Charles E. Jennings, MD
Erectile dysfunction (ED) becomes more common as men age. But it is not necessarily a normal part of aging. How can you avoid ED? Here's what experts told WebMD.
A diet that's bad for a man's heart is also not good for his ability to have erections.
Research has shown that the same eating patterns that can cause heart attacks due to restricted blood flow in the coronary arteries can also impede blood flow to and within the penis. The blood flow is needed for the penis to become erect. Diets that include very few fruits and vegetables along with lots of fatty, fried, and processed foods can contribute to decreased blood circulation throughout the body.
Anything that is bad for a man's heart is also bad for his penis, says Andrew McCullough, MD, associate professor of clinical urology and director of the male sexual health program at New York University Langone Medical Center.
Recent studies show that ED is relatively uncommon among men who eat a traditional Mediterranean diet, which includes fruits, vegetables, whole grains, heart-healthy fats including nuts and olive oil, fish, and wine, particularly red.
"The link between the Mediterranean diet and improved sexual function has been scientifically established," says Irwin Goldstein, MD, director of sexual medicine at Alvarado Hospital in San Diego.
Being overweight can bring many health problems, including type 2 diabetes, which can cause nerve damage throughout the body. If the diabetes affects the nerves that supply the penis, ED can result.
High cholesterol or high blood pressure can damage blood vessels, including those that bring blood to the penis. Eventually, this may lead to ED.
Make sure your doctor checks your cholesterol levels and blood pressure. You might also want to check your blood pressure between doctor visits. Some stores and fire stations offer free screenings. Blood pressure monitors are also sold for home use.
If your cholesterol or blood pressure is out of whack, get it treated.
Blood pressure drugs can make it hard to get an erection. But doctors say many cases of ED that get blamed on these drugs are actually caused by arterial damage resulting from high blood pressure (also called hypertension).
There is no evidence that mild or even moderate alcohol consumption is bad for erectile function," Sharlip says. But chronic heavy drinking can cause liver damage, nerve damage, and other conditions -- such as interfering with the normal balance of male sex hormone levels -- that can lead to ED.
Strong evidence links a sedentary lifestyle to erectile dysfunction. Running, swimming, and other forms of aerobic exercise have been shown to help prevent ED.
Watch out for any form of exercise that puts excessive pressure on the perineum, which is the area between the scrotum and anus. Both the blood vessels and the nerves that suppl the penis can be adversely affected from excessive pressure in this area. Goldstein says bicycle riding, in particular, can cause ED.
An occasional short ride is unlikely to cause trouble. But men who spend a lot of time biking should make sure their bike fits them properly, wear padded cycling pants, and stand up frequently while pedaling.
"No-nose" bike seats protect against genital numbness and sexual dysfunction, according to the National Institute for Occupational Safety and Health.
One form of exercise that doesn't seem helpful is Kegel exercises, which involve repeatedly contracting and relaxing the muscles in the pelvis. Kegels can be helpful for men and women suffering from incontinence. But there's no evidence that they prevent erectile dysfunction.
Even in healthy men, testosterone levels often begin falling sharply around age 50. Every year after age 40, a man's testosterone level typically falls about 1.3%.
Symptoms like a low sex drive, moodiness, lack of stamina, or trouble making decisions suggest a testosterone deficiency, as do spongy erections. Your doctor can check on that.
These drugs, which are often abused by athletes and bodybuilders, can shrink the testicles and sap their ability to make testosterone.
Smoking cigarettes can harm blood vessels and curb blood flow to the penis. And nicotine makes blood vessels contract, which can hamper blood flow to the penis.
Some cases of erectile dysfunction stem from penile injuries that occur during sex. To keep your penis from bending painfully, start thrusting only after making sure her vagina is well lubricated. And make sure your penis doesn't slip out of the vagina while thrusting (so you won't accidentally jam your penis against a hard part of her body). If she moves in such a way that hurts your penis -- for instance, by bending it the wrong way -- have her stop at once.
"If the woman is on top and comes down hard, and the penis does not enter the vagina, that is the equivalent of a big weight crashing down on the penis," Goldstein says. "No penis on earth can withstand that."
Psychological stress boosts levels of the hormone adrenaline, which makes blood vessels contract. That can be bad news for an erection. Anything a man can do to ease tension and feel better emotionally is likely to give his sex life a big boost.
SOURCES:Irwin Goldstein, MD, director, sexual medicine, Alvarado Hospital, San Diego. Research funding: Pfizer. Research studies: Vivus and Medtronic.J. Stephen Jones, MD, chairman, department of regional urology, Cleveland Clinic. Consultant: Pfizer.Andrew McCullough, MD, associate professor of clinical urology and director, male sexual health program, New York University Langone Medical Center, New York City. Lecturer: Auxillium. Research grant: Pfizer. Data safety monitoring board: Pfizer. Consultant: Slate Pharmaceuticals. Clinical trials: Warner Chilcott, Vivus, Lilly, Bayer-GSK, ICOS, Timm, Schering Plough, Aeterna.Ira Sharlip, MD, clinical professor of urology, University of California San Francisco School of Medicine. Disclosures: Advisory board member and/or speakers bureau: Pfizer, Lilly, Johnson & Johnson, Shionogi, Boehringer Ingelheim, Plethora Solutions.American Heart Association: "Mediterranean Diet."Medline Plus: "Erectile Dysfunction."National Institute for Occupational Safety and Health: "No-nose Saddles for Preventing Genital Numbness and Sexual Dysfunction from Occupational Bicycling."National Kidney and Urologic Diseases Information Clearinghouse: "Erectile Dysfunction."
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