Erectile dysfunction (ED) is a very common concern affecting millions of men. There are many ways to define ED, or impotence. It can be considered the inability to achieve erection or keep an erection firm enough for sexual intercourse, or the lack of sexual desire and problems with ejaculation or orgasm. Although the frequency of erectile dysfunction increases with age, age is not the only cause. Side effects of medications, vascular disease and injury can also be to blame. In order to rule out treatable causes, a complete history and physical exam is done as well as laboratory tests. These labs include checking for diabetes, high cholesterol, low testosterone and urinary or thyroid problems. Minimizing known modifiable risk factors for vascular disease can reduce both the risk of ED and the risk of a subsequent cardiovascular event.
Increasingly, research supports that ED can be an early warning sign of coronary artery disease, which if left untreated, can lead to heart attacks and stroke. With more men suffering from ED, there are many who might be at risk without realizing it. Making lifestyle changes such as eating a healthy diet, exercising regularly and not smoking could save a man's life, not just his sex drive. In addition, being especially vigilant about control of blood pressure, diabetes and lipids can also decrease risk for ED and cardiovascular disease.
Although inadequate production of testosterone is not a common cause of ED, replacement therapy can improve the problem. Testosterone is a hormone produced by the testicles that is important in maintaining muscle bulk, adequate levels of red blood cells, bone growth, sense of well-being and sexual function. An early morning blood level is the most accurate means of detecting testosterone deficiency. Another treatable cause that is important to screen for is thyroid dysfunction. The thyroid produces hormones which in excess or deficiency may lead to ED. Consequently, specific treatment for ED should be postponed until after achieving balanced hormonal function.
For some men, quitting smoking, losing excess weight and increasing physical activity can help to regain sexual function. In addition, cutting back on any drugs with harmful side effects, and considering psychotherapy and behavior modifications next if problems are indicated. Further treatments can include remedies such as nutritional supplements, acupuncture and herbs. Viagra, Levitra and Cialis all belong to a class of drugs called phosphodiesterase (PDE) inhibitors, which help to increase penile blood flow.
The amino acid arginine has been used to improve erectile function and has been called the “natural” Viagra. However, studies are inconclusive on its effectiveness. In terms of safety, arginine should be used with caution in people with heart disease, diabetes, heartburn, kidney disease or liver disease. It should not be used after a recent heart attack. In addition, dehydroepiandrosterone (DHEA) can improve erectile dysfunction and age-related low testosterone. However, the long-term safety of DHEA is not known, and a careful monitoring of blood levels should be done during therapy. Asian ginseng has also been used for ED but should not be used for more than 3 months. This should be administered with caution if diabetes or blood pressure issues are present. Side effects may include headache, sleep disturbances and stomach problems. Although many herbal supplements are widely marketed with the claim that they can relieve symptoms, none have been proven both safe and effective.
Risk for ED can be decreased by working with a doctor to manage conditions that can lead to the condition, such as diabetes and heart disease. The following practices are also recommended:
- Avoid the use of alcohol, smoking and illicit drugs.
- Eat whole foods and plenty of fruits and vegetables.
- Exercise regularly.
- Reduce stress.
- Get enough sleep.
- Treat anxiety or depression.
