madman
Super Moderator
38.1 Introduction
Sexual health plays an important role in the lives of many men and, for some, erectile function, specifically, helps define one’s sense of masculinity. Erectile dysfunction (ED), referring to the inability to attain and/or maintain an erection sufficient for sexual activity, is one component of sexual health. ED is common in the United States, affecting over 18% of men over the age of 20 with the risk of experiencing ED increasing as menage [1]. Moreover, the disease is often debilitating for men and can lead to significant psychosocial consequences [2]. ED results in decreased physical and emotional satisfaction from sexual activity as well as an overall decrease in quality of life. Fortunately, a variety of medical and surgical options exist to restore erectile function, including oral medications, vacuum erection devices, penile constriction rings, medicated urethral suppositories, intracavernosal injections, and penile implants.
Lifestyle modification considered first-line therapy for many disease processes, is often overlooked and under-discussed in the management of men presenting with ED. Early initiation of lifestyle changes can help improve function in these men, as well as reduce the risk of developing dysfunction [3]. Furthermore, some men prefer a less medicalized approach to the treatment of ED, as one study involving Mexican men demonstrated [4]. Modifications to lifestyle or initiation of alternative medicines were the preferred source of change in this subset of men who described their view of medications, such as phosphodiesterase 5 (PDE5) inhibitors, for the treatment of ED as physically dangerous due to the significant side effects mentioned on television commercials. Though pharmacologic and surgical interventions to restore erectile function are important tools in the armamentarium of the healthcare provider, the authors believe that discussions regarding pertinent lifestyle modification should play a role at the time of patient presentation and throughout the treatment process.
The aim of this chapter is to review the literature assessing lifestyle modification for the treatment of ED. Medications for the treatment of ED are directly marketed to consumers via television with commercials for Viagra® and Cialis®, alone, exceeding $300 million a year [5]. The authors believe that behavioral modification should be marketed as a prevention strategy, a standalone treatment strategy, and as an adjunct to current pharmacotherapy by healthcare providers who treat those with ED. We hope to clarify what is currently known about the efficacy of lifestyle modification so as to improve the clinician's ability to educate patients on the importance of making healthier choices and to spawn ideas for future work to address gaps in knowledge.
38.2 Pathophysiology of Erection
38.2.1 Nitric Oxide
38.2.2 Reactive Oxygen Species
38.2.3 Cytokines
38.3 Lifestyle Changes
38.3.1 Exercise
38.3.2 Pelvic Floor Physical Therapy
38.3.3 Weight Management
38.3.4 Nutrition
38.3.5 Drug Use
38.3.7 Treatment of Sleep Apnea
38.3.8 Impact of Psychological Factors
38.3.9 Limitations
Few studies objectively assess changes in erectile function with various lifestyle modifications. Much of what we know about lifestyle interventions on the vascular system comes from its effect on the cardiovascular system with little objective data showing effects on cavernosal blood flow. Future research is warranted to better assess the effect of lifestyle modification behaviors on objective measurements of erectile function.
Sexual health plays an important role in the lives of many men and, for some, erectile function, specifically, helps define one’s sense of masculinity. Erectile dysfunction (ED), referring to the inability to attain and/or maintain an erection sufficient for sexual activity, is one component of sexual health. ED is common in the United States, affecting over 18% of men over the age of 20 with the risk of experiencing ED increasing as menage [1]. Moreover, the disease is often debilitating for men and can lead to significant psychosocial consequences [2]. ED results in decreased physical and emotional satisfaction from sexual activity as well as an overall decrease in quality of life. Fortunately, a variety of medical and surgical options exist to restore erectile function, including oral medications, vacuum erection devices, penile constriction rings, medicated urethral suppositories, intracavernosal injections, and penile implants.
Lifestyle modification considered first-line therapy for many disease processes, is often overlooked and under-discussed in the management of men presenting with ED. Early initiation of lifestyle changes can help improve function in these men, as well as reduce the risk of developing dysfunction [3]. Furthermore, some men prefer a less medicalized approach to the treatment of ED, as one study involving Mexican men demonstrated [4]. Modifications to lifestyle or initiation of alternative medicines were the preferred source of change in this subset of men who described their view of medications, such as phosphodiesterase 5 (PDE5) inhibitors, for the treatment of ED as physically dangerous due to the significant side effects mentioned on television commercials. Though pharmacologic and surgical interventions to restore erectile function are important tools in the armamentarium of the healthcare provider, the authors believe that discussions regarding pertinent lifestyle modification should play a role at the time of patient presentation and throughout the treatment process.
The aim of this chapter is to review the literature assessing lifestyle modification for the treatment of ED. Medications for the treatment of ED are directly marketed to consumers via television with commercials for Viagra® and Cialis®, alone, exceeding $300 million a year [5]. The authors believe that behavioral modification should be marketed as a prevention strategy, a standalone treatment strategy, and as an adjunct to current pharmacotherapy by healthcare providers who treat those with ED. We hope to clarify what is currently known about the efficacy of lifestyle modification so as to improve the clinician's ability to educate patients on the importance of making healthier choices and to spawn ideas for future work to address gaps in knowledge.
38.2 Pathophysiology of Erection
38.2.1 Nitric Oxide
38.2.2 Reactive Oxygen Species
38.2.3 Cytokines
38.3 Lifestyle Changes
38.3.1 Exercise
38.3.2 Pelvic Floor Physical Therapy
38.3.3 Weight Management
38.3.4 Nutrition
38.3.5 Drug Use
38.3.7 Treatment of Sleep Apnea
38.3.8 Impact of Psychological Factors
38.3.9 Limitations
Few studies objectively assess changes in erectile function with various lifestyle modifications. Much of what we know about lifestyle interventions on the vascular system comes from its effect on the cardiovascular system with little objective data showing effects on cavernosal blood flow. Future research is warranted to better assess the effect of lifestyle modification behaviors on objective measurements of erectile function.
