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Erectile Dysfunction

What is erectile dysfunction?

Erectile dysfunction (ED) is the inability to achieve an erection, or dissatisfaction with the size, rigidity or duration of erections. You might also hear it referred to as impotence. If you have symptoms of erectile dysfunction, you may have trouble getting an erection, get an erection that doesn’t last long enough for sexual activity, or get an erection sometimes, but not every time you would like to have sex. 

Other sexual disorders related to, but different than, ED include premature ejaculation, delayed ejaculation and anorgasmia (the inability to have an orgasm even after sufficient stimulation).

Many men occasionally have problems with erections. But with ED, problems occur more often or become more frequent. It’s a condition many men deal with, even though they may not want to discuss it. Untreated, ED can lead to low self-esteem, depression or relationship problems. But by talking to your doctor, you can get the treatment you need. Here’s what to know about erectile dysfunction.

What are the causes and risk factors of ED?

There’s a process that occurs when you get an erection. Blood flows into two chambers inside the penis, which are called the corpus cavernosum. The tissues in these chambers trap blood. During arousal, the blood vessels in the corpus cavernosa relax and blood fills these chambers. This additional blood is what makes the penis firm. After orgasm, these tissues contract, the blood circulates back into the bloodstream and the penis becomes soft again. ED occurs when you don’t get enough blood flow to your penis, or when the nerves in and around your penis don’t work properly.

Certain medical conditions related to your vascular system, nervous system or endocrine systems can cause ED. Men of any age can experience it, but it’s more common in older men. However, aging alone doesn’t cause ED.

Risk factors and potential causes of erectile dysfunction include:

  • Heart disease
  • Cardiovascular diseases and conditions such as high blood pressure, atherosclerosis (when fats, cholesterol or other materials build up in the arteries) and high cholesterol (lipid) levels
  • Diabetes - men with diabetes are two to three times more likely to develop ED than those who don’t have diabetes
  • Endocrinopathies (diseases of the system that produces hormones)
  • Neurologic diseases or nerve damage
  • Depression
  • Anxiety
  • Stress
  • Psychosexual relationship problems
  • Excessive alcohol consumption
  • Some prescription medications and recreational drugs
  • Smoking
  • Pelvic trauma
  • Peyronie’s disease
  • Surgery to treat bladder, colon or prostate cancer 
  • Obesity
  • Inactivity
  • Concerns about sexual performance

How is ED diagnosed?

If your problems with getting and maintaining erections are becoming bothersome, you most often can see your primary care physician for diagnosis and treatment. Since ED can stem from various causes, getting the correct diagnosis is essential. When you talk to your doctor about your erectile dysfunction concerns, you’ll probably be asked questions about your erection problems, medical history, lifestyle and heart health. Be prepared to answer questions about prescription medications and other drugs, smoking, alcohol use and physical or mental health problems. 

Your doctor may also ask specific questions about your sex life. You might feel uncomfortable answering these questions. But they can help your doctor figure out exactly why you are experiencing ED and what the best treatment options are. It’s essential to answer them truthfully.

Your doctor will evaluate your overall health with a physical exam. That might include checking your heart and blood pressure. You may need a digital rectal exam to check your prostate. And your doctor will likely examine your penis and testicles for any issues that could be contributing to ED. They might also take blood or urine samples and send them to a lab for analysis.

In some cases, your PCP may refer you to a urologist—a doctor who specializes in sexual and urinary conditions—for care.

What treatments are available for erectile dysfunction?

To treat ED, you’ll often start with taking care of other health problems that could be contributing to it. For example, improving the control of diabetes could help reduce ED symptoms. 

Your doctor may suggest lifestyle changes such as:

  • Choosing a healthy diet with vegetables, fruits and whole grains and limited amounts of saturated fat
  • Lowering your cholesterol level
  • Losing weight or maintaining a healthy weight
  • Exercising regularly
  • Quitting smoking
  • Drinking less alcohol 

If prescription drugs are a potential cause of ED, your doctor can talk to you about the pros and cons of changing or stopping your medication. Don’t stop taking any medication without talking to your doctor first.

You may also want to see a mental health professional to treat stress, depression, anxiety, relationship issues or performance anxiety related to sexual intercourse.

In addition to those options, there are three lines of treatment for ED that treat it directly:

  1. Oral medications. You’re probably familiar with prescriptions such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) and avanafil (Stendra). These medications for ED are heavily advertised on television.

    They all work slightly differently, but they increase blood supply to the penis so you can get and maintain an erection. These medications generally work well with few side effects and are often the first treatment men try. Your doctor can help you decide which medicine is right for you.

  2. Treatments at the penis before sex. Most men start with oral medications to treat ED. If those aren’t successful, they can try other alternatives. There are three treatment options in this category. One is a medication called intra-urethral alprostadil, where you insert a small capsule through the opening of the penis into the urethra (the tube urine passes through). Once the capsule dissolves, your body absorbs the medication, and you get an erection.

    A second option is intra-cavernous vasoactive medications, where you inject yourself at the base of the penis to cause an erection. And the third is a vacuum pump (vacuum erection device), which works by creating negative pressure that draws blood into the penis.

  3. Penile prosthesis or penile implant. In this type of surgery, inflatable cylinders are inserted into the parts of the penis that fill with blood. You use a small bulb to pump fluids into the cylinders when you want to have an erection.

For many men, psychosexual therapy is helpful in combination with these treatment options. Even if you have a physical condition that’s causing ED, sex therapy can help address issues that are impacting your ability to function sexually. Therapy can also help sexual partners better understand and accept the impact of ED on the relationship.

Some men with ED may feel embarrassed or uncomfortable talking about their symptoms with their doctor. They might turn to dietary supplements for a more private way to treat ED. However, according to the U.S. Food and Drug Administration, these supplements can include hidden or undisclosed ingredients. They may also have the same ingredients found in prescription-grade, FDA-approved medications, but in inconsistent doses. If you have symptoms of ED, it’s best to talk to a health care professional about your options for treatment.