Sexual performance is something that many men are reluctant to discuss with their physicians. Doctors, on the other hand, also hesitate to bring up this subject for a variety of reasons. Despite increased awareness regarding ED (Erectile Dysfunction) in the past ten years, especially after introduction of drugs such as Viagra, Cialis and Levitra which are fairly effective, ED and other related sexual issues are still significantly under diagnosed and under treated. In addition, up to one third of the men don't respond well to Viagra or its like, or they experience intolerable side effects.
From the standpoint of integrative and holistic medicine, one must ask the question: Do lifestyle changes work for improving ED or sexuality? There is increasing evidence that ED is associated with vascular disease. Risk factors such as diabetes mellitus, dyslipidemia, hypertension and smoking all present oxidative stress to the endothelial cells which form lining of the blood vessels. Endothelial cell injury and decrease in nitric oxide (NO) synthesis lead to impaired smooth muscle relaxation in the corpora cavernosa and ED. That being said, weight loss, management of metabolic syndrome/diabetes mellitus, control of blood sugar, blood pressure and cholesterol may improve sexual performance. There are several studies showing exactly what is predicted.
Acupuncture may help ED too. In traditional Chinese medicine, the liver and kidney channels are said to nourish the genital area and are linked to reproductive energy. Energy deficiency in these channels or imbalance of Yin and Yang energy may be responsible for decrease in libido and performance. Chinese herbal therapy has also been used for centuries with success.
Last if not least, it is estimated 10% of men with ED have very low blood testosterone level and these men benefit from testosterone replacement therapy, either transdermal in the form of gel or cream, or a long acting injection. Those on testosterone should undergo close monitoring because of potential side effects, especially risk of prostate cancer. For the majority of aging men with slightly decreased testosterone blood level, hormone replacement is a bit controversial at the present time. Some experts have encouraged the government to sponsor a large randomized clinical trial to fully address its risk and benefit.