Erectile dysfunction (ED) is treated pretty casually, but many people don’t realize how incredibly common this condition is. In fact, millions of Americans are affected by ED—including 1 in 2 men over the age of 40. I’ve written about ED before, but I’d like to take another opportunity to pull back the curtain on this needlessly taboo topic. Let’s take another look at the best ways to diagnose and treat ED.


What is erectile dysfunction?

Also known as impotence, erectile dysfunction is defined as an inability to get or keep an erection firm enough for sex. Men with ED may also experience symptoms of sexual dysfunction like low libido or difficulty orgasming.


What causes erectile dysfunction?

There are a number of physical conditions associated with ED, including:

  • Obesity
  • Diabetes
  • High blood pressure
  • Heart disease
  • High cholesterol
  • Atherosclerosis (clogged blood vessels)
  • Alcoholism/other substance abuse
  • Multiple sclerosis
  • Metabolic syndrome
  • Sleep disorders

ED is also a potential side effect of many prescription and over-the-counter medications. These include blood pressure drugs like hydrochlorothiazide (abbreviated as HCTZ) and atenolol, antidepressants like fluoxetine (Prozac) and sertraline (Zoloft), anti-anxiety medications like diazepam (Valium) and lorazepam (Ativan), muscle relaxants like cyclobenzaprine (Flexeril), and even over-the-counter antihistamines like Benadryl and Dramamine.

These are only partial lists, so one of the first steps in treating ED would be to look at what medical conditions you might have that aren’t optimally under control or what meds and supplements you are taking.

Just as common, if not more, but often harder to recognize are psychological causes of ED. Both depression and anxiety can interfere with a man’s ability to have and enjoy sex. Stress is another big contributor to ED—whether it’s relationship problems, preoccupation with work, or general distress about the state of the world.


How is erectile dysfunction diagnosed?

Although it may not seem like the kind of thing you need (or want) to see a doctor about, those who suspect they have ED should always be evaluated by a medical professional. This is especially important because ED is associated with so many health conditions—you may have something going on with your health that’s causing ED and not know it (like plaque in your arteries which can be a big risk for having a heart attack – so ED could be an early warning sign of heart problems).

An ED evaluation typically includes a detailed medical history (including information about your sex life), followed by a thorough physical examination. Your doctor may also want to order lab work like a urine test, morning serum testosterone test, and/or a lipid profile.


What are the best ways to treat erectile dysfunction?

Although they tend to be the punchline to jokes, prescription drugs like Viagra and Cialis really can work well to treat ED by improving blood flow to the penis. If you receive an ED diagnosis, you and your doctor can discuss medication options.

Pills (and jokes) aside, lifestyle changes can be an excellent way to manage ED symptoms. For men whose weight may be causing ED, something as simple as getting more exercise may help. As I explain here, a study of obese men with ED who restricted calories for two years and were advised to be more active found that participants not only lost weight but also experienced decreased severity of their ED. Aerobic exercise provides the added benefit of improving blood flow throughout the body.

Finding ways to get your stress levels under control can also be incredibly helpful for treating ED. If you’re struggling with relationship problems or mental health issues like anxiety and depression that might be causing ED, talking to a professional who can help you work things through is a good idea.

Another great way to lower your stress is through meditation. Although it may seem a little out there, mindfulness meditation is scientifically proven to effectively relieve stress. In one study, people with generalized anxiety who followed a stress-reduction program based on mindfulness were considerably less anxious than those in a control group who were taught other stress management techniques. Meditation is often recommended for people in high-pressure fields like medicine, and it may even be useful for veterans and others dealing with PTSD.

Supplements can relieve symptoms of sexual dysfunction, but it can be difficult to separate legitimate products from scams. I suggest working with an expert and sticking to supplements with efficacy backed by solid science. My list of top five supplements to increase sex drive is a good place to start.


Wondering what others areas of your health could use your attention? Consider taking my Optimal Men’s Health quiz. It’s designed to help you determine your next best step to getting healthier and closer to winning.

Myles Spar, MD, MPH is the Chief Medical Officer of Vault Health, a national medical practice specializing in care for men, and Is board certified in Internal Medicine and in Integrative Medicine. As a clinician, teacher and researcher on faculty of two major medical centers, he has led the charge for a more proactive, holistic and personalized approach to care that focuses on cutting edge technology and preventative care. Dr. Spar has traveled with the NBA, presented a TEDx Talk, appeared on Dr. Oz, and been featured in publications such as the Men’s Journal and the Los Angeles Times.