height="40px" width="100px" What Is Erectile Dysfunction (ED)?
Erectile dysfunction—defined as difficulty in getting or maintaining an erection firm enough for sex—is a very common issue. Overall, research suggests as many as 50 million U.S. men have erectile dysfunction.[1] The issue becomes particularly prevalent during the aging process—it’s estimated to impact 9% of men between 40 and 44 years old, and 56% of men over the age of 65.[2]
The causes of this common condition are wide-ranging, from health issues to underlying psychological issues. The good news is, erectile dysfunction is highly treatable, and there are a number of options that individuals living with this condition can explore.
ED At a Glance
ED can occur if there is insufficient blood flow into the penis, or if the penis cannot trap the blood during an erection. Erectile dysfunction can also happen if the nerve signals from either the brain or the spinal cord do not reach the penis.
This definition is “a bit more subjective than objective,” explains Justin Houman, M.D., a urologist and male reproductive medicine and surgery specialist at Tower Urology in Los Angeles, ” because it really comes down to what’s considered “satisfying pleasure.” “If you’re unsatisfied then you could fall into the category of ED,” says Dr. Houman.
Another way to think of ED is “a constellation of multiple conditions,” explains Scott Lundy, M.D., a male infertility and sexual medicine staff urologist at Cleveland Clinic. This is because erections are “a complicated process that requires multiple pathways in the body to work well,” says Dr. Lundy, explaining “if any one of these parts of the erectile process don’t work, the erection doesn’t work.”
How Common Is Erectile Dysfunction?
As mentioned above, erectile dysfunction is a very common condition, especially as individuals age. In fact, it’s described as one of the most common conditions impacting men who are middle-aged and older, generally around age 40 and up.
The condition is also more prevalent among people who have comorbidities, such as high blood pressure, diabetes, high cholesterol and obesity, among others.
What Can Cause Erectile Dysfunction?
There are a variety of potential causes of erectile dysfunction. This includes:
- Aging
- High blood pressure
- High cholesterol
- Diabetes
- Cardiovascular disease
- Obesity
- Pelvic trauma, such as from radiation or surgery
- Nerve dysfunction
- Brain or spinal injuries
- Abnormal hormone levels
- Medications
- Smoking
- Drinking
- Emotional issues, such as depression, anxiety or stress
It’s important to note that many of the causes of ED are also risk factors for overall blockage of arteries throughout the body, a condition called atherosclerosis—the primary cause of heart attacks and strokes. Because of this, for some men, ED may be an early warning sign of increased risk for cardiovascular disease. If you are experiencing ED, it’s a good idea to speak with your doctor about getting your cholesterol, blood sugar and blood pressure checked.
Medications That May Cause Erectile Dysfunction
Medications are a very common contributing cause of ED—it’s estimated that one-fourth of all cases of erectile dysfunction are due to prescription medications, per the National Library of Medicine.[3] These medications include:
- Antidepressants, particularly SSRIs
- Cimetidine
- Ketoconazole
- Spironolactone
- Sympathetic blockers (methyldopa, clonidine and guanethidine)
- Thiazide diuretics
- Other antihypertensives
Additionally, beta blockers can play a minor role in contributing to ED.
Depression and Erectile Dysfunction
Depression and other mood disorders can strongly affect the ability to get and maintain an erection. Individuals with depression are 40% more likely to suffer from erectile dysfunction, according to the National Library of Medicine, which also points out there is an inverse link between depression and ED, with depression being three times more likely among men who have erectile dysfunction[4].
Depression can also result in a cycle of ED, notes Dr. Lundy, as a person might be less likely to put themselves “in a position to be sexually active, which will impair his overall well-being and his image.”
How Is Erectile Dysfunction Diagnosed?
“When a man comes into the office with a complaint of ED, the mere fact that he’s reporting this is enough to give him a diagnosis because it’s a subjective and personal experience and opinion,” explains Dr. Lundy.
However, there are still steps that a provider will take to assess the condition and understand the underlying cause(s). An individual can expect to go through a detailed review of their medical history, including medical conditions (in the case of ED, vascular health specifically), psychiatric history and substance use. The health care provider will also ask whether the patient ever gets erections, such as early in the morning, as well as what they have tried so far to address the issue.
From there, a provider will conduct a physical exam, and they may order lab tests to look for any health issues. In some instances, more advanced testing of erectile functioning may occur, such as a penile Doppler to check blood flow into and out of the penis.
How Is Erectile Dysfunction Treated?
There are a number of treatment options for ED. Initially, a provider may advise the patient to take steps to improve their lifestyle habits, such as increasing their level of physical activity, cutting back on smoking, drugs and alcohol, maintaining a healthy body weight, eating a nutritious diet and taking steps to improve their blood sugar or cholesterol levels.
From there, Dr. Lundy describes the available treatment options as a staircase. “We start on the lower levels that are easy and safe, if you will, and then climb to higher and more complicated levels as we need,” he explains.
Here are the more common treatment options that might be explored:
- Medications: Known as phosphodiesterase type-5 inhibitors, these drugs are the most commonly prescribed treatment in the U.S. These medications “cause arterial dilation so more blood flow gets down there,” so it’s easier to get and maintain an erection, explains Dr. Houman. According to the National Library of Medicine, these drugs are effective, with an overall success rate of about 76%.[5]
- Injection therapy: If oral PDE-5 inhibitors are not successful, a common next step in treatment are injections of papaverine, which is an alpha-blocker and vasodilator. Individuals give themselves an injection every time they would like to have an erection. Though there are some drawbacks, such as potential discomfort and bruising, Dr. Lundy says injections are “highly efficacious” and offer a quick onset.
- Vacuum erection device: A non-surgical option for individuals is an external vacuum device, which is placed over the penis and then pumped to create pressure around the penis, pulling blood into the penis. Then, a small rubber band is placed around the base of the penis to trap the blood and keep the penis erect. “Some discomfort and potentially some bruising or bleeding” can occur with this treatment, according to Dr. Lundy, and the penis “isn’t nearly as well anchored as with a natural erection so it’s less stable.”
- Penile implants: According to Dr. Houman, this surgical procedure is the “gold standard for ED.” This option is typically offered when other treatments are not successful or viable. With an inflatable prosthesis, a small pump is inserted in the scrotum that an individual squeezes to inflate and stiffen the penis. Though the inflatable prosthesis is “more commonly used” and “far more user friendly,” per Dr. Lundy, there’s also the option for a malleable prosthesis. With this option, two bendable rods are implanted in the penis which a person can then use to bend their penis up or down.
Both Dr. Houman and Dr. Lundy encourage individuals living with ED to seek treatment. “See someone as soon as possible. The earlier you see a doctor, the better off you’ll be,” says Dr. Houman.
Dr. Lundy also emphasizes that individuals shouldn’t feel nervous about talking to a medical professional about their issues, noting that while you may feel awkward, “for us it’s going to be another weekday,” says Dr. Lundy, who also encourages people to “do some homework and identify health care professionals they can trust.”
Premature Ejaculation
Premature ejaculation represents another significant sexual health challenge, often occurring alongside erectile dysfunction, yet distinct in its manifestation and impact. Characterized by early ejaculation during sexual activity, premature ejaculation affects confidence and sexual satisfaction for both partners. Understanding premature ejaculation within the broader sexual health landscape highlights the importance of addressing both conditions for comprehensive care. Treatments for premature ejaculation, such as behavioral techniques, medications, and counseling, offer hope and improved quality of life, underlining the value of professional consultation for those experiencing sexual health concerns. Like erectile dysfunction, premature ejaculation’s treatment is geared towards enhancing sexual function and relationship dynamics, emphasizing the interconnectedness of sexual health issues.
Sources
- Sooriyamoorthy T, Leslie SW. Erectile Dysfunction. [Updated 2022 Nov 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
- Mazzilli F. Erectile Dysfunction: Causes, Diagnosis and Treatment: An Update. Journal of Clinical Medicine. 2022;11(21):6429.
- Mobley DF, Khera M, Baum N. Recent advances in the treatment of erectile dysfunction. Postgraduate Medical Journal 2017;93:679-685.
- Sooriyamoorthy T, Leslie SW. Erectile Dysfunction. [Updated 2022 Nov 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
- Sooriyamoorthy T, Leslie SW. Erectile Dysfunction. [Updated 2022 Nov 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
