How Erectile Dysfunction Is Treated

Erectile dysfunction (ED) is a common sexual disorder for which there are several treatment options. These range from taking medication or using a device to counseling, lifestyle changes, and natural remedies.

After a careful assessment of the pluses and minuses of each therapy (and often, a trial and error process), you and your doctor can choose the treatment or combination of treatments that is uniquely right for you.

A variety of personal habits and lifestyle choices have been linked to ED. In some ways, this is a good thing, since habits can be altered and choices reconsidered.

What's more, many of the lifestyle factors that contribute to sexual problems are ones that affect overall health and well-being, both physical and mental. Addressing these factors, therefore, can have benefits beyond improving erectile dysfunction.

Regular physical activity improves blood circulation and decreases the risk of heart disease, diabetes, and obesity, all of which can have an impact on sexual function.

In fact, research shows that men who exercise more in midlife have a 70% lower risk of erectile dysfunction than sedentary men. In addition to preventing ED, physical activity has been found to improve ED.

Excess body fat may play a role in erectile dysfunction by promoting inflammation and converting testosterone to estrogen. According to one study, a third of obese men with erectile dysfunction regained sexual function after participating in a two-year weight loss program.

Smoking affects circulation in ways that can inhibit blood flow to the penis and affect the ability to achieve or sustain an erection. This is why male smokers are at an increased risk of developing ED, regardless of their age or underlying medical conditions.

That said, it remains unclear whether stopping smoking once a person has started will necessarily improve ED. Research suggests this may be only true in younger men who have a limited smoking history.

Regardless, smoking cessation has many other health benefits, such as reducing heart disease and diabetes—two major causes of ED.

People who eat diets rich in whole-grain foods, vegetables, and fruits and low in red meat, full-fat dairy products, and sugary foods and drinks have a reduced risk of ED.

Similar to smoking, adopting healthy eating habits has other health benefits too, especially with regards to improving your heart health.

Research has found that moderate alcohol intake (less than 21 drinks per week) may protect against ED—possibly because, in the long-term, alcohol can raise high-density lipoprotein (HDL or "good cholesterol"). There is still debate about whether excessive alcohol consumption negatively impacts ED.

Perhaps a less obvious lifestyle strategy is to see your dentist for regular teeth care. This is because, according to a review article of five studies involving more than 200,000 men, chronic gum disease (periodontitis) might be associated with a more than twofold increase in the risk of erectile dysfunction.

The oral medications for erectile dysfunction—phosphodiesterase-5 (PDE5) inhibitors—work by enhancing the effects of nitric oxide, a naturally-occurring substance that relaxes blood vessels to allow blood to flow into the penis. With this effect in place, it's possible to get an erection in response to sexual stimulation and to sustain it.

• Viagra (sildenafil): May be effective within 30 to 60 minutes can last up to 12 hours
• Cialis (tadalafil): May be effective within 60 to 120 minutes and may last up to 36 hours
• Levitra or Staxyn (vardenafil): May be effective within 30 to 60 minutes and can last up to 10 hours
• Stendra (avanafil): May be effective within 15 to 30 minutes and can last up to 12 hours

Keep in mind—for Viagra, Levitra, and Stendra—eating a high-fat meal may delay the absorption of the drug, which can prolong the time it takes to get an erection and diminish the drug's overall effectiveness.

In addition, PDE5 inhibitors do have some potential side effects—for example, flushing, headache, dyspepsia, and nasal congestion. They also cannot be taken with nitrates or Adempas (riociguat), a medication used to treat pulmonary hypertension.

If a PDE5 inhibitor is ineffective or contraindicated, your physician may have you try Caverject (alprostadil for injection), a hormone that you inject into your penis using a fine needle, or Muse (alprostadil urogenital), a tiny suppository that you insert into the tip of the penis. Both of these will bring on an erection within five to 15 minutes without sexual stimulation.

A doctor may prescribe testosterone replacement therapy if a man is found to have a low testosterone level, along with bothersome symptoms, such as low libido and ED.

That said, testosterone deficiency is uncommonly the primary cause of ED. Before you take testosterone, your doctor will have you tested to make sure that you do indeed have a deficiency.

Taking a step back, besides taking a prescription, it's equally if not more important to first review your current list of medications with your doctor. It is very possible that one or more of them may be causing or contributing to your erectile dysfunction.

While you may not necessarily be able to stop that medication, recognizing it as a potential culprit may at least help you and your doctor understand the "why" behind your erectile dysfunction.

Medications that classically cause erectile dysfunction as a side effect are antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), such as Zoloft (sertraline).

Other potential medications linked to erectile dysfunction include certain blood pressure medications and pain medications.

A mechanical device may be worth trying if medication and other interventions don't work.

One option is a vacuum pump, a plastic tube that is placed over the penis. When air is sucked out of the tube it creates pressure that causes blood to be forced into the penis. A ring can then be temporarily placed at the base of the penis to stop the blood from draining away too quickly.

A penile implant is another option, of which there are two types. One of them, called a semi-rigid penis implant, keeps the penis erect all the time, though it can be bent downward when you aren't having sex. The other type, an inflatable penis implant, includes a pump that's implanted in the scrotum and can be squeezed in order to make the penis erect.

While not a conventional therapy, an emerging treatment for erectile dysfunction is low-intensity shockwave therapy. This treatment entails delivering sound waves to the penis, which is believed to ultimately increase blood flow and, thus, improve erectile dysfunction.

Research suggests that combining a psychological intervention with medication improves sexual satisfaction and symptoms of erectile dysfunction better than either therapy alone.

This makes sense considering that even though ED is most often caused by a medical condition (e.g., heart disease or high blood pressure), stress and mental health problems, such as anxiety and depression, can exacerbate it.

Moreover, suffering from ED often has emotional consequences, which may negatively impact relationships or a person's self-esteem.

If you are considering therapy for ED, be sure to see a certified sexual therapist. You may also consider group psychotherapy, which has been shown to be beneficial for men with ED or going to psychotherapy with a sensate focus with your partner.

Research has found that, to some extent, acupuncture can improve ED. While the precise mechanism remains unclear, experts suspect that acupuncture may help regulate nerve sensitivity and improve blood flow to the penis.

There are lots of herbs and nutritional supplements claiming to improve sexual function in general and to treat ED in particular. However, there's very little research to prove that any of them actually work. Options like red Korean ginseng, L-arginine, L-carnitine, zinc, and niacin all have potential side effects when taken in high doses.

In addition, when research has shown a nutrient such as zinc or niacin to improve sexual function, it's usually in people who are deficient in it. So, before you stock up on over-the-counter supplements for ED, speak with your doctor. They can test you for deficiencies and steer you toward the most effective and safest way to treat your erectile dysfunction.

There are obviously a lot of treatment options available for ED, which in no small part is due to the fact that a healthy sex life is important for many people's sense of well-being. That said, try not to get overwhelmed with all the different choices. It may take a bit of time and patience on your part, but under the guidance of your doctor, you can find the treatment that works best for you.