Most urologists provide care for men with erectile dysfunction (ED). These men also suffer from hypertension, diabetes, and elevated cholesterol levels. Of course, we can prescribe phosphodiesterase-5 inhibitors (PDE-5Is), often restoring men’s potency and ability to engage in sexual intimacy. But are we helping men to lead healthier lifestyles by providing them with a prescription? You will all agree that PDE-5I is the band-aid for the ED problem. Since this medication option is in our armamentarium, we should certainly avail ourselves and our patients of this treatment. However, we could be good urologists and lead men to better lifestyle changes if we could encourage them to lead healthier lifestyles, including diet and exercise. Let me share a discussion I have had with men who present with ED and men to whom I have provided PDE-5Is.

I have treated many men with ED, and I have a script to talk to men about lifestyle changes. The conversation with “Mr Smith” might go something like this: “Mr Smith, would you like a pill that decreases your risk of cancer, decreases your cholesterol level, improves your type two diabetes so that you don’t need to take diabetic medication, will lower your blood pressure and you will not need to take anti-hypertensive medication, decreases your joint pain in your knees, prevents constipation, solves your insomnia, improves your sex drive, increases your testosterone level, increases your energy level, improves your sexual performance, and increases the length of your penis by one and a half to two inches?”

Mr Smith, and all the men who hear this spiel, usually respond, “Do you mean there’s a pill that can do all of that? I would certainly like a prescription for those pills if the answer is yes.”

I pat Mr Smith on the back and say, “Mr Smith, it’s not a pill”… I pause, and I smile …. “It’s exercise!” Mr Smith usually giggles and might inquire about how exercise would make his penis longer? My answer is that when he loses his abdominal panniculus, he will be able to see his toes when he showers, and his penis will “appear” longer!

Does this kind of communication impact men with ED to change their behaviors? Few men will take my advice and leave the office to begin an exercise program. However, the discussion offers men an alternative to the quick fix for treating ED and continuing with 5 or more medications a day. I can’t tell you how many men have taken my advice and left their anti-hypertensive, cholesterol, and diabetes medications in the medicine cabinet. But I can tell you that I have made men aware that the control of their health is in their hands and legs, and that if they take personal responsibility for their health, including an exercise program, they will lead happier and healthier lives.