How Erectile Dysfunction Is Treated

There are so many potential reasons a man might develop erectile dysfunction (ED), it's nearly impossible to generalize the best ways to treat it. What works for one man may not work for another simply because they are having problems for different reasons. That said, it may encouraging to hear that there are a variety of options that may be considered, from psychological counseling to lifestyle changes, medications to treatments and devices.

It's important to also remember that when ED is a complication of an underlying chronic condition such as high blood pressure or diabetes, the most effective treatment approach will likely involve focusing on the health problem itself.

Lifestyle Changes

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 broken 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.

Here are some lifestyle changes that can have a significant impact on erectile dysfunction:

Stop Smoking

Smoking affects circulation in ways that can inhibit blood flow to the penis and affect the ability to achieve or sustain an erection.

If you've tried to quit in the past and haven't been able to, going cold turkey probably won't work this time either. But there are plenty of medications and aids you can try to kick the habit. 

Rethink Alcohol

Drink less or stop drinking altogether, if you know you drink too much for your overall health.

If you're dealing with alcohol addiction, a 12-step program such as Alcoholics Anonymous can help you manage it.

Get More Exercise

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.

Research shows that men who exercise more in midlife have a 70 percent lower risk of erectile dysfunction compared to sedentary men.

Shed Extra Weight

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. 

Take Care of Your Teeth

Gum disease can trigger inflammation that can result in erectile dysfunction. Research has found that treating the periodontal disease can remedy ED. In a 2017 study, men with gum disease who received treatment for it had significantly improved erectile function after three months.

For Cyclists: Switch Seats

If you bike a lot and have a very narrow saddle on your bicycle, consider switching to a "no-nose seat" which is wider at the back than a conventional saddle, allowing more of your weight to be distributed to the sitting bones.

Make sure the seat is level or angled slightly downward and at a height that allows your knee to be just slightly bent at the bottom of the pedal cycle. Raising the handlebars on your bike so that you're sitting upright may also help.

Padded cycling shorts are a good idea, but a heavily padded seat is not: You'll actually sink deeper into the saddle and feel more pressure and numbness. If you do feel pain or numbness in your groin while on a long bike ride, take a break, stand up on the pedals, stretch, and "adjust yourself" until normal sensation returns.

Prescriptions

The oral medications for erectile dysfunction that follow 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) is one of the best-known ED medications; it takes effect within an hour and usually lasts for three to four hours.
• Cialis (tadalafil) must be taken 30 minutes before sexual activity.
• Levitra or Staxyn (vardenafil) must be taken from 10 minutes to one hour before sex and can be effective for up to 12 hours.
• Stendra (avanafil) can be taken 15 minutes before sexual activity.

These drugs do have some serious side effects, so talk about this option with your doctor, making sure that he or she knows your entire medical history and all other medications and supplements that you take.

Note that for some men, drugs like Viagra may only work when combined with other therapies. There's not a lot of research about combination treatment for ED, but it's worth talking to your doctor about. 

If you can't take one of these oral medications, 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.

Hormone Treatments

Research shows that men in midlife who have ED accompanied by low libido may have testosterone deficiency. Testosterone products should only be used under a doctor’s guidance, as it’s important to monitor one’s testosterone levels. If they are too high, the body’s own production of testosterone declines.

Hormonal problems are rarely the cause of ED, though hormone replacement therapy to increase testosterone levels can help some men. Before you take testosterone your doctor will have you tested to make sure you that you do indeed have a testosterone deficiency.

Counseling

If you're dealing with erectile dysfunction because of a psychological issue—you and your partner are having problems in your relationship, say, or you've been diagnosed with a condition such as depression—counseling can help. Counseling also can be useful in addition to treatment for a medical condition that's linked to ED.

In sessions with a trained therapist, for example, you can learn techniques to decrease anxiety and stress that you may associate with sex. Couples counseling with your loved one to resolve your relationship problems also may be a key to invigorating your sex life.

Pumps and Implants

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. 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, a hydraulic penis implant, includes a pump that's implanted in the scrotum and can be squeezed in order to make the penis erect.  

Natural Remedies

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 nutritional supplements for ED, speak with your doctor. He can test you for deficiencies and steer you toward the most effective and safest way to treat your erectile dysfunction. 

Sources:

Collins, CE, Jensen, ME, Callister, R., Plotnikoff, RC, and Morgan, PJ.  Improvement in Erectile Function Following Weight Loss in Obese Men: The Shed-it Randomized Controlled Trial. Obes Res Clin Pract. 2013 Dec;7(6):e450-4.

Dhir, RR, Lin, H, Canfield, SE, and Wang, R. Combination Therapy for Erectile Dysfunction: An Update Review. May, 2011. 13, 382-390. DOI: dx.doi.org/10.1038/aja.2011.2

Frühauf S, Gerger H, Schmidt HM, Munder T, Barth J. Efficacy of Psychological Interventions for Sexual Dysfunction: A Systematic Review and Meta-analysis. Arch Sex Behav. 2013 Aug;42(6):915-33.

Liu, LH, et.al. Chronic Periodontitis and the Risk of Erectile Dysfunction: A Systematic Review and Meta-analysis. Int J Impot Res. 2017 Jan;29(1):43-48. DOI: 10.1038/ijir.2016.43. 

Schrader, SM, Breitenstein, MJ, Lowe, BD. Cutting Off the Nose to Save the Penis. J Sex Med. 2008 Aug;5(8):1932-40. DOI: 10.1111/j.1743-6109.2008.00867.x.