The Facts
What is E.D.?
Erection problems, impotence, problems with the equipment, trouble in bed, a hard time having a hard time…whatever you choose to call it, if you are finding it difficult to achieve or maintain an erection long enough for satisfying sex, you may have the medical condition that doctors call erectile dysfunction.
Occasional erectile dysfunction is normal. Many men will find it difficult to get or keep an erection at some time in their lives. This can be due to stress, anxiety, too much alcohol – or even lack of sleep. The occasional let-down, though, is different from having erection problems most of the time. Constant erection problems not only undermine your confidence, but prevent you from having a satisfying sex life.
Erectile dysfunction does NOT mean that you lack virility, or that you are infertile, or can't ejaculate or have an orgasm.
You're not alone
Being unable to get or keep an erection long enough for satisfying sex is common. It's estimated that in 1995 there were over 152 million men worldwide who experienced erectile dysfunction, and this number is expected to double by 2025.
Erectile dysfunction is associated with depression, anxiety and loss of self-esteem. Your partner can suffer too. They may feel rejected, unattractive and even guilty. But the good news is that erectile dysfunction is a medical condition, and like most other medical conditions, there are causes for it and treatments that may help.
Many men miss out on finding a solution to their erection problems because they are too embarrassed to talk to their doctor.
Don't be one of them. Speak to your GP and get your love life back on track.
TAKE THE E.D. TEST
How erections work
What goes on inside your penis when you get an erection? I bet you thought it was simple, but getting an erection is a complex process.
An erection is caused by increased blood flow to the penis. So to get and keep an erection that's suitable for satisfying sex, proper blood flow to the penis is vital. Sometimes, this blood flow can be restricted and this can lead to erectile dysfunction.
Getting and maintaining an erection requires several steps
First you need sexual stimulation. This may be sexual thoughts or actions, or a sexual activity that stimulates the head of your penis.
Next comes sexual arousal. When you feel ‘turned on', messages pass from the brain, via nerves, to the blood vessels that supply blood to the penis. These messages cause the blood vessels to relax and widen allowing more blood to flow into the penis.
Your erection begins when the increased blood flow causes the penis to become hard and erect as the spongy erectile tissue in your penis fills with blood.
This increased volume of blood is trapped in the penis as the veins that normally carry blood away from the penis get compressed, allowing you to maintain your erection until orgasm.
After orgasm the process is reversed, allowing the trapped blood to flow out of your penis and back into your body, and you lose your erection.
What goes on inside your penis when you get an erection?
This picture shows how the inside of the penis looks before you get an erection.
There are two main blood vessels that bring blood into the penis. These are called the deep central arteries and they run through the middle of a spongy substance called erectile tissue. The deep central arteries deliver the blood to the erectile tissue and, as this tissue fills with blood, it becomes firm and swells giving you an erection.
Adapted from myDr, UBM-Medica Australia, 2000-2001
This picture shows how the inside of the penis looks when the penis is erect. As the deep central arteries expand to deliver more blood to the erectile tissue the veins, which normally carry blood away from the penis, are squeezed trapping the blood inside your penis. This allows your penis to stay erect.
Adapted from myDr, UBM-Medica Australia, 2000-2001
Is it my age?
Although erectile dysfunction is more common in older men, it is not an inevitable part of getting older. Erectile dysfunction can occur at any age and, no matter what your age, there are treatments that may could help you. Sometimes medical conditions that often accompany older age, such as high blood pressure among others, may cause erection problems and may need to be treated as well. While all men notice that their sexual response slows down as they get older, you should still be able to enjoy satisfying sex whatever your age.
So what's normal?
Click on the age ranges below to see what changes all men may experience with their erections at different times of their lives.
Teen to 40 years
Most young men get firm erections quickly and easily, climax quite quickly, and are ready to have sex again soon after ejaculating.
Approaching middle age, it may take longer to gain an erection, ejaculate, and regain another erection than it used to. Some men feel less of a need to ejaculate (orgasm) during sex, or when they do it may be less intense.
40 to 70 years
As men get older it may take more stimulation to become aroused and their erection may be less firm than it used to be. Research shows that one third of Australian men aged 40 to 69 years visiting GPs have some sort of erection problem, while one in ten are thought to have erection problems all the time.*
*Study of 1240 men aged 18 years and over presenting to Australian general practices.
70 years plus
Many men in their 70s and 80s can still get and keep erections long enough for satisfying sex. But when men are aged over 70 it's more likely that they will have erection problems than when they were younger.
What causes E.D.?
Most erection problems may be due to a combination of causes that can vary from person to person.
Getting an erection involves your blood vessels, nervous system, body chemicals and state of mind. If there is a problem with any of these things it may cause erection difficulties. Talking to your doctor to work out what may be causing your erection problems is the first step that may help you to enjoy sex like you used to. It may be that you need treatment for another condition that's contributing to your erection problems.
Some of the things that can cause or contribute to erectile dysfunction are listed here.
Physical Causes of erectile dysfunction
Vascular disorders
The process of getting an erection involves blood vessels in the penis relaxing and widening so that the penis can fill with blood. Most cases of erectile dysfunction occur as a result of vascular disorders which restrict the circulation of blood to the penis. Any condition that makes your blood vessels less likely to relax and widen can make getting an erection difficult, no matter how much you may want it to happen.
Examples of these disorders include:
- Hardening of the arteries (atherosclerosis) where fat builds up on the inside of blood vessels, making them narrow and more rigid.
- Heart disease
- High blood pressure (hypertension)
- Some types of stroke
If you have a medical condition that affects your blood vessels you could have a higher chance of erection problems. For example, in Australia erectile dysfunction affects 52% of men with high blood pressure, 61% of men with heart disease and 40% of men with blood vessel problems caused by high cholesterol.
* Studies of adult males aged 20 years and over in the Australian population
Diabetes
Erectile dysfunction is a common complication of diabetes. If you have diabetes you are more likely to have problems with erections than men who do not have diabetes. In Australia, almost two in three men who have diabetes also have erection problems.*
This may be due to the damage that diabetes does to small nerves and blood vessels over time. To get and keep erections long enough for satisfying sex you need healthy blood vessels and healthy nerves.
If you have diabetes you may have problems with erections at a younger age than men without diabetes.
*Study of 1240 men aged 18 years and over presenting to Australian general practices.
Nerve injury or nervous system disorders
For the blood vessels of the penis to relax, a healthy nerve supply is needed. So conditions that affect the nerves also affect your erections.
Spinal cord injury and conditions such as Parkinson's disease, multiple sclerosis or spina bifida can potentially cause erection problems. Other conditions that affect the health of the nerves may show up as numbness or tingling in the fingers or toes, and may indicate a problem with nerve supply in general, including to the penis.
Prostate problems
Erection problems are common after treatment for prostate cancer, such as radiation therapy or surgery. Untreated prostate cancer can also contribute to erection difficulties.
Problems with the penis
Sometimes, the cause of erection problems can be a physical injury or a deformity of the penis. These can be caused by surgery or direct injury to the penis.
Physical problems may also be due to a disease called Peyronie's disease, which causes scarring within the penis.
Some men may have damage or a blockage in a major blood vessel near the penis, which disrupts the normal process of erection. Sometimes there is a failure to trap blood in the penis that makes it difficult to keep an erection for any length of time.
Sometimes trauma to the pelvic area can cause bruising or more severe damage to the nerves or blood vessels, which may cause short-lived erectile problems. Long-distance and competitive bike riding are examples of this.
Hormonal imbalances
Occasionally, a hormone imbalance is the cause of erection problems. This imbalance could be due to low levels of the male hormone testosterone (for example, Klinefelter's syndrome), or higher than normal levels of prolactin, a hormone produced by the pituitary gland. Testosterone replacement therapy will not help erectile problems unless there is a confirmed testosterone deficiency.
Kidney or liver disease
Men with ongoing medical conditions such as kidney or liver disease can have problems getting and keeping an erection. These diseases affect a range of body functions, including erections.
Medications and erectile dysfunction
Certain medicines can cause or contribute to erection problems. Because of this you should tell your doctor about all medicines you're taking, even if you don't think they could be causing the problem. You should not stop taking any medicine your doctor has prescribed; it may not be the cause of the problem. If you are concerned that your medicine is affecting your sex life it is recommended that you talk to your doctor.
Medicines that may contribute to erection problems include
- treatments for high blood pressure
- antidepressants
- anti-ulcer treatments
- cholesterol-lowering medicines
- anti-epileptic treatments
- medicines used for prostate problems
- medicines for schizophrenia
Lifestyle and erectile dysfunction
Your lifestyle may also have an impact on your ability to achieve and maintain an erection. Factors such as smoking, alcohol, drug abuse, obesity and a sedentary lifestyle can all play a part.
Regular exercise and a sensible diet will reduce the risk of obesity, diabetes, high blood pressure and high cholesterol, making erectile dysfunction less likely.
For some men, seeking treatment for these conditions early can stop erectile problems from getting worse.
Psychological causes of erectile dysfunction
Not being in the right state of mind can also cause erection problems. In fact, about one in 10 cases of erectile dysfunction are caused by psychological factors.
Some psychological factors which can contribute to erectile dysfunction include:
Depression. Nine out of ten Australian men seeing a GP with severe depression suffer from erectile dysfunction. Erectile dysfunction may be a symptom of depression and, in addition, some treatments used for depression may cause erectile dysfunction. Men with erectile dysfunction may also develop depression as a result of the associated stress.
Stress and anxiety are known to be major causes of psychological erectile dysfunction. Concerns about sexual performance or physical appearance, as well as financial or family worries, can all negatively impact on erectile function erection.
Relationship problems.
Erection problems can sometimes occur if you are unhappy in your relationship or lacking self-confidence.
What can I do?
Being unable to get or keep an erection long enough for satisfying sex is common. But it's also a medical condition that can often be treated.
You don't have to put up with an unsatisfying sex life because of erection difficulties. The first step to getting back your confidence is to talk to your doctor. There are many different causes, and treating the cause (e.g. lowering your blood pressure) may be all that's needed. Other times, specific treatment may be more effective.
Regardless of whether your erection problems happen once in a while or all the time, your doctor can help you work out the best erectile dysfunction treatment to get your sex life back on track.
What treatment options are available?
Depending on the cause, your doctor may suggest one or more of the following treatment options:
Lifestyle changes
A healthier lifestyle may be all the treatment that is required. This may mean cutting down on smoking and alcohol, eating a healthy diet, incorporating exercise into your lifestyle and reducing stress.
Changing medications
Replacing prescription medicines that can cause erection problems with ones that are less likely to do so may be all that's needed. It is very important that a qualified doctor is involved with your diagnosis and treatment, as they will be able to undertake a full medical assessment and explore factors that may be contributing to your erectile dysfunction. Your doctor will be able to identify the appropriate treatment for your erectile dysfunction, as well as prescribe suitable medications for any other conditions.
Counselling and psychotherapy
While erectile dysfunction usually has a physical cause, it often has emotional impacts. Talk to your doctor and your partner if you need support and advice. Sometimes erectile dysfunction is the direct result of an emotional situation without a physical cause. You might find it useful to talk to a sexual health or relationship counsellor. You can attend sessions with or without your partner.
Oral therapy
Oral therapy is the most commonly prescribed treatment for erection problems. Oral erectile dysfunction therapies work by helping relax the blood vessels in your penis when you're sexually aroused. This increases blood flow in the erectile tissue of your penis, allowing you to get an erection and to keep your erection long enough to enjoy sexual intercourse or sex.
Many men may need to use oral treatments several times before feeling confident and gaining maximum benefit from them. Some men will stop taking tablets after only one or two doses, thinking that it just doesn't work for them. You may have more success if you talk through any problems with your doctor.
You should only obtain these tablets on prescription from your doctor and purchase them from your pharmacist.
Hormone therapy
In a small number of cases, erection problems can be caused by a hormonal imbalance. This must be diagnosed by your doctor through blood tests. In such cases, it may be possible to restore hormone levels by an appropriate hormone therapy such as testosterone replacement therapy.
Self-administered injections
This treatment involves injecting a medicine directly into the base of the penis (intracavernosal injection). An intracavernosal injection relaxes the blood vessels, increasing blood flow into the penis, and making it easier for men to have an erection. After learning the procedure, men and/or their partners find it fairly easy to administer the injection.
Mechanical devices (vacuum pumps)
In some cases, a doctor will prescribe a vacuum constriction device for men with an erection problem. This consists of a plastic cylinder which is placed over the penis. Air is then pumped out with an attached pump. This creates a vacuum, drawing blood into the penis leading to an erection. The erection is maintained by trapping the blood in the penis with a constricting band at the base of the penis. This treatment has a high rate of success.
Surgery (prosthetic implants)
Penile implants are suitable only for a small number of men in whom all other treatments have failed or are unsatisfactory. Surgery requires a referral to a urologist, who will assess whether your erection problem is suitable for surgery and discuss details of the operation.
Severe curvature of the penis (called Peyronie's Disease) may interfere with intercourse and this condition can also be surgically corrected.
Counterfeit medications
The relatively recent discovery of oral therapies has transformed the treatment of erectile dysfunction for millions of men. The dark side, however, has been the growth of a harmful and illegal counterfeiting industry. The only way to ensure you are getting a genuine treatment for your erection problem – one that is safe and legal – is to talk to your doctor and get a prescription.
Don't be tempted to bypass your doctor and get treatment another way – through illegitimate websites, emails or friends. While the prices of these medications may appear cheaper than that purchased from a pharmacy with a prescription, many are likely to be substandard or fake. It is not unusual for these products to contain too much or too little active ingredient, the wrong active ingredient or no active ingredient at all. These products may not have been subjected to the stringent quality and safety checks undergone by licensed manufacturers of legitimate medications, and taking them could have serious consequences for your health.
Is This You?
Your Relationship
Erectile dysfunction can affect your emotional and psychological well-being, and can impact on relationship satisfaction for both you and your partner.
Indeed, erectile problems may diminish willingness to initiate sexual relationships because of fear of inadequate sexual performance or rejection.
While erectile dysfunction isn't usually caused by a relationship problem, it may lead to problems down the track. Especially if it isn't understood or handled in the right way. Your partner may think you're not attracted to them any more, or it's something they've done. But it's important to remember that the majority of cases of erectile dysfunction are associated with a physical condition. Relationship problems need to be recognised and attempts made to resolve them as part of the treatment for erectile problems. By talking opening and honestly about the problem, you can get through it together. Seeking treatment for erectile dysfunction is the first step that may get your love life back on track.
Your Partner
Erectile dysfunction doesn't only affect you – it can have a profound effect on your partner.
Sharing Is Caring
Erectile dysfunction should be regarded as a shared sexual problem, which affects both you and your partner. It will help if you are both motivated to resolve the problem. Get your partner involved from the start. It's a good idea to go to the doctor together, that way you will both get a clear idea of the condition and the treatments that are available. With a good understanding of the problem and how the treatment should work, couples can work together to achieve a positive result. It's widely accepted that a partner plays a key supportive role in success. Understanding is the key to getting back the 'old you'.
Bring back the spark to your relationship
Re-establishing intimacy with your partner is important to the success of your treatment.
Rekindling intimacy is never easy. So put the phone on silent, switch off the computer, leave work behind and make time to be with each other. Save external distractions such as work or finances for another day and do something as a couple which makes being together feel good again. This could be as simple as a walk on the beach, a candle-lit dinner or a sensual massage.
As you feel more secure and accepted by your partner, you will also feel more able to talk to them; this is fundamental to overcoming sexual problems. If your GP has prescribed treatment for your erectile dysfunction; discuss how you and your partner can integrate it into your sex life. Only once you are feeling more comfortable with each other, should you think about having sexual intercourse.
Start Talking And Stop Worrying
Although most cases of erectile dysfunction are associated with a physical condition, erection problems can easily be mistaken as a loss of attraction or interest by your partner.
Be open and communicative about your sex life. Talking openly and honestly with each other about what you want can help make sure the channels of sexual communication are open.
For some men, talking about 'problems down there' can be difficult. But remember, talking openly also gives you both a chance to air any other issues which may be affecting your relationship.
Learning to feel comfortable talking about erectile dysfunction with your partner may take some time. But don't give up. Good communication is essential to improving your sex life and relationship quality.
How to talk to your partner about ED
Don't know where to start? Here are some ways you might start a conversation:
I don't think our sex life is all that it could be
I know things haven't been the best in the bedroom, but I think I know a way we can change that
You're probably as frustrated as I am with our sex life. How about we go and see the doctor to see what we can do about it?
I've heard there are some great treatments that may help our sex life
Take Action
Although up to 39% of Australian men have some kind of erection problem, less than 12% will see a GP for treatment.*
As a result, many men miss out on a solution to their erectile dysfunction because they are too embarrassed to talk to their doctor.
* Study of 1240 men aged 18 years and over presenting to Australian general practices.
Get your old self back
If you've been having problems either achieving or maintaining an erection, it's nothing to be embarrassed about. There are treatments that have helped thousands of men in your situation. Not all treatments are suitable for everyone. To find out which one is right for you, you need to talk to your doctor.
Get your questions ready
You may have many questions about your erectile dysfunction. Why has it happened, why you, and why now? Don't let embarrassment stand in the way of you enjoying a satisfying sex life. Your problem may be related to another medical issue and, for doctors, erection problems are just another of the many medical conditions they treat every day.
There is no right or wrong way to bring up the subject. What is important is to take that first step and ask for help.
Remember, you're not alone. Millions of men have already had THAT awkward conversation with their GP.
Need some help getting started?
Here are some ways you might start a conversation about erectile dysfunction with your GP.
Get the most from your visit to the doctor
Your doctor will want to find out all about your erection problems to work out what's causing them and how best to manage them.
Your doctor will ask you some questions about your sex life and general health. You will be given a physical examination and your doctor may order some additional tests.
Whatever the problem, your doctor will help you to find the best way to manage it. Your doctor may be able to tell you why you are having problems with your erections, or he or she may refer you to a specialist if more information is needed.
There are several different types of treatment. How your doctor decides to treat you will depend on the cause of your erection problems. Together, you and your doctor will choose the one most likely to help get your sex life back on track.
Questions Your GP Might Ask You
Your doctor may ask you some questions about your sex life and general health in order to find out more about your erection problems.
Some questions you may be asked about your sex life:
- What happens when you try to have sex?
- Do you find it difficult to get or keep an erection long enough for sex?
- How long have you been having problems?
- Did the problem happen suddenly or gradually?
- How often can you get an erection firm enough to have satisfying sex?
- Do you still get early morning erections?
- Have you lost interest in sex?
- Some questions you may be asked about your health in general:
- Do you have any other medical conditions?
- Are you taking any medicines?
- Have you had any surgery?
- How much alcohol do you drink; do you smoke; do you exercise; what's your diet like; how well do you sleep?
- Do any members of your family have medical conditions e.g. diabetes?
Getting A Check Up
Your doctor may give you a physical examination to help work out why your erections are letting you down.
Your doctor may check your...
- blood pressure
- thyroid (by looking at your neck)
- abdomen
- genitals (for any problems with your penis)
- prostate
Tests You May Have
Your doctor may order blood or urine tests to help him or her understand why you're having erection problems and to check whether you have any other medical conditions.
Your doctor may test...
- your blood sugar
- your cholesterol levels
- the health of your liver, kidney and thyroid
- the levels of the male hormone testosterone, and perhaps some other hormones
Erectile dysfunction is a very common presentation in my clinical practice. In fact every man will have problems with erections at some time in his life. It's only if the erection difficulties become persistent that it is considered to be a sexual dysfunction. Erectile dysfunction can affect men of all ages but it has been estimated that up to half of men aged 40 to 70 experience some degree of erectile dysfunction. However, men find it difficult to seek help for erectile dysfunction. Studies have shown that in Australia less than 15% of men with erectile dysfunction are receiving treatment.
In my practice, men presenting with physical erectile dysfunction often have high blood pressure or high cholesterol. They may be obese, diabetic or cigarette smokers. They often lead sedentary lifestyles and don't get much exercise. They may have low testosterone levels. Some men have erectile dysfunction due to the medications they are taking such as antidepressants or antipsychotics.
Men who present with erectile dysfunction that is mainly psychological can have a range of underlying problems. Stress, relationship discord, depression, performance anxiety, grief and even financial worries can negatively affect erectile function.
My first task is to make a correct diagnosis. I take a full medical history from the patient including all health problems and medications, lifestyle habits like drinking alcohol and smoking, and a family history. Many men who think they have erectile dysfunction actually have other sexual problems, such as loss of libido or premature ejaculation. These problems require treatment that differs from erectile dysfunction therapies. My next step is to decide if the problem is mainly physical or psychological. I ask how long the problem has been present; if it came on gradually or suddenly and if the problem is there all the time or if it is intermittent. I ask about all erections: how hard is the erection when he is with his partner – for example can he still penetrate and have intercourse? Does the man wake with a firm erection in the morning? Are his erections firm when he self stimulates? These questions help me make the diagnosis. I also ask about premature ejaculation and loss of sexual desire.
My first piece of advice is to avoid talking about erection problems at the end of a consultation for some other condition. By then the doctor is usually pressed for time and will not be able to deal with the issue then and there. Make an appointment to talk specifically about erectile dysfunction and say to your doctor something simple like, "My sex life is not what it used to be..." The doctor can take it from there. Remember doctors are used to talking to their patients about sexual problems – it's part of their daily routine, so don't be embarrassed. Your GP may help many men with sexual problems in the course of their daily practice.
Sometimes the partner comes with the man and other times he comes alone. I really appreciate seeing the partner as well. The partner has shared the problem and is usually keen to share in the solution as well. In addition, when you are seeing a doctor about a sensitive issue like erectile dysfunction it can help to have two pairs of ears to listen to the information given by your doctor. You will be discussing treatment options and how to use them, and two heads are often better than one when it comes to remembering the details. Also, your partner may have some questions or concerns that she wants to discuss. However, there are some men who do not want their partners to know that they are being treated for erectile dysfunction.
What's good for your health is also good for your erection so leading a healthy lifestyle is of paramount importance if you want to keep your sex life going. Simple measures like keeping your weight down through regular exercise and a healthy diet can help to maintain erectile function. Avoid smoking at all costs – I tell my patients that smoking is sexual suicide! Cigarette smoking blocks the arteries that supply blood to your erections and smokers are far more likely to experience erectile dysfunction than non-smokers. Try to limit your alcohol intake and avoid recreational drugs as well. Finally, spend time enjoying yourself with your partner – a happy relationship is good for your health and good for your sex life too.
I have been a GP in my area for more than 20 years. I know my patients and they wait to see me by appointment. This means I can be direct yet tactful with them about most issues including sexual problems such as erectile dysfunction. I estimate that about 40% of men over 40 years of age and about 70% of men over 70 years of age have erectile dysfunction. Managing erectile dysfunction in my patients is very satisfying, when successful, as they are very grateful for the improvement in their sex life and relationships, as well as in their general health.
The most common causes of erectile dysfunction that I encounter in my practice are diabetes, high blood pressure, enlarged prostate, depression, stress and overwork, drugs, alcohol and psychological issues.
Not all treatments will work for everyone, however it is important to ensure adequate trial of a drug treatment (PDE5 inhibitor tablet), at the maximum effective dose, before deciding it is ineffective.
Questions that I ask my patients when they see me about erection problems include: How long have they noticed this problem? Did it come on suddenly or slowly? Does it occur all the time or only sometimes? Do their erections differ between morning and night, and with masturbation? I also ask about their relationship and their partners' reaction.
The approach most of my patients take is to ask about the medications available for erectile dysfunction.
Most of my patients do not bring their partners and I feel it is really up to the patient to decide.
Healthy lifestyle and good health include addressing serious problems such as diabetes, as well as avoiding smoking, alcohol abuse and stress. It is also important to have realistic goals for lovemaking and performance.
The main causes of erectile dysfunction that I see in my clinical practice are vascular-related – hypertension (high blood pressure), hyperlipidaemia (high cholesterol and lipids), hyperglycaemia (high blood sugar, associated with diabetes); increased central adiposity (overweight) and smoking.
We have many different treatments for erectile dysfunction and these treatments need to be tailored to the individual patient. It is also important to remember that many patients do not respond immediately to an oral erectile dysfunction treatment (PDE5 inhibitor tablet) and so they should persevere at least 4 times with a particular brand of treatment before declaring it unsuccessful.
I ask my patients about the duration of the problem; the quality of all their erections, including night time erections; other sexual difficulties they may be having such as desire or ejaculation problems; relationship issues; other medical and surgical history; their lifestyle; and any current medications they may be taking.
Unfortunately, very few patients book a dedicated appointment time to discuss erectile dysfunction. Most patients mention it at the end of a consultation when there is usually insufficient time to deal with the issue adequately. It's important that patients book dedicated appointment times with their GP to discuss sexual issues.
Sexual problems are a couple's problem, so it is very important that they're dealt with as a couple – I always encourage my patients to bring their partners along.
The lifestyle risk factors leading to cardiovascular disease are the same ones that lead to erectile dysfunction. General health and lifestyle changes that will lead to lower blood pressure, lower cholesterol, lower blood sugar, lower waist circumference and increased physical activity have all been shown to improve erectile function.