black middle aged couple in bed

Viagra is not the only way men can firm up fading erections

Mention erectile dysfunction (ED) treatment and most people say Viagra. And no wonder. Since its 1998 approval, Viagra has become one of the world’s best-known brands, up there with Coca-Cola and McDonald’s.

Unfortunately, few people can name the many possible contributors to erection impairment. University of Zurich urologists asked 81 ED sufferers to list its risk factors. Half the men (51 percent) could not name a single one, and only three (2 percent) could name three.

Can you name any?

Here’s the list:

Aging. From age 40 to 50 and certainly by 60, the large majority of men notice a loss of firmness, and fantasy alone is no longer sufficient to raise an erection. Direct fondling becomes necessary. This is not ED. It’s middle-age erection dissatisfaction. But after 50, true ED, the inability to raise an erection even with sustained masturbation, becomes more prevalent, in part because of aging, and in part because of age-related medical conditions and the medications used to treat many of them.

Medical issues. Many chronic conditions impair the circulatory system, reducing the amount of blood available to the penis for erection: heart disease, stroke, diabetes, obesity, high cholesterol, and high blood pressure. Other conditions interfere with the nerves that control erection, among them: depression and paraplegia.

Smoking. Smoking accelerates the narrowing of the arteries, including those that carry blood into the penis. Narrowed arteries mean less blood available for erection.

Prostate cancer treatment. Both surgery and radiation involve substantial risk of ED.

Alcohol. As Shakespeare wrote in Macbeth, alcohol “provokes the desire, but takes away the performance.” Alcohol is a central nervous system depressant. Beyond a couple drinks in an hour or so, erection becomes difficult or impossible.

Other drugs. High on the list are antidepressants and blood pressure medications. But many other drugs may also contribute to ED.

Prolonged bicycling on a narrow seat. Sitting on a narrow (banana) seat more than three hours a week can impair the nerves involved in erection.

Emotional stress. Erection-deflating stressors include relationship problems and difficulties with family, children, friends, work, and money.

Obstructive sleep apnea. Apnea is caused by excess tissue in the throat, often the result of obesity. The hallmark symptom is loud snoring punctuated by choking silences when the throat becomes blocked, momentarily interrupting breathing. This sets off biological alarms that rouse the person, restoring breathing. But frequent rousings destroy sleep and substantially increase the risk of ED.

Many studies show that minimizing or eliminating these risk factors. improves erection function. Some examples:

• Italian researchers reviewed the medical literature on diet and ED. A Mediterranean diet, high in fruit and vegetable and low in meat, cheese, fast food, and junk food, has been shown to reduce weight, blood pressure, cholesterol, and diabetes. It also reduces the risk of ED and helps reverse it.

• Another group of Italians surveyed 555 diabetic men about their diet and erections. Those who adhered most closely to a Mediterranean diet had the least ED. (A similar study of diabetic women showed that as the commitment to a Mediterranean diet increased, sex problems decreased.)

• A third group of Italian researchers worked with 209 men who had ED or were at high risk because they were overweight, sedentary, and had diabetes, high cholesterol, or high blood pressure. Half were given information about healthy lifestyle (controls). The other half received intensive counseling about the health and sexual benefits of weight loss, healthy diet, and exercise. At the start of the study one-third of the men in both groups reported satisfying erection function. Two years later, erection function was largely unchanged in the control group, but in the intensively counseled group, those reporting satisfying erections increased to 58 percent.

• If your bedmate says you snore with intermittent silences, ask your doctor to refer you for a sleep study. If you sleep alone and feel drowsy during the day, a sleep study might also be indicated.  Sleep apnea can be effectively treated with a device that gently pushes air down the throat, a continuous positive airway pressure machine (C-PAP). Swedish researchers prescribed C-PAPs for 401 men with apnea and ED. Their sexual function improved significantly. A Chinese study of 207 men with apnea and ED showed similar results.

No matter what your age, for better erection function:

  • Don’t smoke.
  • If you drink, limit alcohol to one or two drinks a day.
  • Ask your doctor and pharmacist if the medication you take might increase the risk of ED. If so, ask if a less impairing drug might be substituted.
  • Get daily exercise, the equivalent of walking for 30 to 60 minutes.
  • If you ride a bike, use a wide seat.
  • Incorporate a stress management regimen into your life.
  • Eat a low-fat, low-calorie diet containing at least five servings of fruits and vegetables a day. Minimize meats, cheese, whole-milk dairy products, fast foods, and junk foods.
  • Get evaluated for sleep apnea, and if you have it, use a C-PAP machine at night.

You’ll be healthier—and so will your erections.

You might also like to read – Kegel Exercises: More Pleasurable Orgasms


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Budweiser, S. et al. “Long-Term Changes of Sexual Function in Men with Obstructive Sleep Apnea After Initiation of Continuous Positive Airway Pressure,” Journal of Sexual Medicine (2013) 10:524.

Claes, H and L Baert. “Pelvic Floor Exercise Vs. Surgery in the Treatment of Impotence,” British Journal of Urology (1993) 71:52.

Dorey, G. “Restoring Pelvic Floor Function in Men: Review of Randomized Controlled Trials,” British Journal of Nursing (2005) 14:1014.

Dorey, G et al. “Pelvic Floor Exercises for Erectile Dysfunction,” BJU [formerly British Journal of Urology] International (2005) 96:595.

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Giugliano, F. et al. “Adherence to a Mediterranean Diet and Sexual Function in Women with Type-2 Diabetes,” Journal of Sexual Medicine (2010) 7:1883.

Giugliano, F. et al. “Adherence to a Mediterranean Diet and Erectile Dysfunction in Men with Type-2 Diabetes,” Journal of Sexual Medicine (2010) 7:1911.

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Petersen, M. et al. “Sexual Function in Male Patients with Obstructive Sleep Apnea After 1 Year of CPAP Treatment,” Clinical Respiratory Journal (2013) 7:214.

Sighinolfi, MC et al. “Potential Effectiveness of Pelvic Floor Rehabilitation Treatment for Post-Radical Prostatectomy Incontinence, Climacturia, and Erectile Dysfunction: A Case Series,” Journal

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