What You Need To Know About Erectile Dysfunction

Most adults have heard of the term erectile dysfunction, but there are many misconceptions about what it actually is, what causes it, and how men can treat it. 

Erectile dysfunction, also called ED, is a widespread condition, impacting approximately 18% of men in the United States. As men age, the prevalence of ED increases drastically. It is estimated that 22% of men between 40 and 49 and 49% of men 70 and older experience at least moderate ED. 

ED can negatively affect a person's self-image, confidence, and relationships. Learn more about what ED is, what can cause it, how doctors diagnose it, and more. 

What is erectile dysfunction?

Erectile dysfunction is the inability to produce and maintain an erection firm enough for sexual activity or satisfactory sexual performance. Many men experience some degree of erection issues occasionally, but erectile dysfunction is a chronic issue that leads to regular erection difficulties.

For many, erectile dysfunction is an embarrassing problem that can cause stress and confidence issues, and men that experience it often feel like they are alone. Hundreds of millions of men worldwide have ED, making it significantly more common than most people realize. The good news is that many affordable and easily accessible treatment options are available to most people.

Statistics

Erectile dysfunction, also called ED, is a widespread condition, impacting approximately 18% of men¹ in the United States. 

As men age, the prevalence of ED increases drastically. It is estimated that 22% of men² between 40 and 49 and 49% of men 70 and older experience at least moderate ED.

Symptoms

The main ED symptoms are difficulty achieving and maintaining an erection long enough for normal sexual activity. The inability to maintain an erection can also lead to increased performance anxiety, confidence issues, and even depression. 

Complications of ED

Erectile dysfunction causes complications, straining many aspects of your life. These include: 

  • Increased stress

  • Reduced confidence

  • Relationship issues

  • An unsatisfying sex life

  • The inability to get your partner pregnant

It's common for men to avoid talking about these issues due to embarrassment. Many try to overcome ED on their own by taking supplements or undergoing other lifestyle changes. 

While certain lifestyle changes can reduce the impact of ED, it is a good idea to talk with your doctor to see whether other factors may be causing the condition. 

It can also be helpful to have an open dialogue with your partner, which may reduce some of the performance anxiety that could be contributing.

Diagnosis and tests for erectile dysfunction

The first step in getting an ED diagnosis is to talk with your doctor about your difficulties with achieving and maintaining erections. They will ask questions about your health and sexual history. These questions can understandably feel embarrassing, but answering them honestly can help your doctor pinpoint the cause of your ED faster and create a solution that works. 

Your doctor may conduct a physical examination. They might order blood or other imaging tests to determine the potential cause(s) of your ED. Some common erectile dysfunction tests include:

Complete blood count (CBC)

A complete blood count looks at different counts of your blood. These include hemoglobin, hematocrit, the number of white and red blood cells, and how many of each kind of white blood cell you have. They can also look at the size and shape of your blood cells and how many new blood cells your body creates in a given amount of time.

Doctors often order CBCs for ED testing as they can detect anemia, which can cause fatigue and ED. 

Blood hormone studies

Hormone imbalances from testosterone, prolactin, or both can cause erectile dysfunction. Blood hormone studies see if there are abnormal amounts of these hormones, which can lead to ED. 

Urine test

A urine test, or urinalysis, can provide lots of information about your overall health. This can help your doctor detect health problems that may contribute to your ED. Some common conditions that can show up on urine tests include: 

  • Diabetes

  • Kidney disease

  • Liver damage

  • Infection

  • Other health problems that may be causing your ED

Thyroid function tests

Your thyroid is a small gland that sits in your throat. It’s responsible for regulating hormones, including your sex hormones. If your thyroid isn't working correctly, you may feel a wide range of symptoms, one of which can be erectile problems. 

If your thyroid function tests detect an issue with your thyroid, several treatments are available that promote normal thyroid function and alleviate erectile issues. 

Liver and kidney function tests

Liver and kidney function can impact numerous processes throughout the body, leading to ED. Your kidney is a part of your urinary system, which is closely linked to your reproductive system. 

If your kidney function test is abnormal, it may tell your doctor that your kidney function is responsible for erectile dysfunction. If you have kidney failure, ED may present due to leaky blood vessels, poor blood supply, nerve damage, hormonal problems, or fatigue.

Similarly, poor liver function can also produce erectile dysfunction. People with advanced liver disease, cirrhosis, or nonalcoholic fatty liver disease often struggle with ED. 

Duplex or Doppler ultrasound

Many people are familiar with ultrasound technology for examining developing fetuses in pregnant women, but doctors can also use ultrasounds to look at other tissues in the body. 

With an ultrasound, your doctor can:

  • Look at how your blood flows

  • Check for atherosclerosis

  • Find tissue scarring

  • Look for a venous leak

Your doctor will look at the ultrasound before and after an erection. In most cases, they will use an injection to produce an erection. 

These are just a few of the many possible tests your doctor may order, depending upon your unique situation. It can be frustrating to undergo numerous tests to find the origin of your ED, but narrowing down the cause is the best way to develop a treatment strategy that works in the short and long term.

Penile biothesiometry

If your doctor suspects the cause of your ED is due to abnormal nerve function or nerve damage, they may order a penile biothesiometry. This involves using a device that produces electromagnetic vibrations, which can test nerve function. If you have decreased sensitivity to these vibrations, you might have nerve damage. 

Causes

There are several different possible causes of erectile dysfunction, and it may take your doctor some time to figure out the root of your condition. Some of the most common causes of erectile dysfunction include:

Organic erectile dysfunction

Organic erectile dysfunction is the most common cause of ED, and it stems from issues with the blood vessels within the penis. Atherosclerosis (hardened arteries) can cause problems with your penile arteries. Lifestyle factors like high blood pressure, lack of exercise, and smoking cigarettes can cause atherosclerosis.

Trauma or injuries to your penis can also cause blood vessel issues.

Another cause of organic ED is smooth muscle tissues within your penis. As men age, muscles commonly atrophy, including those in the penis. Your doctor may also refer to this problem as a venous leak, though it doesn't actually involve issues with the veins.

When you can get an erection but have difficulty maintaining it for long enough, it could be a smooth muscle problem. Several other medical and psychological conditions can cause ED, which we will cover more in-depth below. 

Medication

Several medications can cause erection issues, including chemotherapy and medication for high blood pressure, allergies, anxiety, and depression. 

If you were regularly able to get and maintain erections before starting medication but began to struggle after taking your medicine for a while, that may be the cause of your ED. 

If you suspect your medication may be causing erection issues, don't stop taking it before talking to your doctor. Some medicines can cause serious problems if you stop or change them without taking certain precautions. Sometimes, your ability to get and maintain erections can resolve on its own after your body adapts to your medications. 

Psychological factors

Many psychological factors and conditions can lead to erectile dysfunction, including anxiety, depression, and chronic stress. Unfortunately, ED can lead to anxiety, prompting worse ED and kicking off a vicious cycle. 

Anxiety that causes ED may or may not be related to sexual performance, as generalized anxiety can also cause erection issues. This is because anxiety and stress can inhibit your autonomic nervous system response, interfering with your body's ability to feel psychologically aroused. 

Depression can also cause ED, as people with depression often have low energy levels, reduced self-esteem, and don't feel pleasure from activities they used to enjoy. Plus, antidepressants can also alter communication between the brain and sex organs, preventing erections and orgasms. 

Lifestyle habits

ED can also result from lifestyle factors and habits, such as inadequate physical activity levels, unhealthy diets, cigarette smoking, and carrying too much weight. Fortunately, modifying these lifestyle habits can improve the symptoms of ED. 

Still, it can be difficult to make drastic lifestyle changes in a short amount of time. For this reason, start with small lifestyle changes over time, such as taking a 10-minute walk each day if you don't currently do any intentional physical activity. 

You could also increase your vegetable consumption by one serving per day and gradually replace calorie-dense foods and drinks with nutrient-dense ones, like whole grains, fruits, and legumes. Quitting smoking is notoriously tricky, so talk to your doctor about potential treatment options to increase your chance of success. 

Underlying conditions

Sometimes erectile dysfunction comes about because of other conditions like diabetes, high blood pressure, multiple sclerosis, nerve damage, cancer, or hormonal abnormalities. Your doctor can help you create a treatment plan to address the condition that is causing ED. They can also prescribe medications or other treatment options to address the ED specifically. 

It might feel difficult to tell your doctor that you're experiencing erectile dysfunction. Being open and honest is the best way to get the treatment you need to resolve the problem. 

Risk factors of erectile dysfunction

Even though ED is a prevalent condition that many men struggle with at some point in their lives, some risk factors can make you more likely to experience ED, such as:

Some medical conditions

Some medical conditions can be an actual cause of ED, though they can also simply increase your risk of developing it. These are medical conditions commonly associated with ED:

  • Diabetes

  • Cardiovascular disease

  • Liver cirrhosis

  • Chronic kidney disease

  • High blood pressure

  • Chronic obstructive pulmonary disease (COPD)

  • Hormonal disorders like hyperthyroidism, Cushing’s syndrome, or hypogonadism

  • Neurological conditions such as stroke, neuropathy, or multiple sclerosis

  • Prostate issues

Physical trauma

After experiencing some type of physical trauma from an accident or surgery, you may be at a higher risk for developing ED, especially if you had:

  • Prostate, vascular, or urologic surgeries

  • Spinal cord injuries

Lifestyle choices

Numerous behaviors can increase your risk of ED, especially:

  • Using illegal drugs

  • Drinking excessive amounts of alcohol

  • Smoking cigarettes

  • Using anabolic steroids

Having any of the above risk factors doesn't mean you will develop ED, but your chances of struggling with it increase with each risk factor you have.

Treatments

Erectile dysfunction tends to be a highly treatable condition, but it may take time for you and your doctor to determine which treatments work best for you. The best line of treatment is addressing the root cause of ED, whether that’s diabetes, liver cirrhosis, low testosterone, or lifestyle factors. 

Beyond those measures, some treatment options can address ED, including:

Medications

Numerous medications can help with the symptoms of ED, such as tadalafil (Cialis), vardenafil (Levitra) sildenafil (Viagra). They increase blood flow to the penis and typically produce an erection within 15 to 60 minutes. Some won't work if you take them with or after meals. You still need sexual stimulation for drugs to work well.

These medications can have unpleasant side effects, like skin flushing, headaches, indigestion, and nasal congestion. Still, they are well-researched and are commonly prescribed by doctors. It is also not recommended to take ED medications if you are on other drugs that contain nitrates, as this combination can cause a fatal drop in blood pressure. 

If your doctor thinks low testosterone is the cause of your ED, some drugs target testosterone. There are several types of testosterone replacement medications that come as: 

  • Skin patches

  • Oral capsules

  • Gels applied to the skin

  • Injections

  • Pellets that your doctor places under the skin to slowly release testosterone over months

The good news is that most men start to feel like themselves within a few weeks of testosterone replacement treatments. 

Mechanical devices

Mechanical devices that can help with erectile dysfunction include vacuum constriction devices and penile constriction rings. Vacuum devices consist of a hollow cylinder that you place over your penis. Once you pump the air from the cylinder out, this draws blood into your penis, producing an erection.

Placing a constriction ring on the base of your penis maintains the erection. You can keep the band on for up to 30 minutes. 

These devices are highly effective, but many men don't like using them because they feel less spontaneous, and the devices are annoying to store and carry around. Vacuum devices are quite expensive, often between $300 and $500. Some insurance companies will cover some of the costs. Unfortunately, these devices can cause penile bruising, numbness, and difficulty with ejaculation. 

Sex therapy

Sex therapy is the process of working with a counselor or therapist to investigate psychological reasons why you may have difficulty with erections. They can recommend changes in behavior that can result in an increased ability to get and maintain erections. 

Sometimes, sex therapy involves psychological testing, discussing various factors that can lead to erectile dysfunction, and exploring strategies to enhance sex for both partners. 

Penile injections

Penile injections are shots given with tiny needles into the penis, and they can help stimulate an erection within five to 15 minutes. Penile injections work by relaxing the smooth muscles within the penis, which can open blood vessels and cause an erection. Some penile injections must be stored in the refrigerator, while others don't need to be. 

If your doctor thinks penile injections might work for you, they will give you training and instructions for using the medication. Certain areas of the penis are most effective for penile injections, and it's always best to alternate where you inject the medicine. 

If you use a penile injection, there are some oral erectile dysfunction medications that you cannot take within a specified amount of time. Talk to your doctor or pharmacist about using this treatment combination safely. 

Implants

Surgical implants are also an effective treatment for erectile dysfunction. It involves implanting a prosthesis into the penis to facilitate an erection. Many men prefer implants, as they don't inhibit their ability to orgasm, and they still allow a degree of spontaneity.

There are two types of implants, malleable and inflatable. Your surgeon inserts malleable implants at the base of your penis, making it permanently firm. 

Inflatable implant surgery involves inserting two inflatable cylinders, a reservoir, and a pump into the penis and scrotum. When you press the pump, the cylinders within the penis inflate and facilitate an erection-like state. Inflatable implant surgery usually requires six or so weeks of recovery, and the implanted devices can eventually break down.

In these cases, you may need additional surgery to repair or replace them. 

Outlook

Erectile dysfunction can be a disruptive condition in any man's life, and it might feel isolating, embarrassing, and hopeless.

Many men reach for supplements advertised to help with libido and sexual performance, but most of these have not been thoroughly tested, with many containing illegal substances. Additionally, they may produce dangerous adverse side effects. If you want to take supplements to improve your ED, it's best to speak with your doctor and tell them about everything you are taking. 

If you find yourself struggling with ED,  there is hope. Thanks to innovations in medicine, treating erectile dysfunction is easier than ever. Speak to a trusted healthcare practitioner, and they can prescribe medications, therapies, medical devices, and other treatments to treat your condition. 


Medications for erectile dysfunction