I see a number of middle aged men in my clinical practice presenting with the chief complaint of erectile dysfunction often accompanied by low libido. Many of these patients had been prescribed one of the PDE5 inhibitor medications for erectile dysfunction and some had found the medication was no longer effective often requiring higher dosages. Others found the side effects of the medication such as headache, heart pounding and nasal congestion unbearable.
I do a sexual health assessment which includes a review of systems and a more detailed review of their erection function. I check blood pressure, abdominal girth and weight. I review their diet and exercise regime as well as alcohol consumption and nicotine use.
Erections are about blood flow and there are many factors that effect that and ultimately the quality of an erection. Age is a factor. But aging may be trumped by modifiable lifestyle behaviours. Most of these men are overweight with a BMI >30 and high blood pressure. Many are sedentary, sitting most of the day, now considered to be the new smoking. Nicotine is a no-no. So I suggest they butt out and I am surprised by this stage they don’t want me to butt out. But they don’t. These men are motivated to change because a healthy sex life is important and they are not ready to shut that aspect of their life down. Pun intended.
One needs to alter their diet to some version of a high protein, low carbohydrate, low glycemic index diet. I may recommend a particular nutritional plan depending on what I believe would be most beneficial for each individual man. I suggest light exercise like daily walking. I stress the need to reduce or ideally eliminate alcohol. Many of these men have been daily drinkers for twenty years or more and will need to wean off of alcohol over or risk alcohol withdrawal syndrome.
There may be significant changes within a month. Girth decreases along with blood pressure and things begin to look up. With their doctor’s guidance, some have reduced the dose of their blood pressure medication. Others no longer need Viagra to attain or maintain an erection or are able to reduce the dose. Many feel better about themselves and notice a lift in libido along with improved erection function. Most of the men are surprised by my getting “back to basics approach” to their getting back to the bedroom. There’s a lot to be said about a clean, healthy lifestyle especially when it comes to love and libido!