The pills currently available by prescription all work the same way—by boosting the effects of NO in the penis. They typically have mild side effects. Some work faster but others last longer. There is no “best” drug, as some will work better for some men than others, but they all are about equally effective at increasing the hardness of an erection. Pills don’t work for everyone. The main risk is using them with nitroglycerine which can be fatal and must absolutely be avoided.


So here’s something that’s really fascinating. Healthy eating is a way to reduce anxiety and stress. Now how, you may be asking, right? Well, think about it. We live in a world where there are so many variables and where we don’t have control over our lives. But now, with healthy eating, we have control over what goes into our body. And now having that control empowers us to be even healthier, to be more directive in what we do. And certainly, that begins then to reduce the anxiety and the stress. So all in one, you have a healthier body, but certainly a healthier mind.
The article, "Inactivation of phosphorylated endothelial nitric oxide synthase (Ser-1177) by O-GlcNAc in diabetes-associated erectile dysfunction," appears in the Aug. 16 issue of the Proceedings of the National Academy of Sciences and was published online Aug. 5.  Melissa F. Kramer and Robyn E. Becker, also of the Brady Urological Institute, collaborated on this study.
A 19-year-old male presents with a history of anxiety, depression, and asthma and chief complaint of ED that began 1-year ago after a “nerve twinge with subtle pain” during masturbation. He also reports decreased penile sensation since the event. He can obtain and maintain an erection with masturbation. He reports inability to obtain or maintain an erection with a partner unless he takes tadalafil 5 mg. He reports straight phallus, normal libido, orgasm, and ejaculation. The remainder of his history is negative. His physical examination is normal. His previous laboratory assessment, including CBC, CMP, TSH, T4, T and Free T, was normal.

A medical history focused on risk factors, such as cigarette smoking, hypertension, alcoholism, drug abuse, trauma, and endocrine problems including hypothyroidism, low testosterone levels, and hyperprolactinemia, is very important. Commonly used drugs that disrupt male sexual function are spironolactone (Aldactone), sympathetic blockers such as clonidine (Catapres), guanethidine (Islemin), methyldopa (Aldomet), thiazide diuretics, most antidepressants, ketoconazole (Nizoral), cimetidine (Tagamet), alcohol, methadone, heroin, and cocaine. Finally, assessment of psychiatric history will help identify emotional issues such as interpersonal conflict, performance anxiety, depression, or anxiety.


“Sex often feels different for your partner when you experience ED,” warns Dr. Schwarts. “Men may not notice gradual changes to the girth or angle of his erection. But his partner does.” If you or your partner notice a persistent change in your erections that affects your sexual intimacy, you may have erectile dysfunction—even if you’re still able to get an erection.
The condition is often an early warning sign of heart disease and other circulatory problems. To achieve and maintain an erection, extra blood must be able to flow unimpeded. Anything that interferes with healthy flow – for example atherosclerosis, the artery-clogging process at the root of most heart attacks, strokes, and other cardiovascular conditions – has the potential to cause erectile dysfunction, too.
What’s good for the soul (cycle) may not be good for your member. The research is somewhat controversial, but the link between cycling and ED is getting stronger. In fact, anything that places pressure on the pudendal artery can result in penile numbness and impotence. For those of you who don’t remember these from anatomy class, this is the area commonly referred to as the “undercarriage.”
With coronary artery disease, a buildup of plaque inside the arteries can limit the amount of blood that’s able to flow through them. If the flow of oxygen-rich blood to your heart muscle is reduced or blocked by this hardening of the arteries, the result can be angina (chest pain) or a heart attack.17 Because the arteries that supply blood to the penis are much smaller than the ones that feed the heart, the problem may show up earlier as having difficulty getting an erection.18

Erectile dysfunction is more common than most people think. About 40% of men will notice some degree of problem by age 40. The aging of the penis can begin as early as the late 20s but becomes severe enough to notice typically starting in the 40s. As men get older, their odds of getting erectile dysfunction increases by about 10% per decade, and the severity of the problem also increases.
Monitoring erections that occur during sleep (nocturnal penile tumescence) can help you and your doctor to understand if the erectile dysfunction is due to psychological or physical causes. The nocturnal penile tumescence test is a study to evaluate erections at night. Normally men have three to five erections per eight hours of sleep. The test can be performed at home or in a sleep lab. The most accurate way to perform the test involves a special device that is connected to two rings. The rings are placed around the penis, one at the tip of the penis and the other at the bottom (base) of the penis. The device records how many erections occur, how long they last, and how rigid they are. The test is limited in that it does not assess the ability to penetrate.

The relationship between ED and couple relation impairment is well documented. In our population of subjects consulting for sexual dysfunction, subjects reporting conflicts within the couple were characterized by a broad spectrum of sexual symptoms, including a severe extent of ED, and they had a higher SIEDY Scale 2 score, indicating a strong relational component in the pathogenesis of ED (88). If on one hand, it is easy to understand that problems in couple relationship can cause ED, the other way around is also feasible. In the Female Experience of Men’s Attitudes to Life Events and Sexuality (FEMALES) study, 292 female partners of men aged more than 20 years complaining for ED were involved in a survey assessing the quality of their sexual experience (89). In this study, women reported a significant deterioration of satisfaction for sexual intercourse after the onset of ED in their partners. The satisfaction, sexual desire, arousal and orgasm were then improved in women whose partner used PDE5i (89). The role of ED as a risk factor for female dysfunction, including impairment in arousal, orgasm, sexual satisfaction and sexual pain, has been also confirmed in a study involving 632 sexually active couples, whose male partner age ranged 18–80 years (90).
Inflatable prostheses are complex mechanical devices that imitate the natural process of erection. Parts are inserted surgically into the penis and scrotum, and activated by squeezing. When erection is no longer desired, a valve on the pump is pressed, and the penis becomes flaccid. Self-contained single-unit prostheses are similar to the inflatable types, but more compact. The entire device is implanted into the penis. When erection is desired, the unit is activated by either squeezing or bending, depending on which of the two types of self-contained prostheses is used.

Psychological Causes of ED – Between 10% and 20% of ED cases have a psychological cause. Because arousal starts in the brain, psychological issues can be a significant contributing factor to erectile dysfunction. Mental health conditions like depression or anxiety can negatively impact your libido, making it more difficult for you to become aroused.


Diabetes can cause nerve, blood vessel, and muscle damage that results in problems like pain, numbing or loss of sensation in the hands and feet.12 These issues can also result in ED problems, because nerve signals and blood flow are necessary to the process of getting an erection.6 And as men with diabetes get older, ED problems become even more common.13


Another common reason for failures of oral therapy is the absence of sexual or genital stimulation prior to attempting sexual intercourse. These medicines facilitate an erection by increasing blood flow to the penis, but they do not act as an aphrodisiac or as an initiator of the erection. A man who is not “in the mood” or does not have adequate physical stimulation will not respond with an erection.
This category of treatments includes external vacuum therapies: devices that go around the penis and produce erections by increasing the flow of blood in, while constricting the flow out. Such devices imitate a natural erection, and do not interfere with orgasm. External vacuum therapy mechanisms are approximately 95 percent successful in causing and sustaining an erection. All are portable, and costs range between $200-$500, covered under most insurance plans and Medicare Part B.
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