“Are you able to get and maintain the erection you want? Do you still have morning erections?” These are common questions I ask patients who have a penis, and most times on the first visit. I never imagined I would be in a career asking such questions about erectile dysfunction on a regular basis. However, the quality of erections lends valuable insight into one’s overall health. Failure to achieve erections may even be the first sign that something more sinister is looming, and it is associated with a shorter lifespan! 


Erectile dysfunction (ED) is defined by the American Urological Association as, “the consistent or recurrent inability to acquire or sustain an erection of sufficient rigidity and duration for sexual intercourse.”  It is common for the quality of erections to decline with age. A study in the Journal of Urology showed the incidence of ED is 18% in those 50-59 years old and increases to 37% in those over 70 years old. The Massachusetts Male Aging Study showed that by 40 years old, 40% of men demonstrate some degree of decrased sexual function, which increases which each decade after 40.  However, let’s not mistake what is common for what is normal. 


There are many causes of ED. The most common are:

  • Atherosclerosis, leading to plaque in blood vessels, decreasing blood flow to the penis.
  • Hormonal imbalances
  • Type 2 diabetes
  • Hypertension
  • Medication side effects – Antihypertensives, antidepressants, antipsychotics, antiandrogens, recreational drugs, alcohol, etc.
  • Performance anxiety
  • Smoking
  • Other (scleroderma, Peyronie’s, Prostate cancer treatments)


Likely you already knew ED was common, as the pharmaceutical industry has heavily marketed the little blue ED pill. Pfizer’s Viagra (tadalafil), for example, earned nearly 500 million dollars in global revenue in 2019. Drugs like tadalafil work by blocking an enzyme, enabling blood vessels in the penis to relax and fill with blood, resulting in increased erection quality.


These medications are helpful because healthy sexual activity is key for good quality of life and general well-being. That is why I often recommend these drugs as part of an initial treatment plan. However, they do not provide a long-term solution, and the cost can be a real barrier. A daily dose of tadalafil may cost $5-$25 per pill, or $150-750 per month!


Besides the cost issue, ED medications potentially mask serious underlying health concerns, and do not address the root cause of the problem. Notably, ED may be an early sign of cardiovascular disease causing plaque build up in the small vessels of the penis. Coronary artery disease (CAD), is a disease of plaque build up in the delicate vessels that supply oxygen to the heart wall, thus increasing the risk of a heart attack. A European Urology study showed 67% of men with erectile dysfunction were diagnosed with CAD 3 years after the initial ED diagnosis. While unfortunate, this is not surprising, considering the penile artery is half the size of the vessels feeding the heart. 


ED is undeniably a marker of blood vessel health, risk of cardiovascular disease and a shortened life. For these reasons, I believe every physician should discuss sexual health with their male patients. 


Two proven treatments for erectile dysfunction


Fortunately, there is more you can do for ED than just taking a pill to mask the symptoms. Natural Medicine of Seattle is happy to announce we are offering a breakthrough treatment that treats the root cause of the problem. Extracorporeal Pulse Activation Technology (EPAT), often referred to as “sound wave”, is a non-surgical, non-drug treatment that uses sound waves to improve blood flow to the penis. This exciting technology is able to treat the underlying cause of erectile dysfunction by stimulating the body’s natural ability to heal, and remove plaque build up to these small vessels. The results of sound wave therapy include stronger erections, increased sensitivity and more spontaneous erections. 


The research on sound waves is well-documented and impressive, with the majority of those treated noting significant improvement in erection quality. We maximize results by taking a holistic approach, which may include individualized nutrition recommendations, lifestyle modifications and hormone testing. Sound wave therapy for ED generally requires 6 treatments over 2 months to experience long-lasting benefits. The process involves a clinician applying sound waves to the penis, which feel like small vibrations, up to mild discomfort. Sound wave therapy is an outpatient procedure with little to no recovery time needed. In fact, we often encourage sexual activity the evening of treatment!


To maximize results, we often combine sound wave therapy with Platelet Rich Plasma (PRP) injections. This involves injecting the patient’s own concentrated plasma into numbed tissues to stimulate healing. Often called “liquid gold”, PRP causes the body to release local cytokines and growth factors, which encourage the proper healing of the tissues. Combining sound wave and PRP maximizes the body’s natural healing mechanisms. Our patients receive this treatment with very little to no downtime, with no drugs or surgery!


We at Natural Medicine of Seattle are committed to discovering the underlying cause of ED, in order to find the best treatment plan for the individual. Your initial investigation may involve blood testing, imaging, hormone balancing, or a referral to a urologist, in order to acquire the full picture of the problem. Remember, ED is common, but it does not have to be! It all starts with a discussion with your naturopathic doctor. 


Schedule a free 15-min phone consultation or ask your doctor today about our sexual health treatments.  

Dr. Payton Robertson is a naturopathic doctor who specializes in men’s health, cardiovascular health, and regenerative injection therapies.