Urologist Tobias Kohler, M.D., answers the most frequently asked questions about erectile dysfunction.
Problems with erectile dysfunction are super common. If you look at the decade of life, that predicts what percent of men will have problems. So, for example, 50% of 50-year-olds, 60% of 60-year-olds, so on and so forth, will have problems with erections.
But that does not necessarily mean that as you get older, you have to have problems of the penis. There are plenty of men in their 60s, 70s and 80s and 90s with great sex lives. In other words, if you take great care your penis, your penis will take great care of you.
So the things that you can do to take care of yourself to help with erections include exercising, eating well, including a diet high in fruits and vegetables, having a slimmer waistline, sleeping well, and quitting smoking. A lot of these things I mentioned are as powerful as medications in helping with erections and improving your sex life.
The penis and overall health is so strongly connected, it’s really important to remember that the penis is one of the most powerful predictors we have, especially in young men, for heart attacks. The blood vessels that feed the penis are relatively small. Blood vessels in the heart and the neck are a little bit bigger. So therefore, the penis can predict heart attacks or strokes years in advance when they may occur.
So when we talk about what truly is a problem with erectile dysfunction, the definition is a problem that lasts greater than three months and is a consistent inability to obtain or maintain an erection adequate for intercourse. So when young men get problems with erections, which is very, very common because it’s normal to have bad nights here and there.
And so, if it happens occasionally, you don’t need to be as worried about that.
But if you have consistent problems, you absolutely should and must get checked out by a doctor to figure out what’s going on, not only because there are great treatments available, but because we may discover underlying medical problems.
When young men have problems with erections, most of the time it’s a confidence issue. And so, there are different ways to deal with that. One way is to give medications to get the confidence back. Another way is to use specialists trained in behavioral techniques to get confidence back, so sexual counsellors or therapists can really help with this problem.
Modern day, we have several new, exciting, experimental things, such as shockwave therapy of the penis or platelet-rich plasma or stem cell therapy. These are not ready for prime time, and so you should not, as a patient, have to spend your hard-earned money to see whether or not this works for you. It’s better to be part of a clinical trial to see if that works or to go with more traditional therapies at this point.
If you want to be a great partner for your medical team to help solve problems with erections, the number one thing you can do is book an appointment.
Just like anything else in life, you have to take the initiative, set up an appointment for your physician, say, “Doc, I have a problem with sex.” Never hesitate to ask your medical team any questions or concerns you have. Being informed makes all the difference.
For many people, a physical exam and answering questions (medical history) are all that’s needed for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist.
Tests for underlying conditions might include:
Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation.
Blood tests. A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.
Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
Ultrasound. This test is usually performed by a specialist in an office. It involves using a wandlike device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems.
This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection.
Psychological exam. Your doctor might ask questions to screen for depression and other possible psychological causes of erectile dysfunction.
Exercise
Recent studies have found that exercise, especially moderate to vigorous aerobic activity, can improve erectile dysfunction.
Even less strenuous, regular exercise might reduce the risk of erectile dysfunction. Increasing your level of activity might also further reduce your risk.
Discuss an exercise plan with your doctor.
Psychological counseLling
If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship tension — your doctor might suggest that you, or you and your partner, visit a psychologist or counsellor.
Lifestyle and home remedies
For many people, erectile dysfunction is caused or worsened by lifestyle choices. Here are some steps that might help:
● If you smoke, quit. If you have trouble quitting, get help. Try nicotine replacement, such as over-the-counter gum or lozenges, or ask your doctor about a prescription medication that can help you quit.
● Lose excess pounds. Being overweight can cause — or worsen — erectile dysfunction.
● Include physical activity in your daily routine.
Exercise can help with underlying conditions that play a part in erectile dysfunction in a number of ways, including reducing stress, helping you lose weight and increasing blood flow.
● Get treatment for alcohol or drug problems. Drinking too much or taking certain illegal drugs can worsen erectile dysfunction directly or by causing long-term health problems.
● Work through relationship issues. Consider couples counselling if you’re having trouble improving communication with your partner or working through problems on your own.
Alternative medicine
Before using any supplement, check with your doctor to make sure it’s safe for you — especially if you have chronic health conditions. Some alternative products that claim to work for erectile dysfunction can be dangerous.
The US Food and Drug Administration (FDA) has issued warnings about several types of “herbal viagra” because they contain potentially harmful drugs not listed on the label. The dosages might also be unknown, or they might have been contaminated during formulation. Some of these drugs can interact with prescription drugs and cause dangerously low blood pressure. These products are especially dangerous for anyone who takes nitrates.
Coping and support
Whether the cause is physical, psychological or a combination of both, erectile dysfunction can become a source of mental and emotional stress for you and your partner. Here are some steps you can take:
Don’t assume you have a long-term problem.
Don’t view occasional erection problems as a reflection on your health or masculinity, and don’t automatically expect to have erection trouble again during your next sexual encounter. This can cause anxiety, which might make erectile dysfunction worse.
Involve your sexual partner. Your partner might see your inability to have an erection as a sign of diminished sexual interest. Your reassurance that this isn’t the case can help. Communicate openly and honestly about your condition.
Treatment can be more successful for you when you involve your partner. Don’t ignore stress, anxiety or other mental health concerns. Talk to your doctor or consult a mental health provider to address these issues. – mayoclinic.org
