Erectile Dysfunction

What Is Erectile Dysfunction

Erectile dysfunction, also known as impotence, is characterized by the inability to get or maintain an erection suitable for sexual intercourse. Erectile dysfunction is a common problem affecting up to 1 in 5 men in the USA. According to a 2007 study published in the American Journal of Medicine, erectile dysfunction, or ED affects about 18 million men in the United States.

Occasional trouble getting and maintaining an erection is not necessarily a cause for concern, but if ED is a recurring problem, treatment should be sought. Problems getting or keeping an erection can be a sign of a more serious underlying health condition like heart disease, and can contribute to stress, self-confidence, relationship problems and more.

Erectile dysfunction can be caused by a variety of factors, and is strongly correlated with conditions such as cardiovascular disease and diabetes. There are a variety of treatments available for erectile dysfunction. Untreated erectile dysfunction can cause interruptions to a healthy sex life and may lower sexual confidence.

What Causes Erectile Dysfunction

Erectile dysfunction can be caused by a variety of physical, lifestyle, and psychological factors. Each case of erectile dysfunction has unique circumstances. Sexual arousal is a complex process, which involves hormones, brain chemistry, emotions, nerves, muscles, blood vessels and self-confidence. ED can manifest as a result of an issue with any of these processes, or a combination. Stress and anxiety can exacerbate (or cause) ED—and when you have a confluence of factors impacting ability to maintain an erection, a bad, self-defeating cycle can begin whereby anxiety about one factor can worsen ED.
The following factors may contribute to the development of erectile dysfunction:

  • Medications, including pain medications, sedatives, blood pressure medications, and anti-depressants.
  • Low testosterone levels
  • Prostate surgery or radiation
  • Pre-existing medical conditions:
    • Obesity
    • Cardiovascular Disease
      • High blood pressure
      • Atherosclerosis (clogged blood vessels)
      • High cholesterol
    • Arthritis
    • Urinary tract infections
    • Lung disease
    • Diabetes
    • Sleep disorders
  • Neurological conditions such as:
    • Injury to the spinal chord
    • Parkinson’s disease
    • Multiple sclerosis (MS)
    • Stroke
  • Pain
  • Smoking 
  • Alcohol misuse and abuse
  • Anxiety
  • Chronic stress
  • Depression
  • Relationship problems
  • Physical inactivity


Risk Factors For Erectile Dysfunction

The following factors may affect your risk of developing erectile dysfunction:

  • Age. The likelihood of erectile function increases with age. About 15% of men ages 70 and older are affected by erectile dysfunction as compared to 5% of younger men.
  • Pre-existing medical conditions such as:
    • Arthritis
    • Cardiovascular disease
    • Lung disease
    • Diabetes
    • Parkinson’s disease
    • Multiple sclerosis (MS)
    • Stroke
  • Injuries that have caused nerve damage, especially those that have caused damage in the brain or spine.
  • Smoking. Prolonged tobacco use can cause the thickening of arteries and ultimately decrease blood flow to the penis.
  • Medications. Medications that have sedative effects (anti-anxiety medications, depression medications, pain medications, etc.) can decrease libido and overall functioning of the penis. Medications for high blood pressure can cause interruptions to the penis blood flow.
  • Physical inactivity. According to a study conducted at Harvard University, just 30 minutes of walking each day lowered the risk of erectile dysfunction by 41%.
  • Prolonged bicycle riding. Blood flow to the penis can be affected by nerve compression that can occur during bike riding, which impacts blood flow to the penis.
  • Weight. According to researchers at Harvard Medical School, a man with a 42-inch waist is 50% more likely to have ED than one with a 32-inch waist.
  • Drug and alcohol abuse. Drug and alcohol use can alter one’s ability to sexually respond, especially when used in excess quantities.
  • Depression. Depression can alter sexual response and cause erectile dysfunction.
  • Psychological factors such as stress and anxiety. Stress and anxiety interfere with the body’s hormone levels and can cause decreased libido or erectile dysfunction.

Diagnosing Erectile Dysfunction

Before arriving at a diagnosis of erectile dysfunction, your doctor will most likely conduct a combination of the following tests:

  • Medical history, including sexual history, to assess your risk of ED based on your pre-existing medication conditions, family history, and sexual habits.
  • Physical examination to check for any irregularities in the penis or prostate.
  • Psychological/social examination. This may be as formal as an examination by a psychiatrist or as informal as filling out a questionnaire.
  • Blood tests and/or Urinalysis to assess hormone levels and particular populations of blood proteins.

Symptoms of Erectile Dysfunction

The following may be symptoms of erectile dysfunction:

  • Inability to get an erection
  • Inability to maintain an erection
  • Decreased libido/lessened sexual confidence


The prognosis for erectile dysfunction depends largely on the cause(s) and the individual’s response to treatment. If the cause of ED is reversible and the patient is responsive to treatment, then it is likely that the ED can be resolved. If the cause of ED is not reversible and/or the patient is unresponsive to treatment, there is the chance that the condition cannot be resolved. To determine whether or not your case of erectile dysfunction can be treated, schedule a visit with your doctor.


Living With Erectile Dysfunction

The following tips can help you live a fuller life with erectile dysfunction:

  • Eat a balanced diet. Although there isn’t a direct connection between erectile dysfunction and diet, eating a balanced diet can help keep your body in overall good health and can boost mood and self-confidence. This may help decrease the severity of your erectile dysfunction. Exercise can also help maintain a healthy bodyweight, which lowers the risk of developing (or worsening) erectile dysfunction.
  • Exercise regularly. According to researchers at Harvard University, just 30 minutes of walking each day lowers the risk of erectile dysfunction by 41%.
  • Lose weight. Being overweight can cause—and also exacerbate—erectile dysfunction.
  • Quit smoking.  If you need help, talk to your doctor—smoking cessation is not just good for treating ED, it’s great for your overall health and wellbeing.
  • Get treatment for alcohol or drug problems. Excess drinking, and taking illicit drugs can cause and/or worsen erectile dysfunction.
  • Be open with your partner. Share your condition with them and talk about adjustments you two can make for a fulfilling sex life
  • Work through relationship issues. If you and your partner are having a hard time, consider seeing a couple’s counselor. Click here to find one near you
  • Consider all treatment options, including medications, pumps, and surgical implants. Listen openly to your doctors suggestions and weigh the risks and benefits of each procedure.
  • Find ways to relax. Stress and anxiety contribute to ED. Find a hobby, play a sport, or simply spend some time with your feet up every once and a while.



Erectile dysfunction is not typically screened for, although general sexual health questionnaires may help doctors in recognizing ED. ED is most often self-reported by patients in special visits or general check-ups.


The following tips can help you prevent developing erectile dysfunction:

  • Eat a balanced diet. Although there isn’t a direct connection between erectile dysfunction and diet, eating a balanced diet can help keep your body in overall good health and can boost mood and self-confidence. This may help decrease the severity of your erectile dysfunction. Exercise can also help maintain a healthy bodyweight, which lowers the risk of developing (or worsening) erectile dysfunction.
  • Exercise regularly. According to researchers at Harvard University, just 30 minutes of walking each day lowers the risk of erectile dysfunction by 41%.
  • Visit your doctor regularly for checkups. Frequent checkups make it more likely that your doctor will detect  symptoms and conditions that may contribute to ED
  • Don’t smoke. Smoking can lead to atherosclerosis (thickening of the arteries) which may restrict the blood flow to the penis and cause ED.


Medication And Treatment

There are a number of treatment options for ED. Options range from oral medications to injections to surgical procedures; your doctor will help guide you to the right option for you, depending on the cause and severity of your ED, along with any other underlying health conditions.

Oral medications are the most common first-line medical treatment for erectile dysfunction in men—and are very successful at treating the condition. Phosphodiesterase-5 inhibitors (PDE-5). This is a class of oral medications that works to relax the muscle cells within the penis to promote blood flow and enhance the length and rigidness of an erection. These medications are extremely effective and produce results in about 80% of men.  It’s important to understand that taking one of these medicines will not produce an erection automatically—it just helps the body respond more normally to sexual stimulation. The medications listed below vary in potency and length of impact. Your physician will prescribe based on your particular circumstance, and will work with you to find the right efficacious dose.

The following are the available treatment methods for erectile dysfunction (ED):

Oral PDE-5 medications include:

  • Sildenafil citrate (Viagra, Revatio)
  • Tadalafil (Cialis, Adcirca)
  • Vardenafil HCl (Levitra, Staxyn)
  • Avanafil (Stendra)

 Side effects of PDE-5 medications include:

  • Flushing
  • Headache
  • Muscle ache
  • Cold-like symptoms
  • Priapism is a rare but very serious side effect—and is an erection that lasts 4 or more hours, which usually is painful and can be dangerous. If this happens to you or your partner call the doctor immediately

Please not that oral medications for ED may not be right for you if you:

  • Have heart disease or heart failure
  • Have had a stroke
  • Have either uncontrolled high blood pressure or very low blood pressure

Take certain medications like nitrate drugs for chest pain, blood-thinners, certain high blood pressure medications
Testosterone replacement. Some men have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step.

Self-injection medication.  Alprostadil is a medication that is delivered either through self-injections in the side of the penis or intraurethral suppository. This is also a very effective medication, as approximately 85% of men see results.

Possible side effects of alprostradil:

  • Unusual penile discharge
  • Headache
  • Mild pain the penis, urethra, or testicles
  • Back pain
  • Itching/warmth/numbness of penis
  • Rash on the penis skin
  • Cold-like symptoms

Penis pump/vacuum. This is a device that fits over the penis and uses suction to create an erection, and a rubber band at the base of the penis to maintain the erection. About 75% of men who try the penis pump can achieve an erection.

If none of the above treatments are effective, the option of surgical implants may be explored. Surgical implants typically require inflation to achieve an erection, but their more or less permanent nature makes them a good option for men facing serious erectile dysfunction. Penile implants are typically implanted in an outpatient procedure that requires 4 to 8 weeks of recovery.

Complementary and Alternative Treatment

The following alternative treatments may prevent or diminish erectile dysfunction:

  • Herbal therapy. The following herbs may help to reduce or prevent erectile dysfunction:
    • Gingko. Gingko increases arousal in both men and women by boosting energy and increasing blood flow to the genitals.
    • Yohimbe. Yohimbe is the bark of an African tree which has an aphrodisiac effect.
    • Maca. An herb that stimulates the sexual centers of the brain.
    • Ashwaganda. Ashwaganda is a mild aphrodisiac and can help prevent good moods and even energy levels.
    • Ginseng, which boosts mood and energy.
  • Acupuncture. Acupuncture is a form of traditional Chinese medicine in which small needles are inserted into the body at various points in order to restore the flow of bodily energy. In a 2003 study published by the International Journal of Impotence Research: The Journal of Sexual Medicine, acupuncture was found to be an effective mode of treatment in 68% of patients with erectile dysfunction.
  • Mind/body techniques such as yoga, tai chi, and meditation. These can help to lessen the effect of stress and anxiety on erectile function.

When To Contact A Doctor

If you are experiencing occasional erectile dysfunction, contact a doctor if:

  • The ED persists after one or two months
  • It is significantly disrupting your sex life
  • If you have health conditions such as diabetes and cardiovascular disease that could lead to the development of erectile dysfunction.

Contact a doctor if you experience any of the following:

  • Flushing
  • Muscle aches
  • Persistent cold-like symptoms
  • Persistent nausea
  • Vomiting
  • Changes in mood
  • Skin rash on the penis

**If you experience an erection lasting longer than 4 hours, contact emergency services. This could cause serious and permanent damage.

Questions For A Doctor

You may want to ask your doctor the following questions:

  • Could my symptoms be caused by erectile dysfunction?
  • What is the cause of my erectile dysfunction?
  • What treatments are available?
  • What are the side effects?
  • What lifestyle changes should I make?
  • How will this affect my sex life?
  • Will I still be able to have regular intercourse?
  • Is it likely that my condition will be cured?
  • What is my prognosis?

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