What is Erectile Dysfunction?
Erectile dysfunction is the inability to achieve or maintain an erection adequate for sexual activity.
If you have erectile dysfunction, you are not alone; it is extremely common. Erectile dysfunction typically occurs in approximately 10% of the decade, for example, 20% of 20-year-olds, 50% of 50-year-olds, and 70% of 70-year-olds. The only exception to this is that it occurs in 49% of men over the age of 40.
Erectile Dysfunction can result from a combination of age, an unhealthy lifestyle, health problems, and emotional issues.
Some known risk factors are:
- Being over age 50
- Not exercising
- High blood sugar (Diabetes)
- High blood pressure
- Cardiovascular disease
- High cholesterol
- Drug use
- Alcohol abuse
Depending on the cause of erectile dysfunction, it can be classified into the following categories:
- Vasogenic. This can refer to an arterial disease that affects the arteries in your body, causing erectile dysfunction.
- Venous leak. This is a problem with the erectile muscular tissue that is required to relax and expand to trap the blood in your penis and make an erection happen. When this muscle is stiff and cannot trap the blood in your penis, there’s a leak of venous blood. Because the veins can’t keep blood in your penis during an erection, you lose it.
- Psychogenic. This is a mental state where stressors, anxiety or thought patterns can make it difficult to get or keep an erection. This can be situational, where it is more functional in some circumstances and less functional in other circumstances.
- Neurogenic. This happens when there is damage to the nerves either in the brain, the spinal cord, or the peripheral nerves such as the pelvis. When this happens, the nerve signal does not make it to the penis adequately, so it does not signal the penis to create an erection.
- Medication-induced erectile dysfunction. Some medications are associated with erectile dysfunction.
- Mechanical or end-organ erectile dysfunction. This happens when patients have had injuries.
- Peyronie’s disease. Peyronie’s is a disease where scar tissue in your penis causes it to bend, curve or lose length or girth. This can be painful and cause erectile dysfunction.
Can blood pressure medications cause erectile dysfunction?
Yes, many different blood pressure medications can cause erectile dysfunction.
If you’re experiencing erectile dysfunction as a side effect of your blood pressure medication, it’s best to talk to your primary care doctor to consider trying a different medication. They can help you to find one that adequately controls your blood pressure and does not lead to erectile dysfunction.
Can diabetes cause erectile dysfunction?
Yes. Diabetes, in the long run, can create disease of the small arteries and capillaries within our bodies, and these are essential for function. Living with diabetes puts men at increased risk of erectile dysfunction over time.
Can nerve damage cause erectile dysfunction?
Absolutely. Nerves must be working normally for a man to get and keep an erection. Nerves can be damaged by diabetes, multiple sclerosis, prostate surgery, or damage to the spinal cord.
However, it depends on the region where the nerves are damaged.
- Spinal cord injuries can lead to difficulties with erections. However, erections can be preserved with contact or simulation in many circumstances depending on the level of spinal cord injury.
- Injury to the peripheral nerves, or nerves that travel between the spinal cord and the penis, can result in erectile dysfunction. Common examples of this would be damage to the nerves associated with taking a prostate out for prostate cancer or sometimes after colorectal surgery for colon cancer.
Can male enhancement pills cause erectile dysfunction?
It’s unclear what the ingredients of male enhancement pills are, and because they’re not FDA-approved medication, the level of control over the ingredients and substances in these pills is likely lacking. Therefore, it is possibly damaging. Over-the-counter male enhancement pills are generally not recommended due to these reasons.
Can mental blocks cause erectile dysfunction?
Absolutely. Our psychological state is critically important for being able to achieve and maintain erections. If we’re worried about getting an erection or being able to maintain it, or if we have anxiety or feel stressed or tired, these factors can lead to difficulties in getting and maintaining an erection.
These circumstances are treatable but often require some work to train our thought patterns and readapt our sexual approach. Working with professionals such as psychiatrists or psychologists with skill sets in this area can be helpful; using techniques such as cognitive behavioural therapy (CBT) or mindfulness therapy can also be helpful.
For some individuals using medications such as phosphodiesterase-5 (PDE-5) inhibitors such as sildenafil, tadalafil or vardenafil, can help make it easier to get and maintain an erection. Eventually, men can regain their confidence and slowly wean off these medications.
Can anxiety cause erectile dysfunction?
Yes. Anxiety, stress, and unproductive thought patterns can lead to difficulties getting and maintaining an erection.
Can high blood pressure cause erectile dysfunction?
Yes. In the long run, high blood pressure can cause damage to the small vessels in our bodies. These vessels are important for erectile function. Therefore, men with high blood pressure are at increased risk of developing erectile dysfunction over time.
Can masturbation cause erectile dysfunction?
When no injuries have occurred from masturbation, it is healthy. Regular erections and exercising the cavernous muscle tissue (the erection muscle tissue within the penis) are important for maintaining good, healthy muscle and potentially reducing fibrosis and any plasticity over time.
The muscle within the penis that causes and produces erections is similar to other muscles in the body where we have to exercise them to promote good health and sustained function.
Can too much sex cause erectile dysfunction?
Having regular erections and using these erections is healthy for erectile tissue. There are injuries during sexual activity that can lead to erectile dysfunction; however, that is very uncommon.
There is something called the refractory period where, after orgasm or ejaculation, our bodies enter a period where physiologically it is difficult to obtain another erection. This period increases as we age. When you’re young, it does not take long to generate another erection after orgasm or ejaculation; as you get older, this period lengthens in time, and you will likely have to take longer to be able to obtain an erection.
Can a swollen prostate cause erectile dysfunction?
Prostates don’t necessarily swell. However, prostates can grow and enlarge over time because of a condition known as benign prostatic hyperplasia (BPH). This occurs for many men as they age and is associated with erectile dysfunction.
Live a healthy lifestyle with a healthy diet and regular exercise to help you to have regular erections by optimizing and maintaining penile health.
Eating a healthy diet rich in vegetables, with healthy sources of protein, Omega-3s and fatty acids (which is helpful for your heart health and vascular health), is helpful for penile health.
Coldwater fish, like wild salmon, mackerel, and tuna are great sources of Omega-3s. Taking DHA fish oil is another great way to supplement your Omega-3s intake.
There is data that connects regular exercise with the promotion of good erectile function. Keeping fit and having the rest of your body healthy is essential. These factors are important for optimizing penile health.
Studies show that 40 minutes of aerobic exercise of moderate to vigorous intensity 4 times per week over the course of 6 months contributes to decreasing erectile problems in men with ED.
Drinking some alcohol in moderation is acceptable. Excessive alcohol can lead to erectile dysfunction.
Sexual dysfunction is common in men with alcohol dependence.
Men should not drink more than 15 drinks in one week, with no more than 3 drinks in one sitting, and with days off in between drinking days.
Smoking is damaging to the vessels in your body and your general health. When you quit smoking, you will help prevent further damage to the vessels and tissue to help maintain and optimize erectile function.
Stress and anxiety can have a negative impact on the ability to get and maintain erections. Staying present, reducing stress, and enjoying sexual encounters can encourage your sex drive and your erectile function.
Talking to a counsellor can help if you are suffering from ED. Other things you can try by yourself are meditation, breathing exercises, and yoga.
The MindFit Toolkit is another simple way to help you build the skills to cope with stress and anxiety better.
Signs & symptoms
Erectile dysfunction is usually a progressive disease. Early on, it may include slight difficulties in getting an erection or maintaining an erection, or an erection might not be quite as firm as previously recalled. This may progress over time.
If you’re having difficulties in getting or maintaining an erection after several encounters, then this might be because of erectile dysfunction. It is appropriate to speak with your primary care physician to get further assessments or management tips.
ED is typically diagnosed by taking your history and getting it diagnosed by a medical health professional.
What are common treatments for erectile dysfunction?
- Therapy sessions. For individuals with situational or psychogenic erectile dysfunction, i.e., related to your mental health, you can help to improve it with CBT or mindfulness-based therapies.
- Medication. Sometimes, the use of erection medications can be helpful for the general population with erectile dysfunction. Typically, pills will be considered if lifestyle or conservative measures are not helpful; these include vardenafil, tadalafil or sildenafil. These can be used daily or on-demand, one to two hours before sexual activity.
- Tablets in the urethra. If pills don’t work, or there are side effects or reasons not to take the pills, little tablets can be introduced into the urethra.
- Injections into the penis. This will work in many individuals where there’s either nerve damage or pills are no longer responding.
- Vacuum therapy. This draws blood into the penis, and a soft silicone band is placed at the base of the penis to trap the blood.
- Penile implant surgery. If these treatments are not successful, penile implant surgery can sometimes be used. This is typically performed with a three-piece penile implant, where cylinders are placed into the penile shaft, a pump in the scrotum, and a reservoir in the abdomen. The individual squeezes the pump in the scrotum several times to move fluid into the cylinders so that they become firm and erect. When the individual is done using them, they can press the button for the erection to come down and resolve. Other forms of penile implants don’t have reservoirs or don’t have a pump. They are more simple to use but less dynamic.
Are there over-the-counter medications?
The only over-the-counter device would be a vacuum, where the penis is placed in the cylinder and pumped, and negative pressure in the cylinder brings blood into the penis. A silicone band is placed at the base.
Are there natural cures for erectile dysfunction?
Other than with stress or anxiety-induced erectile dysfunction, no.
Are there exercises you can do to help with erectile dysfunction?
Not necessarily. However, getting regular erections to exercise the muscle is important, and regular physical activity can help maintain body health and potentially penile health.
There are a lot of resources and management strategies available. The best thing to do is connect with your primary care physician, who will help with the management. If your primary care physician has limitations in this, they can refer you to a urology specialist that will be comfortable with the full spectrum of erectile dysfunction treatments.
How to help your partner cope with erectile dysfunction?
It’s important to:
- Engage in open conversation and dialogue
- Have your partner understand that you are supportive of their situation
- Engage in discussions around management strategies and options
- Be open and flexible to exploring different forms of sexual activity
- Encourage your partner to see a medical professional for diagnostic evaluation when appropriate
- Engage with management strategies when appropriate
How to help someone you care about with erectile dysfunction?
Encourage them to connect with their primary care doctor or health professional, as it’s important to have the conversation and understand if there’s any additional diagnostic testing to be performed or management strategies required.
Frequently asked Questions
Are there any vitamins that help prevent erectile dysfunction?
None with conclusive evidence. Some data suggests that healthy vitamin D levels can be associated with good erectile function, and low levels can be associated with erectile dysfunction. More evidence is needed in this space, looking at vitamins and erectile function.
Can erectile dysfunction be cured?
In most circumstances where there is a problem with the mechanisms of erections, there is no curative or regenerative therapy for erectile dysfunction. Most of the treatments available currently aim at optimizing or managing erectile dysfunction to help encourage more normalized function.
If an individual has psychogenic erectile dysfunction where unproductive thought patterns, stressors and anxiety are the underlying cause for difficulties in getting or maintaining an erection, addressing these concerns can cure erectile dysfunction since the physical mechanisms within the penis are otherwise normal.
Can men experience temporary erectile dysfunction?
Yes, often for various reasons. Excessive alcohol use, psychological factors, use of certain medications, lack of sleep, stressors, anxiety, new partners, or distraction can all lead to temporary difficulties with erections. By optimizing these variables, normal erectile function can be restored.
How long does erectile dysfunction last after prostate surgery?
Erectile dysfunction after prostate cancer surgery typically is at its worst in the first six months, and then there’s some degree of recovery for the next two years. Very small improvements may occur up to four years after the surgery. At that point (around two to four years after the surgery), this is likely to become the new baseline of erectile function.
Is erectile dysfunction a sign of prostate cancer?
No. Erectile dysfunction is not a sign of prostate cancer.
Is erectile dysfunction a sign of diabetes?
Not typically. Usually, erectile dysfunction will occur after having had diabetes for some time. However, if diabetes has been present for a long time but has not been diagnosed, then it is possible.
Does COVID-19 cause erectile dysfunction?
Men with recent COVID-19 infections are at a significantly increased risk of erectile dysfunction.