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Men who cannot have or maintain an erection at least 75% of the time that they attempt sex are considered to have erectile dysfunction. According to the Massachusetts Male Aging Study, about 40% of men experience some degree of inability to have or maintain an erection at age 40 compared with 70% of men at age 70. And the percentage of men with erectile dysfunction increases from 5% to 15% as age increases from 40 to 70 years.

When blood fills two chambers in the penis (known as the corpora cavernosa) an erection occurs. This causes the penis to expand and stiffen, much like a balloon as it is filled with water. The process is triggered by nerve impulses from the brain and genital area.

Anything that interferes with these impulses or restricts blood flow to the penis can result in erectile dysfunction. The link between underlying chronic disease and erectile dysfunction is most striking with diabetes.

Approximately half of the men with diabetes experience erectile dysfunction. Nevertheless, good blood sugar control can minimize this risk.

In addition, the following four diseases can lead to erectile dysfunction by interfering with blood flow or nerve impulses throughout the body.

Cardiovascular disease Atherosclerosis (hardening of the arteries) Kidney disease Multiple sclerosis. Lifestyle choices, such as smoking, alcohol abuse, and obesity can impair blood circulation and lead to erectile dysfunction. Smoking, excessive drinking, and drug abuse may damage the blood vessels and reduce blood flow to the penis. Smoking makes men with atherosclerosis even more vulnerable to erectile dysfunction.

Smokers have almost twice cheap sildenafil 100 the risk of erectile dysfunction compared with nonsmokers. Being overweight and getting too little exercise also contribute to erectile dysfunction.

Men who exercise regularly have a lower risk of erectile dysfunction.

Surgical or radiation treatments for prostate cancer, bladder cancer, or prostate enlargement (BPH) can sometimes damage nerves and blood vessels near the penis. Occasionally, the nerve damage is permanent and the patient requires treatment to achieve an erection. Sometimes, surgery causes temporary erectile dysfunction that improves on its own after 6 to 18 months. Many medications can cause or contribute to erectile dysfunction, including certain blood pressure drugs, antidepressants, and tranquilizers.

Men with erectile dysfunction should talk with their doctor if they suspect a prescription cheap sildenafil 100 or over-the-counter drug may be causing erectile problems.

It is common for men with erectile dysfunction to have an underlying physical basis for it, particularly in older men. However, psychological factors may be present in 10% to 20% of men with erectile dysfunction. Experts say stress, depression, poor self-esteem, and performance anxiety can impair the ability to have an erection. These factors can also make erectile dysfunction worse in men whose sexual dysfunction stems from something physical. Avid cyclists suffer more erectile dysfunction than other athletes because the shape of some bicycle seats causes pressure on the nerves that are vital to sexual arousal. Cyclists who ride for many hours each week may benefit from seats designed to protect the perineum.

To diagnose erectile dysfunction, the doctor will ask questions about the symptoms and medical history. A complete physical exam is done to detect poor circulation or nerve trouble.

The physician will look for abnormalities of the genital area that could cause problems with erections. Many lab tests can be helpful in diagnosing male sexual problems.

Measuring testosterone levels can determine whether there is a hormonal imbalance, which is often linked to decreased desire.

These tests may reveal underlying medical causes of ED: Blood cell counts Cholesterol levels Blood sugar levels Liver function tests.

Erectile dysfunction can be a warning sign of serious underlying disease. Research has found that erectile dysfunction is a strong predictor of heart attack, stroke, and even death from cardiovascular disease.

All men with erectile dysfunction should be evaluated for cardiovascular disease. Notably, this does not mean every man with erectile dysfunction will develop heart disease, or that every man with heart disease has erectile dysfunction; however, erectile dysfunction patients should be aware of the link. Often men with erectile dysfunction are able to improve sexual function by making a few lifestyle changes.

Stopping smoking, losing weight, and exercising regularly can help by improving blood flow.

If you suspect a medication could be contributing to erectile dysfunction, talk to your doctor about it.

While popularized in the media, Viagra is not the only erectile dysfunction drug.

Other erectile dysfunction drugs include: Cialis Levitra Staxyn Stendra. These drugs work by improving blood flow to the penis during arousal and are taken 30 to 60 minutes before sexual activity.

Cialis can be taken up to 36 hours before sexual activity and also comes in a lower, daily dose.

There are also injectable drugs for erectile dysfunction. Some men sustain stronger erections by injecting these medications

directly

These drugs work by widening the blood vessels, causing the penis to become engorged with blood.

Another option is a medicated pellet that is inserted into the urethra and can trigger an erection within 10 minutes. Patients should discuss the use of these injections in detail with their doctor before use. Erectile Dysfunction Treatment: Vacuum Devices (Pumps) Vacuum devices for erectile dysfunction, also called pumps, offer an alternative to medication.

To use a pump, the penis is placed inside a cylinder. Then the pump draws air out of the cylinder to

create

Individuals should discuss the use of this device, and especially the elastic band use to avoid potential penile damage.

If erectile dysfunction is caused by a blockage in an artery leading to the penis, surgery can be used to restore blood flow. Optimal candidates are typically younger men whose blockage stems from an injury to the crotch or pelvis. The surgery is not recommended for older men with widespread narrowing of the arteries throughout their bodies. For those men with persistent erectile dysfunction, a penile implant can restore sexual function.

An inflatable implant uses two cylinders that are surgically placed inside the penis. When an erection is desired, the man uses a pump to fill the cylinders with pressurized fluid.

Alternatively, a malleable implant with surgically implanted rods can be used to bolster erections. Psychotherapy can be beneficial for men with erectile dysfunction even when erectile dysfunction has a known physical cause.

The therapist can instruct the man and his partner in techniques to reduce performance anxiety and improve intimacy. Therapy can also help couples adjust to the use of vacuum devices and implants.

Erectile Dysfunction Treatment: Alternative Therapies. Men with erectile dysfunction should talk with their doctors before trying supplements for erectile dysfunction. They can contain 10 or more ingredients and may complicate other health conditions.

Asian ginseng and ginkgo biloba (seen here) are popular, but there isn't a lot of good research on their effectiveness.

Some men find that taking a DHEA supplement improves their ability to have an erection. Unfortunately, the long-term safety of DHEA supplements is unknown. There are dozens of "dietary supplements" that claim to treat erectile dysfunction, but the FDA warns that many of these are not what they seem. One investigation discovered that supplements for erectile dysfunction can often contain prescription drugs not listed on the label, including the active ingredient in Viagra. These can put the man at risk for dangerous drug interactions. To reduce your risk of erectile dysfunction, exercise and maintain a healthy weight, stop smoking, avoid alcohol and substance abuse, and keep your diabetes under control, if you have it.

It's natural to feel angry or embarrassed when confronted with erectile dysfunction. Talking openly about erectile dysfunction with your partner will help them understand the diagnosis and treatment options (and will reassure your partner that you haven't lost interest).

IMAGES PROVIDED BY: Zoran Milich/Allsport Concepts Fancy Plush Studios/Digital Vision Thomas Hoeffgen/Stone Brian Evans/Photo Researchers Inc Cristina Prdrazzini/Photo Researchers Inc Altrendo Images Robert Llewllyn/Workbook Stock Jeffrey Hamilton/Photodisc Dream Pictures/The Image Bank Glow Images Jose Luis Pelaez/Blend Images Lew Robertson/Brand X Thierry Dosogne/The Image Bank Corbis Photo Inc/ Age Fotostock Neville Sukhia Photography/Flickr Superstock Inc BSIP/Photo Researchers Inc Nucleus Medical Art, Inc. David Bluffington/Age Fotostock Smneedham/FoodPix DiMaggio, Kalish/Flirt Moodboard Marcus Lund/Cultura.

Reviews in Urology Journal: "Relationship Between Testosterone and Erectile Dysfunction" 3 ways to treat erectile dysfunction without Viagra. Erectile dysfunction occurs when you can't get an erection or can't keep a firm enough erection to have sex. Having mild or moderate erectile dysfunction is common — it affects about half of men at age 50 and becomes increasingly more prevalent beyond 50. Being unable to keep an erection can cause issues in your relationships or your self-confidence, but there are ways to treat or even cure the condition. Though there are drugs like Viagra on

the

"Kegel exercises help strengthen the muscles that keep the erection full and hard," says William Brant, MD, a urologist at Granger Medical Clinic in Utah.

These muscles, called cheap sildenafil 100 your pelvic floor muscles, sit beneath your prostate and rectum and their strength can affect your ability to keep an erection. This is because when you flex your pelvic floor muscles, they put pressure on the veins in your penis., This makes it harder for blood to flow out of your penis and keep your erection intact. You can find your pelvic floor muscles by acting as if you are trying to stop peeing mid-flow or keep yourself from passing gas.

The muscles that you feel moving are the ones you will use in kegel exercises. Here is how to do a kegel workout: Tighten your pelvic floor muscles – sitting or lying down may make this easier. To get positive results, you should aim to do 3 sets of 10 repetitions per day.

Though more research is needed, there is some evidence that Korean red

ginseng

Ginseng works by helping the muscles in the penis relax, Brant says, "it is this relaxation that allows blood to fill the penis and

create

and

However, many of these studies were on small groups and larger studies are still needed to see if these results apply to a general population.

You can find red ginseng sold as capsules or as a tea, but Brant cautions that these supplements are not always reliable.

Because supplements are not regulated by the FDA, the dosages on the labels may not be accurate or they may contain other unlisted ingredients.

It is important to talk to your doctor before trying over-the-counter remedies for erectile dysfunction to make sure that you are not putting your health at risk. Getting an erection involves many of the systems in your body including your nerves, your blood circulation, and your muscles.

For this reason, conditions linked to an unhealthy lifestyle, like heart disease and obesity, can put you at greater risk for erectile dysfunction.

"Don't think of the penis in isolation," Brant says, "penis issues may represent general health issues." To improve erectile functioning, it's important to make lifestyle changes that will improve the health of your blood vessels, the channels that carry blood to all parts of your body, including your penis.

Brant recommends three lifestyle shifts that can help treat erectile dysfunction: Exercise more. When you exercise, your body produces more nitric oxide, a compound that causes the muscles in your blood vessels to relax, allowing blood to flow more freely. This allows your penis to more easily become erect and stay erect.

A 2018 review found that physical activity can significantly improve erectile dysfunction, and experts recommend doing 40 minutes of exercise four times per week for best results. If you smoke cigarettes, you are almost twice as likely as nonsmokers to experience erectile dysfunction.

This is because the chemicals in cigarettes damage the lining of your blood vessels, known as the endothelium.

The endothelium is what produces nitric oxide and without enough of it, it is much more difficult for blood to flow into your penis. Drinking a low to moderate amount – fewer than 14 drinks per week for men – is not likely to increase your risk for erectile dysfunction. However, if you drink more than this, especially over a long period of time, you may have a harder time keeping an erection. This is because alcohol dilates your blood vessels, allowing blood to flow into your penis, but also allowing it to flow out, leaving your penis flaccid.

Erectile dysfunction is a common issue for men, particularly as you grow older, but there are several ways to treat it at home. If none of these methods work for you, reach out to your doctor to discuss other options like prescription medication. When your erec­tion falls flat, you need real and hon­est infor­ma­tion on what to do.

Ignore those mir­a­cle cures and ran­dom Google search­es; get seri­ous about fix­ing your prob­lem and talk to a doctor.

Erec­tile dys­func­tion ( ED ), or male impo­tence, is the per­sis­tent inabil­i­ty to achieve or main­tain an erec­tion firm enough to have sex­u­al inter­course and occurs for more than a few weeks or months.

The Nation­al Insti­tutes of Health esti­mates that erec­tile dys­func­tion strikes rough­ly 30 mil­lion men in the Unit­ed States, so you are not alone.

Erec­tile dys­func­tion pri­mar­i­ly affects men over the age of 20 , but preva­lence does increase with age. The Jour­nal of Sex­u­al Med­i­cine reports that one of out every four new ED patients is less than 40 years old.

There are many dif­fer­ent rea­sons you expe­ri­ence impo­tence rang­ing from health prob­lems like high blood pres­sure to psy­cho­log­i­cal and emo­tion­al issues, or even side effects from a med­ica­tion. It is impor­tant to talk to your doc­tor about this con­di­tion because erec­tile dys­func­tion may be a sign of addi­tion­al health problems. Every per­son is dif­fer­ent, so your physi­cian will focus on the spe­cif­ic con­di­tion that could be caus­ing your erec­tile dys­func­tion. Read more about five treat­ment options for erec­tile dysfunction. Oral Med­ica­tions There are a num­ber of pre­scrip­tion med­ica­tions avail­able (Via­gra, Lev­i­t­ra, Cialis) that may improve blood flow to the penis.

Com­bined with sex­u­al stim­u­la­tion, this can pro­duce an erec­tion.

These med­ica­tions all work sim­i­lar­ly to each oth­er; how­ev­er, there are some dif­fer­ences in effec­tive­ness and how quick­ly they begin to work. Com­mon side effects may include headache, facial flush­ing, stuffy nose and an upset stomach.

These med­ica­tions can NOT be tak­en if you use Nitrates for chest pain or oth­er med­ical prob­lems. This com­bi­na­tion can cause dan­ger­ous­ly low blood pressure. Vac­u­um Erec­tile Device (Penile Pump) A vac­u­um erec­tile device ( VED ) is a device that con­sists of a hol­low plas­tic tube, a hand or bat­tery-pow­ered vac­u­um pump and a ten­sion ring. The tube, placed over the penis, cre­ates a vac­u­um that pulls blood into the penis.

Once an erec­tion is achieved, an elas­tic ten­sion ring is placed at the base of the penis to help main­tain the erec­tion. Since effec­tive oral med­ica­tion came onto the mar­ket, VEDs are used less to achieve erec­tion since they can be cum­ber­some and less effective. Intrau­rethral Suppository/?Medicated Ure­thral Sys­tem for Erec­tion ( MUSE ) Med­icat­ed Ure­thral Sys­tem for Erec­tion ( MUSE ) uses an appli­ca­tor con­tain­ing a small pel­let with a med­ica­tion that is insert­ed into the ure­thra. Once the pel­let is released, the med­ica­tion dis­solves inside the ure­thra and helps to increase blood flow to the penis to achieve an erec­tion. Patients admin­is­ter the med­ica­tion them­selves as need­ed before intercourse. Penile Self-Injec­tion Therapy Injec­tion ther­a­py was the first FDA-approved med­ica­tion for the treat­ment of ED and uses a tiny nee­dle to inject med­ica­tion direct­ly into the base or side of the penis.

The inject­ed med­ica­tion can cre­ate an erec­tion by improv­ing blood to flow into the penis direct­ly. Patients can admin­is­ter the injec­tion them­selves as need­ed before intercourse. Penile Implant Surgery In use since the 1970 s, a penile implant is a med­ical device that is implant­ed into the penis dur­ing an out­pa­tient or overnight-stay sur­gi­cal

pro­ce­dure

The device is entire­ly con­tained with­in the body, so it is dis­crete.

The device allows for an arti­fi­cial erec­tion to be achieved at any time the patient desires by oper­at­ing a con­cealed pump in the scrotum. If you are expe­ri­enc­ing erec­tile dys­func­tion, talk to your pri­ma­ry care physi­cian or urol­o­gist to help find the best solu­tion for you. HEIDELBAUGH, MD, University of Michigan Medical School, Ann Arbor, Michigan. Patient information : See related handout on erectile dysfunction, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Abstract Diagnosis Causes and Related Conditions History and Physical Examination Laboratory Evaluation Treatment Managing Psychogenic ED References. Abstract Diagnosis Causes and Related Conditions History and Physical Examination Laboratory Evaluation Treatment Managing Psychogenic ED References.

Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.

The five-question International Index of buy sildenafil 20 mg tablets Erectile Function allows rapid clinical assessment of ED.

The condition can be caused by vascular, neurologic, psychological, and hormonal factors. Common conditions related to ED include diabetes mellitus, hypertension, hyperlipidemia, obesity, testosterone deficiency, and prostate cancer treatment.