ED, A Medical Problem with a medical solution

Erectile dysfunction (ED) is extremely common in modern day men (see survivalofthefirmest). Some degree of ED occurs in about 40% of men at age 40, rising to 70% at age 70. Body weight, inactivity, oxidative stress, diabetes, medical conditions requiring medications with an effect on erectile function and prostate cancer all increase with age. There is also evidence that the enzyme responsible for producing NO (Nitric Oxide) decreases with age. Decreasing sexual frequency undoubtedly also plays a role (like almost every organ in the body including even the brain, “use it or lose it”).

It used to be said that 95% of ED is “psychological”.  A high percentage of ED could be related to “psychological” factors  in the sense that stress is very often a contributing cause of  poor erectile function (see stress and erectile function), but we feel that only a small minority of erectile problems start out as purely psychological, such as with depression. In fact, it could be that 95% of ED has a medical basis when one considers factors such as lack of exercise, excess body weight, poor diets, diabetes, prostate surgery, and side effects of medications!

It is therefore very important for men with significant ED to be screened for potential medical problems.. Calculation of BMI and the waste to hip ratio, and measurement of blood pressure, blood sugar, blood lipids, and total and free testosterone levels will exclude most medical problems. Examination of the prostate and measurement of prostate specific antigen (PSA) is advisable in men age 50 or older. Questionnaires may be used to assess whether there might be a significant component of depression or anxiety. Always it is important to review any medications that are being taken, particularly for high blood pressure or depression.

Besides weight loss and exercise, which themselves may make high blood pressure or diabetes disappear, treatment of other medical conditions may be helpful if it is kept in mind to avoid medications that can worsen ED. In treating high blood pressure, for example, receptor blockers for angiotensin II have been shown to improve ED, presumably by reducing constriction of penile blood vessels. Treatment of diabetes may improve ED by lowering blood sugar, and certain medications for anxiety or depression may be used that have little or no adverse effect on erectile function.

If erectile function does not improve sufficiently by following the recommendations on this site and in our books, a man will almost certainly respond to a lower dose of Viagra-like drugs (click on the links provided). CAUTION.  If you have optimized NO production by following our recommendations, Viagra-like drugs could cause a prolonged erection (priapism), requiring a trip to the emergency room. Start with one-fourth of the usual dose and gradually increase until you are sure you are not having an excessive response. You can review all of the benefits, side effects and risks of taking these drugs with your prescribing physician and at www.viagra.com, www.cialis.com and www.levitra.com.

If all of this has not solved your problem, see a urologist and he may suggest medications that can be injected into the penis, a suppository that can be placed into the penile opening, and other medications. Even if all else fails there are surgical implants that can be considered.

Above all, be optimistic. There are many possible solutions and one or others of them will be likely to work for you.