Erectile Dysfunction

With all the ads on TV and in magazines heralding pills to treat erectile dysfunction (ED), it’s tempting to think that treatment for ED begins and ends with a prescription. These drugs are safe, easy to use, and for many men, quite effective. But it’s important to be aware that many men can ease, or even reverse, ED by making simple lifestyle changes — such as losing excess weight and quitting smoking — that also are likely to boost their overall health and reduce their chances of developing diabetes, cardiovascular disease, and metabolic syndrome. And these oral medications for ED don’t work for all men. Luckily several other treatments are available.

This report offers a comprehensive review of these treatments, as well as the causes of erectile dysfunction and how ED may be an early warning sign for other serious health problems such as heart disease or high blood pressure. It also includes information on sex therapy, involving your partner in treatment, and talking to your doctor about ED, as well as a special section on “Creating a better sex life.”

Prepared by the editors of the Harvard Health Publishing in consultation with Beth Frates, MD, FACLM, DipABLM Associate Professor, Part-Time, Physical Medicine and Rehabilitation, Harvard Medical School and Fitness Consultant Michele Stanten, Certified Fitness Instructor, American Council on Exercise. 45 pages. (2024)

How common is ED?

ED can strike any man old enough to have an erection, but it becomes increasingly common with age. Changes occur in many aspects of our physical selves as the years pass. Can you run as fast as you did at 20? Hit a baseball as far as you once could? Bash a tennis ball with the same speed and spin? Probably not. Nonetheless, there are plenty of ways to stay in the game and enjoy it. That’s as true of sex as it is of sports.

Often, erectile difficulties happen because of several health issues that become more prevalent with age. ED is also a potential side effect of many common medications, and people tend to take more drugs as they get older.

Testosterone levels naturally decline starting in midlife. While the level remains within normal limits in most men, if it drops abnormally low, it can affect libido and worsen ED. Other age-related factors also impact a man’s ability to have an erection. For example, tissues become less elastic and nerve communication slows as we age.

Differences in lifestyle help account for why some older men maintain good erectile function, while others start to have problems in their 40s. Regular physical activity, a healthy weight, and good nutrition are all associated with lower rates of ED and less severe ED over all. In part, that’s because these measures help to maintain the health of your arteries. They also help reduce chronic, low-grade inflammation and increase levels of the signaling molecule nitric oxide, which plays a key role in producing erections.

If you’re a smoker, it’s time to quit. Tobacco use is an assault on your health on multiple fronts. Smoking doubles the risk for ED. But if you quit, you have a good chance of improving erectile function.

Sexual satisfaction is possible well into older age. Research bears out that most healthy older couples can—and do—have an active sex life. According to the National Poll on Healthy Aging, sponsored by AARP and published by the University of Michigan, 40% of adults ages 65 to 80 are sexually active, and 76% said that sex is an important aspect of romantic relationships at any age.

• Understanding ED
  • What is ED?
  • How common is ED?
• How an erection occurs
• Causes of ED
  • Vascular disease
  • Neurological problems
  • Fractions and other injuries
  • Diabetes
  • Prostate cancer treatments
  • Benign prostatic hyperplasia
  • Medications
  • Low testosterone
  • Medication
  • Overweight, inactivity, and poor diet
  • Smoking
  • Alcohol use
  • Psychological factors
  • Other culprits
• Diagnosing ED
  • Providing your medical history
  • The physical exam
  • Additional test
• A questionnaire to evaluate ED
• Treating ED
  • Including your partner
  • Counseling
  • Viagra and other PDE5 inhibitors
  • Penile injections
  • MUSE therapy
  • Testosterone therapy
  • Devices to help achieve or maintain an erection
  • Surgical implants
  • Potential new therapies
• Special bonus section: Creating a better sex life
• Resources
• Glossary

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