sets the implant in place with an attached low-powered ultraviolet light. As the wound heals, the stem cells work to restore tissue into its healthy state, and multiply and differentiate into bone, muscle, or nerve cells. The BioPen has now completed its prototyping stage, and is currently undergoing optimization for clinical trials.To my non-medically trained eye it certainly looks like this approach would fit very nicely into a Peyronies Disease research project.More Peyronies Disease Research - In BriefRecently diagnosed? Maybe you should do nothing.Sloan-Kettering examined 176 men who were diagnosed with Peyronies Disease, opted for no treatment and were followed for 12 months.



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