Erectile dysfunction (ED) is common – as many as one in three men have to deal with it at some point in their lives – and has different causes and treatment options. There are many ways to prevent or minimize its impact on your life.
The first step is often an open conversation with a doctor who can address common misconceptions and offer support and insight into a sexual health issue that can be uncomfortable to talk about for many.
Rory Ratzlaff, M.D., is a family medicine provider who specializes in men’s health services at Sanford West Fargo Clinic in North Dakota. He advises those dealing with ED to get past the stigma and seek out medical help.
Why? Because help is out there. ED is a problem that is often avoidable or solvable.
“You should be comfortable talking about ED with your provider,” Dr. Ratzlaff said. “It’s not just a problem you have because you’re getting older. There are often other factors that we can effectively address.”
What is erectile dysfunction (ED)?
“Erectile dysfunction is basically the inability to achieve or maintain an erection that allows a man to climax,” Dr. Ratzlaff said. “It is quite common and the likelihood does increase as you get older.”
It is not necessarily a normal part of aging, however.
“It can be a symptom of an underlying health condition that needs to be addressed,” Dr. Ratzlaff said.
What causes ED?
ED can be caused by physical or psychological issues.
Common physical causes:
- Heart disease
- Peripheral vascular disease
- Diabetes
- High blood pressure
- Obesity
- Sleep apnea
- Low testosterone
Common psychological causes:
- Stress
- Anxiety
- Depression
“I’ve had a lot of young individuals come in stating that they have erectile concerns,” Dr. Ratzlaff said. “Most of the time with the younger population the cause is psychological. It can be stress-induced or the ED may be provoked by anxiety experiences.”
What are the treatment options?
Management strategies for treatment are often dependent on the underlying cause.
As an example, if heart disease or high blood pressure are factors in your ED, then making lifestyle changes that address those health issues can also play a role in addressing the ED.
“Improving your diet, exercising, stopping smoking and reducing alcohol intake can all be important factors,” Dr. Ratzlaff said. “If there is an underlying issue causing it, obviously that’s the first thing we’re going to look at. If it’s diabetes or high cholesterol, for instance, we’re going to start by trying to get those things under control.”
Common treatments should begin with a conversation with your provider. Often those conversations about ED will include:
- Lifestyle changes. These include cutting back on alcohol, quitting smoking, losing weight, and increasing physical activity.
- Reviewing medicines. You may need to cut back on or change those medicines that may be linked to ED.
- Psychotherapy. This may be used to help decrease the stress and anxiety that may be linked to sex.
- Prescription medicines taken by mouth. These are often used to treat ED. There are many different medicines available.
- Testosterone therapy. This may improve energy and mood and increase sexual interest in older men who have low testosterone.
- Other options. Vacuum devices, injections, implants or surgery could help if other options are ineffective.
Can you prevent ED?
Dr. Ratzlaff will often work with patients who are approaching an age when their health concerns are shifting. ED can become a concern prior to it becoming a real issue because patients associate it with aging. Like many other issues that can come with age, they want to avoid them or postpone them if possible.
He answers the prevention question with advice that applies to overall health but can also apply to avoiding ED.
“It will often boil down to regular exercise, making sure you have a good diet, managing your weight, avoiding tobacco usage and managing your stress,” Dr. Ratzlaff said. “They all roll into each other. If you exercise regularly and you’re eating properly, that is going to help your blood pressure and potentially also help manage your stress.”
What can a patient expect on their first visit?
Dr. Ratzlaff encourages candor from his patients.
“Keep your mind open and be comfortable in your own skin,” he said. “I see a lot of patients who are very hesitant and embarrassed about having these kinds of discussions, but they should not be. I can tell you that regardless of what the issue is, it’s very likely your provider has treated this problem before.”
Be prepared to answer questions about lifestyle that involve eating habits, exercise, drinking and smoking, but also be prepared to answer detailed questions about sexual activity. That may take some getting used to for the patient.
“I’ll preface our conversations by telling the patient that some of these conversations are going to get very personal,” Dr. Ratzlaff said. “If you can be open and honest in your responses, it helps your provider understand where you’re coming from. I would say just be ready for a few questions that might seem a little weird.”
Do you recommend any mass-marketed ED ‘cures’?
Television and other media that target male viewers is often inundated with advertising about products claiming to be able to solve ED problems. Dr. Ratzlaff is wary of recommending products bought online without consulting with a regular provider.
When lifestyle modification isn’t enough, medications like sildenafil (Viagra) or tadalafil (Cialis) are commonly prescribed. These drugs improve blood flow to the penis, helping to facilitate an erection. However, medication is most effective when combined with addressing any underlying health concerns.
Patients will often come in and tell Dr. Ratzlaff they’ve heard from a friend or from an advertisement that a particular product works.
And when it is not effective, the patient then turns to their regular provider for help.
“It’s not that we don’t want to fix the issue. We just want to know for sure what patients are getting rather than just trying something they found online,” Dr. Ratzlaff said. “I would say about one of four guys who come in to see me have tried something they bought online or tried a buddy’s prescription pill.”
Seeking help
Conversations about your concerns about ED should start with your primary care provider. Your provider can point you toward Sanford Health’s urology services, which includes ED diagnosis and treatment. Experts offer discreet care and can answer questions about your condition and treatment options.
Learn more
- Men’s health: Gearing up for a healthier tomorrow
- Should you get a PSA screening?
- Reasons you may not be enjoying sex
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Posted In Family Medicine, Fargo, Healthy Living, Internal Medicine, Specialty Care
