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No need to be in your flop era.
Between 30 million and 50 million men in the US have erectile dysfunction (ED) — defined as difficulty getting and keeping an erection — including a staggering 70% of men over 70.
Two physicians explained to The Post what’s behind this common condition — and how to get your mojo back.
What causes erectile dysfunction?
Flaccidity is often caused by blood flow issues stemming from hardened arteries, high blood pressure, high cholesterol and smoking.
Nerve damage that disrupts signals from the brain or spinal cord to the muscles is also a major factor.
“A normal erection requires coordination between the brain, hormones, nerves, blood vessels and smooth muscle. Any disruption in that pathway can cause erectile dysfunction,” Dr. Justin Houman, of Tower Urology at Cedars-Sinai, told The Post.
Metabolic, hormonal and neurological disorders can interrupt these important nerve signals.
Diabetes, for instance, is a metabolic disorder characterized by high blood sugar, which can damage nerves and blood vessels essential for erections.
“Medications, including blood pressure drugs, antidepressants and chemotherapy agents, can cause erectile dysfunction,” Houman added.
“Pelvic surgery, obesity, sleep apnea, chronic kidney or liver disease and smoking also increase risk, while psychological factors like depression, anxiety and relationship stress can trigger or worsen erectile dysfunction.”
Can you be attracted to your partner but still have ED?
“This is a very common complaint,” Dr. Jay Amin, a urologist at Orlando Health Medical Group Urology, told The Post.
“In these scenarios, we want to rule out medical or hormonal conditions and then tackle reversible things like blood flow issues.”
Houman noted that desire and arousal are two distinct processes.
“Men who find their partners attractive may still struggle with erections if blood vessels, nerves or hormones are impaired,” he explained.
“Partners often assume the issue is a lack of attraction, but this is rarely the case.”
Anxiety about performing or underperforming can create a cycle of avoidance that is easily misinterpreted as disinterest, Houman added.
“Open communication and medical evaluation help couples understand that erectile dysfunction is usually a medical issue, not a reflection of their relationship,” he said.
Both experts encourage couples to discuss ED troubles.
“Just having that conversation with your partner often gets that stress off your mind and shows that you care for their needs and are actively working on figuring out a solution,” said Amin.
Studies show that men who have stronger emotional bonds with their partners tend to have fewer ED issues or bounce back faster.
What should you do if you have ED?
Amin and Houman agree that men experiencing ED should first contact their primary care doctor.
“Primary care physicians can evaluate underlying conditions, such as heart disease, diabetes and hormonal disorders, and manage simple cases. If erectile dysfunction persists or requires specialized treatment, the doctor can refer the patient to a urologist,” said Houman.
Because ED can signal a more serious underlying condition, particularly heart disease, it should not be ignored.
The good news is that there are several treatment options for ED.
Amin pointed out that medications are easier to access than ever before, thanks to direct-to-patient platforms like HIMS or Ro, so you don’t even have to see a doctor in person.
How is ED treated?
Treatments vary depending on the cause of the ED and the patient’s goals, but any plan should begin with lifestyle changes, Houman said.
“Lifestyle changes are the foundation: controlling blood pressure, cholesterol and blood sugar; losing weight; exercising; reducing alcohol and quitting smoking can improve erectile function,” he said
Addressing sleep apnea and/or depression can also lessen symptoms of ED, while oral medications can enhance blood flow to the penis.
Further, psychological counseling can help confront performance anxiety, depression and relationship stress.
For those who require more intensive treatment, vacuum erection devices are designed to draw blood into the penis with a plastic cylinder and a pump. A constriction band helps maintain the erection.
Beyond the band, Houman said that intracavernosal injections or intra‑urethral medications produce reliable erections that satisfy about 70% of patients.
“When other therapies fail, inflatable or semi‑rigid penile implants provide dependable erections with high satisfaction rates,” he said.
He reported that more experimental therapies, such as low-intensity shock-wave therapy, platelet-rich plasma injections and melanocortin activators, show promise but require further research.
