Preserving Intimacy

More common than you may think, erectile dysfunction can be an embarrassing topic. Fortunately, most cases are preventable or treatable.

Don’t be too quick to lump erectile dysfunction (ED) in with other conditions, such as achy joints and memory loss, many people expect to experience as they age. 

“Healthy men should be able to function sexually most of their lives,” says Drogo Montague, MD, head of prosthetic surgery and genitourinary reconstruction in Cleveland Clinic’s Glickman Urological & Kidney Institute. “Age is not accepted as a cause of erectile dysfunction. Rather, it is the diseases that increase with aging, particularly cardiovascular disease, that most often cause ED.”

An erection requires nerve function, adequate blood flow to the penis and stimulus in the brain. If any of these conditions are not met, ED, formerly called impotence, can occur. Here, some of the most common causes:

Radical Prostatectomy

This surgical procedure is often performed to treat prostate cancer. In addition to removing the prostate itself, the surgery sometimes requires the removal of the nerves and tissues surrounding the prostate if the cancer is locally extensive. Removing the nerves almost always results in permanent problems achieving erections.

A procedure called nerve-sparing radical prostatectomy, in most cases, can be safely considered. However, this procedure is not always successful, and ED can result. (Colon and rectal surgery and pelvic vascular surgery can sometimes result in ED as well.)

What can you do?
Prescription medications, such as sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil HCl (Levitra®), can enhance an erection by increasing blood flow to the penis.

Cardiovascular Disease

Because it affects blood flow, cardiovascular disease (including atherosclerosis, or hardening of the arteries) is responsible for 50 to 70 percent of ED cases.

What can you do?
“Don’t smoke, follow a heart-healthy diet and exercise,” Dr. Montague says. If cardiovascular disease still occurs and causes ED, some of the common prescription drugs (see above) may help.


Studies suggest that at least half of men with diabetes will experience difficulties with erections. Diabetic patients can have accelerated and earlier vascular disease. Diabetic neuropathy can affect the nerves in the penis, causing ED. Erectile dysfunction also affects diabetic patients who use oral medications or insulin for disease control.

What can you do?
In general, the success rate of oral medications for diabetic patients with ED is less than their reported success rates in the general population. Talk to your doctor about the best treatment for you.


There is a common belief that ED is rooted in psychological causes, which is really not always the case, according to Dr. Montague. “Depression may cause decreased libido, which is somewhat of a factor in ED, but it is not a major cause,” he says.

What can you do?
Seek help for your depression, which should, in turn, improve “situational” ED.

Related Content

Female sexual dysfunction is at least as common as male sexual dysfunction. For more information, visit our Overview of Sexual Dysfunction.