Erectile dysfunction
Last reviewed: February 2009

While anxiety sometimes causes erectile dysfunction, that disorder usually stems from physical problems, often the same ones
that cause heart disease.
Sildenafil (
Viagra), tadalafil (
Cialis), and vardenafil (
Levitra) can help improve men's potency by dilating blood vessels in the penis, to allow for the increased blood flow necessary for
an erection. However, such drugs should be used cautiously, since they can cause potentially serious side effects. Those risks
may include an increased chance of heart attack or stroke among men already at risk of such events-including those with coronary
disease-as well as fertility problems and worsened sleep apnea. In some men, the drugs may also cause temporary vision or
hearing problems. And they can interact with many medications, most notably nitrates (used to relieve angina) and certain
herbs, including St. John's wort.
What to do: Addressing coronary risk factors—reducing blood pressure, cholesterol levels, and weight, stopping smoking, exercising more,
and rigorously treating diabetes—may help correct erectile dysfunction. Therapy or counseling might also help some people.
Pelvic-muscle exercises called Kegels—where you tightly tense the muscles that interrupt the flow of urine or passage of gas—may
be worth trying as well.
If reducing risk factors and performing
Kegels don't help, men could consider erection-boosting medication. Tadalafil, which lasts for about 36 hours compared with 4 hours
for the other two drugs, may be a good choice for men who value spontaneity, though side effects may also be prolonged. Men
considering any impotence drug should first have a doctor assess their risk of heart disease and review all of their medications
for possible interactions.