Penises are moody. If you have one, you know that they can make their presence known at the most inconvenient and embarrassing moments. They might be a little over-eager and ejaculate too quickly. There is also the possibility that they “no-show” in the heat of the moment, which can be both frustrating and humiliating. Problems with sexual performance have been shown to cause mental health problems like low self-esteem. Over time, recurring erection problems can start to affect your sex life, whether it be with one or multiple partners.

Erectile dysfunction is a tricky subject for men. It’s not something that we bring up to our friends, nor is it something that we feel comfortable leading off with as we start to get intimate with a partner. Despite the stigma and embarrassment around ED, however, it’s important to remember that it is very common. As in, 30 million American men deal with some form of erectile dysfunction. Put another way, some studies have shown that 3 in 5 American men have dealt with problems related to erectile function.

To help you manage this tricky condition, we’ve put together some basic information about erectile dysfunction, as well as some tips for how to manage it. Every man is different, and there is no “one-size-fits-all” treatment plan for ED, but use these tips as a starting point toward better sexual health.

Erectile dysfunction is a condition in which you are unable to achieve and maintain an erection firm enough for sexual activity. In some cases, men who experience ED are unable to get an erection at all, while others are unable to get or maintain an erection firm enough for sex. While many men experience some sexual performance problems from time to time, you should seek medical advice if you regularly deal with erectile dysfunction.

Erectile dysfunction can be caused by a wide range of underlying physical and mental conditions. It most commonly affects men over the age of 40 and becomes more and more common the older a man gets. However, data from The Journal of Sexual Medicine finds that over 25% of men under the age of 40 also deal with ED. Aside from aging, other health conditions that may cause ED include:

• Poor vascular health (heart disease, high blood pressure, and high cholesterol)
  
• Performance anxiety (anxiety around being able to get and maintain an erection)
  
• Substance abuse
  
• Diabetes
  
• Obesity
  
• Multiple sclerosis (MS)
  
• Psychological problems (such as depression or anxiety)
  
• Peyronie's disease (scar tissue inside the penis)
  
• Spinal cord injuries
  
• Medications (like some blood pressure medication and antidepressants)
  
  

So, with so many causes for ED, what’s a guy supposed to do about it?

If you’re dealing with frequent episodes of sexual dysfunction, we highly recommend that you get in touch with a licensed health care provider. Primary care providers (sometimes known as family doctors), as well as Doctors of Urology, are capable of diagnosing and treating erectile dysfunction. It's generally recommended that you speak to a primary care provider (PCP) first to help determine if any underlying conditions or health problems are causing your erectile dysfunction. From there, your PCP might refer you to a men’s health expert such as a urologist, based on your medical history and symptoms.

Urologists specialize in the urinary tract and reproductive systems of both men and women. A urologist can conduct urine tests, as well as penile ultrasounds to check for conditions such as kidney disease, STIs or blood flow issues that might be causing erectile dysfunction.

Talking to a doctor can help you figure out whether or not your ED is being caused by a medical condition that requires treatment. Inform your provider about any medication and/ or supplements you are taking, as certain products have been shown to contribute to ED. Even if no underlying cause is determined, a health care provider can provide you with ED treatment options to help improve your sexual performance.

Moderate to vigorous exercise can help increase blood flow and lower cholesterol. Blocked blood vessels and poor cardiovascular health are some of the most common causes of ED. Because of this, physical activity is one of the most effective and commonly prescribed erectile dysfunction treatments offered by doctors. Adopting a regular exercise routine can help fix ED, and improve mental health at the same time.

Similarly, a diet high in cholesterol, fat and processed foods can restrict your body’s ability to get the blood pumping to the penis when it’s time for you to perform. Implement more fruits, vegetables, lean proteins (like skinless chicken breast or fish) and whole grains to improve your overall wellness and sexual function. Want to know what to put in your grocery cart? The Mediterranean diet has been shown to improve and prevent ED symptoms.

It’s not an urban myth: drinking alcohol can seriously impair your sexual performance. Alcohol depresses the nervous system, which can keep your brain from telling your penis to fill with blood when it’s sexually stimulated. Studies have also found that regular alcohol consumption can lead to low testosterone levels. Low testosterone is a common cause of ED.

If you smoke, quit. Smoking causes blood vessels to narrow, limiting blood flow to different parts of your body. This can seriously affect your ability to get and maintain an erection. Additionally, chemical addiction can lead to psychological side effects, further complicating your ability to respond to sexual stimulation. Quitting smoking is a major lifestyle change that can positively impact your sexual health, your vascular/ cardiovascular health and your mental health.

Erectile dysfunction can be caused by stress, anxiety or depression. These mental health risk factors affect sexual stimulation and can make sexual performance/arousal difficult. Speaking to a licensed counselor or therapist can help you with stress management, relationship issues, depression and anxiety. If sexual performance is putting a strain on your relationship, couples counseling can help you and your partner find solutions to help improve and manage your sex drive.

Prescription medication is usually not the first line of treatment for erectile dysfunction, but recurring episodes may make you eligible for drugs used to treat ED.

Your doctor may prescribe oral medication (known as PDE5 inhibitors) to treat persistent ED. Oral erectile dysfunction medication relaxes muscles in the penis by increasing the effects of nitric oxide in the body. Nitric oxide widens blood vessels, resulting in improved blood flow throughout the body. This can help you get an erection in response to sexual stimulation. These drugs do not cause erections but allow the blood flow needed for function during sexual intercourse. Examples of drugs used to treat ED include:

• Viagra (Sildenafil)
  

• Cialis (Tadalafil)
  

• Levitra (Vardenafil)
  

• Stendra (Avanafil)
  
  

These oral medications have been known to cause mild, short-term side effects such as headaches, congestion, muscle aches and indigestion. Because of this, it is recommended that you talk to your doctor before taking any PDE5 inhibitors to be sure that oral medication is the right treatment plan for you.

Curious about an ED prescription? Doctors on Sesame are authorized to write prescriptions for the drugs listed above if deemed clinically appropriate. Depending on the medication, they can order the drug to be delivered to your house, or made available for same-day pickup at a pharmacy near you.

If you’re dealing with some form of erectile dysfunction, you are not alone, but it’s important to remember that ED treatment will vary from man to man. The condition, however, rarely goes away without some lifestyle changes or medical treatment. Reaching out to a health care provider is the first step towards improving your sex life. ED can be tough to talk about, but not getting treatment for it can be worse.