i am 56 year old and sufferinng with erection problem what should i do
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"erectile dysfunction"[MeSH Terms] AND treatment
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I now have solid, textbook-grounded information to give you a thorough, practical answer.
Erectile Dysfunction (ED) at Age 56 - What You Should Know & Do
What Is ED?
Erectile dysfunction is defined as the inability to achieve and/or maintain an erection sufficient for satisfactory sexual performance. It is very common - affecting about 6% of men aged 50-59, rising to 17% by age 60-69. So at 56, you are not alone, and this is absolutely treatable.
- Textbook of Family Medicine 9e
Why Does It Happen? (Common Causes)
Your doctor will look for these underlying causes:
| Category | Examples |
|---|---|
| Cardiovascular | High blood pressure, coronary artery disease, high cholesterol |
| Metabolic | Diabetes (very strong link), obesity |
| Hormonal | Low testosterone (hypogonadism), thyroid problems |
| Neurological | Peripheral neuropathy, prior pelvic surgery |
| Psychological | Depression, anxiety, relationship stress |
| Medications | Beta-blockers, thiazide diuretics, antidepressants (SSRIs), antipsychotics, spironolactone, finasteride |
| Lifestyle | Smoking, alcohol, sedentary lifestyle |
Important: Men with ED often have underlying cardiovascular disease - sometimes before heart symptoms appear. ED and heart disease share the same risk factors. As the textbook says: "What is bad for the heart is bad for the penis." Getting a cardiac risk assessment is important.
Step 1: See a Doctor for Proper Evaluation
Before any treatment, your doctor should assess:
- Medical history - heart disease, diabetes, blood pressure, surgical history
- Medication review - many common drugs cause ED (see table above)
- Physical exam - blood pressure, genital and prostate exam, peripheral pulses
- Blood tests:
- Fasting blood sugar and HbA1c (diabetes)
- Lipid panel (cholesterol)
- Testosterone level (total and free)
- Kidney function, liver function
- PSA (prostate)
- Thyroid (TSH)
Step 2: Treatments Available
First-Line: PDE5 Inhibitors (Oral Pills) - Most Effective
These are the standard first-choice treatment and work for most men:
| Drug | Brand Name | How to Use |
|---|---|---|
| Sildenafil | Viagra | 30-60 min before sex, as needed |
| Tadalafil | Cialis | Daily low dose OR as needed (lasts 36 hrs) |
| Vardenafil | Levitra | 30-60 min before sex |
These drugs work by increasing blood flow to the penis (they block PDE5, which allows cGMP to build up, relaxing the smooth muscle and enabling erection). They do not cause an automatic erection - you still need sexual stimulation.
Important warnings:
- Do NOT take with nitrates (nitroglycerin, isosorbide) - dangerous blood pressure drop
- Talk to your doctor if you have heart disease before starting
If Testosterone Is Low
If your testosterone comes back below 300 ng/dL, testosterone replacement therapy can help. Options include:
- Testosterone gel applied daily to skin
- Intramuscular injections every 2-4 weeks
- Testosterone patches
- Subcutaneous pellets every 3-6 months
Second-Line Treatments (If Pills Don't Work)
- Alprostadil (PGE1) - injected directly into the penis (intracavernosal) or inserted as a pellet into the urethra. Very effective even when pills fail.
- Vacuum Erection Device (VED) - a pump device that draws blood into the penis. Works for nearly any cause of ED.
Third-Line
- Penile implant (prosthesis) - surgical option, used only when all other treatments have failed. High satisfaction rates.
Step 3: Lifestyle Changes That Help
These actually work and can significantly improve erections:
- Lose weight if overweight - weight loss alone can restore erectile function in obese men
- Exercise regularly - improves blood flow and testosterone
- Stop smoking - smoking damages penile blood vessels directly
- Reduce alcohol - alcohol is a depressant and impairs erection
- Manage stress and sleep - psychological factors are real contributors
- Control blood sugar, blood pressure, and cholesterol
Step 4: Address Psychological Factors
If there is performance anxiety, relationship stress, or depression involved, psychosexual counseling or sex therapy can help - especially when combined with medication. Men receiving group therapy plus sildenafil showed significantly better outcomes than sildenafil alone.
What to Do Right Now - Action Plan
- Book an appointment with your doctor (GP or urologist) - do not self-treat
- Get blood tests - testosterone, blood sugar, lipids, kidney/liver function
- List all your current medications - some may be causing this
- Start lifestyle changes today - exercise, diet, quit smoking
- Discuss PDE5 inhibitors with your doctor - sildenafil or tadalafil are safe for most men
- If you have cardiovascular symptoms - get those evaluated first
Disclaimer: This information is for educational purposes only. Please consult a qualified doctor before starting any medication or treatment. ED can be an early sign of heart disease, so a medical evaluation is important.
- Sources: Textbook of Family Medicine 9e, Campbell-Walsh Urology (textbook library)
Which PDE5 inhibitor would be best for me based on my lifestyle?
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Excellent - I now have everything needed for a detailed, personalized recommendation.
Best PDE5 Inhibitor for You
Based on your profile - planned sex once or twice a week, no major cardiac conditions, no nitrates - here is a thorough comparison and a clear recommendation.
How They All Work (Same Mechanism)
All four PDE5 inhibitors work identically: they block the enzyme that breaks down cGMP, allowing blood to flow into the penis during sexual stimulation. They do not cause erections on their own - you still need to be sexually stimulated. All four have equivalent efficacy overall.
The Four Options - Head-to-Head
| Feature | Sildenafil (Viagra) | Tadalafil (Cialis) | Vardenafil (Levitra) | Avanafil (Stendra) |
|---|---|---|---|---|
| Onset | ~60 min | ~60-120 min | ~60 min | ~30 min (fastest) |
| Duration | 4-6 hours | Up to 36 hours | 4-6 hours | 4-6 hours |
| Half-life | 4-5 hours | 17-18 hours | 4-5 hours | ~5 hours |
| Food effect | High-fat meal delays it | Not affected by food | High-fat meal delays it | Fatty meal slightly delays |
| Daily dosing option | No | Yes (5 mg/day) | No | No |
| Starting dose | 50 mg | 10 mg (or 5 mg daily) | 10 mg | 50 mg |
| Main side effects | Headache, flushing, nasal congestion, blue-tinted vision | Headache, flushing, back pain/muscle aches | Headache, flushing, nasal congestion | Headache, flushing |
| Special caution | - | - | Avoid with heart rhythm drugs (QTc prolonging) | - |
| Cost | Lowest (generic available) | Moderate | Moderate | Highest |
My Recommendation for You: Tadalafil (Cialis)
Given that you have sex once or twice a week on a planned basis, tadalafil is the best fit. Here is why:
Option A: Tadalafil 10-20 mg "As Needed"
- You take it a couple of hours before planned sex
- It stays active for up to 36 hours, so there is no pressure to perform within a narrow time window
- Food does not affect it - you can eat a normal meal before sex without worrying
- Works effectively in 70%+ of men, including those with diabetes or hypertension
- If it does not work well enough at 10 mg, your doctor can increase to 20 mg
Option B: Tadalafil 5 mg Daily (Low Dose)
- You take a small pill every day regardless of when you plan to have sex
- This completely removes the "planning" factor - you are always ready
- Studies show this reduces side effects while maintaining consistent effectiveness
- Also beneficial if you have any prostate/urinary symptoms (BPH) - tadalafil is the only PDE5 inhibitor approved for both ED and BPH
- Particularly useful if you want spontaneity even within your planned schedule
"Tadalafil therapy has a broader window of clinical responsiveness than avanafil, sildenafil, or vardenafil because of its longer half-life (17.5 vs 4-5 hours for sildenafil or vardenafil). Tadalafil enhances erectile function in men with ED for up to 36 hours and may mean less planning and pressure to have sexual intercourse according to a schedule."
- Smith and Tanagho's General Urology, 19th Edition
When Sildenafil Might Be Better
Sildenafil (Viagra) is a perfectly good choice if:
- Cost is a concern - generic sildenafil is significantly cheaper than branded options
- You want something well-tested with decades of data
- You only need it occasionally and are fine with the 1-hour planning window
Take it on an empty stomach or with a light meal for best results - a fatty meal delays absorption.
Side Effects to Know About (All PDE5 Inhibitors)
| Side Effect | How Common | Notes |
|---|---|---|
| Headache | ~15% | Most common, usually mild |
| Flushing (face warmth) | 5-10% | Usually goes away after a few uses |
| Nasal congestion | 5-10% | Especially sildenafil/vardenafil |
| Back pain / muscle aches | 1-4% tadalafil | Unique to tadalafil, usually resolves in 2 days |
| Slight blood pressure drop | Mild | Not dangerous unless on nitrates |
| Vision changes (blue tint) | Rare | Mainly sildenafil - affects PDE6 in the eye |
| Sudden hearing loss | Very rare | Stop drug and see doctor immediately |
Practical Tips for Best Results
- Do not take with alcohol - alcohol impairs erections and increases side effect risk
- Sexual stimulation is required - the pill alone does nothing
- Do not expect instant results on the first try - many men need 6-8 attempts before getting the best response as the body adjusts
- Tadalafil: eat freely - no food restrictions at all
- Sildenafil/vardenafil: avoid fatty meals within 1-2 hours of taking the pill
- Never combine with nitrates (nitroglycerin, isosorbide) - can cause dangerous blood pressure drop; wait 24 hours after sildenafil, 48 hours after tadalafil
Summary Recommendation
| Your situation | Best choice |
|---|---|
| Planned sex 1-2x/week, want flexibility | Tadalafil 10 mg as needed |
| Want to never think about timing | Tadalafil 5 mg daily |
| Budget is tight | Generic sildenafil 50 mg |
| Want fastest onset (30 min) | Avanafil 50 mg |
Bottom line: Talk to your doctor about tadalafil - either the as-needed 10/20 mg dose or the daily 5 mg dose. Given your lifestyle, the 36-hour window removes all performance pressure and the absence of food restrictions makes it the most convenient option.
Disclaimer: This is educational information only. Your doctor must prescribe and supervise PDE5 inhibitor therapy after reviewing your full medical history and current medications.
- Sources: Smith and Tanagho's General Urology 19e, Lippincott Illustrated Reviews: Pharmacology, Kaplan & Sadock's Comprehensive Textbook of Psychiatry
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