DEAR DOCTOR K: I'm a man in my mid-60s. Lately I've been unable to perform sexually. Are there non-drug strategies I can try before turning to medication?
DEAR READER: Even if you'd prefer to handle this drug-free, start with a trip to your doctor. There may be a straightforward explanation for your erectile dysfunction (ED), such as a side effect of medication. If this is the case, maybe the drug can be discontinued or a new one substituted that is less likely to produce ED.
If the cause is uncertain, the following lifestyle changes may help:
-- Start walking. Just 30 minutes of walking a day reduces your risk for ED. I've had several patients tell me that their erectile dysfunction disappeared after they started a moderate exercise program -- without any drugs.
-- Eat right. Make sure you're getting enough vitamin B-12, which can be found in multivitamins, fortified foods, salmon, beef and yogurt. A simple blood test can tell if your level of vitamin B-12 is low. A deficiency can cause ED.
-- Check your vascular health. The penis becomes erect because more blood enters it and causes it to swell. If the blood supply to the penis is impaired because of atherosclerosis in the arteries carrying blood to the penis, it can cause erectile dysfunction. Risk factors for poor vascular health include high levels of blood pressure, blood sugar (because of diabetes), LDL (bad) cholesterol and triglycerides.
-- Diabetes. People with diabetes are more likely to have atherosclerosis of the arteries supplying blood to the penis. They also are more likely to have neuropathy, or damage to the nerves that control how much blood enters and leaves the penis. So diabetes can be a double whammy. If you have diabetes, controlling your blood sugar can help slow the neuropathy.
-- Trim your waistline and slim down. A man with a 42-inch waist is much more likely to have ED than one with a 32-inch waist. Obesity raises risks for vascular disease and diabetes, two major causes of ED. Slimming down, along with the regular exercise that it usually takes to do so, can improve sexual function.
-- Move a muscle. Strong pelvic floor muscles support erections. Kegel exercises strengthen these muscles and may help restore normal erectile function. Locate your pelvic floor muscles by pretending to avoid passing gas. Tighten up, hold and release these muscles several times a day.
If psychological factors or tensions with your partner are contributing to your ED, counseling may help you and your partner deal with the tensions.
We have more information on erectile dysfunction in our Special Health Report, "What to Do About Erectile Dysfunction." Learn more about this report at AskDoctorK.com, or call 877-649-9457 toll-free to order it.
If these lifestyle changes don't get things moving in the right direction, you may have to talk to your doctor about medication.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.
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