People tend to shy away from talking about their sexual health. However, while the topic may be taboo, sexual dysfunction is a significant issue all over the globe. In fact, according to clinical research, an estimated 31% of men experience erectile dysfunction at some point in life.
Knowledge is key to tackling erectile dysfunction and regaining control over your sexual health. In this article, we’ll provide a complete overview of erectile dysfunction and all that it entails, including the possible symptoms, typical diagnosis methods, and available treatments.
Defining Erectile Dysfunction
Most adults have some degree of understanding of erectile dysfunction, or ED. But, what’s the medical definition? According to the National Institute of Diabetes and Digestive and Kidney Disease, erectile dysfunction is a condition that occurs when a man can’t get or keep an erection that’s firm enough for intercourse.
Many men find it difficult or uncomfortable to talk about their ED, but doing so is the first step to recovery. A trusted healthcare provider can evaluate your symptoms and determine the right treatment path for your needs.
What Are The Symptoms of Erectile Dysfunction?
The symptoms of ED can vary from person to person. However, the primary symptom is not being able to get or maintain an erection that’s sufficient for sex. Some men with ED can get an erection, but it doesn’t last long enough for intercourse. Other men with ED can’t get an erection, even with arousal.
ED can also cause stress, poor self-esteem, and other mental health concerns, including anxiety and depression.
What Causes Erectile Dysfunction?
It’s often challenging to pinpoint the root cause of ED because there are so many possible causes. These factors can be separated into two broad categories: physical and psychological.
Physical Causes of ED
As the name suggests, these causes of ED relate to problems with your physical health. Examples include:
- Underlying medical conditions, including heart disease, high blood pressure, kidney disease, obesity, and diabetes
- The use of nicotine products (i.e. smoking), which can restrict blood flow to the penis
- Excessive alcohol consumption (casually referred to as “whiskey dick”)
- Peyronie’s disease, a condition in which fibrous scar tissue creates an abnormal curve in the penis
- An injury to the penis
Some men develop erectile dysfunction from taking certain prescription medications, such as:
- Blood pressure medications
- Antidepressants
- Antiandrogens for prostate cancer therapy
- Prescription sedatives
- Ulcer medications
- Appetite suppressants
Psychological Causes of ED
Your brain plays an indispensable role in your ability to get and maintain an erection. Signals from the brain trigger increased blood flow to the penis when a man is aroused, allowing the penis to become firm. Stress, anxiety, depression, relationship issues, and other mental health concerns can interfere with these neurological signals, making it tough to get an erection.
Anxiety and depression are known risk factors for ED. A 2023 study found that the prevalence of anxiety among ED patients is 38.16%, while the prevalence of depression among ED patients is 64.97%. This not only illustrates the impact of mental health conditions on ED, but also that ED can contribute to anxiety and depression.
Is Erectile Dysfunction Preventable?
Not all cases of erectile dysfunction are preventable, especially those involving underlying medical conditions or penile injuries. However, it is possible to lower your risk of ED with healthy lifestyle choices, including:
- Quitting smoking
- Eating a balanced diet that’s low in fat and sodium
- Limiting alcohol consumption and avoiding recreational drugs
- Exercising regularly (at least 150 minutes per week)
- Effectively managing stress
Your doctor can provide other lifestyle tips to reduce your risk of ED with your medical history. For example, if you’re at an increased risk of high blood pressure, your doctor may suggest that you lose weight and reduce your caffeine intake.
How is ED Diagnosed?
Erectile dysfunction can be diagnosed by your primary care physician or, more commonly, a urologist. Urologists specialize in conditions affecting the urinary tract and male reproductive system. If you report symptoms of ED to your PCP, they’ll likely refer you to a urologist for specialized treatment.
The process of diagnosing ED generally starts with a complete medical history, including your sexual history, and physical exam. During the physical exam, your urologist may check the sensitivity and appearance of your penis to rule out nervous system problems and Peyronie’s disease. They may also check your pulse to ensure that your circulation is normal.
Along with a physical exam, your urologist will ask you a series of questions to gather information about your ED symptoms. Here are some examples of questions that you might be asked:
- How confident are you in your ability to get and keep an erection?
- How often can you maintain an erection during intercourse?
- How often do you have erections that are firm enough for intercourse?
- In general, how would you describe your libido?
- How often do you have an erection when you wake up in the morning?
- How often are you able to orgasm and ejaculate?
- Do you typically find sexual intercourse satisfying?
The Path to ED Relief: What Treatments Are Available?
Though erectile dysfunction can be frustrating for both men and their partners, we now have access to several ED treatment options. After evaluating your symptoms and determining the most likely cause of your ED, a urologist can suggest a course of treatment. In many cases, this treatment plan includes prescription medications.
Prescription Medications for Erectile Dysfunction
You’ve probably heard of “the little blue pill” – also known as Viagra or sildenafil, it’s the one most commonly prescribed medications for erectile dysfunction. It’s also one of the four main PDE5 inhibitors used for ED today.
PDE5 inhibitors work by blocking an enzyme called PDE5. In doing so, this type of drug relaxes certain muscles and boosts blood flow to the penis, making it easier to get and maintain an erection. Take note that sexual arousal is still essential to getting an erection while you’re taking PDE5 inhibitors – these drugs simply help the process along.
Besides Viagra, other PDE5 inhibitors for ED include:
- Cialis/tadalafil
- Levitra/vardenafil
- Stendra/avanafil
| Medication | Time Before it Takes Effect | How Long the Effect Lasts | Typical Dose |
| Viagra | 30 to 60 minutes | About 4 hours | 50 mg |
| Levitra | 60 minutes | About 4 hours | 10 mg |
| Cialis | 30 to 60 minutes | Up to 36 hours | 5 mg |
| Stendra | 15 minutes | Up to 6 hours | 100 mg |
These PDE5 inhibitors can have similar side effects, including headache, flushing, dizziness, stomach discomfort, and nasal congestion. Viagra and Levitra may also cause nausea, while Cialis and Stendra may cause back pain. In some men, Viagra causes vision changes, like blurry vision or light sensitivity.
Vacuum Devices
When prescription medications fail, one of the next steps to consider is a vacuum device. This device consists of a plastic tube that fits over the penis. A pump is located toward the tip of the penis, and a band at the other end creates a seal. When it’s in use, this device makes a vacuum that pulls blood into the penis, helping to make it erect.
While results can vary, one study found that vacuum erectile device therapy boosts erectile function in 84 to 95% of patients. It can be used in combination with other treatments, like prescription medication, for even better results.
Surgery for Erectile Dysfunction
Surgery is usually only used as a last resort for erectile dysfunction, when all other treatments fail. Though a few different surgical methods can be used to treat ED, penile implants are the most common. There are two main types of penile implants: semi-rigid and inflatable.
Penile implants are surgically placed inside the penis, making it firm enough for intercourse. This allows men to have sex more spontaneously than prescription medications, which usually must be taken in advance. However, penile implant surgery requires recovery time and involves all of the risks associated with anesthesia and surgery, including postoperative infection.
Therapy for Psychological ED
If your erectile dysfunction is caused by stress, anxiety, depression, or other psychological conditions, your urologist may recommend therapy. Therapy can address the root cause of psychological ED and gradually improve your sexual function by promoting confidence, mindfulness, and stress relief.
Studies on therapy for ED are promising. One study found that there wasn’t a significant difference between the results of cognitive behavioral therapy (CBT) and 50 mg of sildenafil in treating non-organic erectile dysfunction. Another study found that CBT was an effective adjunctive treatment for ED patients taking a PDE5 inhibitor and that it provided benefits long after the treatment concluded.
Men may also want to consider talking to a sex therapist. This type of therapist specializes in treating mental and emotional issues that relate to sexual dysfunction.
Moving Forward with ED
Coping with erectile dysfunction can be a challenge. But, you don’t have to bear this burden alone. Find a trusted urologist that you can discuss your symptoms with and strategize a path forward. Your physician will work with you to find a treatment plan that fits your needs.