The inability to experience intimacy fully can be devastating psychologically to a man and his partner. In fact, current research indicates that as many as 30 million men in the United States may experience erectile dysfunction (ED) and the consequences of this medical condition.^[5] As men age, the likelihood of ED increases, however it is not a natural part of the aging process.^[4]

What exactly is erectile dysfunction?

Once known as “impotence” erectile dysfunction, ED is a medical condition that occurs when a man cannot get or maintain an erection fully for sexual intercourse.

A man may be diagnosed with erectile dysfunction if:

• He is unable to get an erection every time.
• He is unable to sustain an erection long enough for sexual intercourse.
• He is unable to get an erection at all.^[5]

What causes erectile dysfunction?

Erectile dysfunction (ED) may be caused by a number of both psychological and medical issues. While causes may be directly related to medications or injury, for some, the reasons are much more complex.

Physical causes of erectile dysfunction are many. These may include nerve damage within the penis itself, or damage to the arteries, muscles, or fibrous tissue within the organ.

Diseases and disorders that affect the penis include:

• Elevated blood pressure
• Diabetes
• Atherosclerosis (plaque build up within arteries
• Disease of the heart and blood vessels
• Kidney disease (chronic)
• Multiple sclerosis
• Prostate cancer treatment (radiation or surgery)
• Direct injury to the penis, prostate, bladder, pelvis, or spinal cord
• Bladder cancer surgery
• Peyronie’s disease (scar tissue from plaque in penis)^[2]
• Smoking
• Excess alcohol use
• Illegal drug use
• Overweight
• Lack of exercise

A number of psychological or emotional issues affect erectile function and can contribute to ED.

These include:

• Anxiety
• Depression
• Anxiety or fear of failure sexually
• Guilt
• Low self-esteem
• Stress^[5]

* Anxiety over medical conditions that impact erectile dysfunction may exacerbate the problem.

Certain medications can negatively impact healthy erectile function including:

• Blood pressure medication
• Appetite suppressants
• Ulcer medication
• Antidepressants
• Tranquilizers
• Antihistamines

A small number of men diagnosed with erectile dysfunction may suffer from low testosterone levels as well.

ED—Not Just For Seniors

While it is estimated that 30 million men in the country suffer with erectile dysfunction, not all are older. In fact, about 12% are under the age of 60. Another 22% are aged 60-69, and 30% are over 70.^[5]

How is ED diagnosed?

Many men are diagnosed with erectile dysfunction based solely on disclosure to their primary care physician about sexual health and history. Medical or psychological evaluations may be necessary to pinpoint the underlying cause of ED, however.

These may include a physical examination to check nerve and sensation in the penis, blood or urine tests to identify disease processes, ultrasound to evaluate blood flow to the organ, or overnight erection tests to determine whether dysfunction is physical or psychological.^[5]

Psychological evaluation, including a sexual health questionnaire may also be used to screen for depression, anxiety, or other mental health concerns.

Specialized Testing for ED

Depending on preliminary findings, doctors may also order specific tests such as:

• Color duplex Doppler ultrasonography (to evaluate blood flow to the penis)
• MRI
• Nocturnal penile erection monitoring

Treatment For Erectile Dysfunction

Prescriptions & Natural Supplements—Treatment for erectile dysfunction may include both medical and pharmacological intervention, as well as natural support through dietary supplements and lifestyle changes.

There are many FDA approved prescriptions for erectile dysfunction that support erectile health by helping relax blood vessels. Treatment with these PDE5 inhibitors works by enhancing the body’s natural chemical release of nitric oxide, in response to sexual stimulation.^[7] Nitric oxide in turn, facilitates blood flow to the penis.

Oral medications include:

• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra, Staxyn)
• Avanafil (Stendra)^[1]

Other medications may be injected into penal tissue, or inserted into the urethra as a suppository.

ED medications are not without some side effects, however. These prescriptions may cause facial flushing, nasal congestion, headaches, changes in vision, stomach upset, or backaches.

Some men have restored sexual health through other medical means including, penile prosthesis, vacuum devices that draw blood into the penis, and revascularization to correct blood flow through the organ vessels.^[5] Testosterone replacement may also be appropriate if low levels of the hormone affect erectile function.

Natural Supplements and A Healthy Lifestyle For ED

A number of herbs and natural supplements may help improve erectile function in men.

These include:

• Asian Ginseng—May work to improve libido and maintain erection.
• Ginkgo Biloba—Can help increase blood flow to the penis.^[8]
• Yohimbe—May increase blood flow and nerve impulses to the penis.
• Viramax containing yohimbe, catuaba, muira puama, and maca is believed to be an aphrodisiac.
• L-arginine—May increase blood flow.
• Dehydroepiandrosterone (DHEA)—May aid individuals whose erectile dysfunction is the result of low testosterone levels.

* Individuals who use the above natural herbs or supplements to help treat erectile dysfunction should know that certain herbal extracts and formulas may interact with prescription (or over-the-counter) medications. Before using any drug or natural supplement it is important to check with a physician to ensure it is safe for use with other medications.^[3]

Lifestyle Changes

Certain lifestyle changes may actually help prevent or combat erectile dysfunction. Toxins in the body, excess weight, and stress, all contribute to chronic conditions that impact sexual health and function.^[6] Smoking, excessive use of alcohol, sedentary behavior, and poor nutrition may indirectly affect circulation, stress levels, and overall feelings of health and wellness.^[5]

Male erectile dysfunction is a complex and sensitive issue for many men and their partners. There is no reason to suffer with erectile dysfunction alone, however. While most people assume that ED is a natural consequence of aging, it is generally due to underlying medical or psychological issues. Much can be done to support sexual health and well being through intervention. While talking about erectile dysfunction can be embarrassing, it is important to seek the advice of a trusted medical practitioner or therapist familiar with ED issues. Erectile dysfunction treatment is a personal decision for every individual and couple.