Lifestyle modification
It has also been shown that, in a group of patients with
congestive heart failure, short-term moderate exercise training can improve sexual function114. A review of the patient’s
medications might reveal some drugs that are well known to have erectile dysfunction as an adverse effect (BOX 2).
However, much of the data on iatrogenic erectile dysfunction are based on observational studies, with severe limitations.
Smoking has been shown to have a direct relationship with
erectile dysfunction, and a dose response relationship has been suggested because men have increased erectile difficulties with greater numbers of packets of cigarettes smoked or more years of smoking38,115,116 . One study suggested that cessation of cigarette smoking can improve erectile function117 .
Mild alcohol consumption might improve erectile function by reducing anxiety; however, chronic use or alcohol abuse can have lasting effects on the liver, leading to low levels of
testosterone and increased levels of oestrogen, both of which can contribute to erectile dysfunction118,119.
Patients with psychological stressors (such as performance anxiety, relationship issues and current life stress)120 may benefit from confidence restoration with erectogenic
medications and/or counselling with a psychologist or other health care professional specializing in sexual dysfunction121.
Accordingly, the European Association of Urology states that
“lifestyle changes and risk factor modification must precede or accompany any [erectile dysfunction] treatment”, and classifies the level of evidence for lifestyle modification as 1b with a
grade A recommendation122 .
