Sometimes a man will call to make an appointment with me and describe his issue as a "personal problem".  That personal problem is often erectile disfunction.  This problem can be a sign of aging.  Though men and women can have an active sex lives into their 90's, men typically will take longer to get erections as they get older.  They will usually require physical stimulation to become erect.  But if a man has a consistent problem getting or maintaining an erection during intercourse, he may seek out treatment for erectile dysfunction (ED).

    Although ED may be caused by an underlying psychological problem, the majority of men who have difficulty iniating or maintaing erections have underlying physical problems.  One of the first things to rule out in discovering the problem causing the ED is to see if the man has low testosterone.  This can be established by seeing an endocrinologist specilizing in treating hormone imbalance. A medical test and testostrone supplements are available.  But know that less than 4% of erectile disfunction cases are related to testosterone deficiency.  In addition testosterone supplements can exacerbate a man's condition if he has either prostate cancer or benign prostate enlargement.  In reality, the long-term benefits and risks of testosterone supplements are still not clear and more studies need to be done in this area.

      Be aware that some medications including those used to treat high blood pressure or depression can have a side effect of causing ED.  More than 40% of men with hypertension also suffer from impotence.  And nerve damage from diabetes can also be a cause.  Diabetes is believed to contribute to almost half of impotence cases.

     If medications, diabetes  or low testosterone are not the underlying reasons for ED, consider that erectile dysfunction may be an early warning sign of future cardiovascular problems.  High blood pressure, diabetes or pre-diabetes, and higher triglyceride or cholesterol levels may eventually result in clogging or blockages in the arteries.  The main artery in the penis is only about one-half millimeter in diameter.  Even small accumulations of plaques (fatty deposits) can inhibit blood flow.  For that reason those small arteries will begin to clog sooner than the larger arteries that supply the brain or heart. 

     Because erectile dysfunction could be a symptom of cardiovascular disease, men experiencing ED should get a complete cardiovascular workup.  Of course, we have all seen the ads on tv for ED.  After watching all the television commercials for sildenafil (Viagra), vardenafil (Levitra) and  tadalafil (Cialis), many viewers may get the impression that erectile dysfunction will go away by just popping a pill.  Millions of prescriptions have been written for these drugs and they are considered a very safe drug.  Taking that pill may take care of the ED issue for a particular night, but the underlying, more serious problem of what caused it including the possibility of atherosclerosis (clogging of the arteries) is still there.

    For most men, ED can be prevented by making lifestyle changes that promote cardiovascular health.  ED is a wake-up call.  So what can you do to prevent or perhaps even reverse ED?    First of all you need that visit to your physician.  A man whose total cholesterol level is 200 or higher is much more apt to have ED than someone whose numbers are lower.  Numbers can some times be brought down through dietary changes such as eating less saturated fat and increasing fiber consumption while many will need a cholesterol-lowering statin drug such as atorvastatin (Lipitor) or pravastatin (Pravachol).

    A man who has ED may want to have his doctor review the drugs he is taking for side effects.  In addition to almost all blood-pressure lowering drugs and drugs for treating diabetes, antihistamines, sedatives, pain medications, antipsychotics and antidepressants may have the side effect of ED.  Drug side effects are highly individual and switiching to a different drug, may reverse the problem.

    The oral drugs, the penile implants and the vacuum devices prescribed by doctors are all tools to help men deal with ED.  In many cases, life style changes can help.  I always tell my clients, "If you value your sex life, stop smoking."  Smoking damages the inner lining of blood vessels in the penis and increases the risk of plaque buildup.  If you smoke one or more pack of cigarettes daily, your risk of erectile dysfunction is 60% higher than those who never smoked.  In addition weight loss, exercise and improved diet may be necessary to have the best chance at reversing ED.  If you value your sex life, going to a hypnotherapist to get motivated to quit smoking, to lose weight, to exercise more, may be valuable.