The no-drug approach to erectile dysfunction

There are ways to manage ED without medication.

Erectile dysfunction (ED) is one of the more common health issues older men face, especially those with cardiovascular disease and diabetes. Some estimates suggest between 50% and 70% of men ages 50 to 70 experience mild to moderate ED.

ED is defined as difficulty achieving or sustaining an erection. It is often caused by a combination of physical and emotional issues. ED makes intercourse difficult, which can lower sex drive and desire, increase anxiety and depression, and affect a man's relationship with his partner.

ED drugs are a standard solution for most men, but they have their downsides, like possible side effects and over-reliance on using them. But pills don't have to be your first or only choice.

"In many cases, lifestyle changes may slow the progress of ED and help manage it, so you may not need ED medications or have to rely on them as much," says Dr. Marc Garnick, professor of medical oncology and urologic cancer at Harvard-affiliated Beth Israel Deaconess Medical Center.

Look for signs

You should always monitor your sexual function for any changes, no matter how insignificant. For instance, can you get an erection, but not complete sex? Do your erections take longer, or are they inconsistent?

Consult your primary care doctor if symptoms become more frequent or severe. Besides confirming your condition, your doctor also can check for other health issues that may cause ED (see "Signs of other health problems").

If ED is confirmed, talk with your doctor about treatment options, including lifestyle changes. "These can have an immediate and long-lasting impact on managing ED, and often should be the first course of action before trying medication," says Dr. Garnick. Here are some strategies that have proved effective.

Do more aerobic exercise. An analysis in the June 2018 Sexual Medicine found that, on average, 40 minutes of moderate to vigorous aerobic activity, four times a week for six months, can improve ED. The type of exercise did not matter as long as the proper intensity was met; examples include jogging, swimming, cycling, circuit-type resistance training, and brisk walking. There are many ways to increase your amount of exercise. If you can't go to a gym, YMCA or community center to do aerobic and strength training classes, you can do similar exercises online at home.

Try performing Kegels. Kegel exercises strengthen pelvic floor muscles, and some research suggests they may help with ED by increasing blood flow to the penis. A Kegel is done by tightening the muscles you would use to stop the flow of urine or to hold back gas. A typical routine consists of multiple Kegels with set amounts of time to hold the muscle contraction and to rest between repetitions. The number of reps can vary from 10 to 100 contractions. You can learn how to perform Kegels at /kegels.

Watch your waistline. A 2015 study found that clinically obese men have a 40% higher risk of developing ED. If you are overweight, reducing your weight by 5% to 10% has been shown to improve sexual function.

Change your diet. Several studies have found that the health benefits of a Mediterranean diet extend to ED, too. An online guide found at /meddiet can help you begin a Mediterranean diet.

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