A Real Guy Offers Advice on How to Beat ED
One man shares how erectile dysfunction let him down—until a life-changing treatment raised his spirits and sexual performance.by Matt McMillen Health Writer
When Jimmy Williams got married a few years back, he wanted what every guy wants: to spend quality time between the sheets with his new wife. But Williams, 61, who hails from Staten Island, NY, had erectile dysfunction, or ED. The problem had been developing for the previous three to four years as a side effect from having diabetes. His relationship gave him an urgent reason to finally address it.
“I was trying to perform with my wife, and I didn’t want us to have a bad experience,” he says.
Sound familiar? If so, you’re far from alone. According to the American Urological Association, ED is the most common sex problem that men talk about with their doctors. But while an estimated 30 million American men have erectile dysfunction, few openly discuss their experiences with other guys. That’s why Williams is being so frank now. He wants to share what happened to him, and explain how treatment for ED changed his life—and maybe even saved his new marriage.
Many Guys Suffer Silently With ED
So, what is ED, exactly? It’s not the occasional failure to launch caused by stress, too much to drink that night, or a host of other temporary roadblocks to erections. That’s normal, if frustrating. ED, on the other hand, spoils the party on a regular basis. When you’re ready for sex, you have trouble getting or maintaining a sufficient erection.
That’s what was happening to Williams.
“I was at a desperate point,” Williams admits now. “I was disheartened, I didn’t have confidence, and there was a hopelessness about achieving sexual activity with my wife.”
An appointment with a urologist for an unrelated bladder problem led to his ED diagnosis. The doctor asked him about his sex life.
“I ask all my patients in Jimmy’s age range how things are going down there,” says Williams’s doctor, urologist Miguel A. Pineda, M.D., director of Male Sexual Dysfunction and Urologic Prosthetics at Staten Island University Hospital. “When I learned that Jimmy had ED, I said this is something that I can help you with, and we just jumped right in.”
It helps to have a doctor who raises the topic like that, but if your doc doesn’t, it’s up to you. That can be hard for a lot of guys who feel uncomfortable talking about what happens in the bedroom. Maybe this will help encourage you: There are many effective options exist to help you get your groove back—you've just got to ask.
“When guys learn that, the room kind of lightens,” says urologist Bob Berookhim, M.D., director of Male Fertility and Microsurgery at Lenox Hill Hospital in New York City. “The guy perks up and is much more willing to have a conversation about it.”
What Can Get in the Way of a Guy “Getting It Up”?
Why does ED happen? It will help to first understand the basics of how erections work.
When you get turned on, your brain sends signals that trigger an increase of blood flow below your belt.
Two chambers in your penis—called the corpus cavernosum—relax.
The spongy tissue inside those chambers fills with blood and holds it there, causing you to become erect, ideally until you have an orgasm.
Many things can get in the way, says Jamin Brahmbhatt, M.D., a urologist at Orlando Health in Orlando, FL. Anxiety and depression, for starters, as well as some of the drugs that treat those conditions, can compromise your ability to get and stay hard. Stress is a common cause, too. Like anxiety and depression, stress interrupts your brain’s messaging system, so sufficient blood does not make it to your penis. Stress is particularly prevalent right now. “I’ve seen an uptick in men with sexual dysfunction during the COVID pandemic," Dr. Brahmbhatt says. "It’s caused by a psychological impact on their sexual function.”
Who Gets ED, and How Does a Guy Get It Diagnosed?
If you’re a younger man, say in your 30s, such psychological issues likely will be among the first causes your doctor will investigate. Your doctor also may check your testosterone levels to determine whether a hormone imbalance is to blame. Though low testosterone itself rarely causes ED on its own, it can dampen your desire for sex, and that can make getting an erection difficult.
ED also can be a side effect of medications, including some that treat high blood pressure, depression, and anxiety. Once you get off the medication causing the problem, normal erections generally return right away, if the medication was the only factor. Here are a few examples of drugs that may affect your ability to get an erection.
Blood pressure medications that can cause ED include:
Antidepressants and anti-anxiety drugs that can cause ED include:
Erectile dysfunction can also be a consequence, often temporary, of surgical treatment for prostate cancer or an enlarged prostate. Prostate surgery can take several weeks to several months to recover from. For some men who have surgery for prostate cancer, nerves that help control erections will have to be removed along with the prostate. To regain the ability to have an erection, such men may require a penile implant (more on that in a moment).
But at Williams’s age and older, other causes become more common. Heart disease and diabetes often accompany ED because they damage the small and fragile blood vessels that supply blood to your penis. In fact, as many as 85% of men with diabetes have erection troubles.
“When we see older men with ED, we think heart disease, diabetes, high blood pressure, high cholesterol, and smoking,” says Dr. Berookhim.
Dr. Pineda agrees. When he sees a man whom he expects has ED due to blood vessel damage, he’ll treat him for ED but also refer him to a cardiologist to have his heart health evaluated.
But the heart-erection connection isn't just an age issue, Dr. Brahmbhatt says. When ED occurs in younger men, especially those who are obese, it may also indicate future heart problems. “It’s important we get young men to discuss their ED at an early age because it can often be a warning sign for silent heart conditions,” he adds. That means that you may be developing heart disease but have no other symptoms yet.
What Can a Guy Expect From ED Treatments?
If your doctor discovers that your ED is caused by a medication you’re taking, solving your problem may be as simple as switching to a different drug, if possible. Psychological counseling can ease depression and anxiety, if either is what’s causing your ED.
Lifestyle changes, such as weight loss, exercise, and a nutritious diet, can help prevent or limit damage to your blood vessels and may protect your ability to have an erection. But if that damage has already occurred, says Dr. Pineda, lifestyle improvements may keep ED from getting worse, but it won’t repair the damage itself. You will likely need treatment, possibly one of these options:
Oral medications that boost blood flow to the penis are often the first-line defense for treating ED. They belong to a class of drugs called PDE5 inhibitors. You may recognize the name Viagra (sildenafil) as the best-known of the lot, but other pills do pretty much the same thing. They are Cialis (tadalafil), Levitra (vardenafil) and Stendra (avanafil). While they tend to do the job of increasing blood flow well, these drugs don’t allow for a lot of sexual spontaneity. You may have to wait as long as an hour for them to take effect. And you can only use them every 48 hours.
You may also experience side effects, like headaches, which was one reason Williams stopped using them. Muscle aches may also occur. And they should not be taken if you’re already on nitrates for heart disease—taken together, this combo may suddenly lower your blood pressure and cause you to faint.
Also, for some men, they don’t work well enough, Dr. Pineda says. “They may get you an erection that’s sufficient for penetration, but their penis remains half soft so sex is not that pleasurable,” he explains.
Another potential downside? Dr. Pineda also says that even if the meds work well now, they might not work forever. If the blood vessels that supply blood to your penis continue to deteriorate (due to diabetes or heart disease, for instance), you may need to try another option. With his diabetes, that’s the direction Williams was heading.
These are for men who find PDE5 inhibitors ineffective or don’t like the side effects. Williams tried them as an alternative to pills. The most commonly injected drug is called Caverject Impulse (alprostadil). Like the pills, it works by increasing blood flow to the penis. However, injections—which go directly into your penis—act much more quickly than pills (which are taken by mouth, and must be first digested and absorbed into the bloodstream). After a shot, you should have an erection in under 20 minutes, according to Dr. Pineda, possibly as quickly as five minutes.
However, you may not love the idea of injecting your penis. That’s understandable. Still, the needle is small and thin, and the drug is very effective. The American Urological Association estimates that it enables erections in 85% of men who use it.
The side effects can include pain and scarring at the injection site. Your erection should last about 30 minutes or until you orgasm. If it doesn’t go away after two to four hours, Dr. Pineda advises that you head to the emergency room. Why? Because long-lasting erections can cause damage that may make your ED untreatable.
Williams did not take injections for long. He felt throbbing at the injection site, which Dr. Pineda says is not common.
Another drug, called Muse (alprostadil), is used for injections, but it also comes as a tiny suppository, which is inserted into the head of your penis. It goes to work as it dissolves. More appealing, perhaps, than an injection, but research shows that it may not be as effective.
This tube-shaped tool fits over your penis with an air-tight seal. Negative pressure draws blood into your penis to give you an erection, and then an elastic band is fitted to the base of your penis to hold the blood in. That keeps you erect. While effective, Dr. Pineda says that these devices are cumbersome and can be uncomfortable. The advantage? No medication or surgery needed. Williams says he skipped this option altogether—it just wasn’t for him.
Speaking of surgery, the final option for ED is a penile prosthetic implant. These are for men who have exhausted other treatment options. According to the Cleveland Clinic, the most commonly used implant consists of three parts. Surgery requires a general anesthesia or spinal anesthesia, which prevents pain in your lower body, and will take about an hour.
During the procedure, your doctor will make an incision in one of three places: just below the head of your penis, at the base of your penis, or in the lower part of your abdomen. Two inflatable cylinders are then implanted inside your penis. They will serve the same purpose as your corpora cavernosa, the spongy cylinders that normally fill with blood as you become erect.
Your surgeon will also implant a fluid-filled pouch near your bladder. This will connect to the two artificial cylinders as well as to the third part of your prosthetic, a pump which is placed inside your scrotum. When you want to have an erection, you squeeze and release the pump until the cylinders have filled with fluid. In under two minutes, you have an erection.
“You can be very spontaneous when you can get an erection that fast,” says Dr. Pineda.
In the end, Williams opted for one of these. He admits that he was apprehensive at first. The idea of surgery down there gave him pause. But after a few discussions with Dr. Pineda, he gave it the green light.
Now, he couldn’t be happier. “It does the job better than a real penis,” he says. “You don’t realize there’s something inflatable in there. It’s that realistic to me.”
Dr. Pineda says that implants in no way lessen the pleasure of sex. He also offers another advantage: You can go all night. When you inflate it, it stays inflated, even after you ejaculate. Williams concurs.
“I’m not trying to make light of it, but it’s like the Energizer Bunny,” Williams enthuses. “You can go on and on and on until you deflate it yourself. You have that option. It’s given me a new lease on life.”
Erectile Dysfunction (1.): American Urological Association. (2018). “What is Erectile Dysfunction?” urologyhealth.org/urology-a-z/e/erectile-dysfunction-(ed)
Erectile Dysfunction (2.): American Urological Association. (2018). “Erectile Dysfunction: AUA Guideline (2018).” auanet.org/guidelines/erectile-dysfunction-(ed)-guideline
Erectile Dysfunction (3.): Cleveland Clinic. (2019). “Erectile Dysfunction.” my.clevelandclinic.org/health/diseases/10035-erectile-dysfunction
Erectile Dysfunction (4.): Johns Hopkins. (n.d.). “Erectile Dysfunction.” hopkinsmedicine.org/health/conditions-and-diseases/erectile-dysfunction
Erectile Dysfunction (5.): The National Institute of Diabetes and Digestive and Kidney Diseases. (2017). “Erectile Dysfunction (ED).” niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction