When Your Business Is Out Of Business:

Top 10 Things You Need to Know From Your Erectile Dysfunction Doctor

Dr. Joseph Pazona, Board Certified Urologist

I’m certain there is no more sensitive subject for men than their performance in the bedroom. The cultural expectation is that you’ll be a virile stud for your entire life. If, god forbid, you have any difficulties “getting it up” there must be something wrong with your masculinity.

Yeah, right. Unfortunately, those expectations are both unreasonable and unfair.

Your erectile dysfunction doctor is here to help. Here’s what you need to know about erectile dysfunction.

How common is erectile dysfunction or ED?

It is estimated that 30 million men in the U.S. have erectile dysfunction.


Here’s another way to look at ED. Take your age in decades, and that’s the percentage of men your age with ED issues. For the math-challenged, this means:


50% ED by age 50

60% need the little blue pill by age 60

70% would rather take a good nap then get busy by age 70


In other words, it’s going to happen to most of us. And we need not be ashamed. 

What causes erectile dysfunction?

The most common explanation for ED is atherosclerosis (fancy doctor term for hardening and clogging of the arteries). Yes, you’ve heard of this before. That’s because atherosclerosis also causes heart attacks and strokes.


Some studies estimate that once erection troubles begin, you’re at risk for a heart attack or stroke within 5-10 years. Why is this? 


The smallest arteries to become clogged lead to... wait for it...the penis. The 2nd biggest blood vessels to become blocked go to the heart and brain. 


In other words, once you notice erectile dysfunction make sure that you take a serious look at your overall health. ED may be your warning sign of some serious medical conditions in the future.

What causes atherosclerosis?

If you have any of the following medical conditions or risk factors, then you are at risk for atherosclerosis:

  • High blood pressure
  • Diabetes
  • High cholesterol
  • Obesity
  • Smoking
  • Lack of exercise
  • Poor dietary habits
  • Genetics (family history of heart disease)
  • Rooting for Alabama (just kidding)


It’s important to have a primary care doctor that you trust to help treat these conditions. With lifestyle changes and proper medications, you can, in some cases, reverse erectile troubles.

Are there other causes of ED?

For those of you who may be saying, “I don’t have any of these problems! What else could be going on,” there are certainly numerous other causes of ED including: 

  • Stress, depression, anxiety
  • Low testosterone
  • Medications 
  • Previous abdominal or pelvic surgery 
  • Previous pelvic trauma
  • Neuropathy 


Stress and anxiety often cause situational erectile dysfunction. One moment you're at peak performance and then . . . nothing. Don’t worry, your erectile dysfunction doctor can help.


Low testosterone can start as young as age 30. It is often associated with a low libido or interest in sex. Adequate testosterone levels are necessary for proper erectile function. 


Countless medications have been implicated as a contributing factor to ED. Some of the more common medications include antidepressants, high blood pressure pills, muscle relaxers. If you’re on a medication that you think is causing erectile dysfunction, ask your doctor about alternative medications.


The nerves that lead to erections run deep in the pelvis (bowl shaped area behind your pubic bone). These nerves can be damaged during prostate or colon surgery, pelvic fracture or radiation to this area. 

Are there any over the counter erectile dysfunction drugs that work? Are there any natural ED medications?

We all have seen the “erectile dysfunction pills” at GNC and the truck stop bathroom. (Yes, ladies, that’s what they sell in the men’s bathroom.) Don’t waste your money on them. They do not work. 


More importantly, who knows what’s in them? Non-FDA approved medications do not undergo the same rigorous safety inspection that prescription medications must pass.

Is Viagra safe? What do I need to know about “the little blue pill?”

If you actually want to improve erections, then a prescription medication is your best bet. 


Viagra (sildenafil), Cialis (tadalafil) and Levitra (vardenfil) are the most common prescription medications. They are safe and do not cause heart attacks. Just make sure that your most vigorous exercise isn’t getting off the couch for a beer. It’s the physical stress of sex in some men that kills them, not the pills.


Side effects from these medications are usually temporary and mildly unpleasant. You won’t get sausage fingers, lose function of your bowels, or have your business explode. Four hour erection!? Trust me, you don’t want this and it’s rare with the pills, anyway.


These pills can be expensive. Insurance companies rarely, if ever, cover the cost of ED medications. Ask your erectile dysfunction doctor about generic substitutes available through well-regarded compounding pharmacies.

I tried the pills and they don’t work. What else is there? Are there injections for erectile dysfunction?

The first option is a vacuum erection device (VED) or “The Penis Pump.” It is a cylinder that you place your “man” inside of while a vacuum stretches him out. A ring will then be placed around the base of the penis to “keep it up.”


About 60% of couples consider a VED satisfactory for intercourse. Others don’t feel like it works, the ring “hurts” or don’t like the mechanical nature of the device.


For the truly motivated we have needle injections into the penis (yeah, no way doc). 


Sounds crazy? Yes. 


But do they work? Yes.


Medication(s) that dilate blood vessels are injected directly into the penis, bypassing the blocked arteries. The injection works within 5-10 minutes and often provides men with their firmest erection in years.


The main risk of penile injections is priapism or a painful, prolonged erection. This is an emergency which requires immediate medical attention.


For motivated couples these options can allow for a very satisfying intimate experience. However, I certainly understand why pumps and needles are unwelcome in some bedrooms. This is a very personal decision based on quality-of-life. 

Is there surgery for erectile dysfunction?


When all else fails, there is surgery for erectile dysfunction (gasp!). A penile prosthesis can be inserted internally within the erectile chambers, allowing men to be hard as long as they want. You’ll put the fraternity boys to shame with this contraption. However, this is for highly motivated men in whom the only other option is no more hanky panky.


Penile prosthesis surgery should be performed by high-volume surgeons who are expert erectile dysfunction doctors. In the right hands, infections and mechanical complications from surgery are rare. 

Are there any new therapies for ED? I read about ESWT and “P-Shots”.

Until recently, we did not have any medical therapy to help reverse erectile dysfunction. We now have some promising new treatments.


ESWT, or shockwave therapy for ED, delivers sound waves via a painless, in-office procedure. The shockwaves help break up plaque and blockages within the penile blood vessels. ESWT also recruits the body’s natural growth factors to help new blood vessel growth. Shockwave therapy for ED shows 70-80% efficacy.


Platelet rich plasma (PRP) injections have been used in restorative medicine for many years. It was only a matter of time before someone was going to inject PRP into a penis. Because that’s what men do.


Now we have the “P-Shot”. This is often used in combination with ESWT to increase the growth factors in the penis and improve erectile dysfunction.

How should I find an erectile dysfunction doctor near me?

With new digital men’s health clinics and online pharmacies popping up (excuse the pun) every day, finding an erectile dysfunction doctor is easier than ever. The problem is finding someone with expertise who you can trust.


Although I’m a bit biased, a board-certified urologist has the training and experience to best manage all aspects of erectile dysfunction. Unfortunately many doctors treat erectile dysfunction because it’s a lucrative business. I’d rather see the expert myself.


Looking for an erectile dysfunction doctor in Nashville? Please email me at hello@pazonamd.com to see if I can help. At Pazona MD, we offer the latest therapies for ED and can be your full-service erectile dysfunction doctor.


Until we see you in our clinic, please eat healthy, exercise, and take your blood pressure medication. 


Your penis will thank you for it.


- Dr. P

Dr. Joseph Pazona is a board-certified urologist in Nashville, TN with expertise in the management of erectile dysfunction.

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About the Author

Doctor Joseph Pazona is the founder of Pazona MD, a specialty urology practice located in Nashville, TN. He has been published in medical journals on the topic of urology & authored several consumer ebooks on a variety of urologic conditions in addition to the topics of telemedicine, and continuing medical education (CME). When he’s not treating patients or writing he enjoys traveling, hiking, running, cooking, and spending time with his three children and fiancé, Catherine.


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