The Medicine Cabinet: Ask the Harvard Experts
Q: Now that I am getting older, I have occasional problems keeping an erection. What do you suggest, other than popping a pill before sex?
A: Occasional erectile dysfunction (ED) is very common, even at young age. As men age, it’s likely to happen more often. In the past, it was often viewed as a psychological disorder. While a man’s state of mind clearly can influence holding an erection, more often there is some physical problem contributing to it.
The best way to consider what natural ways will help ED is to recognize that ED can be a sign of fatty build-up in arteries. In fact, ED can be the first symptom of vascular problems, which might but a man at risk of a heart attack or stroke.
The two conditions often share common risk factors. Smoking, high blood pressure, high blood sugar, and abnormal cholesterol levels can all damage arteries feeding oxygen to the heart and brain, and also the penis. And what’s good for your heart and brain is also good for your penis.
Taking a medication like Cialis, Levitra, Stendra or Viagra is an appropriate quick fix for some men with erectile dysfunction. These drugs increase the body’s production of a molecule called nitric oxide. Extra nitric oxide helps arteries around and in the penis relax and carry the blood needed to generate an erection. But medication is a temporary — and expensive — solution that can cause side effects.
A more intensive effort that involves much more than popping a pill can yield longer-term improvements in both sexual function and cardiovascular health.
Exercise. Physical activity stimulates arteries to produce more nitric oxide. That’s good for erections — and for blood flow throughout the body.
Smoking cessation. Smoking damages the inner lining of arteries. This thin layer of tissue, called the endothelium, is a big source of nitric oxide. Stopping smoking allows arteries to heal and make more nitric oxide.
Healthy eating. In the Massachusetts Male Aging Study, eating a diet rich in fruit, vegetables, whole grains, and fish — with fewer red and processed meat and refined grains — decreased the likelihood of ED.
Weight control. Excess weight can diminish testosterone production and damage the endothelium. Among men who are overweight or obese, modest weight loss can improve erectile function.
Mind management. Stress and depression contribute to erectile dysfunction and cardiovascular disease. Strategies to manage stress and ease depression are good all around.
Drug therapy and lifestyle changes aren’t mutually exclusive. Combining a medication with exercise and other efforts is a good place to start. Stick with the healthy changes and you may not need the medication down the road. They may also extend your life — and your love life.
(Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)