Erectile Dysfunction Couple Embracing On Beach by Salt Aesthetics bar in Wilmington

In this blog post about erectile dysfunction, sexual health expert, Sara Tennant discusses causes and treatments for ED. Have you ever played a game with your friends where you have to list all the slang terms for getting an erection? Give it a try – a boner, a…hard on, a stiffy, a chubby, pitching a tent, morning wood, or even a party in your pants. I am sure that the list can go on and on and will bring a lot of laughter. You know what is not a fun game? The dreaded ED or erectile dysfunction that ruins a good time for all parties involved. It can be a man’s worst nightmare when you are no longer able to obtain or maintain the erection that you want when it comes down to getting busy, doing the nasty, bumping uglies or doing the horizontal mambo.

Here is the sad truth. ED affects over 30 million American men (Current Opinion in Nephrology and Hypertension, 2012) and that is just the men that are willing to open up and admit there is a problem. This number is expected to increase significantly over time.

A common misconception is that it only happens to older men. However, about 26% of men under the age of 40 have been affected as well according to The Journal of Sexual Medicine, 2013. Erectile dysfunction doesn’t just mean that you can’t “rise to the occasion” but can be many variables of this. There are many different scenarios for example you may not be able to get firm enough to penetrate; you may be able to obtain an erection but you lose it before climax; you may lose your erection as soon as you change positions or you may ejaculate within a minute of beginning intercourse.

Any of these scenarios are far from the ideal for you and your partner when it comes to have a satisfying sexual relationship.

Causes of Erectile Dysfunction: Why is this happening to me?


They are sometimes a necessary evil. There are many causes of erectile dysfunction but medications top the list as a deterrent to a healthy erection. Medication for high blood pressure is probably the number one medication responsible for erectile dysfunction. DO NOT stop taking your blood pressure medication in the hopes that your erections will come back because uncontrolled hypertension is worse for ED and has many other ramifications.

Unfortunately, certain antidepressants known as SSRI’s can also lead to ED. An important class of medication but with many sexual side effects not limited to ED, premature ejaculation, delayed ejaculation, and difficulty reaching orgasm. There are certain medications that can help treat depression and have less side effects and less effect on your sex life. Be sure to discuss this with your provider.

Prescription pain medications like Percocet, Vicodin, and Suboxone will drive down your testosterone levels making an erection almost impossible.

Low Testosterone

A Game Changer Testosterone is a conversation on its own but it is definitely a piece to the puzzle when it comes to ED. Having suboptimal testosterone can be a big reason for a lot of the scenarios of failure in the bedroom. It causes low desire, low arousal, depressed mood and decreased ability to obtain and maintain an erection. Low testosterone can also be a reason for premature ejaculation. It has many effects outside of sexual side effects including sleep, muscle tone and ability to decrease fat and your mental and emotional health and well-being. Hormone optimization is essential to give yourself your best chance at obtaining and maintaining a satisfying erection.

Alcohol and Smoking

When you are 20 years old and go out drinking and come home to get lucky you can have an all nighter and still not reach climax. However, as you get older, that is no longer the scenario. It is much more difficult to even obtain an erection after a few drinks even if you don’t necessarily have a problem with erections. In fact, this is a scenario that has driven many young men to my office with concerns that they have a problem. Alcohol also tends to make medications like Viagra and Cialis ineffective. Smoking causes vascular damage and yes this means to the vessels that feed blood to the penis causing an erection. Put the cigarettes down and walk away to save your erections.

Venous Leak and Peyronie’s Disease

What the heck are those?? You need to have proper blood flow to get an erection but you also need to be able to hold blood in the penis to maintain this erection. This is a frustrating scenario where you are able to get an erection and get things started but as soon as you decide to change positions you lose your erection almost like the air is leaking out of a tire. This is known as a venous leak meaning that the veins in the penis cannot store blood in the penis to keep an erection. This can happen with peripheral arterial disease, diabetes, anxiety and Peyronie’s disease (curved penis). What is this Peyronie’s disease you speak of? This is where the penis becomes curved to the point where penetration is not comfortable for you or your partner or even painful when you attempt an erection. 

Underlying or Untreated Medical Problems

If you are under the age of 40 and do not have any known underlying medical problems and you do not smoke and alcohol or a venous leak is not your scenario then being tested for underlying heart disease is always a good next step. Diabetes is another silent killer of erections. If your sugars are not well-controlled then you can expect that your erections will be affected and not what you want them to be in the bedroom. Pornography and/or excessive masturbation is an underlying not commonly discussed reason for erectile dysfunction.

Treatment Options for Erectile Dysfunction: Is there hope for me?

YES!! There are so many options for treatment for all of these scenarios listed above. First things first; get all medical problems under control. Medications are sometimes unavoidable to control various disease states so if you need them then take them. Eat a healthy, well-balanced diet. Get plenty of fruits and vegetables and lean protein. Do not let the high-fat and sugary foods get out of control. Drink plenty of water and limit caffeine. Avoid alcohol, smoking and recreational drugs. Get 30 minutes of exercise at least 5 days per week. Cardio and resistance training are equally important as we age. “But I have already tried Viagra and it does not work”. Well, my friends, there are some more medication options aside from Viagra and Cialis so don’t limit yourself to only these. Continue reading to learn about treatment options for erectile dysfunction.

Oral medications

Viagra, Cialis, Levitra, Stendra and now the generics Sildenafil and Tadalafil are a great stepping stone. There are also some great supplements that can help in mild cases of ED. There also compounded medications outside of the standard approved medications that have been extremely successful. These medications need to be taken typically on an empty stomach for faster results or at the very least not after a heavy meal or you may not get that erection until the moment has already passed you by. These medications also do not tend to work well with alcohol so wait to have your drinks until after you have had your bedroom time.

The External Vacuum Device

AKA “the penis pump” – You may remember the Austin Power’s movie where they were making jokes about the pump. However, when used appropriately this can offer a significant improvement in size, girth and function. You exercise your body and you exercise your mind now you need to exercise your penis.


You want me to stick a needle where!?!??!?! I completely understand that this idea is intimidating and scary as hell at first but there are some great medications that when used with the tiniest needle can deliver amazing results quickly. These can be used safely for those that are not allowed to take medications like Viagra or Cialis due to heart conditions or interactions with other medications.

Peptide Therapy

If you aren’t crazy about an injection into your manhood then maybe a small injection into your stomach is more appealing. PT- 141 is a peptide that works for ED in 80% of men that failed Viagra or Cialis.


This is commonly known as the P-shot that was created by Dr. Charles Runels. Platelet rich plasma injections use your body’s own healing properties to improve vascularity and blood flow improving the function and in some cases the size and girth of the penis. This procedure can be done in the office within an hour and has no down time.

I have close to a decade of experience in treating Erectile Dysfunction and can help when Viagra and Cialis no longer do. There are so many options as you can see above and I would love to sit down and come up with a plan to get you back to where you want to be with your erections.

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