The treatment of erectile dysfunction could be fundamentally altered by a novel approach. 01.27.2026

 Erectile dysfunction (ED) is one of the most common health conditions affecting middle-aged and older men, impacting an estimated 52 percent of men between the ages of 40 and 70 in the US, and globally affecting at least 150 million men.  Obesity, diabetes, cardiovascular disease, depression, previous pelvic surgery, and lifestyle factors like smoking and alcohol consumption are all strongly associated with ED. 

In addition to affecting one's quality of life, erectile dysfunction (ED) is an under-recognized cardiovascular risk factor that can indicate deeper health issues like endothelial dysfunction, hormone imbalances, or vascular issues.

PDE5 (phosphodiesterase type 5) inhibitors, such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra), have been the most common first-line treatment for erectile dysfunction (ED) since their introduction nearly 30 years ago.

 These drugs act by enhancing the nitric oxide (NO) pathway, which stimulates blood flow into the penis.  They have improved the sexual health of many patients, with up to 60% achieving sufficient erections for sexual activity.

However, between 30% and 35% of ED patients do not respond appropriately, especially those with diabetes, nerve injury from prostate surgery, Peyronie's disease, or other conditions that prevent sexual stimulation, blood flow, or neural signaling. In these cases, the underlying dysfunction disrupts the physiological processes needed to initiate the NO cascade, making PDE5 inhibitors significantly less effective.