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According to HealthLine.com, major pharmaceutical companies have been developing and testing creams that contain alprostadil, a drug already widely used in penile injection therapy to overcome erectile dysfunction. However, as of early 2014, the FDA had not yet approved any of these creams for sale in the United States.

Already available on the Canadian and European markets, Vitaros is a cream formulation of alprostadil that is manufactured by Apricus Biosciences, headquartered in San Diego, California. While acknowledging that the PDE5 inhibitors currently on the market are generally effective in treating erectile dysfunction, Apricus points out that they do have some side effects, such as headache, vision and hearing impairment, and muscle aches, that are generally mild but tend to be more problematic for some users.

Vitaros is applied directly to the penis and produces rapid results, according to Apricus, which notes that the topical cream has been tested for efficacy and safety in more than 3,000 patients.

Yohimbine is an alkaloid chemical found in yohimbe, which is derived from the bark of a West African tree. Before the advent of the PDE5 inhibitors, such as Viagra and Cialis, doctors sometimes prescribed yohimbine hydrochloride as a treatment for erectile dysfunction. Today, the drug is not widely prescribed, because it is not nearly as effective as the newer impotence drugs on the market, according to WebMD.

MayoClinic.com says scientists and medical researchers do not fully understand how yohimbine works. However, it is believed that it stimulates your body to produce more of the chemicals that support erectile function. It works for some men with impotence but has little or no effect for others.

To treat erectile dysfunction, you should take one tablet of 5.4 to 6 milligrams three times daily. This is no miracle pill that can produce an erection within an hour or less. You must take the pills for two to three weeks before seeing any results at all.

While the jury is still out on this question, what evidence there is seems to indicate that marijuana use can compromise erectile function. Two researchers from the University of Ottawa’s Department of Urology undertook a review of the scientific literature on the impact of cannabis use on erectile function.

Their review, published in the April 2011 issue of “Journal of Sexual Medicine,” acknowledged that while some studies showed that marijuana use can enhance erectile function, other studies showed the opposite.

The researchers cited, in particular, recent animal and human studies that showed potential links between marijuana use and sexual health, noting that cannabis may have “peripheral antagonizing effects on erectile function by stimulating specific receptors in the cavernous tissue.” Cavernous tissue fills with blood and expands to create an erection. The researchers urged additional clinical studies in an attempt to definitively determine exactly how marijuana use affects erectile function.

Once again, that old truism about what’s good for the heart is good for the penis comes into play. Just as your heart needs a strong blood flow to operate optimally, your penis must have a strong blood flow to achieve and maintain an erection.

This means that anything that tends to compromise healthy circulation throughout the body is almost certainly going to have an adverse effect on both cardiac and penile function. And smoking definitely can lead to erectile dysfunction, according to WebMD, which points out that the risk of ED increases based on how much you smoke.

In September 2011 Time magazine reported on a study that involved 65 sexually active male smokers who wanted to kick the habit and were willing to have their erections periodically evaluated in the laboratory. Enrolled in an eight-week smoking cessation program that used nicotine patches to wean them off their habit, 20 of the men reported that they had ED at the start of the study. By the time the program, 15 of these men no longer suffered erectile problems.

Many people tend to think of Obamacare and the coverage it provides in very monolithic terms, as if the government itself were the insurer for all the health plans offered under the Affordable Care Act. In fact, health insurance plans under Obamacare must all provide a certain set of services for policyholders and all are required to cover prescription medicines. But each of the private insurers offering an ACA-qualified plan can have its own formulary, or list of prescription medicines that are available and at what copays.

Going back to your original question, treatment of erectile dysfunction involves diagnostic services, which can usually be obtained from your personal doctor or a specialist such as a urologist. With copays based on the plan you choose — bronze to platinum — such doctor visits are covered. As are other diagnostic services from laboratories.

When it comes to treatment for erectile dysfunction, some plans may include one or more of the popular PDE5 inhibitors as a preferred medication on their formulary of prescription drugs. This means that insurance will pay the bulk of the price of the medication, and you will contribute only a small copay. But the only way to find out which drugs are covered is to start shopping for an ACA-qualified health plan, taking care to see which medications are listed as preferred under each plan.

There is no quick and easy answer to this question, according to WebMD, which suggests that you consult with your insurance provider to determine if the form of treatment you’re considering is covered under your health insurance plan. Generally speaking, however, most insurance plans will cover at least some of the cost of treatment of documented medical conditions that are shown to be causing erectile dysfunction.

However, WebMD says your health insurance plan probably won’t cover sex therapy or medications that have not yet been approved by the FDA.

Medicare Part D provides coverage of the vast majority of the prescription medications taken by Americans over the age of 65. However, the Center for Medicare & Medicaid Services (CMS) says Part D coverage explicitly excludes “drugs when used for treatment of sexual or erectile dysfunction, unless such agents are used to treat a condition, other than sexual or erectile dysfunction, for which the agents have been approved by the FDA.” However, Medicare does cover vacuum erectile systems, known as “penis pumps,” under the prosthetic benefit provided under Medicare’s Part B.

Having high blood pressure can deliver a double-whammy to your erectile function, often resulting in a persistent inability to achieve and maintain an erection.

Over time, high blood pressure causes damage to the linings of your blood vessels. Arteries gradually harden and narrow, a phenomenon known as atherosclerosis, according to MayoClinic.com. Atherosclerosis results in diminished blood flow to the penis, making it more difficult or even impossible to achieve an erection. High blood pressure can also reduce your level of sexual desire and interfere with ejaculation.

Because high blood pressure, left untreated, can lead to a heart attack or stroke, most patients with hypertension are prescribed medications to lower blood pressure. Therein lies the second half of the double-whammy as many of these medications in and of themselves can cause ED. Among all anti-hypertensive drugs, the ones most likely to cause ED are thiazides, which are diuretics, followed closely by beta-blockers, according to MedlinePlus. Alpha-blockers are less likely to impede erectile function.

Some men swear by ginseng, particularly Panax ginseng, which is the Asian variety of this gnarled root that has been a mainstay of traditional Asian medicine for centuries. According to the University of Maryland Medical Center, human testing of ginseng’s ability to improve erectile function and fertility has so far been too limited to produce definitive evidence one way or the other.

In its overview of ginseng’s medicinal properties, the medical center cites one small-scale study that produced positive evidence of ginseng’s effect on erectile function. In that study, which had a study group of only 45 men, those who took 900 milligrams of Korean ginseng three times a day had less trouble getting an erection than those who received placebo.

In a somewhat larger study, conducted by South Korean researchers, 119 men were divided into two groups. One group got four 350-milligram tablets of ginseng extract per day, and the other got placebo. At the end of the eight-week study period, those who got ginseng showed improvement in all areas of sexual function.

Happily, the answer to your question is no. Although the incidence of erectile dysfunction increases as men age, many men go through life without experiencing any significant difficulties in getting and keeping an erection. WebMD estimates that roughly 20 million American men experience erectile dysfunction, which leaves a fair amount of the country’s male population unaffected.

That said, it should be noted that most men have an occasional problem achieving an erection, but most such incidents do not persist and can usually be traced to overindulgence in alcohol, extreme stress or fatigue, or to the effects of a medication. In cases where medication appears to be the culprit, substituting another drug or adjusting dosage often alleviates the problem.

The key to staving off ED for most men is to follow the same general advice your doctor offers for healthy living: Eat a well-rounded and nutritious diet and maintain a program of regular physical activity.

Diabetes is one of the leading risk factors for erectile dysfunction. According to the National Diabetes Information Clearinghouse, estimates of the prevalence of ED among diabetic men vary widely, ranging from 20 to 75 percent. And the risk of ED among diabetic men is two to three times what it is for nondiabetics, according to NDIC.

Among all men with erectile dysfunction, men with diabetes tend to develop the problem 10 to 15 years earlier than those who aren’t diabetic. Because diabetes goes untreated in a large number of both men and women, research indicates the ED may be an early indicator of diabetes, particularly in men who are 45 or younger.

As men with diabetes age, the incidence of ED increases fairly sharply, according to WebMD. Among men over the age of 50, ED occurs in 50 to 60 percent of diabetics. Among men 70 and over, ED affects roughly 95 percent of male diabetics.