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Erectile dysfunction (ED) is the inability to develop and maintain a penile erection for satisfactory sexual intercourse or activity. It is the most commonly reported sex problem in people with a penis, affecting at least 18 million people in the United States. It is also called erectile disorder.
The symptoms of ED may be exacerbated by age due to natural declines in testosterone. Testosterone is a hormone that influences the sex drive, among other functions. Testosterone replacement does not improve ED but can help with libido and arousal, making it easier to get an erection.
The ability to develop and maintain an erection is largely governed by sexual arousal, a complex process that involves the brain, hormones, emotions, nerves, muscles, and blood vessels.
Although older age is the variable most strongly associated with ED, physical or psychological factors can impact sexual function, desire, or arousal, all of which can cause ED.
This article will discuss ways to prevent ED, including diet, exercise, losing excess weight, managing high blood pressure and cholesterol, smoking cessation, alcohol moderation, stress reduction, and more.
Eat a Healthy Diet
Eating a diet rich in natural foods like fruits, vegetables, whole grains, and fish—with lesser amounts of red and processed meats and refined grains—has been shown to decrease the likelihood of ED.
A study of over 21,000 found that men with the greatest adherence to a Mediterranean diet or Alternative Healthy Eating Index 2010 (AHEI-2010) diet were least likely to develop erectile dysfunction.
These diets emphasize the consumption of vegetables, fruits, nuts, legumes, and fish or other sources of long-chain fatty acids (types of omega-3 fatty acids), and avoidance of red and processed meats.
Men under 60 who most closely adhered to the Mediterranean diet were 40% more likely to regain normal sexual function. Of note, eating a heart-healthy diet also lowers your cardiovascular risk factors, such as blood pressure, blood sugar, and cholesterol levels. These factors greatly contribute to the development of ED.
Keeping up with a regular exercise routine is especially helpful for those whose ED is caused by inactivity, poor circulation, obesity, low testosterone, or cardiovascular disease.
Exercise lowers blood pressure and blood sugar, increases blood circulation throughout the body, and improves heart health. It is also a natural way to raise testosterone levels. Burning fat also decreases the risk of vascular (blood vessel) disease and diabetes—two major causes of ED.
Curing your ED doesn’t necessarily mean that you have to make drastic changes. Even small increases in activity can make a difference.
One study found that patients recovering from a heart attack who were put on a progressive walking program starting at just six minutes a day reported 71% fewer incidences of ED over 30 days than those who didn’t walk.
Other research has suggested that moderate exercise can help restore sexual performance in obese middle-aged people with ED.
People with ED found at an early age (before age 50) may have undiagnosed cardiac problems. A person in this age group may be sent for a heart evaluation before treatment is started for the erection problems. Early-onset ED could be a warning sign for deeper issues in the heart.
Lose Weight If Needed
Losing weight is a health goal for many reasons. Can one of those reasons be to help cure erectile dysfunction? The short answer is yes.
Weight loss has a twofold advantage of directly alleviating ED and improving your physical health. Dropping a few pounds lowers blood pressure and prevents further narrowing and blockages in your arteries, allowing blood to travel more efficiently.
Studies have shown that excess belly fat can cause an inability to get or maintain an erection. The endothelium, a small sheath of tissue that forms the interior lining of all our blood vessels, can become damaged by excess belly fat.
As a result, your body may not release enough nitric oxide—a molecule that signals the surrounding muscles to relax in order for the blood vessels to dilate and create an erection. Even more, carrying excess weight can lower testosterone levels, which further compounds the problem.
Having excess weight can also lead to a visible loss in penile length. Losing weight may lead to a visibly larger length to the penis, with the extra fat and tissue no longer covering up the base of the penis. The extra visible length is an added bonus to better erection quality with weight loss.
Fortunately, reducing your beltline can reverse your ED. In one major study, over 30% of men minimized, if not completely cured, erectile dysfunction via weight loss by eating 300 fewer calories per day and exercising more over several weeks.
Weight loss typically comes from both reducing your calorie intake and increasing physical activity. Increasing physical activity seems especially helpful in lowering rates of ED.
Losing weight, particularly belly fat, is integral to alleviating ED. Here are some ways you can reduce your waist size:
- Eat regular nutritious meals. Avoid skipping meals. Substitute cooked meals for processed foods and takeout. Eat a balanced diet of fruits and vegetables.
- Emphasize portion control. Keeping portion sizes in check using the MyPlate method (in which you eat the different food groups in appropriate amounts) is a great way to curtail overeating and ensure that you eat a balanced meal.
- Replace sugary beverages like soda, energy drinks, and fruit juices with water, black coffee, or unsweetened tea.
- Limit alcohol. Alcohol use is often associated with poor eating habits. Also, the liver burns alcohol instead of fat, which results in bigger waistlines.
- Incorporate more fiber into your diet. Fiber makes you feel fuller for longer, which curtails mindless eating.
- Exercise daily. The United States Preventive Services Task Force (USPSTF) recommends 30 minutes of sweat-breaking exercise for a minimum of five days a week.
Manage Blood Pressure
High blood pressure damages blood vessels, reducing blood flow throughout the body, including the penis. Hardened and narrow blood vessels make it difficult for blood to flow into the penis before intercourse.
Erectile dysfunction may be an early warning sign of damaged blood vessels. When your blood flows naturally, you can have healthy erections. Natural arousal leads to increased blood flow to your penis, causing an erection.
This process becomes more difficult with high blood pressure. Slowing of blood flow in the pelvic region can make getting or maintaining an erection a challenge. This change in sexual function is sometimes a warning sign of a larger problem, prompting people to seek help.
People who have isolated high blood pressure but otherwise a clean bill of health are usually safe taking ED drugs. But if you have health complications like severe cardiovascular disease or urinary tract issues, ED drugs are generally not recommended.
It is also important to avoid high blood pressure, as medical treatments for blood pressure have the potential side effect of ED.
Avoid High Cholesterol
High cholesterol is a risk factor for many conditions that can lead to ED, such as heart disease. High cholesterol levels lead to atherosclerosis, a condition that hardens and narrows blood vessel walls.
Atherosclerosis reduces blood flow throughout the body, including the penis. Hardened and narrow blood vessels make it difficult for blood to flow into the penis before intercourse.
One of the earliest signs of heart disease is the inability of blood vessels in the penis to enlarge, allowing enough blood flow to get and maintain an erection. One study found that men over the age of 69 with ED had more than twice the number of heart attacks, cardiac arrests, and strokes than similarly aged men without ED.
Eating a heart-healthy diet, doing routine exercise, and taking a statin, or another prescribed cholesterol-lowering drug, can bring your cholesterol to healthy levels, decreasing your cardiovascular risk and potentially alleviating your ED symptoms along the way.
Smoking is an independent risk factor for ED. It causes vascular changes to the endothelium of blood vessels, which interferes with nitric oxide production and signaling.
Smoking also causes vascular changes that increase your risk of heart disease, hypertension (high blood pressure), and diabetes, which are also associated with the development of erectile dysfunction.
Many people smoke to reduce their sexual performance anxiety (fear or worry related to having sex), unaware that they are exacerbating the problem.
Quitting smoking has immense health benefits. So even though it may not completely reverse ED, it may contribute significantly to improving penile function and your overall health.
Experts believe that vaping is no better than cigarettes when it comes to the risk of erectile dysfunction. Try to avoid smoking altogether, whether cigarettes, cigars, or vaping.
Drink Alcohol in Moderation
Drinking large amounts of alcohol can make it difficult to get or keep an erection because alcohol interferes with the chemical messengers that tell the penis to fill with blood.
One study looking at nearly 50,000 men found that over half of those who reported that they were alcohol dependent had some type of sexual dysfunction, with one quarter citing ED as their main problem.
Chronic alcohol use also interferes with the production of testosterone, the hormone that governs male sexual functioning. Lower testosterone levels affect sperm production and sexual desire. Alcohol can also increase your total calorie intake; that can cause increased weight gain, which can also exacerbate ED.
Heavy alcohol use has also been associated with:
- Low sexual drive (libido)
- Reduction in size of sex organs (binge drinking over a long time can cause the testes and penis to shrink)
- Lower fertility
- Higher rate of sexually transmitted infections (chronic alcohol users are more likely to engage in sexual practices that carry a higher risk)
If alcohol use is the sole culprit of ED, the condition will usually resolve once alcohol use is stopped.
Testosterone levels drop with aging, so as you get older you may want to check your levels if you’re experiencing symptoms of ED.
Testosterone is central in the male sexual response, including the desire for sex and the mechanics of triggering an erection. Lower levels could mean problems getting and maintaining an erection, although people with perfectly normal amounts of testosterone can have erectile dysfunction.
Boosting testosterone alone doesn’t always improve erections, but it can in a subset of people, so it should be considered for those with low testosterone. Taking low doses of testosterone may also give you the added benefit of increased libido.
Still, improved testosterone levels don’t always mean levels that are high enough to make a difference in sexual performance. It is not unusual for a healthcare professional to add Viagra (sildenafil) or a similar medication if a person is still not satisfied with the quality of their erection when given testosterone therapy alone.
Avoid Anabolic Steroids
Every year, 1 million to 3 million people in the United States use anabolic steroids (AAS). These drugs have been used off-label (for other than indications approved by the Food and Drug Administration, or FDA) for decades. Various reasons include enhanced aesthetics, improved athletic performance, increased muscle mass, or other symptomatic benefits.
Anabolic steroids interfere with the body's capacity to produce testosterone, which may lead to erectile dysfunction.
Taking steroids, whether androgens taken as part of testosterone therapy for a medical condition or recreational anabolic steroid use in bodybuilding, can affect the hypothalamic-pituitary-adrenal (HPA) axis. This means that it upsets your balance and regulation of hormones and impacts pituitary gland function.
Fortunately, ED issues such as testicle shrinkage and low libido may begin to disappear once you stop steroid use.
Check Medication Side Effects
It's been estimated that 25% of all ED is caused by side effects from medication. Certain drugs taken for high blood pressure—notably thiazide diuretics (water pills) and beta blockers—have been linked with deterioration in sexual function.
Therefore, be on the lookout for medications in these drug classes, and never start a blood pressure medication without medical supervision.
Like alcohol, stress interferes with signals between the brain and body that get and maintain erections. The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement.
A number of stressors can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:
- Depression, anxiety, or other mental health conditions
- Job loss, job promotion, or work stress
- Financial burdens
- Death in the family
- Changes in health
- Relationship problems due to stress, poor communication, or other concerns
- Anxiety about sexual performance
Increased stress can also increase your risk of other conditions that may cause ED, such as heart disease, high blood pressure, high cholesterol levels, obesity, and excessive alcohol consumption. These all contribute to ED independently, so addressing the root cause of your stress is paramount in alleviating ED in many people.
Talk therapy is a useful tool to unpack your thoughts and feelings, and sometimes it’s all that you need to jumpstart your sex life. It’s also important to note that stress can be both a cause and a symptom of ED.
In other words, stress can affect your sexual arousal and therefore cause ED. But not being able to perform in bed may also make you anxious and nervous or lead to sexual avoidance, which can further exacerbate your ED.
Talking to your partner about ED can be understandably difficult, but communication is a part of any healthy relationship and sex life. Talking about your difficulties takes the pressure off you and informs your partner of what’s going on.
It can also serve as an opportunity to engage in more pro-healthy behaviors like quitting smoking, exercising more, and eating a heart-healthy diet.
Joining a support group and reimagining your sex life are also worthwhile coping mechanisms. Talking to strangers can be a stress reliever.
Hearing the thoughts and feelings of others can serve as a reminder that intimacy is not dependent on penile penetration. Naughty talk, foreplay, and intimate touching are also important components of a healthy sex life.
You can help prevent many of the causes of erectile dysfunction. Following a healthy eating plan, quitting smoking, never doing drugs, limiting alcohol, maintaining a healthy body weight, monitoring blood pressure and blood sugar, and aiming for at least 30 minutes of activity most days are tried-and-true methods that not only stave off ED, but keep your heart healthy and strong.
A Word From Verywell
If you are having trouble maintaining a healthy lifestyle or natural methods have not prevented ED, talk to a healthcare professional who has expert knowledge in the management of ED. Together, you may uncover other tactics to use. In addition, there are prescription medications and even surgical treatments that may help.
Frequently Asked Questions
- Who is most at risk of erectile dysfunction?
People over the age of 60 are at the highest risk of ED because of natural drops in testosterone levels. Approximately 40% of people with a penis have some experience of ED by age 40. By age 70, nearly 70% are impacted to some degree.
- What is the main cause of erectile dysfunction?
It's difficult to think of ED as a condition with one cause and one effect. A multitude of risk factors for ED should be considered.
The ability to develop and maintain an erection is largely governed by sexual arousal, a complex process that involves the brain, hormones, emotions, nerves, muscles, and blood vessels. Physical or psychological factors can impact sexual function, desire, or arousal, all of which can cause ED.
ED is commonly caused by decreases in testosterone with age, as well as impaired blood flow to the penis due to a multitude of conditions ranging from diabetes and high blood pressure to heart disease and side effects of medication.
The impact of mental illness, such as depression and anxiety, as well as psychological factors like stress, are also major contributors to ED at any age.
- Which drugs cause erectile dysfunction?
Using recreational drugs like cocaine, opiates, amphetamines, and possibly marijuana can prevent you from getting or maintaining an erection.
While some substances may disrupt the physiological processes that lead to erections, others may hinder your ability to become aroused or mask psychological, emotional, or physical factors that may be causing your ED.
A wide variety of prescription drugs also can influence erections.