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Risk factors

  • Medical conditions, particularly diabetes or heart conditions
  • Tobacco use, which restricts blood flow to veins and arteries, can — over time — cause chronic health conditions that lead to erectile dysfunction
  • Being overweight, especially if you’re obese
  • Certain medical treatments, such as prostate surgery or radiation treatment for cancer
  • Injuries, particularly if they damage the nerves or arteries that control erections
  • Medications, including antidepressants, antihistamines, and medications to treat high blood pressure, pain, or prostate conditions
  • Psychological conditions, such as stress, anxiety, or depression
  • Drug and alcohol use, especially if you’re a long-term drug user or heavy drinker

Symptoms

  • Trouble getting an erection
  • Trouble keeping an erection
  • Reduced sexual desire

Causes

Physical causes of erectile dysfunction

  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Obesity
  • Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist, and high cholesterol
  • Parkinson’s disease
  • Multiple sclerosis
  • Certain prescription medications
  • Tobacco use
  • Peyronie’s disease — development of scar tissue inside the penis
  • Alcoholism and other forms of substance abuse
  • Sleep disorders
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord
  • Low testosterone

Psychological causes of erectile dysfunction

  • Depression, anxiety, or other mental health conditions
  • Stress
  • Relationship problems due to stress, poor communication, or other concerns

Medications that may cause erectile dysfunction

  • Antidepressants, particularly SSRIs
  • Cimetidine
  • Ketoconazole
  • Spironolactone
  • Sympathetic blockers (methyldopa, clonidine and guanethidine)
  • Thiazide diuretics
  • Other antihypertensives
  • You have concerns about your erections, or you’re experiencing other sexual problems such as premature or delayed ejaculation
  • You have diabetes, heart disease,e or another known health condition that might be linked to erectile dysfunction
  • You have other symptoms along with erectile dysfunction

Medications

  • Avanafil (Stendra).
  • Sildenafil (Viagra).
  • Tadalafil (Cialis).
  • Vardenafil.
  • Sildenafil (Viagra). This medicine works best when you take it on an empty stomach an hour before sex. The body takes longer to absorb it after a high-fat meal or alcohol. Its effects often last for 4 to 5 hours. It might work longer if you have mild to moderate erectile dysfunction.
  • Vardenafil. This medicine also works best when you take it an hour before sex on an empty stomach. As with sildenafil, a high-fat meal or alcohol keeps the body from absorbing it as quickly. Vardenafil usually works for 4 to 5 hours. Its effects might last longer if you have mild to moderate ED. A newer form of the medicine that dissolves on the tongue might work faster than the pill you swallow.
  • Tadalafil (Cialis). This medication is taken with or without food an hour before sex. It works for up to 36 hours. You can take it in a small dose daily or in a larger dose as needed.
  • Avanafil (Stendra). You can take this medicine with or without food 30 minutes before sex, depending on the dose. It lasts 4 to 5 hours or longer if you have mild to moderate ED.
  • Over-the-counter supplements have become just as popular as prescription medications. But these pills should be used with a large amount of caution, IF AT ALL—especially those purchased online or at drugstores or gas stations.
  • Some dietary supplements, vitamins, and herbs are known to have some potential to assist with ED and cause longer and stronger erections.

Natural Options

  1. Talking to your partner about your sex life
  2. Getting regular exercise
  3. Eating a healthy, balanced diet
  4. Getting enough sleep
  5. Monitor your testosterone levels
  6. Cutting your tobacco and alcohol use
  7. Managing your stress
  8. Strengthening your pelvic floor muscles

Other Options

  • Injection therapy: If oral PDE-5 inhibitors are unsuccessful, a common next step in treatment are injections of papaverine, an alpha-blocker and vasodilator. Individuals give themselves an injection every time they would like to have an erection. Though there are some drawbacks, such as potential discomfort and bruising, Dr. Lundy says injections are “highly efficacious” and offer a quick onset.
  •  Cock rings This O-shaped toy fits around your penis and helps keep blood in the shaft, where you want it. A cock ring also helps prevent venous leakage, a form of erectile dysfunction where blood flows to your penis but has trouble staying there. 
  • Vacuum erection device: A non-surgical option for individuals is an external vacuum device, which is placed over the penis and then pumped to create pressure around the penis, pulling blood into the penis. Then, a small rubber band is placed around the base of the penis to trap the blood and keep the penis erect. “Some discomfort and potentially some bruising or bleeding” can occur with this treatment, according to Dr. Lundy, and the penis “isn’t nearly as well anchored as with a natural erection, so it’s less stable.” 
  • Penile implants: This option is typically offered when other treatments are not successful or viable. With an inflatable prosthesis, a small pump is inserted in the scrotum that an individual squeezes to inflate and stiffen the penis. Though the inflatable prosthesis is “more commonly used” and “far more user friendly,” per Dr. Lundy, there’s also the option for a malleable prosthesis. With this option, two bendable rods are implanted in the penis, which a person can then use to bend their penis up or down.

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