It wasn’t long ago that a discussion about erectile dysfunction was something that only took place in the doctor’s office, if at all. Men were afraid of being perceived as less virile, and the topic was still considered taboo.

All of that changed in the late 1990s, when Viagra hit the market and its messages began to permeate the national and international airwaves. This did a lot for raising awareness and making men feel more secure in opening up a dialogue on the subject, whether it was with their doctor, their partner, or their friends. As a result, ‘erectile dysfunction’ is a topic of discussion that more men feel safe and secure having today.

Doctors and patients alike have benefitted from this discussion, in large part because the penis serves as the barometer of a man’s overall health, with dysfunction acting as a precursor for other existing or potential health issues. Even mild symptoms of ED can mean that something is amiss in other parts of a man’s body, such as unhealthy glucose and insulin levels or heart problems.
What’s more, maintaining sexual health goes beyond managing other health problems—it supports overall health well into old age.  So, what do men do if they are having problems with sexual performance and what are their options? The good news is that there are a range of options available—men of all ages and health conditions can regain their sexual health.


ED is not a disease that affects a mild few. According to the Mayo Clinic, up to 30 million men suffer from erectile dysfunction.
But impaired sexual function is not a standalone problem. As noted above, ED can be an early sign of cardiovascular disease, diabetes and other physical ailments. A joint study by Bayer Pharmaceuticals, Schering-Plough and GlaxoSmithKline found that 58 percent of men with diabetes are likely to experience decreased erectile function. In addition, two out of three men with high blood pressure experienced changes in erections, while the risk of ED was found to be nearly two times greater in men with total cholesterol levels above 240 than in men with total cholesterol levels below 180.

Other Health Conditions and Contraindications

Yes, erectile dysfunction can be a barometer of men’s overall health and is heavily associated with conditions like heart disease and diabetes. But, oftentimes, ED is associated with these conditions not only because of the systemic health issues that they present, but also because of the other medications that are prescribed to them to treat their conditions.


There are two types of cancer most likely to be associated with ED: prostate and rectal cancer. However, ED is more likely to be a result of the treatments for these cancers rather than the diseases themselves. Prostate cancer patients, in particular, should be aware that erectile dysfunction is a common residual side effect of related cancer treatments. Because the nerves that support the penis run through the prostate, any surgery or radiation that effects the prostate is likely to effect the penis, no matter how “nerve sparing” the treatment.

According to the Prostate Cancer Foundation, about 50% of prostate cancer patients who undergo external beam radiation experience ED for up to two years. It becomes imperative that, after such treatments for the prostate, the patient is placed on an ED treatment program as soon as possible; delaying such treatments may further result in the worsening of ED through disuse atrophy. As the old saying goes, “use it or lose it!”

Heart Disease

Impaired sexual function can be an early sign of cardiovascular disease. Industry experts cite damaged or clogged arteries as a possible cause of both ailments, meaning that the very same impaired blood vessels that aren’t feeding your heart are also preventing your ability to have a healthy erection.

And to add insult to injury, the blood pressure and cholesterol medications that are often prescribed to men with heart conditions and diabetes often mean that oral ED medications (like Viagra or Cialis) are either rendered useless, or are dangerous for men with these systemic disorders.

Diabetes. Diabetes affects the penis several ways, including narrowing or hardening the penile blood vessels, lowering testosterone levels and causing damage to penile nerves. Also, blood sugar level imbalances can prevent men from producing enough nitric oxide, which is needed to maintain an erection. If not treated, diabetes can result in permanent damage to the penis. As a result, many doctors urge patients to seek immediate medical attention to both improve ongoing sexual virility and to get tested for related disorders such as heart disease.

Traditional Solutions and Their Drawbacks

So, what are the treatment options for men with ED, and what are patients to do if existing conditions and medications preclude them from taking common oral medications for their erectile dysfunction?

Men with health conditions such as diabetes, hypertension, cancer and kidney or liver problems often find erectile dysfunction to be an upsetting side effect. Yet, because these diseases pose health risks to circulation, hormones and the nervous system, men with these diagnoses frequently can’t treat their ED with oral medications. Oral treatments don’t merely affect the sexual organs; they can affect all the systems of the body and potentially produce dangerous side effects. These side effects range from disruption of blood flow to important organs to vision problems and hearing loss. What’s more, a dangerous drop in blood pressure may result for men taking heart medications that contain nitrates.

As a result, Viagra and other oral medications aren’t always safe for many of the very same men who require it and, even when they are safe, they often don’t work at all. For instance, Viagra is found to be ineffective 40 percent of the time in men with diabetes (as compared to up to 85 percent effective for the general population).

Imitation oral medications are also on the rise and people who spend money on Viagra may not realize that the product they are buying is not authentic. Bolstered by the success of Viagra, this dubious industry has grown considerably, and is estimated to take in revenues in the hundreds of millions of dollars a year.

At the other end of the spectrum is penile implant surgery, which comes with its own set of risks. During the procedure, a mechanical device is implanted under surgery that can give the patient an erection on demand. Not everyone is an appropriate candidate for this procedure due to overall health, age, and medications they are taking. Risks include post-operative complications such as infections, damage to surrounding tissues and nerves, and even deathly reactions to anesthesia.

But this is not where the story ends. There are alternatives that fill the gap between convenient oral medications and invasive surgery. All men, no matter what their overall health conditions, can and should have a healthy sex life.

Other Options

For many men, oral medications are a viable treatment option, but in others they may not be effective or can pose dangerous health risks. For these men, there are treatment options available that are personalized and safe, without the harmful side effects that are associated with traditional or alternative medications.

These alternatives include intracavernous pharmocotherapy (ICP)—a painless injection of a combination of FDA-approved vasodilators into the spongy tissue of the penis using an auto-applicator. ICP fills the gap between oral medicines and surgery, bringing men both the convenience of an immediate solution, and the safety of a localized treatment option. It is minimally invasive and effective in producing consistent erections. And, as a localized treatment, there is little concern about its effects on the rest of the body, no risk to other health conditions and a low likelihood of contraindication. ICP addresses the source of the problem directly and can be very effective.

Other alternatives include intraurethral suppository (a vasodilator known as Alprostadil, or Prostaglandine E1), prepared in the form of a pellet that is inserted into the urethra via an applicator; and vacuum suction devices (a battery or manually-operated cylindrical pump which fully encloses the penis).

Scores of men have found success with a variety of ED treatments, and treatments are definitely not one-size-fits all.


There is a great deal of consumer confusion around ED treatments and options today. It’s important that men understand all their options and the benefits and side effects of each avenue.

Remember, ED may be just one symptom of other health issues in the male body and, to understand all underlying health problems, doctors should take the time to ensure that their patients understand their medical conditions and present various treatment options before encouraging patients to embrace any specific remedy.

Patients with ED don’t have to suffer in silence. With the proper diagnosis and treatment, men of all ages and health conditions can have a healthy sex life.

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