It is a subject many men find difficult to discuss openly.
Some avoid naming the problem altogether, saying that “things aren’t working” while gesturing awkwardly towards their pelvis.
Others speak in general terms about difficulties with their partner, without describing what is actually happening.
Often, they are referring to erectile dysfunction. One of their first questions is usually about medicines such as Viagra, which can be highly effective in treating the condition.
However, medication is only one part of the discussion I have with patients.
As a urologist who has spent more than 40 years treating erectile dysfunction, I do not want to simply prescribe a pill without first understanding why a man is having trouble getting or maintaining an erection.
That is because erectile dysfunction is often connected to the health of the heart and blood vessels.
An erection depends on adequate blood flow into the penis.
After more than four decades treating erectile dysfunction, urologist Dr Arthur Burnett says he first looks for the underlying cause before recommending medication
The same vascular problems that restrict circulation elsewhere in the body—including high blood pressure, elevated cholesterol, diabetes and the effects of smoking—can therefore make it more difficult to achieve or sustain an erection.
When the blood-vessel system is not functioning properly, erectile performance can decline. That is why improving cardiovascular health should be central to the conversation.
These changes will not deliver an overnight cure.
For men with severe or long-term erectile dysfunction, medication and other treatments may still be required.
Even so, several lifestyle changes may support better erections while also improving overall health.
Regular aerobic activity can strengthen cardiovascular fitness, while losing excess weight may also help. Quitting smoking eliminates a known source of damage to blood vessels. Better control of conditions such as high blood pressure and diabetes can make a difference as well.
None of these measures is a rapid fix. Over time, however, they can give men the strongest opportunity to preserve—and potentially improve—erectile function.
Dr Arthur L. Burnett II, MD, MBA, FACS, is an internationally recognized urologist, author, researcher and men’s health specialist. A professor of urology at the Johns Hopkins University School of Medicine, he is known for pioneering work in erectile dysfunction, prostate cancer treatment and sexual medicine
So when a patient asks how he can improve his erectile function, this is the approach I explain: which lifestyle changes are worth making, what the evidence suggests may help, and which popular remedies should not be relied upon.
STEP 1: Get your circulation going
If there is one change I most want men with erectile dysfunction to make, it is to become more physically active.
The reason is simple. Exercise improves the health of the cardiovascular system – and the blood vessels supplying the penis are part of that same system.
You don’t need to become an endurance athlete. Research suggests that fairly achievable amounts of aerobic exercise can make a difference.
In one study, researchers recruited 110 obese men aged 35 to 55 with erectile dysfunction and encouraged half to become more physically active.
The men in this group ended up doing an average of about 195 minutes of exercise a week – including activities such as swimming and playing football.
After two years, 17 men in the exercise group reported that their erectile dysfunction had completely resolved, compared with just three in the comparison group.
And that’s not the only evidence.
A 2023 analysis of 11 clinical trials involving more than 1,000 men found that regular aerobic exercise improved erectile function. The programmes typically involved 30 to 60 minutes of activities such as cycling or running, three to five times a week.
Another review concluded that about 40 minutes of moderate-to-vigorous aerobic exercise four times a week may be beneficial.
I see exercise as part of a longer-term strategy rather than a quick fix. You aren’t going to go for a run today and suddenly notice a dramatic difference in the bedroom tonight.
But stick with regular exercise over weeks and months and you are improving your cardiovascular health, blood pressure, circulation and metabolic health – all things that can help create the conditions for better erectile function.
STEP 2: Lose excess weight
Exercise brings another potential benefit: if you’re overweight, it can help you lose weight – and that may improve erectile function too.
I’ve seen some striking changes among patients who have managed to shed excess pounds. They tell me they feel lighter, have more energy and find everyday physical activity easier. Some also report improvements in their sexual function.
There is evidence to support this.
In the study of 110 obese men I mentioned earlier, those encouraged to exercise also lost an average of about ten per cent of their body weight.
For a man weighing 200lb, that would be about 20lb – and the researchers found that the lifestyle intervention significantly improved erectile function.
A separate analysis, published in 2021 and involving 619 men with erectile dysfunction, also concluded that weight loss produced improvements in erectile function among overweight and obese men.
Part of the explanation is likely to be the same one I’ve already described: excess weight is closely tied to cardiovascular and metabolic problems that can affect the blood vessels needed for an erection.
And we’re seeing something interesting in the era of weight-loss drugs such as Ozempic and Wegovy. Some of my patients who’ve lost substantial amounts of weight with these medications tell me their overall quality of life has improved – including their sexual function.
CHECK THIS OUT: Lionel Richie Hospitalized Again After Suffering Another Heart Problem
But I want to add an important caveat.
Men are bombarded with messages about how their bodies are supposed to look, and I don’t want to contribute to the idea that you need a particular physique to have a healthy sex life.
This is about improving health, not achieving a six-pack. If you’re carrying excess weight, losing some may help your erectile function. But a man’s worth – or masculinity – should never be judged by how lean or muscular he looks.
STEP 3: Quit smoking – and go easy on the booze
If you smoke, quitting is one of the most important things you can do for your erectile function.
Cigarettes damage blood vessels throughout the body – including those supplying the penis – and there is evidence that stopping can make a difference.
In one study, researchers followed more than 300 smokers with erectile dysfunction. After a year, erectile function had improved in 25 per cent of those who quit, compared with none of those who continued smoking.
Alcohol is slightly different. I wouldn’t tell a man with erectile dysfunction that he has to give up drinking altogether.
Having an occasional glass of wine or a few drinks socially isn’t something I am particularly concerned about. But regularly drinking heavily – getting through a six-pack every night, for example – can damage your health over time and potentially affect sexual function too.
So my advice isn’t that every man with erectile dysfunction needs to become teetotal. It’s to be sensible about how much you’re drinking – and, if you’re a smoker, to stop.
Neither is a glamorous solution. But when erections depend so heavily on healthy blood vessels and good overall health, these are two habits worth looking at.
STEP 4: Get your heart health checked
This final step is one men shouldn’t overlook – particularly if they haven’t seen their doctor for a while.
When a patient comes to me with erectile dysfunction, I’m interested in much more than what is happening in the bedroom.
I want to know about his wider cardiovascular health. Does he have high blood pressure or high cholesterol? Could he have diabetes? Does he have a history of heart disease?
These conditions are all closely associated with erectile dysfunction because they can affect the blood vessels and circulation needed to produce an erection.
And sometimes erectile problems may bring a man to a doctor when he hasn’t otherwise been paying much attention to his health.
I’ve seen patients who haven’t been having regular health checks and only discover that they have cardiovascular risk factors when they are investigated more thoroughly.
That’s why I don’t think erectile dysfunction should simply be viewed as an embarrassing problem to be solved with a pill.
Americans drink the equivalent of 109 bottles of wine or 366 pints of beers per person every year, Organisation for Economic Co-operation and Development (OECD) data claims
Alcohol and heart disease are among America’s biggest killers – but much earlier they can be an underlying cause of erectile dysfunction, Dr Burnett warns
If there is an underlying condition such as high blood pressure, high cholesterol or diabetes, identifying it and getting it properly controlled is important for your erections – but far more importantly, for your long-term health.
So if you’ve developed erectile dysfunction, particularly if it is new or unexplained, don’t simply buy medication online and ignore it. Speak to a medical professional and make sure the rest of your health is being looked at too.
Beware of ‘quick fixes’ touted online
For every lifestyle change that may genuinely help erectile dysfunction, there seem to be countless supposed quick fixes promoted online.
Kegel exercises are a good example. These involve repeatedly contracting the pelvic-floor muscles and are increasingly touted on social media as a way for men to improve their erections.
There is some logic behind the idea. The muscles around the penis can contribute to the rigidity of an erection, so strengthening them may make an erection feel firmer.
But these muscles aren’t fundamental to the process that creates an erection in the first place.
That is largely controlled automatically by the nervous system, which signals the blood vessels in the penis to relax and fill with blood. If there is a problem with that process, simply strengthening your pelvic floor isn’t necessarily going to fix it.
That’s why I’m wary of recommending Kegels as a treatment for erectile dysfunction. Men may spend weeks doing them only to be disappointed when they don’t solve the underlying problem.
I’m similarly cautious about the growing obsession with testosterone.
I’ve seen a huge increase in interest in the hormone, which is sometimes presented online almost as a fountain of youth – promising men more muscle, more energy and a better sex life.
But testosterone has a much greater role in sexual desire than it does in the mechanics of an erection.
If a man has symptoms suggesting testosterone deficiency, then it can be appropriate to check his levels and, if they are genuinely low, consider treatment.
But taking testosterone isn’t a general cure for erectile dysfunction – particularly when the real problem is vascular.
And it isn’t a treatment to embark on casually. Testosterone therapy can affect fertility in younger men, while older men may have other health considerations that need to be discussed with their doctor.
The same caution applies to the countless supplements and ‘natural’ erection remedies sold online. I hear about everything from herbal preparations to supposed aphrodisiacs, but many simply don’t have good evidence behind them.
Ultimately, erectile dysfunction has many possible causes.
Rather than reaching for the latest supplement, hormone or exercise being promoted on social media, the important thing is to establish what’s actually going wrong – and treat that.
