What to do with erectile dysfunction

Erectile dysfunction is more common than you might think. More than half of men over 40 will experience erection problems, and their prevalence increases with age (although men in their 20s and 30s can also suffer from them).

The experience can have a devastating effect on a man’s well-being, yet a shocking number of men do not seek help. One sector study suggests that only 51 percent of men with erectile dysfunction had discussed the problem with their doctor, and even fewer had discussed it with their own partners.

“There is no medical condition that I know of that has a greater impact on men’s lives,” said Dr. Mohit Khera, urologist and president of the Sexual Medicine Society of North America.

But there are effective treatments, he added, beyond common medications like Viagra. These can include vacuum pumps, injections, implants, lifestyle changes, testosterone replacement therapy and sex therapy. A combination of these options, experts say, almost always improves erections, even in the most severe cases.

However, before men even go near a pill or pump (or the “natural” male enhancement supplements commonly sold at gas stations), they should undergo a health screening to understand the causes of the dysfunction, which could indicate a more serious health problem.

“The penis can be thought of as a barometer of the person’s overall health,” said Dr. Rachel Rubin, urologist and sex medicine specialist in Maryland.

Why erections sometimes fail

When men become aroused, the brain releases chemicals that cause muscles to relax and blood to flow to the penis, making it hard. There are many factors that can disrupt this process. Clogged arteries and high blood pressure can reduce blood circulation; diseases such as multiple sclerosis and Parkinson’s disease can disrupt neurological pathways; and pelvic trauma from surgery, radiation therapy, or injuries can damage penile tissue.

The frequency and severity of erectile dysfunction can also vary widely. Some men experience problems periodically while they are around 5 percent of men aged 40 and over have complete erectile dysfunction. Some men wake up with morning erections, or may get them during masturbation, but have trouble staying erect during penetrative sex.

Finding the right treatment plan

There is a “growing appreciation that individuals can have very different expectations” of their erections, said Dr. Petar Bajic, director of men’s health at the Glickman Urological and Kidney Institute in Cleveland. As a result, there is no clear rule for when men should seek treatment. Some men may hope to have penetrative sex often; others may be satisfied with an erection strong enough for masturbation.

“If you’re not keeping an erection satisfying enough to do whatever you want with it, then it’s worth talking to a doctor,” said Dr. Rubin.

The first thing to consider is making lifestyle changes. Obesity, smoking, alcohol and recreational drug use are all known causes of erectile dysfunction. Dr. Khera said that a healthy diet and regular exercise can sometimes improve the strength of erections without any other intervention.

It is also important to investigate possible psychological causes, such as stress or depression, especially in younger men. a studyresponsible for more than 85 percent of cases among men under 40 years of age.

Also think about which medications you are taking. There are several prescription medications known to contribute to erectile dysfunction, including certain ones antidepressants And finasteridea drug that treats prostate enlargement and hair loss in men.

With all of these things in mind, doctors and patients can work together to develop a treatment plan that includes lifestyle changes and perhaps one or more of the following treatment options.

Oral medications

There are currently four oral prescription medications approved by the Food and Drug Administration to treat erectile dysfunction: sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra). They all work by relaxing muscles and widening blood vessels, allowing more blood to flow. Although oral medications are very effective, do not work for about a third of patients, usually the most severe cases.

Cheaper, generic versions of Viagra and Cialis make up the bulk of erectile dysfunction prescriptions in the United States. Viagra works better on an empty stomach and lasts three to four hours, while Cialis must be taken with food and stays in the system for up to 36 hours. Smaller doses of Cialis can also be prescribed for daily use.

Telehealth sites like Hims and Roman have become an increasingly common way for men to access oral medications — at least in part because men can skip awkward in-person conversations with their doctors and opt for a package in the mail.

Although the prices are often inflatedIt can be fine to purchase medications through these sites, said Dr. Rubin, as long as men also build a relationship with a doctor who is familiar with their medical history. a 2020 study found that some direct-to-consumer companies only partially adhered to this the American Urological Association screening guidelinesmeaning that underlying factors contributing to physical and mental health may go unnoticed.

Vacuum devices

Penis vacuum devices, more commonly known as penis pumps, are one surprisingly effectivealso a non-invasive option, especially for men who find that oral medications don’t work for them. The vacuums work by increasing blood flow to the penis to achieve an erection, which is then maintained using a constriction ring placed at the base of the penis and scrotum.

“For about $300, men can have sex whenever they want, for however long they want,” said Dr. Khera, referring to medical grade devices. Although they are effective and a good solution for some of Dr. Khera, others find them cumbersome, he said, because they need “a little drama” every time they want to have sex.

Injections

Two drug mixtures, known as “bimix” and “trimix”, also induce erections by improving blood flow. They are administered at home after initial instructions from a doctor. However, patients must inject them directly into the penis five to twenty minutes before intercourse.

“They usually say, ‘Wait, do you want me to put some where?'” said Dr. Rubin.

But the injections have been used safely and effectively to treat erectile dysfunction since the early 1980s. However, unlike oral medications, they cause erections regardless of whether a man is aroused or not.

Testosterone Replacement Therapy

Low testosterone levels can reduce sex drive and lead to weak erections, although this is rarely the sole cause of erectile dysfunction. Over time, the hormone deficiency can cause penile tissue to atrophy, making erections even more difficult. The condition is easily treated with testosterone replacement therapy, which is also possible improve effectiveness of oral medications. But it is important to monitor the condition together with a doctor.

Implants

Penile implants, which have been around since the 1970s, were the first major treatment for erectile dysfunction. They are still an effective option for men who don’t respond to (or don’t like) other treatments. Although the implants require surgery, they have… a satisfaction rate of 93 percentAccording to research, this is likely because men can get and maintain an erection at will, Dr. Khera says.

Penile implants use inflatable cylinders that are inserted into the penis by a urologist. The cylinders are attached to a water-filled pouch that is usually implanted under the abdominal wall. The user presses a small pump device (implanted in the scrotum) to fill the penis with fluid. A release valve on this same device returns the penis to a flaccid state.

Questionable remedies

And what about those gas station pills and social media ads that promise men firmer, longer-lasting erections without a doctor’s visit or prescription drugs?

“Buyer beware,” Dr. Rubin said. These supplements, sometimes called “rhino pills,” are not regulated by the FDA, she said, meaning manufacturers “can put whatever they want in them.”

Federal Investigations have discovered that the “all-natural” products promised by some of these brands often contain the active ingredients of drugs like Viagra and Cialis, sometimes in unhealthy amounts.

Alternative treatments for erectile dysfunction, such as amino acids, ginseng And acupunctureare popular, but there is still insufficient evidence to recommend them.

There are several regenerative therapies that are currently undergoing extensive research, including Injections with platelet-rich plasma, stem cell therapy And shock wave therapyWhile some have shown promise in early trials, Dr. Khera said “none of them are ready for prime time yet.”

Approach to underlying health and psychology

If men don’t go to a doctor for their penis, they should do so for their heart. Heart disease is the most common cause of erectile dysfunction, which is often a warning sign of the condition.

In one study, 15 percent of men with recurring erectile dysfunction has had a cardiovascular event, such as a heart attack or stroke, within seven years of the problem beginning. Erectile dysfunction can also be an early indicator of other serious conditions such as diabetes and high blood pressure.

Addressing these issues by making lifestyle changes will not only improve your overall health, but you can also improve erections without the need for other interventions.

There is “no pill on the planet that is more powerful than diet and exercise,” said Dr. Khera, who led A 2023 Meta-Analysis which showed that aerobic exercise was as effective in treating erectile function as oral medications.

Mental health factors – such as anxiety, depression, stress and relationship problems – can also cause erection problems. And erection problems can, in turn, cause depression and anxiety in men, said Dr. Daniela Wittman, a sex therapist and professor at the University of Michigan. If the conditions are left untreated, they can worsen each other, leading to fear of failure or despondency, she added.

Sex therapy, which addresses the psychological and emotional triggers of erectile dysfunction, is often most successful when used together with oral medications. Regardless of the cause, most men could benefit from learning how their “mental and sexual well-being are linked,” she added.

With such a robust toolbox available, said Dr. Rubin, most men don’t have to live with the effects of erectile dysfunction. The hard part is letting men walk through her door.

“Your job is to help me understand what’s going on with you, and what kind of sex you want,” she said. Then ‘we can come up with the best plan’.

David Dodge is a freelance writer focusing on health, wellness, and LGBTQ issues.