Male Sexual Health Concerns: Are You Too Worried About ED?

An increasing number of American men have sexual health concerns, according to replies to a recent questionnaire—but are all their worries valid?

Cleveland Clinic released the results of its latest nationwide survey. What they found was a rise in the number of men concerned about their erectile health, particularly erectile dysfunction (ED), the inability to achieve or maintain an erection sufficient for sexual activity.

ED affects more than 30 million American men, and its prevalence increases with age, although anyone can experience it at any age.

Of the Cleveland Clinic survey respondents, 44 percent reported being "worried about erectile dysfunction," with another 39 percent expressing concerns about a loss of sex drive.

The survey also suggests more than half of the men who responded, roughly 58 percent, "incorrectly think low testosterone is the most common cause of erectile dysfunction."

So, according to sexual health experts, what concerns should men really have about their sexual health?

What male health concerns are most realistic?

Men should focus less on testosterone as a cure-all and instead turn their attention to the following factors that are often overlooked, according to Seth Cohen, M.D., M.P.H., a urologist and associate professor of urology at NYU Langone Health in New York City.

Male sexual health concern No. 1: Overall health

What's happening in a man's penis often has little to do with his sexual partner and more to do with the overall health of his body, particularly his heart. The source of most erectile dysfunction, Cohen said, begins with basic lifestyle choices surrounding diet, exercise and weight control.

"I think an important concept to sort of nail home is the importance of taking care of one's overall health: mind, body, soul," Cohen said. "I think that most of the data we have on protecting men's health overall is based on the data we gather from cardiovascular studies, and everything is basically linked, aside from genetic defects, is based on diet, exercise and weight control."

His sexual health advice for everyone? Run.

"Start running now. Start biking, start Peloton-ing, get on a City-bike," he said. "City-bike to your date and your penis will be harder. Get the heart pumping. Get the heart in good shape. You can't just put on a pair of Nike shoes and go run a marathon if you haven't trained for it. You've got to train for sex, too."

Male sexual health concern No. 2: Heart health

When looking to increase sexual performance, don't forget about the ol' ticker. If your heart isn't healthy, your penis won't be either.

"Patients will go on websites and it'll say the most important thing for men is testosterone, or the most important thing is what's going on in the bedroom," Cohen said. "But really the most important thing is 'how healthy is your heart?' I think it really starts with a heart-healthy mindset, and then everything from there is sort of icing on the cake."

There are a number of lifestyle changes that can increase the strength and longevity of your heart and, almost by default, your erections.

"If your heart is not optimized for healthy cardiovascular exercise, then really how can you expect it to pump enough blood flow to maintain strong erectile performance?" Cohen said. "So really, it all starts with the heart."

Male sexual health concern No. 3: Sleep

A lack of restful sleep is another overlooked sexual health factor men should keep in mind.

"People, especially in New York, don't seem to sleep all that much, but sleep is quite important to control all the hormone levels in the body, including testosterone, cortisol, dopamine, serotonin," Cohen said. "So when we don't sleep, then we're sleep deprived and we go to work and it doesn't allow us to reset all the important hormones and bodily functions that need that."

Sleep, he said, is a "wholly underutilized" way men can easily boost their own health and sexual performance.

Male sexual health concern No. 4: Mind

Are you mentally stressed, depressed or anxious? An unquiet mind can be a real erection killer. Cohen said psychological factors are often another overlooked aspect of men's sexual health.

"Just admit it," he said. "You're totally stressed. You're anxious at work. Your boss is a dick, and your parents are on to you to get married. Yada, yada, yada, yada. So, yeah, we're stressed."

Psychological therapy, he said, could provide an added benefit in the bedroom if men are experiencing a higher-than-usual stress load.

In the absence of psychological or psychiatric help, symptoms of a man's untreated mental health condition may present physical barriers to sexual performance.

Worrying less about your sexual health

It's simple enough to recommend men worry less about their sexual health, but what, specifically, can they worry about less?

Worry less about testosterone

The male sexual health concern Cohen wishes patients would worry about less is low testosterone. Doctors say it isn't near the problem that advertising makes it out to be.

"Really, testosterone is very important for libido and sexual drive, your drive to have sex, but it doesn't, in my mind, do a whole lot for sexual erectile performance," he said. "If they're looking for better erectile performance, I think testosterone is the wrong place to look."

While the addition of testosterone can provide certain health benefits, in Cohen's experience, low-T is far down on the list of erectile dysfunction solutions.

"Everybody focuses on that one (testosterone) as the cure-all for their entire life," he said. "It's going to make me look better. It's going to make me stronger. It's going to make me younger. It's going to make my penis harder. And truth is, it probably doesn't do much other than make you a little hornier."

Worry less about your age

As men age, the chances they will experience erectile dysfunction increase—but doctors want you to remember that not all hope is lost.

Barbara Chubak M.D., an assistant professor of urology at Icahn Medical School at Mount Sinai in New York City, said she often hears middle-aged and older patients say that erectile dysfunction is something they must accept rather than treat.

"That's simply untrue," Chubak said. "Even when something is part and parcel of aging, or aging increases your risk of it, it doesn't mean it can't be improved upon."

There is a wide range of effective treatments for men with ED in addition to lifestyle changes that can have profound effects.

"You don't need to just throw up your hands and give up if you have erectile dysfunction and you'd like that to not be the case," she said.