There’s Nothing I Can Do to Prevent ED / Myths of ED

Many men come to our office deeply concerned about ED or erectile dysfunction – something we also call impotence. After all, a man’s erectile function is often psychologically linked to their virility and is physically critical to their sexual enjoyment. This is especially true if the man is dating and meeting new people.

Unfortunately, too many men believe that erectile dysfunction is simply a natural part of aging and there’s not much they can do to prevent it or slow its progression. That is simply not true. We are told that there are a host of non-modifiable factors that will lead to ED and while some of them may hold water, many can be addressed without the need for medication or further treatment. At very least, a man’s sexual function may improve with lifestyle changes.

Cardiovascular Issues

It is true that cardiovascular issues, diabetes, medication and other metabolic issues may contribute to erectile dysfunction. However, it is important to remember what the root cause of why these diseases and medications exist. Typically, it’s obesity. Obesity causes poor blood flow and erectile dysfunction is, in the end, an issue involving blood flow to the penis. Getting healthier through proper diet and exercise often improves or even resolves erectile issues. This is especially true in younger to middle-age patients. However, OBVIOUS cardiovascular issues account for a minority of men complaining of erectile dysfunction.

Attraction to Partner

Also, while some cases of ED may be as a result of other reasons, a primary cause of ED is lack of interest or attraction to a partner. This can develop over the years of marriage or living together as routine sets in and the relationship loses some of its newness. Once again, this may not need medication or intervention, but rather some work on the relationship. Men should not feel embarrassed or reluctant to speak to their partners about how to rekindle some of the prior feelings in the relationship.

Tobacco and Alcohol

Smoking and drinking can both contribute to vasoconstriction or the narrowing of blood vessels. This of course can lead to a number of cardiovascular concerns but also to erectile dysfunction. To improve their general and overall health, patients should quit smoking as soon as possible. Alcohol can be consumed in moderation – maybe a few times a year during celebratory events – but ultimately has very little in the way of health benefit.


Stress and anxiety can also cause ED. In fact, the United States has a mental health crisis that has largely been ignored for decades. The new reality of coronavirus and social isolation can make these problems much worse. There’s no shame in talking to a counselor or mental health professional to address some of these concerns and live a better, happier life.

The Solutions

Dr. Engel Seminar PromoThe very first step we take to treat erectile dysfunction is medical therapy. These are PDE-5 inhibitors, commonly known and marketed as Viagra and Cialis. Unfortunately, up to half of patients do not get a reliable, satisfactory solution and must move on to the next possible treatment option.

Shockwave therapy to the penis is heavily marketed now, especially at men’s clinics. This can be very expensive and there is very little data to show consistent effectiveness. Dr. Engel may consider this treatment in a very small subset of patients – typically those who for whom pills have worked, but are not the preferred option, for those whom pills may be working, but not quite enough and for those who are willing to spend what could amount to $2,000 on a course of treatment that, at best, has a 50-50 chance of success. Of note, shockwave treatment has very little chance of success on severe ED or ED after a prostatectomy. As such, Dr. Engel strongly discourages it for these patients. It is also worth noting that stand alone or pop up men’s health clinics often charge twice what a urologist does and may perform several expensive and typically unnecessary tests to boot.

When severe impotence is irreversible through lifestyle change alone, patients may consider injection therapy. Injection therapy sounds more difficult than it is and most patients find that it is both simple and very effective in achieving the sex life that they desire. Injection therapy from a urologist such as Dr. Engel can be significantly more cost effective than many men’s clinics that offer the same therapy at multiples of the cost.

For those who have not responded to any of the above therapies, a penile implant may be the best option. Dr. Engel discusses these implants in great detail on his webinar recorded in December of 2020. While implants may seem like a drastic option, the procedure is relatively straightforward with a few side effects. The patient has the ability to achieve and maintain an erection with minimal disruption prior to intercourse.

Of course, Dr. Engel is here for any patients who are experiencing impotence and who wish to discuss potential causes and treatment options. As with any treatment we offer, we take a mindful, stepwise approach starting with the least invasive options and only moving on when we have exhausted all the most conservative treatments.

The Bottom Line

Erectile dysfunction can be the cause of known or unknown cardiovascular and lifestyle issues that should be addressed by improving your general health. Start with a concerted lifestyle change including improve diet and exercise. At the same time, visit your primary care physician, cardiologist or urologist to understand more about what may be at the root of your ED. There will, of course, be times where erectile dysfunction must be treated and the first line of attack is medication management. These medications are can be very effective but also come with side effects and do not address the underlying problem. Of course, we have several options for patients who have exhausted all lifestyle and medical options for their ED care.


Urologic Surgeons of Washington is a proud member of Privia Medical Group. The best doctors in our community have joined together to form Privia Medical Group (PMG), a multi-specialty, high-performance medical group that puts patients first. Our physicians are united by the mission of providing better, more coordinated care for their patients.

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