Men’s Sexual Health and Erectile Dysfunction

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Despite being exceedingly common, men are often reluctant to discuss erectile dysfunction (ED) with anyone, even their physician. The Massachusetts Male Aging Study reported that approximately 52% of men report some level of erectile dysfunction. The study also demonstrated that ED is increasingly prevalent with age: approximately 40% of men are affected at age 40, and nearly 70% of men are affected at age 70.  For men suffering from ED, there are highly effective solutions and approaches to help prevent or minimize the severity of erectile dysfunction as they age.

The Causes of Sexual Dysfunction

According to the Cleveland Clinic - sexual dysfunction in men can be caused by a number of physical ailments, including:

  • Aging

  • Obesity or being overweight

  • Cardiovascular disease (high blood pressure, atherosclerosis, and hyperlipidemia)

  • Prescription drugs (i.e., antidepressants, high blood pressure medicine)

  • Diabetes

  • Smoking (current or past history)

  • Low testosterone levels

  • Surgery or trauma (i.e., prostate removal)

  • Peyronie’s Disease

  • Alcohol or drug use

  • Stress, depression, 

  • Effects of past sexual trauma

  • Performance anxiety

The Impact of Sexual Dysfunction

Sexual complications can result in challenges beyond the bedroom. ED or a decrease in libido can lead to low confidence, challenges with relationships and even depression. Because of the significant problems associated with sexual dysfunction - it is even more important for men to grasp the ways that ED can be addressed.  

A Comprehensive Approach

The most commonly thought of solutions for ED are oral medications such as Viagra and Cialis. However, we favor using both oral medications as well as a more comprehensive approach to address some root causes. A comprehensive approach that includes evaluating risk factors and contributors to ED may help reverse some symptoms and/or prevent the worsening of sexual function with age.  To find the optimal treatment for each individual, it is critical to evaluate and address any underlying issues - which can range from a decline in cardiovascular health to diabetes to compromised hormone health (such as thyroid or testosterone issues).

Our clinic believes that a multi-pronged approach is often the most successful, so we evaluate each case of erectile dysfunction based on a four-pronged approach:

Obstacle Removal: Pre-existing conditions, weight, lifestyle choices, and medication burden can all be contributing factors to erectile dysfunction, so based on the individual patient, we recommend assessing a number of issues, including:

  • Improving cardiovascular health (addressing risk factors for heart disease)

  • Evaluating diabetes and pre-diabetes (insulin resistance is bad for blood vessel health)

  • Targeted weight loss in overweight patients

  • Reducing medications where possible 

  • Implementing 160 minutes of moderate to intensive of cardiovascular exercise per week 

  • Recommending a low-glycemic, whole foods diet 

  • Evaluating and addressing low testosterone or hypothyroidism 

The Hormone Affect - Testosterone Replacement Considerations: Testosterone levels can decline with age - sometimes contributing to ED and loss of libido. We recommend a comprehensive lab to evaluate free and total testosterone levels. Low testosterone has been associated with erectile dysfunction and should be addressed in the appropriate patient. It’s important to note, however, that ED is a multi-variable condition, and testosterone replacement on its own is not always the cure-all.  You can read more about testosterone replacement therapy on this page.


Medication: It’s important to understand the nuances and strategies of taking oral medications like Viagra, Cialis, Levitra, and Stendra. These medications fall under a category called phosphodiesterase Type-5 (PDE-5) inhibitors.   They can be helpful in initiating and maintaining an erection by prolonging the action of vasodilators like nitric oxide in the tissue.  For some men, we might discuss “supercharged” ED meds such as sublingual deliveries or another category of medication called intracavernosal injectables such as Alprostadil and Trimex.

Regenerative Treatments: Because most ED cases are caused by a decline in vascular function (i.e., the health of blood vessels), employing treatments to help improve the number and function of blood vessels can be an effective approach.  There are three regenerative options that commonly lead to an improvement in erectile function including: 

  • Low-Intensity Shockwave (AKA GAINSWave) Therapy - Shockwave therapy ​​utilizes low-intensity sound waves to increase blood flow to the penis, improve the health of blood vessels and the endothelium, stimulate angiogenesis (growth of new blood vessels), and may address micro-plaques in vessels of the penis, resulting in stronger, more frequent erections. (Visit this page for more information)

  • The P-Shot - The Priapus Shot, or P-Shot, harnesses the power of platelet-rich plasma to improve erectile function, penile sensation, stamina, and health - as well as stronger, more frequent erections. (Visit this page for more information)

  • The Penis Pump (Vacuum Device) - Vacuum devices, used properly, can improve vascularity and are an excellent follow-up exercise to treatments such as shockwave therapy and the P-Shot.

You can read more about our comprehensive approach to ED on this page.

By being proactive, patients will be better armed to take control of their sexual performance. When you’re ready to get started - just give the office a call at 425-209-1060.


katherine kass