At a time when millions of men rely on Viagra and other anti-impotence drugs to restore sexual function, researchers have found a less expensive, all-natural way for many of them to spice up their love lives: lose weight.
In a study of obese men who suffered from erectile dysfunction, doctors in Italy found that nearly a third regained their sexual ability after making lifestyle changes that included regular exercise and weight loss.
While physicians can treat erectile dysfunction - with medication, psychotherapy or, in some cases, surgery - this is the first indication that the condition might be reversible.
"This is the first compelling piece of evidence that changing lifestyle risks for erectile dysfunction carries with it a reasonable chance of sexual improvement," said Dr. Abraham Morgantaler, associate professor of urology at Harvard Medical School and author of The Viagra Myth, who was not involved in the study.
The findings, reported in today's Journal of the American Medical Association, could give men added incentive to lose weight - as if lower blood pressure, lower cholesterol and decreased risk of coronary disease aren't enough.
"You have a concrete gain that you can see and use. It's not just a lower cholesterol number. You can have better sex in a month," said Dr. Michael Chancellor, professor of urology at the University of Pittsburgh School of Medicine.
That might be just a bit of wishful thinking. The men who regained sexual function were part of a weight loss and exercise program that lasted two years.
Erectile dysfunction, also known as ED, affects 15 million to 30 million men in the United States. Largely a quality of life issue, it has a variety of causes, including diabetes, kidney disease and vascular disease.
It also can occur as a side effect of surgery, be brought on by certain medications or be rooted in psychological issues such as stress or relationship problems.
For a long time, men were simply too embarrassed to discuss ED. Then came the mass marketing of the first anti-impotence pill, Viagra, which was approved in March 1998.
Suddenly, former presidential candidate Bob Dole was on television talking about the once-taboo issue.
Pfizer, the company that makes Viagra, claims that the small, blue triangular pills have helped 16 million men worldwide - and that nine tablets are dispensed every second. Two newer anti-impotence drugs, Levitra and Cialis, now offer men a choice.
In the research reported today, Dr. Katherine Esposito and colleagues studied 110 obese men, ages 35 to 55, at the Second University of Naples between 2000 and 2003. All had erectile dysfunction as measured by a score of 21 or less on the International Index of Erectile Function, or IIEF, a self-reporting system that helps determine a man's ability to achieve an erection.
The 55 men in the intervention group got individualized instruction in reducing calories and increasing physical activity. Most of the men walked for exercise, but some swam or played sports.
The other half, meanwhile, received information about exercise and healthy food but did not take part in an individualized program.
Not surprisingly, after two years, the men in the intervention group had significant decreases in weight, blood pressure and cholesterol. But their mean score on the IIEF also had risen from 13.9 to 17. Seventeen of the men, or 31 percent, reported a score of at least 22, indicating they had regained sexual function.
The weight loss, researchers found, was accompanied by significant improvement in so-called endothelial function. The endothelium - the extremely thin lining of the walls of veins and arteries - plays a fundamental role in blood circulation.
The group of men that exercised less and shed fewer pounds saw no overall improvement in sexual ability.
The new findings complement those published in August in the Annals of Internal Medicine. In that study, researchers found that physical activity was associated with a decreased risk of erectile dysfunction, while obesity was associated with an increased risk. Men who smoked and drank alcohol also had a higher incidence of ED.
Dr. Christopher S. Saigal, a urologist at UCLA who wrote an accompanying editorial in today's JAMA, said that the new results could make weight loss the "first-line treatment" for obese men with erectile dysfunction. But that's not to say a man has only one option.
"If he was really adamant about Viagra and wanted to go [on it] now, I'm not going to tell him he shouldn't do that," Saigal said. "What I would say is, 'Let's try the Viagra, and let's talk about weight loss and see what we can do in that arena.'"
But Morgantaler said he hopes more patients will try to resolve their problem without medication.
"How wonderful it would be if people could have control over their own health and bodily function, so that instead of taking a pill, as a Band-Aid on erectile dysfunction, they could actually regain their own ability to have natural, spontaneous erections," he said. "That's the point."