Erectile dysfunction (ED) is when a man has persistent problems achieving and/or sustaining an erection. Erectile dysfunction can make sexual intercourse impossible without treatment. Erectile dysfunction can first emerge in a man as early as 40, according to the Massachusetts Male Aging Study on sexual dysfunction. About 30 million men are affected by erectile dysfunction, according to the National Institute of Health.
Erectile dysfunction refers specifically to problems achieving or maintaining an erection. Other forms of male sexual dysfunction include poor libido and problems with ejaculation. Men with erectile dysfunction often have a healthy libido, but their bodies fail to respond in the sexual encounter by producing an erection. Usually there is a physical basis for the problem.
Can Low Testosterone (Low T) Cause Erectile Dysfunction?
While low T isn't the only cause of erectile dysfunction, the two do seem to be connected. However, the connection between low testosterone and erectile dysfunction is complicated. Researchers believe the two are connected because they both seem to coincide as a man ages. However, some men with low testosterone continue to produce healthy erections.
Symptoms of erectile dysfunction include erections that are too soft for sexual intercourse, erections that last only briefly, and an inability to achieve erections. Men who cannot have or maintain an erection at least 75% of the time that they attempt sex are considered to have erectile dysfunction.
Sexual dysfunction is more common as men age. According to the Massachusetts Male Aging Study, about 40% of men experience some degree of inability to have or maintain an erection at age 40 compared with 70% of men at age 70. And the percentage of men with erectile dysfunction increases from 5% to 15% as age increases from 40 to 70 years. erectile dysfunction can be treated at any age.
When blood fills two chambers in the penis (known as the corpora cavernosa) an erection occurs. This causes the penis to expand and stiffen, much like a balloon as it is filled with water. The process is triggered by nerve impulses from the brain and genital area. Anything that interferes with these impulses or restricts blood flow to the penis can result in erectile dysfunction.
The link between underlying chronic disease and erectile dysfunction is most striking with diabetes. Approximately half of the men with diabetes experience erectile dysfunction. Nevertheless, good blood sugar control can minimize this risk.
In addition, the following four diseases can lead to erectile dysfunction by interfering with blood flow or nerve impulses throughout the body.
Lifestyle choices, such as smoking, alcohol abuse, and obesity can impair blood circulation and lead to erectile dysfunction. Smoking, excessive drinking, and drug abuse may damage the blood vessels and reduce blood flow to the penis. Smoking makes men with atherosclerosis even more vulnerable to erectile dysfunction. Smokers have almost twice the risk of erectile dysfunction compared with nonsmokers. Being overweight and getting too little exercise also contribute to erectile dysfunction. Men who exercise regularly have a lower risk of erectile dysfunction.
Surgical or radiation treatments for prostate cancer, bladder cancer, or prostate enlargement (BPH) can sometimes damage nerves and blood vessels near the penis. Occasionally, the nerve damage is permanent and the patient requires treatment to achieve an erection. Sometimes, surgery causes temporary erectile dysfunction that improves on its own after 6 to 18 months.
Many medications can cause or contribute to erectile dysfunction, including certain blood pressure drugs, antidepressants, and tranquilizers. Men with erectile dysfunction should talk with their doctor if they suspect a prescription or over-the-counter drug may be causing erectile problems.
It is common for men with erectile dysfunction to have an underlying physical basis for it, particularly in older men. However, psychological factors may be present in 10% to 20% of men with erectile dysfunction. Experts say stress, depression, poor self-esteem, and performance anxiety can impair the ability to have an erection. These factors can also make erectile dysfunction worse in men whose sexual dysfunction stems from something physical.
Avid cyclists suffer more erectile dysfunction than other athletes because the shape of some bicycle seats causes pressure on the nerves that are vital to sexual arousal. Cyclists who ride for many hours each week may benefit from seats designed to protect the perineum.
To diagnose erectile dysfunction, the doctor will ask questions about the symptoms and medical history. A complete physical exam is done to detect poor circulation or nerve trouble. The physician will look for abnormalities of the genital area that could cause problems with erections.
Many lab tests can be helpful in diagnosing male sexual problems. Measuring testosterone levels can determine whether there is a hormonal imbalance, which is often linked to decreased desire.
These tests may reveal underlying medical causes of ED:
Erectile dysfunction can be a warning sign of serious underlying disease. Research has found that erectile dysfunction is a strong predictor of heart attack, stroke, and even death from cardiovascular disease. All men with erectile dysfunction should be evaluated for cardiovascular disease. Notably, this does not mean every man with erectile dysfunction will develop heart disease, or that every man with heart disease has erectile dysfunction; however, erectile dysfunction patients should be aware of the link.
Often men with erectile dysfunction are able to improve sexual function by making a few lifestyle changes. Stopping smoking, losing weight, and exercising regularly can help by improving blood flow. If you suspect a medication could be contributing to erectile dysfunction, talk to your doctor about it.
While popularized in the media, Viagra is not the only erectile dysfunction drug. Other erectile dysfunction drugs include:
These drugs work by improving blood flow to the penis during arousal and are taken 30 to 60 minutes before sexual activity. They should not be used more than once a day. Cialis can be taken up to 36 hours before sexual activity and also comes in a lower, daily dose. Staxyn dissolves in the mouth. All require a doctor's prescription for safety.
There are also injectable drugs for erectile dysfunction. Some men sustain stronger erections by injecting these medications directly into the penis. These drugs work by widening the blood vessels, causing the penis to become engorged with blood. Another option is a medicated pellet that is inserted into the urethra and can trigger an erection within 10 minutes. Patients should discuss the use of these injections in detail with their doctor before use.
Vacuum devices for erectile dysfunction, also called pumps, offer an alternative to medication. To use a pump, the penis is placed inside a cylinder. Then the pump draws air out of the cylinder to create a partial vacuum around the penis causing it to fill with blood, leading to an erection. An elastic band worn around the base of the penis is used to maintain the erection during intercourse. Individuals should discuss the use of this device with their doctor, and especially the elastic band use to avoid potential penile damage.
If erectile dysfunction is caused by a blockage in an artery leading to the penis, surgery can be used to restore blood flow. Optimal candidates are typically younger men whose blockage stems from an injury to the crotch or pelvis. The surgery is not recommended for older men with widespread narrowing of the arteries throughout their bodies.
For those men with persistent erectile dysfunction, a penile implant can restore sexual function. An inflatable implant uses two cylinders that are surgically placed inside the penis. When an erection is desired, the man uses a pump to fill the cylinders with pressurized fluid. Alternatively, a malleable implant with surgically implanted rods can be used to bolster erections.
Psychotherapy can be beneficial for men with erectile dysfunction even when erectile dysfunction has a known physical cause. The therapist can instruct the man and his partner in techniques to reduce performance anxiety and improve intimacy. Therapy can also help couples adjust to the use of vacuum devices and implants.
Men with erectile dysfunction should talk with their doctors before trying supplements for erectile dysfunction. They can contain 10 or more ingredients and may complicate other health conditions. Asian ginseng and ginkgo biloba (seen here) are popular, but there isn't a lot of good research on their effectiveness. Some men find that taking a DHEA supplement improves their ability to have an erection. Unfortunately, the long-term safety of DHEA supplements is unknown. Most doctors do not recommend using it.
There are dozens of "dietary supplements" that claim to treat erectile dysfunction, but the FDA warns that many of these are not what they seem. One investigation discovered that supplements for erectile dysfunction can often contain prescription drugs not listed on the label, including the active ingredient in Viagra. These can put the man at risk for dangerous drug interactions. You should consult your doctor before using any supplements to treat ED.
To reduce your risk of erectile dysfunction, exercise and maintain a healthy weight, stop smoking, avoid alcohol and substance abuse, and keep your diabetes under control, if you have it.
It's natural to feel angry or embarrassed when confronted with erectile dysfunction. Remember too that your partner is also affected. Talking openly about erectile dysfunction with your partner will help them understand the diagnosis and treatment options (and will reassure your partner that you haven't lost interest).
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- NIH: "Definition & Facts for Erectile Dysfunction." July 2017.
- Maturitas: "Testosterone and sexual function in men." Jun 2018.
- Sooriyamoorthy, Thushanth and Stephen W. Leslie. StatPearls: "Erectile Dysfunction." Feb. 22, 2021.