Impotence is a widespread problem and can affect as many as 50 percent of men between the ages of 40 and 70. But today's physicians are becoming better informed about erectile dysfunction and the wide array of treatment choices. Taking care of your overall health and making wise lifestyle choices can reduce a man's chances of becoming impotent, according to Dr. Scott Tully of Urology Centers of Alabama in Homewood. "Three of the major causes of erectile dysfunction are diabetes, hypertension and smoking," he said. "If someone smokes for more than 20 years, he most likely will lose sexual function at some point." Dr. Chester Hicks of Clinical Urology Associates, PC, in Gadsden said more than half of impotent patients are diabetic. "This can be a problem for even early-stage diabetics because the disease affects the small blood vessels throughout the body, especially in erectile tissue," he said. Physicians can diagnose erectile dysfunction with a simple medical history, a physical exam and routine blood tests. Once the diagnosis is made, referral to a urologist can help the patient take advantage of the latest treatment methods. "We stay current with the advancements in the field," Hicks said. "We are happy to consult with any patient who is looking for help in this area." Tully said that if a physician sees a 40-year-old man with erectile dysfunction, it could be an early presentation of coronary disease. "Plaques in penile arteries can cause erectile dysfunction and can indicate a tendency for vascular disease," he said. "Physicians should screen for that problem if a patient has impotence at a young age." Treatment advancements over the last several years have given physicians a number of tools to fight impotence. "Our first line of therapy is to recommend diet and exercise regimens, as well as a reduction in smoking and alcohol use," Tully said. "If that doesn't work we try drug therapy." Hicks calls drug therapy with the oral medications known as phosphodiesterase-5 inhibitors (PDE5) "the biggest single advancement in the past 10 years." PDE5 drugs, better known as Viagra®, Cialis® and Levitra®, work to increase blood flow to the penis and generally improve erection in almost 80 percent of patients. "All of these drugs work similarly and are effective in a large number of patients," said Hicks. "These drugs are the single most important advancement in the treatment of erectile dysfunction." When oral medications don't work, patients can try injection therapy or urethral suppositories. With injection therapy, the man injects medication into the side of his penis which dilates blood vessels and increases blood flow to create an erection. Urethral suppositories work in much the same way but without the needle. Vacuum devices and penile implants are also options for men who don't get results from other therapies. Implants have been enhanced over the past 25 years and have become one of the most effective treatments for erectile dysfunction. A surgeon inserts a small saline-filled medical device that recreates the erectile function. The device, which is totally concealed, transfers fluid to the penis when an erection is desired. According to the American Medical Association, this procedure has one of the highest patient satisfaction rates of all impotence treatments. Tully said primary care physicians should recommend diet and lifestyle modifications and prescribe the PDE5 medicines to patients with impotence problems. "If they don't respond to those therapies, consider referring them to a urologist," he recommended.