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There are many medications and supplements available today that can help fight the signs and symptoms of aging. Some are available over-the-counter at your local health, nutrition, or beauty ...

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Second-generation cardioselective beta-blockers (atenolol, metoprolol, bisoprolol, etc.) can also lead to ED. Atenolol was shown to cause significant reduction of sexual activity compared with placebo in a double-blind, parallel-arm study.22 The same study also showed a significant reduction in testosterone levels with atenolol versus valsartan. An open, prospective study of hypertensive men treated with atenolol, metoprolol and bisoprolol for at least 6 months showed high prevalence of ED – approaching 66 % – in these patients.23
And when it comes to erectile dysfunction, exercises don't only look like going for a jog or riding a bike. .

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Given that ED isn't openly spoken about, it can feel like an isolating experience but it doesn't have to be. There are simple and effective ways to treat erectile dysfunction (that's where Pilot comes in!) that will help ensure that your sex life, and in turn, you, are happy and healthy.
In patients with low testosterone, testosterone treatment can improve libido and erectile dysfunction, but many men still may need additional oral medications such as sildenafil, vardenafil, or tadalafil. Some studies suggest that men with ED and low testosterone may respond better to PDE5 inhibitors when given testosterone therapy; however, this is controversial.

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The pathogenesis of organic ED is related to dysfunction of the endothelium. Endothelial cells can become injured through a variety of mechanisms, most of which cause oxidative stress on the tissues. Many of these causes of oxidative stress are related to lifestyle issues which lead to hypertension, diabetes and dyslipidaemia (figure 1). Endothelial cell dysfunction results in reduction of endothelium-dependent vasorelaxation as well as increased adhesion of leukocytes to the endothelium. Endothelial cell injury then leads to a variety of sequelae, including ED, other types of vasoconstriction, atherosclerosis and thrombus formation.18
A psychological component, often called "performance anxiety", is common in men with impotence. However, a purely psychological problem is seen in only 10%.

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At Yale Medicine, we take a multidisciplinary approach to determine the underlying causes of your erectile dysfunction. We understand the relationship between erectile dysfunction and other health issues which inspires us to use an interdisciplinary approach to caring for our patients. We regularly collaborate with colleagues across different areas of medicine to help patients who we treat.

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Atherosclerosis and diabetes are common causes of long-standing erectile dysfunction. Other health issues that can significantly contribute to the problem of erectile dysfunction include Heart disease Obesity Hypertension (high blood pressure) Hyperlipidemia (high lipid or cholesterol level) Benign enlargement of the prostate Parkinson’s disease Sleep disorders Chronic kidney disease Liver disease Injury to the penis or prostate Accidents involving trauma to the spinal cord Multiple sclerosis Peyronie’s disease (formation of scar tissue under the skin of the penis) Treatments for prostate cancer Radiation therapy Prostate surgery Surgery for bladder cancer

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    Pelvic floor muscles can be identified by attempting to stop the flow of urine mid-stream. These are the muscles that will be used. Start with an empty bladder and tighten the pelvic floor muscles for 5 seconds, then relax for 5 seconds. Attempt to do 5 repetitions (reps) the first day. Work up to 10 seconds at a time. Aim for 3 sets of 10 reps daily. Avoid tightening muscles in the abdomen, thighs, or buttocks and avoid holding your breath. QUESTION Testosterone is a chemical found only in men. See Answer Men's Health Resources When Prostate Cancer Spreads12 Devices That Can Help Your Low Vision https://bjui-journals.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1464-410X.2005.05690.x https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275865/ Exercises for Erectile Dysfunction, Do They Really Work?

    In some cases, ED can be a warning sign of a more serious disease. One study suggests it can predict heart attack, stroke, and even death from cardiovascular disease. If you’re diagnosed with ED, get checked for cardiovascular disease. This doesn’t mean every man with ED will develop heart disease, or that every man with heart disease has ED, but you should be aware of the link.
    L-citrulline can be converted to L-arginine in the body. L-arginine widens blood vessels, increasing blood flow.

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    To diagnose ED, the doctor will ask about your symptoms and medical history. They’ll do a complete physical exam to look for signs like poor circulation or nerve trouble. They’ll also check for problems in your genital area that could cause trouble with erections.

    Depending on the cause of your erectile dysfunction, your urologist will suggest lifestyle changes that include: Quitting smoking Limiting alcohol intake Exercising regularly Maintaining a healthy weight
    New research suggests that you might be able to reverse erectile dysfunction without medication.

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    If you have a partner, involve them in treatment by discussing your sexual function with them. Include them in physical activity, even if it's starting with a home-based walking program.
    ED is a common disease affecting men with IHD. Endothelial dysfunction is the link between ED and IHD and both diseases share the same aetiology, risk factors and pathogenesis. Aggressive control of these risk factors – along with lifestyle modification – is recommended to improve symptoms of ED and reduce cardiovascular risk. PDE5 inhibitors remain the first-choice treatment for ED in IHD patients and they have been shown to be safe and effective. However, PDE5 inhibitors can potentiate the hypotensive effect of nitrates so concomitant administration of sildenafil and nitrates is contraindicated. Gene and stem cell therapy are being investigated as a future therapies for ED. Hatzimouratidis K, Amar E, Eardley I, et al. European Association of Urology. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol 2010;57:804–14. Crossref | PubMed Solomon H, Man JW, Jackson G. Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator. Heart 2003;89:251–3. PubMed Meller SM, Stilp E, Walker CN, Mena-Hurtado C. The link between vasculogenic erectile dysfunction, coronary artery disease, and peripheral artery disease: role of metabolic factors and endovascular therapy. J Invasive Cardiol 2013;25:313–9. PubMed Fung MM, Bettencourt R, Barrett-Connor E. Heart disease risk factors predict erectile dysfunction 25 years later: The Rancho Bernardo Study. J Am Coll Cardiol 2004;43:1405–11. Crossref | PubMed Giuliano F. New horizons in erectile and endothelial dysfunction research and therapies. Int J Imp Res 2008;20:S2–S8. Crossref | PubMed Rodriguez JJ, Al Dashti R, Schwarz ER. Linking erectile dysfunction and coronary artery disease. Int J Imp Res 2005;17:S12–S18. Crossref | PubMed Kula K, Slowikowska-Hilczer J, Kula W. Pathophysiology of erectile dysfunction – an organisation/activation concept. J Repr Med Endocrinol 2005;2:246–50. Sai Ravi Shanker A, Phanikrishna B, BhakthaVatsala Reddy C. Association between erectile dysfunction and coronary artery disease and its severity. Indian Heart J 2013;65:180–6. Crossref | PubMed Montorsi P, Ravagnani PM, Galli S, et al. Common grounds for erectile dysfunction and coronary artery disease. Curr Opinion Urol 2004;14:361–5. PubMed Dong JY, Zhang YH, Qin LQ. Erectile dysfunction and risk of cardiovascular Disease. J Am Coll Cardiol 2011;58:1378–85. Crossref | PubMed Inman BA, St. Sauver JL, Jacobson DJ, et al. A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc 2009;84:108–13. Crossref | PubMed Banks E, Joshy G, Abhayaratna WP, et al. Erectile dysfunction severity as a risk marker for cardiovascular disease hospitalisation and all-cause mortality: a prospective cohort study. PLoS Med 2013;10:e1001372. Crossref | PubMed Batty GD, Li Q, Czernichow S, et al. Erectile dysfunction and later cardiovascular disease in men with type 2 diabetes: prospective cohort study based on the ADVANCE trial. J Am Coll Cardiol 2010;56:1908–13. Crossref | PubMed Thompson IM, Tangen CM, Goodman PJ, et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005;294:2996–3002. Crossref | PubMed Greenstein A, Chen J, Miller H, et al. Does severity of ischemic coronary disease correlate with erectile function? Int J Impot Res 1997;9:123–6; PubMed Montorsi F, Briganti A, Salonia A, et al. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol 2003;44:360–4. Crossref | PubMed Jackson G. Erectile dysfunction and cardiovascular disease. Arab J Urology 2013;11:212–6. Crossref | PubMed Simonsen U. Interactions between drugs for erectile dysfunction and drugs for cardiovascular disease. Int J Impot Res 2002;14:178–88. Crossref | PubMed Chang SW, Fine R, Siegel D, et al. The impact of diuretic therapy on reported sexual function. Arch Intern Med 1991;151:2402–8. Crossref | PubMed Grimm RH Jr, Grandits GA, Prineas RJ, et al. Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women. Treatment of Mild Hypertension Study (TOMHS). Hypertension 1997;29:8–14. Crossref | PubMed Adverse reactions to bendrofluazide and propranolol for the treatment of mild hypertension. Report of Medical Research Council Working Party on Mild to Moderate Hypertension. Lancet 1981;2:539–43. Crossref | PubMed Fogari R, Preti P, Derosa G, et al. Effect of antihypertensive treatment with valsartan or atenolol on sexual activity and plasma testosterone in hypertensive men. Eur J Clin Pharmacol 2002;58:177–80. Crossref | PubMed Doumas M, Tsakiris A, Douma S, et al. Beneficial effects of switching from B-blockers to nebivolol on the erectile function of hypertensive patients. Asian J Androl 2006,8:177–82. Crossref | PubMed Fogari R, Zoppi A, Poletti L, et al. Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study. Am J Hypertens 2001;14:27–31. Crossref | PubMed Sharp RP, Gales BJ. Nebivolol versus other beta blockers in patients with hypertension and erectile dysfunction. Ther Adv Urol 2017;9:59–63. Crossref | PubMed Boydak B, Nalbantgil S, Fici F, et al. A randomized comparison of the effects of nebivolol and atenolol with and without chlorthalidone on the sexual function of hypertensive men. Clin Drug Invest 2005;25:409–16. PubMed Cordero A, Bertomeu-Martinez V, Mazon P, et al. Erectile dysfunction in high-risk hypertensive patients treated with beta-blockade agents. Cardiovasc Ther 2010;28:15–22. Crossref | PubMed Brixius K, Middeke M, Lichtenthal A, et al. Nitric oxide, erectile dysfunction and beta blocker treatment (MR NOED study): benefit of nebivolol versus metoprolol in hypertensive men. Clin Exper Pharmacol Phys 2007;34:327–31. Crossref | PubMed Nicolai MP, Liem SS, Both S, et al. A review of the positive and negative effects of cardiovascular drugs on sexual function: a proposed table for use in clinical practice. Neth Heart J 2014;22:11–9. Crossref | PubMed Bacon CG, Mittleman MA, Kawachi I, et al. A prospective study of risk factors for erectile dysfunction. J Urol 2006;176:217–21. Crossref | PubMed Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 1993;362:801–9. Crossref | PubMed Schachinger V, Zeiher AM. Prognostic implications of endothelial dysfunction: does it mean anything? Coronary Artery Dis 2001;12:435–43. PubMed Brunner H, Cockcroft JR, Deanfield J, et al. Endothelial function and dysfunction. Part II: Association with cardiovascular risk factors and diseases. A statement by the Working Group on Endothelins and Endothelial Factors of the European Society of Hypertension. J Hypertens 2005;23:233–46. Crossref | PubMed Andersson K, Stief C. Penile erection and cardiac risk: pathophysiologic and pharmacologic mechanisms. Am J Cardiol 2000;86:23f–6. Crossref | PubMed Kloner RA, Zusman RM. Cardiovascular effects of sildenafil citrate and recommendations for its use. Am J Cardiol 1999;84:11n–7. Crossref | PubMed Jeremy JY, Ballard SA, Naylor AM, et al. Effects of sildenafil, a type-5 cGMP phosphodiesterase inhibitor, and papaverine on cGMP and cAMP levels in the rabbit corpus cavernosum in vitro. Br J Urol 1997;79:958–63. Crossref | PubMed Yavuzgil O, Altay B, Zoghi M, et al. Endothelial function in patients with vasculogenic erectile dysfunction. Int J Cardiol 2005;103:19–26. Crossref | PubMed Kaiser DR, Billups K, Mason C, et al. Impaired brachial artery endothelium dependent and independent vasodilation in men with erectile dysfunction and no other clinical cardiovascular disease. J Am Coll Cardiol 2004;43:179–84. Crossref | PubMed Kinsey AC, Pomeroy WR, Martin CE. Sexual behavior in the human male. Am J Pub Health 2003;93:894–8. Crossref | PubMed Feldman HA, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts male aging study. J Urol 1994;151:54–61. Crossref | PubMed Panza JA, Quyyumi AA, Brush Jr JE, et al. Abnormal endothelium-dependent vascular relaxation in patients with essential hypertension. N Engl J Med 1990;323:22–7. Crossref | PubMed Koga T, Takata Y, Kobayashi K, et al. Age and hypertension promote endothelium dependent contractions to acetylcholine in the aorta of the rat. Hypertension 1989;14:542–8. Crossref | PubMed Kung CF, Luscher TF. Different mechanisms of endothelial dysfunction with aging and hypertension in the rabbit aorta. Hypertension 1995;25:194–200. PubMed Taddei S, Virdis A, Ghiadoni L, et al. Cyclooxygenase inhibition restores nitric oxide activity in essential hypertension. Hypertension 1997;29:274–9. PubMed Behr-Roussel D, Chamiot-Clerc P, Bernabe J, et al. Erectile dysfunction in spontaneously hypertensive rats: pathophysiological mechanisms. Am J Physiol Regul Integr Comp Physiol 2003;284:R682–8. Crossref | PubMed Chowienczyk PJ, Brett SE, Gopaul NK, et al. Oral treatment with an antioxidant (raxofelast) reduces oxidative stress and improves endothelial function in men with type 2 diabetes. Diabetologia 2000;43:974–7. Crossref | PubMed Seftel AD, Sun P, Swindle R. The prevalence of hypertension, hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. J Urol 2004;171:2341–5. Crossref | PubMed Nehra A. Erectile dysfunction and cardiovascular disease: efficacy and safety of phosphodiesterase type 5 inhibitors in men with both conditions. Mayo Clin Proc 2009;84:139–48. Crossref | PubMed Tengs TO, Osgood ND. The link between smoking and impotence: two decades of evidence. Prev Med 2001;32:447–52. Crossref | PubMed Eriksson J, Haring R, Grarup N, et al. Causal relationship between obesity and serum testosterone status in men: A bi-directional mendelian randomization analysis. PLoS One 2017;12:e0176277. Crossref | PubMed Tan RS, Pu SJ. The interlinked depression, erectile dysfunction, and coronary heart disease syndrome in older men: a triad often underdiagnosed. J Gend Specif Med 2003;6:31–6. PubMed Rosen RC. Psychogenic erectile dysfunction. Classification and management. Urol Clin North Am 2001;28:269–78. Crossref | PubMed Maiorino MI, Bellastella G, Esposito K. Diabetes and sexual dysfunction: current perspectives. Diabetes Metab Syndr Obes 2014;7:95–105. Crossref | PubMed Lue TF. Erectile dysfunction. N Engl J Med 2000;342:1802–13. Crossref | PubMed Traish AM, Galoosian A. Androgens modulate endothelial function and endothelial progenitor cells in erectile physiology. Korean J Urology 2013;54:721–31. Crossref | PubMed Crossman DC. The pathophysiology of myocardial ischaemia. Heart 2004;90:576–80. Crossref | PubMed Nehra A, Jackson G, Miner M, et al. The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease. Mayo Clin Proc 2012;87:766–78. Crossref | PubMed Gupta BP, Murad MH, Clifton MM, et al. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med 2011;171:1797–803. Crossref | PubMed Kling J. From hypertension to angina to Viagra. Mod Drug Discov 1998;1:31–8. Schwarz ER, Rastogi S, Kapur V, et al. Erectile dysfunction in heart failure patients. J Am Coll Cardiol 2006;48:1111–9. Crossref | PubMed Kostis JB, Jackson G, Rosen R. Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference) Am J Cardiol 2005;96:313–21. Crossref | PubMed Giuliano F, Jackson G, Montorsi F, et al. Safety of sildenafil citrate: review of 67 double-blind placebo-controlled trials and the postmarketing safety database. Int J Clin Pract 2010;64:240–55. Crossref | PubMed Kloner RA, Jackson G, Hutter AM. Cardiovascular safety update of tadalafil: retrospective analysis of data from placebo-controlled and open-label clinical trials of tadalafil with as needed, three times-per-week or once-a-day dosing. Am J Cardiol 2006;97:1778–84. Crossref | PubMed Olsson AM, Persson CA; Swedish Sildenafil Investigators Group. Efficacy and safety of sildenafil citrate for the treatment of erectile dysfunction in men with cardiovascular disease. Int J Clin Pract 2001;55:171–6. PubMed Kloner R, Padma-Nathan H. Erectile dysfunction in patients with coronary artery disease. Int J Impot Res 2005;17:209–15. Crossref | PubMed Conti CR, Pepine CJ, Sweeney M. Efficacy and safety of sildenafil citrate in the treatment of erectile dysfunction in patients with ischemic heart disease. Am J Cardiol 1999;83:29C−34. Crossref | PubMed DeBusk RF, Pepine CJ, Glasser DB, et al. Efficacy and safety of sildenafil citrate in men with erectile dysfunction and stable coronary artery disease. Am J Cardiol 2004;93:147−53. Crossref | PubMed Kloner RA, Goggin P, Goldstein I, et al. A new perspective on the nitrate-phosphodiesterase type 5 inhibitor interaction. J Cardiovasc Pharmacol Ther 2018;23:375−86. Crossref Arruda-Olson AM, Mahoney DW, Nehra A, et al. Cardiovascular effects of sildenafil during exercise in men with known or probable coronary artery disease. A randomized crossover trial. JAMA 2002;287:719−25. Crossref | PubMed Mittleman MA, Glasser DB, Orazem J. Clinical trials of sildenafil citrate demonstrate no increase in risk of myocardial infarction and cardiovascular death compared with placebo. Int J Clin Pract 2003;57:597−600. PubMed De Vecchis R, Cesaro A, Ariano C, et al. Phosphodiesterase-5 inhibitors improve clinical outcomes, exercise capacity and pulmonary hemodynamics in patients with heart failure with reduced left ventricular ejection fraction: a meta-analysis. J Clin Med Res 2017;9:488–98. Crossref | PubMed Assad TR, Hemnes AR, Larkin EK, et al. Clinical and biological insights into combined post- and pre-capillary pulmonary hypertension. J Am Coll Cardiol 2016;68:2525–36. Crossref | PubMed Hackett G, Kirby M, Wylie K, et al. British Society for Sexual Medicine guidelines on the management of erectile dysfunction in men – 2017. J Sex Med 2018;15:430–57. Crossref | PubMed Hackett G, Kirby M, Edwards D, et al. British Society for Sexual Medicine guidelines on adult testosterone deficiency, with statements for UK practice. J Sex Med 2017;14:1504–23. Crossref | PubMed Anaissie J, Hellstrom WJ. Clinical use of alprostadil topical cream in patients with erectile dysfunction: a review. Res Rep Urol 2016;8:123–31. Crossref | PubMed Bivalacqua TJ, Deng W, Champion HC, et al. Gene therapy techniques for the delivery of endothelial nitric oxide synthase to the corpa cavernosa for erectile dysfunction. Methods Mol Biol 2004;279:173–85. Crossref | PubMed Bivalacqua TJ, Usta MF, Champion HC, et al. Effect of combination endothelial nitric oxide synthase gene therapy and sildenafil on erectile function in diabetic rats. Int J Impot Res 2004;16:21–9. Crossref | PubMed Bivalacqua TJ, Usta MF, Champion HC, et al. Gene transfer of endothelial nitric oxide synthase partially restores nitric oxide synthesis and erectile function in streptozotocin diabetic rats. J Urol 2003;169:1911–7. Crossref | PubMed Harraz A, Shindel AW, Lue TF. Emerging gene and stem cell therapies for the treatment of erectile dysfunction. 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    Unlike the other PDE5 inhibitors, sildenafil (Viagra) may affect another phosphodiesterase enzyme in the eye, causing transient abnormal vision (a bluish hue or brightness).

    Because of the relation between erectile dysfunction and heart disease the doctor generally does a cardiac risk evaluation as part of the diagnosis. Your doctor may refer you to a cardiologist for further evaluation and specific cardiac tests, such as a ‘stress test.’
    If you have questions about erectile dysfunction or another urologic issue, consider scheduling an appointment. World Cancer Day & National Cancer Prevention Awareness Month February 1, 2022 What Do Registered Dietitians Do? January 13, 2022 What is a Nurse Navigator? January 6, 2022 Bladder Health (9) Bowel Function (5) Cancers (47) General Urology (23) Kidney Health (5) Men's Health (31) national cancer prevention awareness month (1) Pelvic Floor Physical Therapy (16) Women's Health (18) See all FIND A DOCTOR FIND A LOCATION SCHEDULE AN APPOINTMENT Doctors & Medical Staff Careers With GBU Dorchester/Boston North Easton/Brockton © 2022 Greater Boston Urology. All Rights Reserved | Privacy Policy | Terms & Conditions About Mission Doctors Team Locations Reviews Services All Services Urological Conditions Elevated PSA Prostate Cancer Benign Prostatic Hyperplasia Overactive Bladder Renal / Kidney Masses Bladder Cancer Kidney Stones Erectile Dysfunction Treatments Aquablation Therapy Shockwave Therapy PCR Test for UTI HIFU UROLIFT Patient Education Blog Videos Podcast Current Patients Patient Portal Patient Forms Travelers Privacy News News Schedule Appointment Contact Us 904-727-7955 Email Us Locations Home { Collections } Blog Is There A Better Alternative Than Viagra® To Treat ED?

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If you’re battling ED, you’ll want to arm yourself with credible information. Here are some of Everyday Health’s top resources.

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Only 10 percent of men seek treatment and many (50 percent) discontinue treatment once they start it because they are too embarrassed to discuss their sexual health issues with a doctor. There is no need to suffer in silence.

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Kegel exercises, or pelvic exercises, have proven to be effective in addressing erectile dysfunction, and it should be used as the first-line of treatment. The ischiocavernosus and bulbocavernosus muscles in the pelvic area surround the penis and are active during an erection. The following exercises aim to strengthen these muscles.

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In general, PDE5i works successfully in about 65%-70% of all men with erectile dysfunction (impotence). The greater the degree of damage to the normal erection mechanism and severity of the ED, the lower the overall success rate. Men with diabetes and those with spinal cord injury reported between 50%-60% responding successfully to treatment with oral PDE5i medications. The lowest success rate has been in men who developed ED (impotence) after prostate cancer surgery (radical prostatectomy) for more advanced prostate cancer that required removal of both sets of nerves around the prostate. In men who did not have the nerves removed/damage, there is a better chance of response to PDE5 inhibitors.

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