Maintain General Health
Because many cases of impotence are due to reduced blood flow from blocked arteries, it is important to maintain the same lifestyle habits as those who face an increased risk for heart disease.

Diet. Everyone should eat a diet rich in fresh fruits and vegetables, whole grains, and fiber and low in saturated fats and sodium. Because erectile dysfunction is often related to circulation problems, diets that benefit the heart are especially important. [For more information, see the Well-Connected Report #43, Heart Healthy Diet. ]

Exercise. A regular exercise program is extremely important. One study reported that older men who ran 40 miles a week boosted their testosterone levels by 25% compared to their inactive peers. Another study found that men who burned 200 calories or more a day in physical activity (which can be achieved by two miles of brisk walking) cut their risk of erectile dysfunction by half compared to men who did not exercise.

Limit Alcohol and Quitting Smoking. Men who drink alcohol should do so in moderation. Quitting smoking is essential.

Stay Sexually Active
Staying sexually active can help prevent impotence. Frequent erections stimulate blood flow to the penis. It may be helpful to note that erections are firmest during deep sleep right before waking up. Autumn is the time of the year when male hormone levels are highest and sexual activity is most frequent.

Kegel Exercises
The Kegel exercise is a simple exercise commonly used by people who have urinary incontinence and by pregnant women. It may also be helpful for men whose erectile dysfunction is caused by impaired blood circulation. The exercises consist of tightening and releasing the pelvic muscle that controls urination:

 
• Since the muscle is internal and is sometimes difficult to isolate, practice first while urinating. (Once learned, however, Kegel exercises should not be regularly performed while urinating. Such a practice may eventually weaken the muscles.)  
• Try to contract the muscle until the flow of urine is slowed or stopped. Attempt to hold each contraction for 10 seconds.  
• Then release the muscle.  
• Perform about 5 to 15 contractions three to five times daily.

It may be several months before the patient sees significant improvement.

Changing or Reducing Medications
If medications are causing impotence, the patient and physician should discuss alternatives or reduced dosages.

Psychotherapy and Behavioral Therapy
Interpersonal, supportive, or behavioral therapy can be of help to a patient during all phases of the decision-making process regarding possible methods of treatment. Therapy may also ease the adjustment period after the initiation or completion of treatment. It is beneficial to have the partner involved in this process. The value of sex therapy is questionable. In one study, 12 out of 20 men whose dysfunction had a psychological basis and who were advised to enter a sex clinic resisted sex therapy out of embarrassment or because they felt it wouldn’t help. Of the eight who entered therapy, only one actually achieved satisfactory sex.