Editing Evaluation and Management of Erectile Dysfunction (section)

=== Conservative treatment ===

* '''Psychosexual counselling'''
** May represent a spectrum of approaches from a simple open discussion with the primary care physician to psychologist, sexual therapists and/or psychiatrists
** Consider referral to a mental health professional to promote treatment adherence, reduce performance anxiety, and integrate treatments into a sexual relationship
*** Many men avoid using ED treatments or discontinue using effective ED treatments because of beliefs about loss of masculinity and distress related to possible failure in a sexual situation.
*** '''Psychogenic ED''' is generally driven by a man’s anxiety related to the ability to achieve an erection. '''Medical treatments can be effective in these situations''', but the addition of psychotherapy or psychosexual counseling may help men to use the medications more effectively and ultimately transition off medical ED therapies.
* '''Medication change'''
** '''Certain medications are associated with ED. If this is found, consider changing to a different dose or type of medication entirely, this may reverse ED in some patients'''
** '''Offending drugs such as estrogens, morphine, sedatives, and neuroleptics should be discontinued'''
* '''Lifestyle modifications'''
** '''Changes in diet, discontinuation of cigarette smoking, reducing alcohol, increased physical activity, improve overall health and may improve erectile function'''
** A change to a no-nose saddle from a conventional saddle has been shown to recover erectile function, presumably by alleviating perineal trauma, in a short-term interventional study of men with ED associated with occupational bicycle riding.
** Physical activity
*** Meta-analysis of 5 RCTs found a mean increase in the IIEF-EF score of 3.77 with increased physical activity level§