What lifestyle modifications should I discuss with patients to help manage erectile dysfunction?

When discussing lifestyle modifications to help manage erectile dysfunction (ED) with patients, focus on several key areas that can improve symptoms and overall cardiovascular health. Advise weight loss if the patient is overweight or obese, as this can improve erectile function and reduce cardiovascular risk factors. Encourage regular physical activity, aiming for at least 20 to 30 minutes daily of moderate exercise to improve endothelial function and cardiovascular health, which are closely linked to erectile function. Recommend smoking cessation because smoking is a known risk factor for ED and vascular disease. Advise reducing alcohol consumption to within recommended limits, as excessive alcohol can worsen ED. Manage underlying conditions such as diabetes, hypertension, and dyslipidaemia optimally, since these contribute to ED pathophysiology.

Additionally, if the patient cycles regularly for more than 3 hours per week, suggest a trial period of stopping cycling or using a properly fitted bicycle seat positioned correctly to reduce perineal pressure and nerve compression. Discuss stopping all sexual activity temporarily if the patient is at high cardiac risk until specialist cardiology assessment is completed.

It is important to note that lifestyle changes may produce moderate improvements in erectile function and enhance the efficacy of pharmacological treatments such as phosphodiesterase-5 (PDE-5) inhibitors. These modifications also reduce long-term cardiovascular risk and improve endothelial function, which is a key mechanism in ED. Do not recommend unlicensed herbal or complementary medicines due to lack of evidence and potential safety concerns.