It seems that everyone and their uncle is an expert on erectile dysfunction (ED) which is probably why there is so much false information bouncing around the internet. For openers, most people think that ED is an “old guy’s” problem, but unfortunately, that’s simply not true. Maybe it’s because of the stress of dealing with the pandemic, or maybe it’s because guys are just more open to revealing their challenges, but it’s not unusual for guys in their twenties to have trouble getting hard, or staying hard. One thing that most everyone agrees upon is that the older you get the more likely erectile dysfunction becomes. If you live long enough, you’re number is going to come up, and you will become impotent.

What causes erectile dysfunction?

Any condition which reduces the amount of blood flow can contribute to ED. The most common conditions are:

1) Diabetes

2) Hypertension

3) Heart disease

4) Peripheral vascular disease

5) Neurological diseases including stroke, and Parkinson’s

6) Obesity

Is there anything that I can do on my own to help reverse ED?

This is a subject which doesn’t get enough attention. Studies have shown that it is possible to reverse some of the processes which are responsible for ED. Erectile dysfunction is frequently the first sign of significant cardiac disease, as the same mechanisms that cause occlusion of the cardiac vasculature can occlude the small blood vessels that supply the penis. Patients with erectile dysfunction who have known risks factors and/or a family history of cardiac disease should undergo screening to make sure they are not headed for a heart problem or a stroke.

What exactly happens when you get an erection? How come my erections are soft now?

It’s pretty simple. An erection comes about when there is more blood flow into the corpora cavernosa than their is blood flow draining out. There can be a problem with the inflow, which is the most common cause of erectile dysfunction. Something has caused a blockage and less blood is flowing in. It’s also possible for there to be a leak which is termed venous leak. If enough blood is flowing in, this can compensate for some leakages. Most erection problems come about because of a blood flow problem.

The blood flow is controlled by complex neural mechanisms, and biochemical signals. The two most important biochemical signals are Nitric Oxide, and phosphodiesterase type 5. They have opposing roles.

Viagra, Cialis and Levitra work by inhibiting phosphodiesterase type 5. By reducing pde5, they increase blood flow. There is evidence that low intensity shock waves may help to release Nitric Oxide. Similarly, foods rich in nitrates such as celery, lettuce and spinach may help to boost Nitric Oxide.
I can still usually get hard. It’s just not as hard as it used to be. Do I have an erection problem?

In 30 years of urology practice I can’t tell you how many times I heard this. Many patients in this category benefit from some form of treatment. Obviously the majority of guys with mild ED used to take a pill- Viagra or Cialis- on demand. The other choices were much more cumbersome or invasive. Those draconian options included vacuum pumps, intraurethral pellets, injections into the penis, or surgery. Of course, these days many patients who just want a little tune up choose Low intensity Extracorporeal Shockwave Therapy (LiESWT.)

Does a major league baseball player hitting 280 have a problem? Maybe not. But that doesn’t mean he wouldn’t like to hit 300! If his name was Ted Williams, he might even want to hit 400 (and baseball fans know he did!)

Pde5 inhibitors like Viagra are terrific, and saved more than a few relationships.

Viagra is a sensational drug, and there’s a very good reason it alone has earned Pfizer tens of billions of dollars. Twenty years ago when it was introduced to the United States it was a recognized game-changer. It opened up free flowing discussion about ED, and helped invite patients to bring up a subject with their doctors which was often felt to be taboo. Viagra inhibits phosphodiesterase type 5, which is the erection killer. Most of the phosphodiesterase type 5 receptors are in the penis, but unfortunately, they are also found elsewhere in the body. With drugs there are always some side effects, and Viagra, Cialis, Levitra and Stendra are no different.

It’s no secret. Pde5 inhibitors may have some unpleasant side effects.

Here’s a little secret you may not know.
Most patients who take Viagra like it a lot. At first! I can’t tell you how many patients were absolutely thrilled with their erections when they tried Viagra! But sadly, Viagra does not cure ED. Whatever process caused the problem (usually vascular insufficiency) continues to get worse. It’s not a matter of patients getting habituated to the medicine. It’s more that the drug is being asked to accomplish more and more. Eventually, Viagra, Cialis, Levitra and Stendra all stop working.

What about Testosterone? Does that have a role in treating ED.

Testosterone does have a role in erectile function, and low T should be safely corrected for a variety of potential benefits. However, replacement of T as a sole modality (monotherapy) will likely fail to restore the vascular phenomenon of an erection.

Evidence suggests that many patients treated with low intensity shock wave therapy are cured, and are able regain erectile function without drugs.

Some men who previously failed drugs find themselves more responsive to pills after undergoing LIST. Others who may have noticed a mild decline in their performance, and are anxious to “keep the pipes open” may also benefit.


Low intensity shock waves are very safe, with few side effects. Patients don’t experience down time, and are able to resume normal activities right away. Now, men can treat themselves at home, without a doctor’s visit! Learn more at https://uroshock.com/