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Erectile dysfunction (ED) is a common form of male sexual dysfunction tin which men are unable to get or maintain an erection firm enough for sex. A recent study by the National Institute of Health (NIH) concluded that about 30% of men are affected by erectile dysfunction.

In many cases, erectile dysfunction is a natural product of aging or stress. It is normal to experience difficulty maintaining an erection every now and then. However, ED can also signify underlying health problems that need to be addressed. If you experience persistent ED, it is recommended you consult a doctor.

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 urologist or endocrinologist, 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.

Endocrinologists specialize in the diagnosis and treatment of conditions related to hormones and the glands that create them. You may be referred to an endocrinologist for ED if your primary care provider thinks that your sexual health is being caused by low testosterone or other hormonal issues.

Erectile dysfunction is a common occurrence in men, especially in men over the age of 50. Sexual arousal (getting an erection) is a complex process that involves your brain, hormones, blood flow, nerves, and more. Because of this, it is perfectly normal to have difficulty maintaining an erection now and then. It happens, and it often isn't a cause for concern.

That being said, if you are experiencing persistent ED, or if ED is consistently disrupting your sex life, there may be serious underlying causes behind this change in sexual function.

Some common causes of ED include:

• Heart disease/ cardiovascular disease
  
• High blood pressure
  
• High cholesterol
  
• Diabetes
  
• Atherosclerosis (blood vessels clogged by fatty plaque in the arteries
  
• Obesity
  
• Change in testosterone levels
  
• Prostate cancer treatment
  
• Substance abuse
  
• Prescription medication (such as antidepressants, antihistamines, blood pressure medication, or prostate cancer medication)
  
• Injury/ infection
  

In addition, erectile dysfunction can be a side effect of psychological causes, such as:

• Stress
  
• Depression
  
• Fatigue
  
• Anxiety
  
  

If ED becomes a recurring issue, it is recommended that you consult with a doctor. In many cases, ED can be fixed by working with your doctor on mental health issues, lifestyle changes, and stress reduction. However, in some cases, further treatment may be needed.

There are several treatment options doctors may recommend to reverse or treat erectile dysfunction and prevent it from occurring persistently. Some methods to help ED on your own may include:

Exercise: Moderate to vigorous physical activity done several times a week can increase blood flow by lowering blood pressure. This can help blood move through blood vessels in the body easily during sexual stimulation. Obesity, high blood pressure, and poor vascular health are all underlying causes of erectile dysfunction. Adopting a regular exercise routine can help reverse these effects.

Counseling/ Therapy: 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. Sesame offers Video Mental Health Visits with licensed therapists in .

Routine Physical Exams: Some cases of ED can be caused by underlying medical conditions. Routine physical examinations are recommended for all adults, as they can help catch serious health problems and conditions early. ED might signify problems such as high blood pressure, diabetes, low testosterone, and more. If you are experiencing persistent ED, talk to your physician about any symptoms or concerns you may have. A primary care physician can screen for diseases, and discuss treatment options with you.

Quitting Smoking: 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.

If lifestyle changes and mental health counseling doesn't improve your ability to get and keep an erection, you may want to speak to your primary care physician about your persistent erectile dysfunction. A primary care physician can discuss ED treatment options for you, including:

Prescription medication: Your doctor may prescribe oral medication (known as PDE5 inhibitors) to treat persistent ED. The Food and Drug Administration (FDA) requires a prescription to obtain these drugs, but they have been proven effective by clinical trials. 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. These prescription drugs include:

• Viagra (Sildenafil)
  
• Cialis (Tadalafil)
  
• Stendra (Avanafil)
  
• Levitra (Vardenafil)
  
  

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.

Alprostadil injection/ urethral suppository: Alprostadil is a drug used to treat ED that opens blood vessels and increases blood flow, improving erectile function. Alprostadil is most commonly administered in 1 of 2 ways: through injecting a tiny needle into the base or side of the penis, or through an intraurethral suppository (placing a small suppository of the drug in the penis through the urethra). Alprostadil will usually begin to work in about 5-20 minutes. Alprostadil therapy is generally considered effective and safe. Side effects are minor but may include some discomfort, mild bleeding, and a prolonged erection after ejaculation.

Penis pump (vacuum device): A vacuum erection device is a hollow tube with a pump attached that is operated either by hand or with a battery. The pump pulls air out of the tube, creating a vacuum around the penis. This pulls blood into the penis, causing an erection. After the penis is erect, you slip a tension ring around the base of the penis to keep blood in that area. This should help you keep an erection long enough for sex.

Testosterone therapy: If erectile dysfunction is being caused by low testosterone levels, your doctor may prescribe testosterone replacement therapy (TRT) to help improve libido and erectile function. TRT can be done through patches, gels, and injections. Side effects of TRT are minor, but you should speak with your doctor before starting TRT, to discuss any health risks.

Urologists or primary care providers diagnosing erectile dysfunction will use a number of tests and exams to determine the cause of ED and develop a treatment plan that meets your needs. During an ED consult, doctors will:

Ask questions: You will be asked about your medical history and lifestyle choices. Poor diet, tobacco smoking, and substance abuse may cause erectile dysfunction. Underlying health conditions such as heart disease, diabetes, and prostate cancer can also affect your ability to keep or maintain erections. It's important that you are upfront and honest about your lifestyle, medications you take, and health conditions you have to help doctors create the best treatment plan for you.

Perform a physical exam: Doctors will perform a physical examination of the penis and testicles to check for abnormalities or nerve damage. You may have your blood pressure taken and your pulse checked to test blood flow.

Take a blood test/ urine sample: If your doctor suspects that you are experiencing ED as a side effect of undiagnosed heart disease, diabetes, or kidney disease, you may be asked to have your blood drawn.

Urine Tests: Additionally, urine tests may be conducted to check for kidney function or urinary tract infections.