Once upon a time, problems in the bedroom stayed in the bedroom. Today, sexual difficulties have come out in the open thanks to drug commercials, advances in treatments, and expert endorsements. Impotence, now commonly called erectile dysfunction or ED, is no longer a hushed-up diagnosis, and for good reason. It’s treatable at any age, and many men who seek treatment are returning to normal sexual activity.
Doctors define ED as the consistent inability to obtain or maintain an erection sufficient for sexual intercourse. It’s more common than many people realize, affecting somewhere between 15 and 30 million American men. It’s more prevalent with age. According to the National Kidney and Urologic Diseases Information Clearinghouse, about 5 percent of 40-year-old men experience ED, but for 65-year-old men that number jumps to 15 to 25 percent.
And even more of men have an occasional problem achieving an erection. “If men are honest, every one of them will tell you they’ve experienced impotence at least one time in their lives,” says Neil Baum, M.D. “Not every intimate encounter is a ‘10.’ It can be devastating when ED occurs,” he says. “A man’s whole concept of his masculinity may be undermined.”
Until the early 1970s, experts thought underlying problems in the psyche caused most erection problems. Today, the medical community recognizes that medications, lifestyle choices, or injuries are some of the most common erectile dysfunction causes. Here’s what our experts advise for responding to erectile dysfunction.
Give yourself time.
“As a man gets older, it may take a longer period of genital stimulation to get an erection,” says Dr. Baum. “For men ages 18 to 20, an erection may take a few seconds. In your thirties and forties, maybe a minute or two. But if a 60-year-old doesn’t get an erection after a minute or two, that doesn’t mean he’s impotent. It just takes longer.” The time period between ejaculation and your next erection tends to increase with age. In some men ages 60 to 70, it may take a whole day or longer to regain an erection. “It’s a normal consequence of aging,” says Dr. Baum.
Consider your medication.
Prescription drugs might be at the root of the problem. Or it might be that over-the-counter antihistamine, diuretic, heart medication, medication for high blood pressure, or sedative you’re using. Realize, of course, that not every individual reacts to medications the same way. Drug-induced ED is most common in men older than 50, says Dr. Baum, with almost 100 drugs identified as potential causes of erectile dysfunction. If you suspect your medication, consult your doctor or pharmacist and ask about changing the dosage or switching to a different drug. Do not, however, attempt to do this on your own.
Go easy on the alcohol.
Shakespeare was right when he said in Macbeth that alcohol provokes desire but takes away the performance. This happens because alcohol is a nervous system depressant. It inhibits your reflexes, creating a state that’s the opposite of arousal. Even two drinks during cocktail hour can be a cause for concern. Over time, too much alcohol can cause hormonal imbalances. “Chronic alcohol abuse can cause nerve and liver damage,” says Dr. Baum. Liver damage results in an excessive amount of female hormones in men. Without the right proportion of testosterone to other hormones, you won’t achieve normal erections.
Know what’s good for your arteries.
The penis is a vascular organ, says Irwin Goldstein, M.D. The same things that clog your arteries also affect bloodflow to the penis. In fact, he says, all men over age 38 have some narrowing of the arteries to the penis. So watch what you eat. “High cholesterol is probably one of the leading causes of ED in this country,” says Dr. Goldstein. “It appears to affect erectile tissue.”
Studies show that nicotine can be a blood vessel constrictor, says Dr. Baum. In a study at the University of Texas, researchers had a group of nonsmoking men chew gum with nicotine or a placebo gum. Those who chewed the nicotine gum had a 23 percent reduction in sexual arousal compared with the group who chewed the placebo gum.
Studies show that men who are overweight are more likely to have difficulties maintaining an erection. If you are at least 20 percent heavier than your ideal weight, think about taking off a few pounds. Consider karate or a weight training program. Not only will a fitter body lessen the likelihood of ED, but it will also boost self-confidence. The better a man feels about his body, the better he’ll feel for “the event,” says Dr. Goldstein.
Have more sex.
A five-year study of almost 1,000 Finnish men between the ages of 55 and 75 found that those who reported having intercourse less than once a week had twice the incidence of ED than those men who had intercourse once a week. The researchers conclude that regular intercourse appears to protect men against ED.
A relaxed frame of mind is crucial to maintaining an erection. Here’s why. Your nervous system operates in two modes: the sympathetic nervous system and the parasympathetic nervous system. When the sympathetic nerve network is dominant, your body is literally “on alert.” Adrenal hormones prepare you to fight or take flight. Nervousness and anxiety undermine attaining an erection by pulling blood away from your digestive system and penis to your muscles.
Being anxious will turn on your sympathetic nervous system, says Dr. Baum. For some men, the fear of failure is so overwhelming that it floods the body with norepinephrine, an adrenal hormone. This is the opposite of what it takes to have an erection. The key is to relax and let your parasympathetic nervous system take over. Signals that travel along this network will direct the arteries and sinuses of the penis to expand and let more blood flow in.
Avoid whole-body stimulants.
This means caffeine and certain questionable substances touted as potency enhancers. It’s important to be relaxed during sex, says Dr. Goldstein, and stimulants tend to constrict the smooth muscle that must relax before an erection occurs.
Refocus your attention.
One way to relax is to focus with your partner on the more sensual aspects of intimacy. Experience foreplay and enjoy each other without worrying about having an erection. “The skin is the largest sexual organ in the body,” says Dr. Goldstein, “not the penis.”
Eat more watermelon.
Those heart-shaped boxes of chocolate have some competition. The red, juicy flesh of the watermelon may be the newest romantic food. Researchers at Texas A&M Fruit and Vegetable Improvement Center in College Station, Texas, found that phytonutrients in watermelon have a Viagra-like effect. In particular, this juicy fruit contains citrulline, a compound that causes the body to relax the blood vessels.
Unlike Viagra, watermelon doesn’t target one particular organ. Citrulline encourages blood vessels throughout your body to relax, which benefits your heart, circulatory system, and immune system. The watermelon rind contains more citrulline than the flesh. Because people don’t eat the rind, researchers are working to develop a new breed with higher citrulline concentrations in the flesh. In the meantime, enjoy a generous slab to enhance all of your bodily systems.
When to Call s Doctor About Erectile Dysfunction
Men of every age can be treated for impotence, or erectile dysfunction. When lifestyle changes fail to help, a urologist can assess your problem and offer an array of therapies that may resolve the problem. Here are the main avenues of treatment identified by the National Kidney and Urologic Diseases Information Clearinghouse:
- Drug therapy, including testosterone replacement and drugs that allow more bloodflow into the penis, such as Viagra, Levitra, and Cialis
- Vacuum devices that draw blood into the penis and hold it there to achieve an erection
- Surgically implanted devices that can be mechanically expanded when an erection is desired
- Counseling to deal with the emotional effects of erectile dysfunction
Panel Of Advisors
Neil Baum, M.D., is a clinical associate professor of urology at Tulane University School of Medicine and a staff urologist with Touro Infirmary, both in New Orleans.
Irwin Goldstein, M.D., is director of sexual medicine at Alvarado Hospital and clinical professor of surgery at the University of California at San Diego.