Erectile Dysfunction: Causes, Treatments, and What Your Doctor Wants You to Know

ED is More Common Than You Think

If you're experiencing erectile dysfunction, you're far from alone. ED affects an estimated 30 million men in the United States alone, and that number increases significantly when you include men who experience occasional difficulties but haven't been formally diagnosed. Despite how common it is, erectile dysfunction remains a topic many men feel uncomfortable discussing, even with their doctors.

This silence comes at a significant cost. Many men suffer in silence for months or years, experiencing declining confidence, relationship strain, and missed opportunities for intimacy, all while effective treatments are readily available. The truth is that erectile dysfunction is a medical condition—not a personal failing, not an inevitable part of aging, and not something you just have to accept and live with.

More importantly, ED can sometimes be an early warning sign of other health issues, particularly cardiovascular disease and diabetes. Addressing erectile dysfunction isn't just about restoring sexual function—it's about taking care of your overall health and well-being. This comprehensive guide will help you understand what causes ED, what treatment options are available, and why working with a specialist like Dr. Augustine Mireku-Boateng, a board-certified urologist with more than 35 years of experience, can make all the difference in your recovery.

What Is Erectile Dysfunction?

Erectile dysfunction is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It's important to emphasize the word "persistent"—almost every man experiences occasional difficulty with erections at some point in his life due to stress, fatigue, alcohol consumption, or other temporary factors. This is completely normal and doesn't constitute erectile dysfunction.

ED is diagnosed when difficulties occur consistently over a period of at least three months. This might mean being unable to achieve an erection at all, achieving an erection that isn't firm enough for penetration, or being unable to maintain an erection long enough to complete sexual activity. Some men with ED can achieve erections in some situations (such as during sleep or masturbation) but not others, which can provide important clues about the underlying cause.

How Erections Work

To understand what goes wrong in erectile dysfunction, it helps to understand how normal erections occur. An erection is a complex process involving your brain, nerves, hormones, blood vessels, and psychological state working together in precise coordination.

When you become sexually aroused, your brain sends signals through your nervous system to the blood vessels in your penis. These signals cause the arteries that supply blood to the penis to dilate (widen), allowing increased blood flow into the erectile tissue. At the same time, the veins that normally drain blood from the penis become compressed, trapping blood inside and creating the firmness of an erection.

This process requires healthy nerves to transmit signals, properly functioning blood vessels to deliver blood, adequate hormone levels (particularly testosterone) to support sexual function, and psychological factors that allow for arousal and desire. A problem with any of these components can result in erectile dysfunction.

Types and Severity of ED

Erectile dysfunction exists on a spectrum of severity. Some men have mild ED, experiencing difficulties occasionally but maintaining function most of the time. Others have moderate ED, where problems occur more frequently than not. Severe ED involves the complete inability to achieve erections suitable for intercourse.

ED can also be categorized by its onset. Primary ED (though rare) refers to lifelong difficulties that have always been present. Secondary ED, which is much more common, develops after a period of normal sexual function. Secondary ED is typically easier to treat and is more likely to have a specific identifiable cause that can be addressed.

Physical Causes of ED

The majority of erectile dysfunction cases—particularly in men over 40—have a physical or medical cause, though psychological factors often play a contributing role. Understanding these physical causes is important because many of them are treatable, and some require medical attention for reasons beyond sexual function.

Vascular Disease

The most common physical cause of ED is vascular disease—problems with blood flow to and from the penis. Since achieving an erection requires significant blood flow, any condition that narrows or damages blood vessels can cause erectile difficulties. Atherosclerosis (hardening and narrowing of arteries) is a particularly common culprit.

The arteries that supply the penis are relatively small, so they often show signs of vascular disease before larger arteries do. This is why ED can be an early warning sign of cardiovascular disease affecting other parts of the body. In many cases, men develop erectile difficulties months or years before experiencing chest pain, heart attack, or stroke.

Neurological Conditions

Because erections depend on nerve signals from the brain to the penis, conditions that damage nerves can cause ED. These include diabetes (which can cause nerve damage over time), multiple sclerosis, Parkinson's disease, spinal cord injuries, pelvic surgeries (particularly prostate surgery) that damage nerves, and stroke or other brain conditions.

Nerve damage typically causes consistent, predictable ED rather than intermittent problems. If neurological damage is the primary cause, you likely won't be able to achieve erections during sleep or masturbation either, since the nerve pathways needed for erection are compromised regardless of the stimulus.

Hormonal Imbalances

Testosterone and other hormones play important roles in sexual desire and erectile function. Low testosterone (hypogonadism) is increasingly recognized as a cause of ED, particularly in older men. However, hormonal causes of ED are less common than vascular or neurological causes, accounting for perhaps 10-15% of cases.

Other hormonal conditions that can contribute to ED include thyroid disorders (both overactive and underactive thyroid), elevated prolactin levels, and Cushing's syndrome (excess cortisol). Hormonal causes of ED are usually accompanied by other symptoms such as decreased libido, fatigue, reduced muscle mass, increased body fat, or mood changes.

Anatomical or Structural Issues

Physical abnormalities of the penis itself can sometimes cause erectile difficulties. Peyronie's disease, which involves the formation of scar tissue inside the penis, can cause curved erections, pain, and erectile difficulties. Severe cases may prevent intercourse even if blood flow and nerve function are normal.

Previous injuries to the penis, pelvis, or perineum can also damage the structures necessary for normal erections. This is sometimes seen in men who have experienced significant pelvic trauma, such as from bicycle accidents, motorcycle accidents, or other injuries.

Psychological and Emotional Causes

While physical causes account for most ED cases in older men, psychological factors play a significant role, particularly in younger men. Even when ED has a physical cause, psychological factors often compound the problem, creating a cycle of anxiety and dysfunction that becomes self-perpetuating.

Performance Anxiety

Performance anxiety is one of the most common psychological causes of ED, particularly in younger men and in new relationships. After experiencing erectile difficulties once or twice (which can happen to anyone), men often become anxious about whether it will happen again. This anxiety triggers a stress response that actually makes erections more difficult, creating a self-fulfilling prophecy.

The fear of failure becomes so strong that sexual situations that should be enjoyable instead trigger anxiety and stress. This type of ED often follows a pattern where it occurs in specific situations (such as with a partner) but not others (such as during masturbation or morning erections), suggesting that the physical capability for erections is intact, but psychological factors are interfering.

Stress and Mental Overload

Chronic stress—whether from work, finances, family responsibilities, or other life pressures—can significantly impact sexual function. When your mind is preoccupied with stressors, it becomes difficult to relax and focus on sexual arousal. Additionally, stress triggers hormonal changes, including elevated cortisol levels, that can directly interfere with erectile function.

In our modern world of constant connectivity and 24/7 demands, many men struggle to mentally "switch off" enough to be fully present during intimate moments. This divided attention can prevent the mental focus needed for arousal and erection.

Depression

Depression affects sexual function in multiple ways. The condition itself reduces libido and sexual interest, making arousal difficult. The mental and emotional symptoms of depression—fatigue, lack of pleasure in activities, feelings of worthlessness—are not conducive to sexual desire or performance.

Complicating matters further, many antidepressant medications (particularly SSRIs) can cause or worsen erectile dysfunction as a side effect. This creates a challenging situation where treating the depression may actually contribute to ED, requiring careful balancing of mental health treatment with sexual health concerns.

Relationship Issues

Problems within a relationship—unresolved conflicts, communication difficulties, loss of attraction, or emotional disconnection—can manifest as erectile difficulties. Sexual function is intimately tied to emotional connection and relationship satisfaction for many men. When the relationship is strained, sexual response often suffers.

In some cases, ED can itself become a source of relationship stress, creating a negative cycle where erectile difficulties strain the relationship, and relationship stress worsens the ED. Addressing both the ED and relationship dynamics together often yields better results than treating either in isolation.

Past Trauma

Sexual trauma or abuse can have long-lasting effects on sexual function. Even trauma that occurred years or decades ago can affect a man's ability to relax and be present during intimate moments. Addressing these underlying issues often requires working with a therapist who specializes in sexual trauma, ideally in conjunction with medical treatment for ED.

Lifestyle Factors That Contribute to ED

Many lifestyle choices and habits can contribute to erectile dysfunction, often by affecting the underlying physical health that supports sexual function. The good news is that these factors are modifiable—changes to lifestyle can improve erectile function, sometimes significantly.

Obesity and Poor Diet

Obesity is strongly associated with erectile dysfunction. Excess body fat contributes to ED through multiple mechanisms including reduced testosterone levels, increased estrogen (which is produced in fat tissue), vascular damage from obesity-related inflammation, and development of insulin resistance and diabetes.

Diet quality also matters. Diets high in processed foods, saturated fats, and refined carbohydrates while low in fruits, vegetables, and whole grains contribute to vascular disease, inflammation, and metabolic dysfunction—all of which can impair erectile function. In contrast, Mediterranean-style diets rich in vegetables, fruits, whole grains, fish, and healthy fats have been associated with better erectile function.

Sedentary Lifestyle

Physical inactivity contributes to ED through multiple pathways. Lack of exercise worsens cardiovascular health and contributes to obesity, diabetes, and high blood pressure—all ED risk factors. Exercise, particularly aerobic exercise, improves vascular function, enhances blood flow, helps maintain healthy weight, and reduces stress and anxiety.

Studies have shown that men who exercise regularly have significantly lower rates of ED than sedentary men, and that beginning an exercise program can improve erectile function in men with ED, particularly when combined with other treatments.

Smoking

Tobacco use is one of the most significant modifiable risk factors for ED. Smoking damages blood vessels throughout the body, including those that supply the penis. Nicotine causes blood vessels to constrict, reducing blood flow, and the chemicals in tobacco smoke damage the lining of blood vessels, contributing to atherosclerosis.

The good news is that quitting smoking can improve erectile function. Studies have shown that men who quit smoking often experience improvement in ED, particularly if the damage to blood vessels isn't too advanced. The sooner you quit, the better your chances of recovery.

Excessive Alcohol Use

While a small amount of alcohol can reduce inhibitions and anxiety, excessive alcohol consumption interferes with sexual function. Acute alcohol intoxication impairs nervous system function and reduces testosterone levels temporarily, making erections difficult. Chronic heavy drinking can cause permanent nerve damage, liver disease that disrupts hormone metabolism, and cardiovascular damage—all contributing to persistent ED.

Moderate alcohol consumption (one to two drinks per day) doesn't typically cause ED and may even have slight cardiovascular benefits. However, regular consumption beyond moderate levels significantly increases ED risk.

Recreational Drug Use

Many recreational drugs interfere with erectile function. Marijuana can affect erectile function, though research results are mixed. Cocaine and amphetamines constrict blood vessels and can cause ED despite their short-term stimulant effects. Opioids reduce testosterone levels and decrease libido. Chronic use of any of these substances can lead to persistent erectile difficulties even when not actively under the influence.

Poor Sleep

Quality sleep is essential for hormonal balance and overall health. Poor sleep or sleep disorders like sleep apnea reduce testosterone levels, increase stress hormones, and impair vascular function. Men with untreated sleep apnea have significantly higher rates of ED than those without sleep problems. Improving sleep quality—and treating sleep disorders when present—can improve erectile function.

ED and Cardiovascular Health

The connection between erectile dysfunction and cardiovascular disease is so strong that many cardiologists now consider ED an early warning sign of heart disease. This relationship exists because the same process that causes ED—vascular damage and reduced blood flow—also causes heart attacks and strokes, just in different arteries.

Why ED Often Precedes Heart Disease

The arteries that supply blood to the penis are relatively small—only 1-2 millimeters in diameter. The coronary arteries that supply the heart are larger, around 3-4 millimeters. When atherosclerosis (plaque buildup in arteries) develops, it affects smaller arteries first because they become blocked more easily with less plaque accumulation.

This means the same disease process that will eventually cause chest pain or heart attack often causes ED first, sometimes years earlier. In this sense, ED serves as an early warning system, potentially allowing for intervention before more serious cardiovascular events occur.

Shared Risk Factors

ED and cardiovascular disease share many of the same risk factors including high blood pressure, high cholesterol, diabetes, obesity, smoking, and sedentary lifestyle. Men with any of these risk factors should be particularly attentive to erectile symptoms, as they may indicate that vascular disease is developing.

The Importance of Cardiovascular Evaluation

When Dr. Mireku-Boateng evaluates a patient for ED, part of the assessment always includes consideration of cardiovascular health. In many cases, men presenting with ED will be referred for or advised to undergo cardiovascular screening, particularly if they have other risk factors or if the ED is new onset.

This evaluation might include blood pressure measurement, cholesterol and blood sugar testing, and in some cases, stress testing or other cardiac evaluations. This comprehensive approach ensures that ED isn't just treated in isolation but is recognized as a potential indicator of broader health concerns that need attention.

Treatment Considerations

The connection between ED and heart disease also affects treatment decisions. Some ED medications (though not all) can interact with heart medications, particularly nitrates used for angina. This is why it's crucial to work with a knowledgeable physician who can coordinate ED treatment with any cardiac care you're receiving.

On the positive side, addressing cardiovascular risk factors often improves erectile function. Lowering blood pressure, improving cholesterol levels, managing diabetes, and improving overall vascular health through diet and exercise can all contribute to better erections while also reducing your risk of heart attack and stroke.

ED and Diabetes

Diabetes is one of the strongest risk factors for erectile dysfunction. Men with diabetes are three times more likely to experience ED than men without diabetes, and they typically develop ED 10-15 years earlier than men without diabetes. Understanding this connection is crucial for both prevention and treatment.

How Diabetes Causes ED

Diabetes contributes to ED through multiple mechanisms. High blood sugar levels over time damage blood vessels throughout the body, including those that supply the penis. This vascular damage reduces blood flow needed for erections. Diabetes also causes nerve damage (diabetic neuropathy) that affects the nerves controlling erection. Damaged nerves can't transmit the signals needed to trigger and maintain erections.

Additionally, diabetes often occurs alongside other conditions that contribute to ED, including obesity, high blood pressure, and high cholesterol. The combination of these factors makes ED particularly common in men with diabetes.

Preventing Diabetes-Related ED

The best strategy for preventing ED in men with diabetes is excellent blood sugar control. Keeping blood glucose levels as close to normal as possible reduces the risk of both vascular damage and nerve damage. This requires consistent attention to diet, medications (if prescribed), regular exercise, and frequent monitoring.

Men with diabetes should also be particularly diligent about addressing other cardiovascular risk factors like high blood pressure, high cholesterol, smoking, and obesity. Each additional risk factor compounds the likelihood of ED, so addressing them all provides the best protection.

Treating ED in Men with Diabetes

ED in diabetic men can be more challenging to treat than in non-diabetic men, particularly if significant nerve or vascular damage has occurred. However, treatment is still often successful. Oral medications for ED can be effective in men with diabetes, though sometimes higher doses are needed. Addressing blood sugar control often improves response to ED medications.

For men whose diabetes-related ED doesn't respond adequately to oral medications, other treatment options are available, including injections, vacuum devices, or in severe cases, penile implants. Working with a urologist experienced in treating ED in diabetic patients ensures you receive appropriate, effective treatment.

Medications That Can Cause ED

Many commonly prescribed medications can cause or contribute to erectile dysfunction as a side effect. If you've developed ED after starting a new medication, there's a good chance the medication is contributing to the problem.

Blood Pressure Medications

Several classes of blood pressure medications can affect erectile function. Beta-blockers and thiazide diuretics are particularly likely to cause ED. However, not all blood pressure medications have this effect, and some (like ACE inhibitors and ARBs) are less likely to cause sexual side effects.

It's important to never stop taking blood pressure medication without consulting your doctor, as uncontrolled high blood pressure is dangerous and also contributes to ED on its own. Instead, talk to your physician about alternatives if you suspect your blood pressure medication is affecting sexual function.

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) and some other antidepressants commonly cause sexual side effects, including reduced libido, delayed ejaculation, and erectile difficulties. This creates a frustrating situation where treating depression may improve mood but worsen sexual function.

Options for addressing antidepressant-related ED include switching to an antidepressant with fewer sexual side effects (like bupropion), adding medications to counteract the sexual side effects, or taking "drug holidays" (temporarily stopping the medication before planned sexual activity, under medical supervision). Discuss these options with both your mental health provider and your urologist to find an approach that addresses both your mental health and sexual function.

Other Medications

Many other medications can affect erectile function including antihistamines (particularly first-generation antihistamines like diphenhydramine), prostate medications (particularly finasteride and dutasteride), acid-reducing medications (like cimetidine), and chemotherapy drugs. Opioid pain medications can significantly reduce testosterone levels and libido, leading to ED.

If you suspect a medication is affecting your sexual function, bring a complete list of all medications and supplements you take to your appointment with Dr. Mireku-Boateng. He can review your medications and help identify any that might be contributing to ED, then work with your other physicians to find alternatives if appropriate.

Diagnosing Erectile Dysfunction

Proper diagnosis of ED involves more than just confirming that you're having difficulties with erections. A comprehensive evaluation aims to identify underlying causes, assess overall health, and guide treatment selection.

Medical History

Your medical history provides crucial information about potential causes of ED. Dr. Mireku-Boateng will ask about when the ED started, whether it came on gradually or suddenly, whether you can achieve erections in any circumstances (such as morning erections or during masturbation), and other symptoms you may be experiencing.

He'll also ask about your medical history, including cardiovascular disease, diabetes, high blood pressure, high cholesterol, neurological conditions, psychiatric conditions, previous surgeries (particularly pelvic or prostate surgery), and medications and supplements you take. Lifestyle factors including smoking, alcohol use, drug use, exercise habits, and diet will also be discussed, as will relationship factors and stress levels.

While these questions may feel personal, remember that Dr. Mireku-Boateng has had these conversations with thousands of patients over his 35-year career. The information you provide helps ensure you receive appropriate, effective treatment.

Physical Examination

A physical examination helps identify physical factors that might be contributing to ED. This includes checking blood pressure and heart rate, examining the penis and testicles for abnormalities, assessing for signs of hormonal imbalances (like reduced body hair or breast enlargement), checking pulses in the legs to assess vascular health, and neurological examination if nerve damage is suspected.

The physical exam is professional and respectful. It provides important information that can't be obtained through history alone.

Laboratory Testing

Blood tests help identify underlying medical conditions and hormonal imbalances. Common tests include testosterone levels (typically measured in the morning when levels are highest), blood glucose and hemoglobin A1c (to screen for diabetes), lipid panel (cholesterol and triglycerides), and thyroid function tests. Depending on your symptoms and history, other specialized tests might be ordered.

These tests serve multiple purposes: they can identify treatable causes of ED, assess cardiovascular risk, and establish a baseline for monitoring your health over time.

Specialized Testing

In some cases, specialized testing may be helpful. This might include nocturnal penile tumescence testing (which monitors whether you have erections during sleep, helping distinguish physical from psychological causes), Doppler ultrasound (which assesses blood flow to the penis), or other specialized evaluations depending on your specific situation.

However, for many men, a thorough history, physical exam, and basic laboratory work provide sufficient information to begin treatment. Specialized testing is reserved for cases where the diagnosis is unclear or when initial treatments aren't successful.

Treatment Options Overview

The good news is that erectile dysfunction is highly treatable. The overwhelming majority of men with ED can be successfully treated with one or a combination of available therapies. Treatment selection depends on the underlying cause of your ED, your overall health, your preferences, and your goals.

The Stepwise Approach

ED treatment typically follows a stepwise approach, starting with the least invasive, most convenient options and progressing to more involved treatments only if needed. For most men, treatment begins with lifestyle modifications and oral medications. If these prove insufficient, additional options like injections, vacuum devices, or other therapies are considered. Only in cases where other treatments have failed or aren't appropriate would more invasive options like penile implants be discussed.

This approach ensures you're not using a more complex treatment than necessary while also ensuring that effective options remain available if first-line treatments don't work adequately.

Combination Approaches

Often, the most effective treatment involves combining multiple approaches. For example, lifestyle changes (diet, exercise, stress reduction) combined with oral medication often works better than medication alone. Similarly, addressing underlying medical conditions (like diabetes or high blood pressure) while using ED-specific treatments produces better results than either approach in isolation.

Dr. Mireku-Boateng will work with you to develop a comprehensive treatment plan that addresses all relevant factors contributing to your ED.

Prescription Medications for ED

Oral prescription medications are the first-line treatment for most men with ED. These medications have revolutionized ED treatment since their introduction in the late 1990s, providing effective, relatively easy-to-use treatment for millions of men.

How ED Medications Work

The most commonly prescribed ED medications—including sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra)—all work through the same basic mechanism. They inhibit an enzyme called phosphodiesterase type 5 (PDE5), which breaks down a chemical that promotes erections. By inhibiting this enzyme, these medications enhance the natural erectile response to sexual stimulation.

It's important to understand that these medications don't cause erections on their own—they enhance your body's response to sexual arousal. You still need sexual stimulation for the medication to work. They essentially make it easier for your body to achieve and maintain an erection when you're aroused.

Comparing Different ED Medications

While all PDE5 inhibitors work through the same mechanism, they differ in their duration of action and how quickly they work. Sildenafil and vardenafil typically begin working within 30-60 minutes and last about 4-6 hours. Avanafil works slightly faster (within 15-30 minutes) and lasts about 6 hours. Tadalafil has the longest duration, lasting up to 36 hours, which is why it's sometimes called "the weekend pill."

The choice between medications often comes down to personal preference and lifestyle. Some men prefer longer-acting medications for spontaneity, while others prefer shorter-acting options. Dr. Mireku-Boateng can help you select the medication that best fits your needs and situation.

Effectiveness and Success Rates

Oral ED medications are effective for the majority of men. Overall success rates are typically 60-70% or higher when the medication and dose are properly matched to the individual. Effectiveness is often higher in men with psychological causes of ED or mild to moderate physical causes, and may be lower in men with severe vascular disease, significant nerve damage, or very low testosterone levels.

If one medication doesn't work well, trying another often helps, as individual responses can vary. Similarly, adjusting the dose or timing can improve results.

Side Effects and Safety

ED medications are generally safe when used appropriately under medical supervision. Common side effects include headache, facial flushing, nasal congestion, and indigestion. These effects are typically mild and temporary, often diminishing with continued use.

More serious side effects are rare but can include sudden vision or hearing loss (seek immediate medical attention if this occurs) and priapism (prolonged erection lasting more than 4 hours). ED medications should never be used with nitrate medications (often prescribed for angina) due to the risk of dangerous blood pressure drops. They should also be used cautiously in men with certain heart conditions.

This is why working with a knowledgeable physician is crucial. Dr. Mireku-Boateng will review your medical history and medications to ensure that ED medication is safe for you and monitor you for any adverse effects.

Custom-Blended Treatment Options

For some men, standard oral medications don't provide adequate results, or they cause bothersome side effects. In these cases, custom-blended treatments can offer an effective alternative.

Bi-Mix and Tri-Mix Injections

Injectable medications delivered directly into the penis can produce reliable erections even when oral medications don't work. These injections typically contain combinations of medications that work through different mechanisms than oral ED drugs, making them effective even in cases of severe vascular disease or nerve damage.

"Bi-Mix" typically contains two medications, while "Tri-Mix" contains three medications that work together to produce erections. The injections are administered using a very fine needle directly into the side of the penis about 5-10 minutes before sexual activity.

While the idea of penile injection might sound daunting, most men find that the reality is much less uncomfortable than they expected. The needles are extremely fine, and the procedure becomes routine with practice. Success rates with injectable medications are very high—often 85-90% or better—making them an excellent option for men who don't respond to oral medications.

Custom Compounding

Custom-compounded medications can be formulated to your specific needs, with doses and combinations tailored to produce optimal results with minimal side effects. This personalization allows for fine-tuning that isn't possible with standard commercial medications.

Dr. Mireku-Boateng has extensive experience with custom-blended ED treatments and can help determine whether this approach might be beneficial for you.

Safety and Training

If injectable treatment is recommended, you'll receive thorough training on the proper injection technique, dosing, and safety considerations. This includes guidance on how to inject properly, how to determine the correct dose, what to do if an erection lasts too long, and when to seek medical attention.

With proper training and use, injectable ED medications are very safe and highly effective, offering an excellent option for men who need something more reliable than oral medications can provide.

The P-Shot and Other Advanced Treatments

For men seeking more advanced or longer-lasting treatment options, several newer therapies show promise for improving erectile function.

The Priapus Shot (P-Shot)

The P-Shot, or Priapus Shot, is a treatment that uses platelet-rich plasma (PRP) derived from your own blood to potentially improve erectile function. The procedure involves drawing a small amount of your blood, processing it to concentrate the platelets and growth factors, and then injecting this concentrated plasma into specific areas of the penis.

The theory behind the P-Shot is that the growth factors in PRP can stimulate tissue regeneration and blood vessel growth, potentially improving blood flow and erectile function. Some men report improved erection quality, increased penis size, and enhanced sensation following the procedure.

While research on the P-Shot is still evolving and results vary between individuals, many men have found it helpful, particularly when combined with other treatments. Dr. Mireku-Boateng can discuss whether the P-Shot might be appropriate for your situation.

Shockwave Therapy

Low-intensity shockwave therapy is an emerging treatment that uses acoustic waves to potentially stimulate new blood vessel growth in penile tissue. The treatment is non-invasive and typically involves a series of sessions over several weeks.

Early research suggests that shockwave therapy may help some men with vascular-related ED, though more studies are needed to fully establish its effectiveness and determine which patients are most likely to benefit.

Vacuum Erection Devices

Vacuum erection devices (VEDs) are non-invasive mechanical devices that create erections by drawing blood into the penis using vacuum pressure. A constriction ring is then placed at the base of the penis to maintain the erection.

While VEDs require some planning and aren't as spontaneous as medication, they're safe, effective for most men regardless of the cause of ED, have no systemic side effects, and can be used by men who can't safely take ED medications. They're a good option for men who prefer to avoid medications or who haven't had success with other treatments.

Penile Implants

For men with severe ED who haven't responded to other treatments, surgically implanted penile prostheses can provide a permanent solution. Modern penile implants are sophisticated devices that allow for natural-appearing erections on demand.

While penile implant surgery is more invasive than other treatments, satisfaction rates among men who receive implants are very high—typically 90% or above. This option is generally reserved for men who have exhausted other treatments or have specific medical situations that make implants the best choice.

Lifestyle Changes That Help

Regardless of what other treatments you use, lifestyle modifications can significantly improve erectile function and overall health. These changes address many of the root causes of ED and often enhance the effectiveness of medical treatments.

Weight Loss and Healthy Diet

If you're overweight, losing even 10-15% of your body weight can improve erectile function. Weight loss improves vascular health, reduces inflammation, increases testosterone levels, and improves overall metabolic health—all of which support better erections.

Focus on a diet rich in vegetables, fruits, whole grains, lean proteins, and healthy fats while limiting processed foods, added sugars, and excessive saturated fats. The Mediterranean diet, which emphasizes these foods, has been specifically associated with reduced ED risk and improved erectile function.

Regular Exercise

Regular physical activity is one of the most effective lifestyle interventions for ED. Exercise improves cardiovascular health and blood flow, helps maintain healthy weight, increases testosterone levels, reduces stress and anxiety, and improves overall confidence and mood.

Aim for at least 150 minutes of moderate-intensity aerobic exercise per week (such as brisk walking, cycling, or swimming) along with strength training at least twice weekly. Even modest amounts of exercise can produce benefits, and more activity typically provides greater improvement.

Quit Smoking

If you smoke, quitting is one of the most impactful changes you can make for your erectile function and overall health. Smoking cessation can begin improving vascular function within weeks, and erectile function often improves within months of quitting, particularly in younger men or those who haven't smoked for decades.

Quitting smoking is challenging, but numerous resources can help, including nicotine replacement therapy, prescription medications, counseling, and support groups. Talk to Dr. Mireku-Boateng about smoking cessation resources if you need help quitting.

Limit Alcohol

If you drink alcohol regularly and heavily, reducing consumption can improve erectile function. Aim for no more than two drinks per day, and consider having several alcohol-free days each week. You may find that your erectile function improves significantly as your alcohol consumption decreases.

Manage Stress and Improve Sleep

Chronic stress and poor sleep both contribute to ED. Implementing stress-reduction techniques like regular exercise, meditation or mindfulness practice, adequate leisure time and relaxation, time in nature, and social connection with friends and family can all help reduce stress levels.

Prioritize sleep by maintaining a consistent sleep schedule, creating a comfortable sleep environment, limiting screen time before bed, and addressing sleep disorders like sleep apnea if present. Most adults need 7-9 hours of quality sleep per night for optimal health and hormonal function.

Kegel Exercises

Pelvic floor exercises (Kegel exercises) aren't just for women. Men can benefit from strengthening the muscles that support erectile and ejaculatory function. Some research suggests that pelvic floor exercises can improve erectile function, particularly when ED has a muscular component.

To perform Kegel exercises, identify your pelvic floor muscles (the ones you use to stop urination midstream), contract these muscles for 5 seconds, then relax for 5 seconds, and repeat 10-15 times, multiple times per day. Consistency is key—benefits typically develop over several weeks to months of regular practice.

Why Working with a Urologist Like Dr. Mireku-Boateng Matters

While many healthcare providers can treat ED, working with a board-certified urologist who specializes in men's sexual health offers distinct advantages. Dr. Augustine Mireku-Boateng brings more than 35 years of medical experience to treating erectile dysfunction, combining deep expertise in urology with a comprehensive understanding of men's health.

Specialized Expertise

Urologists receive extensive training in male reproductive and sexual health. This specialized knowledge allows for more accurate diagnosis, access to the full range of treatment options (including specialized treatments that primary care physicians may not offer), ability to perform procedures when needed, and expertise in managing complex cases or situations where initial treatments haven't worked.

Dr. Mireku-Boateng has helped thousands of men overcome ED over his career. This experience means he's seen virtually every variation of ED and knows which treatments are most likely to work for different situations.

Comprehensive Approach

Dr. Mireku-Boateng takes a comprehensive approach to ED treatment that addresses not just the symptom but the whole person. This includes identifying and treating underlying health conditions, coordinating with other specialists when needed, providing both medical and lifestyle guidance, and considering psychological factors alongside physical ones.

This comprehensive approach typically produces better, more sustainable results than simply prescribing medication without addressing contributing factors.

Access to Advanced Treatments

As a urologist, Dr. Mireku-Boateng can offer the full spectrum of ED treatments, from first-line oral medications to advanced therapies like custom-blended injections, the P-Shot, and other specialized treatments. If one approach doesn't work, multiple alternatives are available, all under one roof.

This access to diverse treatment options means you're not limited by your provider's scope of practice or comfort level with different therapies.

Privacy and Understanding

Dr. Mireku-Boateng and his staff understand the sensitive nature of sexual health concerns. Your consultations are conducted in a private, respectful environment where you can speak openly about your concerns without judgment. After 35 years of practice and thousands of ED consultations, there's nothing you can say that will surprise or shock Dr. Mireku-Boateng.

This experience creates an environment where you can be completely honest about your symptoms, concerns, and goals, which is essential for effective treatment.

Convenient San Diego Location

SD Medical Clinic is conveniently located at 353 E Park Ave 102 in El Cajon, serving men throughout the San Diego area. The practice offers flexible scheduling to accommodate your needs, and the staff is committed to making your experience as comfortable and efficient as possible.

Taking the First Step

The hardest part of addressing ED is often the first step—making the decision to seek help. Many men suffer unnecessarily for months or years before finally reaching out for treatment, during which time they experience declining confidence, relationship strain, and missed opportunities for intimacy.

If you're experiencing erectile dysfunction, don't wait. Effective treatment is available, and the sooner you address the problem, the sooner you can return to a satisfying sexual life. Schedule a consultation with Dr. Mireku-Boateng to discuss your concerns and explore your treatment options.

During your consultation, Dr. Mireku-Boateng will take time to understand your situation, perform appropriate evaluations, discuss treatment options that fit your needs and preferences, and answer all your questions in a respectful, judgment-free environment. You'll leave with a clear understanding of what's causing your ED and a concrete plan for addressing it.

Erectile dysfunction is not something you have to accept or live with. With the right treatment and support, the vast majority of men can overcome ED and enjoy satisfying sexual function. Call SD Medical Clinic today at (619) 375-1774 or visit our erectile dysfunction treatment page to schedule your confidential consultation. Your sexual health and confidence are worth it.