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Understanding erectile dysfunction
What is erectile dysfunction?
Erectile dysfunction, commonly referred to as ED or impotence, is defined as the ongoing inability to achieve or maintain an erection for sexual intercourse.
Occasional failure to achieve an erection is not uncommon. Drinking alcohol, stress, tiredness, and relationship issues can contribute to individual incidents of erectile dysfunction. However, ED that continues routinely over time is not typical and might be the sign of an underlying health condition.
In the United States, about 5% percent of men over 40 have ED, increasing to 15% for men over 70. A Massachusetts Male Aging Study reviewed ED in men aged 49–69 years old and found a total occurrence of ED of 52%.
Erectile dysfunction causes
Three components are essential to male sexual function:
- The desire for sexual activity, known as libido
- Obtaining and maintaining an erection
- Ejaculation and climax, known as orgasm
ED symptoms result from deficiencies in any of these areas. An erection is the result of a complex process that involves emotions, hormones, nerves, muscles, and blood vessels. Both physical and psychological issues cause ED in most men. Physical causes may include:
- Heart disease: Blood supply to the penis becomes blocked or narrowed with atherosclerosis, a hardening of the arteries. High blood pressure and cholesterol are contributing factors.
- Diabetes: An estimated 27% to 75% of men with diabetes experience ED. Peripheral neuropathy (nerve damage), with the nerves controlling erections, is commonly seen in men with diabetes.
- Neurological disorders: Multiple sclerosis, Parkinson’s disease, and spinal cord or other nerve injuries (from surgery, stroke, diabetes) all cause ED.
- Hormones: Increased prolactin, steroid abuse, abnormal thyroid hormone levels, and low testosterone contribute to ED.
- Obesity: damages blood vessels, decreases testosterone, and causes inflammation, all of which increase the risk for ED.
- Peyronie’s disease: A condition where scar tissue causes curvature of the penis or decrease in length or girth.
Psychology impacts ED for various reasons. Worrying about getting an erection or performance anxiety might make it more challenging to do so.
ED is also a side effect of many common prescription drugs.
Many prescription drugs list ED as a side effect, including blood pressure medications, anxiety and depression drugs, and cancer treatments. It's vital to continue taking your prescribed medication even if you think it might be causing ED. Contact your doctor to see whether a different medicine without the side effects is available.
Note: It’s a common myth that viewing pornography causes ED. Bowling Green (Ohio) State University conducted a study with 877 men ages 18 to 60 and found no evidence that pornography caused ED.
Diagnosing erectile dysfunction
A complete medical history, physical exam, and laboratory tests help doctors diagnose ED. Thoroughness is essential to address any underlying health conditions. In some cases, healthcare professionals may conduct a psychosocial examination to uncover mental and emotional health issues.
Complications from ED
ED may put stress on a relationship, leading to an unsatisfactory sex life, anxiety, low self-esteem, or depression. Men may avoid sexual situations due to embarrassment, which may cause feelings of rejection for the partner. Fortunately, treatment options are available.
Treatment for ED
Treatment for physical causes of ED includes lifestyle changes and healthy habits. Each of the following practices can reduce the risk for ED:
- Eat a healthy diet
- Quit smoking
- Refrain from using drugs and alcohol
- Increase exercise
Treatment for emotional issues may also help, including individual or couples counseling. Hormone replacement therapy may help certain patients as well. Penile implants are also an option.
Men who take blood pressure medications should take these medications only told to by their doctor. They may lower blood pressure to dangerous levels. Men with medical conditions that cause a sustained erection or those with Peyronie’s disease may not benefit from these drugs, but might be candidates for surgical implants. Communication with your healthcare provider is of utmost importance. Erections that last over 4 hours may be dangerous.
Though common, ED doesn’t need to be part of aging and can be prevented and treated. As with treatment, the best way to prevent ED is to make healthy life choices and manage your health.