For many older men, impotence is treatable without drugs
Losing weight, eating better, getting more active, drinking less alcohol and getting better sleep can all help reverse problems that contribute to impotence, according to a new study published recently in the Journal of Sexual Medicine.
Erectile dysfunction and low sexual desire is often linked to the development of heart disease. The researchers discovered that a large proportion of men were able to naturally overcome erectile dysfunction with heart-healthy changes—no pharmaceutical help necessary.
What's more, focusing on lifestyle change helps ensure an overall healthier and longer life, the researchers added.
While one of the biggest factors contributing to impotence is advancing age, other factors seem to play an even greater role in the development of the problem, explained study lead author Dr. Gary Wittert. Besides, because a significant number of men maintain erectile function into advanced age, it's unlikely that getting older, in and of itself, is the cause of sexual dysfunction, he said.
Instead, impotence seems to be typically related to an unhealthy lifestyle.
"It is always worth reducing obesity, improving nutrition and getting more exercise—firstly, because health and well-being improve and overall cardiovascular risk and risk of diabetes will be reduced," said Wittert, a professor and director of Freemasons Foundation Centre for Men's Health at the University of Adelaide, in Australia.
What's the connection between impotence and heart health? "An erection is a hydraulic event dependent on the dilation of blood vessels that carry blood to the penis," explained Wittert. "These blood vessels are similar to those that supply blood to the heart muscle."
Although other issues such as nerve damage and hormone abnormalities can also lead to erectile dysfunction, the failure of the blood vessels to dilate properly is one of the more common causes, Wittert said. "This is an early abnormality in the pathway to more serious heart disease."
For the study, data was collected from more than 800 randomly selected Australian men, 35 to 80 years old at the beginning of the study, with follow-up five years later. Sexual desire was assessed using a standard questionnaire that addressed interest in engaging with another person in sexual activity, interest in engaging in sexual behavior by oneself, and no interest in sexual intimacy.
Erectile function was also assessed using a standard scoring system. The researchers took factors such as height, weight, blood pressure, hand grip strength, amount of body fat, age, education, marital status, occupation and smoking behavior into account. Depression, the probability of obstructive sleep apnea, medication usage, diet and alcohol consumption, and physical activity were also assessed, as were blood levels of glucose, triglycerides (an unhealthy blood fat) and cholesterol.
People whose health habits and lifestyle improved during the study period tended to see an improvement in sexual function, Wittert's team reported. And the reverse was true: those whose health habits and lifestyle deteriorated during the five years were more likely to experience impotence.
One expert said the study carries valuable lessons for men worried about their sexual health.
"As we get older, there are some natural things we just can't change. The message from this study is, don't get a prescription, but get exercise. Get rid of the fat. Work on the depression," said Dr. David Samadi, chairman of the department of urology at Lenox Hill Hospital, New York.
Samadi, who was not involved in the research, warned that a prescription is not as good as a fundamental lifestyle change. "Long-term, medication is not the answer unless you take care of the high blood pressure or high cholesterol or diabetes," he said. "Medication works well for those who cannot make the necessary changes, but drugs should not be the first line of treatment."
Yet Wittert, the researcher, isn't against using medication to treat sexual dysfunction. However, he said he tries to encourage men to tackle their lifestyle issues at the same time. He recommends using drugs to initially solve the problem, and then begin to modify lifestyle and risk factors. Healthier living can make impotence drugs more effective or make them less necessary, and a better lifestyle also tends to increase sexual desire, Wittert said.
Both experts agree that there are many indirect causes of sexual dysfunction and low sex drive. The best bet is to prevent or treat the underlying disease, they said.
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