Erectile dysfunction (ED) also referred to as impotence, is a type of sexual dysfunction characterized by the persistent inability to develop and maintain an erection of the penis sufficient to have sexual intercourse. A man is considered to have erectile dysfunction if he regularly finds it difficult getting or keeping a firm enough erection to be able to have sex or if it interferes with other sexual activity.
Most men, particularly over 40 years of age, have occasionally experienced some difficulty with their penis becoming hard or staying firm. Having erection trouble from time to time isn't necessarily a cause for concern. However, erectile dysfunction (ED) is only considered a concern if satisfactory sexual performance has been impossible on a number of occasions for some time.
Erectile dysfunction can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.
If you're concerned about erectile dysfunction, talk to your doctor, even if you're embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed. ED is now well understood, and there are various treatments available.
What Causes an Erection?
An erection is the result of increased blood flow into your penis. Blood flow is usually stimulated by either sexual thoughts or direct contact with your penis.
When a man becomes sexually excited, muscles in their penis relax. This relaxation allows for increased blood flow through the penile arteries. This blood fills two chambers inside the penis called the corpora cavernosa. As the chambers fill with blood, the penis grows rigid. Erection ends when the muscles contract and the accumulated blood can flow out through the penile veins.
ED can occur because of problems at any stage of the erection process. For example, the penile arteries may be too damaged to open properly and allow blood in.
What Causes Erectile Dysfunction?
The ability to achieve and sustain erections requires the following:
A healthy nervous system that conducts nerve impulses in the brain, spinal column, and penis
Healthy arteries in and near the corpora cavernosa that when stimulated can bring increased blood flow into the penis
Healthy muscles and fibrous tissues within the corpora cavernosa, which can distend to allow the penis to fill with blood
Adequate levels of nitric oxide in the penis
Normal-functioning tunica albuginea that allows for compression of the veins
Appropriate psychosocial interactions
Erectile dysfunction can occur if one or more of these requirements are not met.
Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these too.
Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.
Physical causes of erectile dysfunction
In many cases, erectile dysfunction is caused by something physical. Common causes include:
Clogged blood vessels (atherosclerosis)
High blood pressure
Metabolic syndrome (a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol)
Certain prescription medications
Peyronie's disease (development of scar tissue inside the penis)
Alcoholism and other forms of substance abuse
Treatments for prostate cancer or enlarged prostate
Surgeries or injuries that affect the pelvic area or spinal cord
Psychological causes of erectile dysfunction
The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:
Depression, anxiety or other mental health conditions
Relationship problems due to stress, poor communication or other concerns
As you get older, erections might take longer to develop and might not be as firm. You might need more direct touch to your penis to get and keep an erection. However, aging doesn’t necessarily mean you will develop ED. In general, the healthier you are, the better your sexual function.
Erectile dysfunction symptoms might include persistent:
Trouble getting an erection
Trouble keeping an erection
Penile erections are not hard enough for penetration
There are often also emotional symptoms, such as
Reduced sexual desire
Complications resulting from erectile dysfunction can include:
An unsatisfactory sex life
Stress or anxiety
Embarrassment or low self-esteem
A loss of intimacy between you and a partner, resulting in a strained relationship
The inability to get your partner pregnant
For many men, a physical exam and answering questions (medical history) are all that's needed for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist.
Tests for underlying conditions might include:
Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation.
Blood tests. A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.
Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
Ultrasound. This test is usually performed by a specialist in an office. It involves using a wand-like device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems.
This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection.
Psychological exam. Your doctor might ask questions to screen for depression and other possible psychological causes of erectile dysfunction.
The good news is that there are many treatments for ED, and most men will find a solution that works for them.
The first thing your doctor will do is to make sure you're getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.
Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner's preferences also might play a role in your treatment choices.
Treatments include psychotherapy, adopting a healthy lifestyle, oral PDE5 inhibitors (Viagra, Levitra, Cialis, Stendra, and Staxyn), intraurethral prostaglandin E1 (MUSE), intracavernosal injections (prostaglandin E1 [Caverject, Edex], Bimix and Trimix), vacuum erection devices, surgery, and (in some cases) changes in medications when appropriate.
Before using over-the-counter products and/or supplements, a discussion with a doctor is strongly recommended.
New research is ongoing in the field of erectile dysfunction to find improved and effective therapies.
There are exercises a man can carry out to reduce the effects of ED.
One of the exercises practised to treat erectile dysfunction without medication is kegel exercise. Kegel exercises are a simple exercise you can use to strengthen your pelvic floor muscles. These are often associated with women looking to strengthen their pelvic area during pregnancy, but they can be effective for men looking to regain full function of the penis.
Firstly, find the pelvic floor muscles. You can achieve this by stopping mid-stream two or three times the next time you urinate. The muscles you can feel working during this process are the pelvic floor muscles, and they will be the focus of Kegel exercises.
One Kegel exercise consists of tightening and holding these muscles for 5 seconds and then releasing them. Try to do between 10 and 20 repetitions each day. This may not be possible when you first start doing the exercises. However, they should become easier over time.
You should be able to notice an improvement after 6 weeks.
Make sure you are breathing naturally throughout this process and avoid pushing down as if you are forcing urination. Instead, bring the muscles together in a squeezing motion.
Aerobic exercise, such as jogging or even a brisk walk, can also help the blood to circulate better and can help improve ED in men who have circulation issues.
Do vacuum erection devices work?
Vacuum erection devices encourage blood to flow to the penis, causing an erection. They are a mechanical way of producing an erection for men who do not want or cannot use drug treatments, or find they are not working.
This type of devices is sometimes referred to as penis pumps and may be used just prior to sexual intercourse. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it.
The devices have three components:
A plastic cylinder, in which the penis is placed
A pump, which draws air out of the cylinder
An elastic band (compression ring), which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body
The vacuum erection devices may be operated by hand or be battery operated.
These vacuum devices may be the only therapy that is effective after the removal of a penile prosthesis. It is also used as part of penile rehabilitation after radical prostatectomy to help preserve the tissue of the penis and prevent scarring within the penis and loss of penile length. Its use, however, may be limited by the mechanical nature of it and the time taken to pump the device and apply the band.
What are the risks of the vacuum erection devices?
The elastic band must be removed immediately after completing intercourse. Leaving the band on too long can harm the penis. Rarely, bruising of the penis or blood in the ejaculate/urine may occur.
Lifestyle changes and diet
Healthy lifestyle habits may prevent ED, and in some situations reverse the condition.
If you smoke, quit. If you have trouble quitting, get help. Try nicotine replacement, such as over-the-counter gum or lozenges, or ask your doctor about a prescription medication that can help you quit.
Lose excess pounds. A trim waistline is one good defence. A man with a 42-inch waist is 50% more likely to have ED than one with a 32-inch waist. Losing weight can help fight erectile dysfunction, so getting to a healthy weight and staying there is another good strategy for avoiding or fixing ED.
Include physical activity in your daily routine. Exercise can help with underlying conditions that play a part in erectile dysfunction in a number of ways, including reducing stress, helping you lose weight and increasing blood flow.
Get treatment for alcohol or drug problems. Drinking too much or taking certain illegal drugs can worsen erectile dysfunction directly or by causing long-term health problems.
Maintain a low blood pressure.
Eat a balanced, nutritious diet.
Work through relationship issues. Consider couples/relationship counselling if you're having trouble improving communication with your partner or working through problems on your own. Relationship counselling can help you reconnect emotionally with your partner, which may also help your ED.
Coping and support
Whether the cause is physical, psychological or a combination of both, erectile dysfunction can become a source of mental and emotional stress for you and your partner. Here are some steps you can take:
Don't assume you have a long-term problem. Don't view occasional erection problems as a reflection on your health or masculinity, and don't automatically expect to have erection trouble again during your next sexual encounter. This can cause anxiety, which might make erectile dysfunction worse.
Involve your sexual partner. Your partner might see your inability to have an erection as a sign of diminished sexual interest. Your reassurance that this isn't the case can help. Communicate openly and honestly about your condition. Treatment is often more successful when a man involves his partner.
Don't ignore stress, anxiety or other mental health concerns. Talk to your doctor or consult a mental health provider to address these issues.
The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions. For example:
Work with your doctor to manage diabetes, heart disease or other chronic health conditions.
See your doctor for regular checkups and medical screening tests.
Limit or avoid alcohol.
Avoid using illegal drugs.
Take steps to reduce stress.
Get help for anxiety, depression or other mental health concerns.