If you are a middle-aged man, can you run as fast as you did when you were 20? Can you hit a baseball as far as you did before? Can you hit a tennis ball with the same speed and spin?

Probably not.

But even as we age, there are still ways to keep moving and having fun. Both with sex and exercise.

The National Institute of Disease Control estimates that 30 million men suffer from erectile dysfunction (ED), which is the inability to get or keep an erection. The problem becomes more common as men age, with about 40 percent of men over 50 having it, according to recent studies.

Erectile dysfunction isn't something you have to live with. Almost all cases of erectile dysfunction are treatable, and treatment can lead to better physical and emotional health for almost everyone with it, as well as improved intimacy between couples.

You can treat erectile dysfunction in two ways.

Treatment with oral medications

Oral medications are often the first choice for treating difficulty getting or keeping an erection (erectile dysfunction, ED). Oral ED medications generally work well and have few side effects.

The four main oral erectile dysfunction medications are as follows:

•Sildenafil (Viagra). This medication works best when taken on an empty stomach one hour before sex. It usually works for 4 to 5 hours. If you have mild to moderate erectile dysfunction, it works longer.

•Vardenafil. This medication also works best when taken on an empty stomach one hour before sex. It usually works for 4 to 5 hours. If you have mild to moderate ED, it works longer. This medication is available in a newer form that dissolves on the tongue and may work faster than swallowing a pill.

•Tadalafil (Cialis). This medication is taken one hour before sex with or without food. It works for up to 36 hours. It can be taken in small daily doses or in larger doses as needed.

•Avanafil (Stendra). The drug can be taken with or without food 30 minutes before intercourse, depending on the dose. Its effects last 4 to 5 hours, or longer in cases of mild to moderate ED.

This class of drugs is called PDE5 inhibitors. They all enhance the effects of nitric oxide, a chemical produced by the body that relaxes the muscles in the penis. This boosts blood flow, helping you achieve an erection during sexual activity.

No-Pill Solutions

You may think prescription medications are your only option for treating ED, but that's not true. In fact, prescription medications may not be the first (or second) treatment your doctor recommends. Non-drug treatments include:

Reduce alcohol consumption. To maintain overall health, men should limit themselves to two drinks per day. You may need to cut back to one (or less) or stop drinking altogether, as drinking alcohol can contribute to erectile dysfunction.

Heart-Healthy Lifestyle Changes. Regular exercise and losing excess weight can boost cardiovascular health. This is important because healthy blood flow to the penis is essential for getting and maintaining an erection. Get 150 minutes of moderate-intensity aerobic exercise per week, such as walking, jogging, or light bicycling.

Medication Adjustment. Erectile dysfunction can be a side effect of some medications. If you're taking medications that may cause erectile dysfunction, your doctor may change your dose or prescribe an alternative medication.

Sleep Quality. Studies show that men who don't get enough sleep have significantly lower testosterone levels, which can lead to depression, obesity, loss of muscle mass, lack of libido, and erectile dysfunction.

Stop Smoking. Smoking blocks blood flow throughout your body, including your penis.

Stress Management. Stress can cause erectile dysfunction. If you're stressed, take time each day to do things that are relaxing or pleasurable for you. You may also find it helpful to talk to a behavioral health specialist.

Surgery. You can have surgery to implant a prosthetic device called a penile implant to produce an erection.

Vacuum Erection Device. This device sits on top of the penis and helps draw blood into the penis, causing an erection.

Penis Injections. These prescription medications are injected directly into the penis to produce an erection.

We understand your concerns and can answer your questions about male sexual problems. We have heard all of these issues before and can find the answers and treatments that are best for you.