Erectile dysfunction is the inability to maintain an erection for satisfactory sexual activity. The definition does not specify a time frame for how long one must have suffered from this condition, although some argue that it should have lasted for at least 6 months to be considered a condition.
The causes behind erectile dysfunction are almost always multifactorial (resulting from multiple causes together), and possible causes can be categorized as follows:
Hormonal diseases - most often focusing on testosterone deficiency
Neurological dysfunction
Vascular disease/vascular conditions which can be divided into:
- Issues with blood flow to the penis
- Issues with blood flow from the penis
As the blood flow to the penis needs to increase approximately 25 times for a usable erection to occur, any vascular impairment, no matter how minor, can affect the ability to achieve an erection. It is commonly stated that about three out of four men with erectile dysfunction - not caused by psychological factors - have some form of vascular disease.
Common causes of vascular-related inadequate blood flow include:
- Atherosclerosis / Arterial Calcification. Many individuals showing this pattern have diabetes and/or smoke.
- Vascular Injuries. Usually caused by trauma or damage to the pelvic region.
Outflow Problems are a less common cause of erectile dysfunction, but a normally due to:
- Anatomical abnormalities. Most commonly, malformed vessels that lead the blood away in a way that prevents the erection. This is more frequently observed in younger individuals.
- Impaired function of anatomical parts in the penis. Prevents the compression of the vessels that need to be constricted to maintain the erection.
Since nerves play a clear and obvious role in the sensations that give rise to arousal and desire, it is not difficult to imagine that nerve damage, for example, leading to reduced sensitivity, can cause erectile dysfunction
Neurological causes of erectile dysfunction include, among others, the following:
- Spinal Cord Injury: Spinal cord injury typically affects erectile function.
- Nerve damage after surgery: Major surgical procedures in the area can damage nerves involved in erectile function.
- Nerve damage due to Type 1 Diabetes: Early onset of erectile dysfunction/impotence is not uncommon.
- Neurological diseases: Multiple Sclerosis (MS) patients often experience erectile dysfunction/impotence.
Psychogenic or psychological causes of erectile dysfunction can either be the sole cause or coexist with other causes of erection problems.
Suspected psychogenic causes of erectile dysfunction commonly arise when the individual:
- Is young
- Reports varying sexual ability
- Often experiences less difficulty with masturbation than with intercourse
- Maintains erections during the night/morning.
Medications can cause erection problems. If erection problems occur in connection with the introduction or change of a medication, it is not uncommon for the medication to contribute to the problem.
If you suspect erectile dysfunction as a direct result of medication, you should contact the doctor who prescribed the medication.
Common groups of medications that can cause erectile dysfunction and ejaculatory problems include:
- Antidepressant medications
- Neuroleptic medications
- Blood pressure medications
The exact number of people who suffer from erectile dysfunction is difficult to determine with certainty, but there are studies suggesting that approximately 5-20% of all men exhibit moderate to severe erectile dysfunction, while other studies suggest that about 50% of all men over 40 years of age experience some degree of erectile dysfunction.
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To be certain if you are suffering from erectile dysfunction, you need to undergo a professional evaluation. However, there are three prominent symptoms strongly associated with erectile dysfunction/impotence:
- Difficulty in achieving an erection
- Difficulty in maintaining an erection
- Reduced sexual desire
The remedies/treatments for erectile problems can vary significantly depending on the underlying cause. However, there are some general tips you can try to enhance your ability to achieve an erection:
- Quit smoking. Smoking damages blood vessels and causes them to constrict.
- Exercise. Physical activity improves blood circulation and increases your ability to engage in sexual activity.
- Drink less alcohol. Alcohol numbs the nervous system and impairs erections both in the short and long term.
- Change your sexual habits. Give yourself time for sex to avoid stress. Change the timing and location of intercourse. Explore different ways of engaging in sexual activity.
Remember, the most important thing is not just achieving an erection, but enjoying the experience.
If the above measures do not help, it may be appropriate to seek professional help.
NOTE: Never purchase potency medications online without consulting your doctor!
The remedies/treatments for erectile problems can vary significantly depending on the underlying cause. Therefore, the first step you need to take is to determine the cause of your erectile dysfunction. As an initial step in attempting to improve your ability to achieve an erection, you can review our tips and advice. If these do not help, you can always turn to your primary care provider.
Having difficulty achieving an erection on isolated occasions is common and does not require medical care. However, if your ability to have an erection deteriorates and becomes regular/persistent, you should consider seeking professional help. Common causes that can lead to persistent/regular erectile problems include:
- Stress/anxiety
- New medication
- Change in dosage of existing medication
- Injury
- Underlying health condition
Risk factors for erectile dysfunction/impotence include:
- Inactivity
- Obesity
- Smoking
- High cholesterol levels
- Cardiovascular disease
- Diabetes
- High blood pressure
- Prostate radiation therapy
- Previous prostatectomy (removal of the prostate)
The older a man gets, the higher the probability that he meets one or more risk factors for erectile dysfunction/impotence. Studies claim that over 50% of men over 50 experience some form of erectile problem.
As with anything else, there is no 100% guarantee to prevent a condition or disease. Everything is about probability and risk. By having good knowledge of risk factors for erectile dysfunction, you can reduce the likelihood of developing erection problems by reducing the risk of these factors.
The causes behind erection problems can vary. Depending on the cause, the solution may differ slightly. To find out why you specifically have difficulty achieving an erection, you can read about possible causes to understand what it might be in your case, which will also help you understand how to seek appropriate help. If you find it challenging to do it on your own or have tried without success, you may need to seek professional help through your primary care provider.
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When it comes to enhancing potency through diet, it refers to food that is believed to increase general desire or the ability to achieve an erection. The ability to achieve an erection is determined by the function and effects of nerves, blood vessels, and hormones, so these are the areas targeted through food.
To potentially increase potency, it is aimed at reducing the risk of nutrient deficiencies, as deficiencies can contribute to poorer erectile function. It is important to note that there is no clear evidence that supplements are necessary if you have a nutritious and varied diet. That being said, certain foods indicate a potential effect on potency, such as:
- Oysters
- Red meat
- Salmon
- Nuts (such as cashews and almonds)
- Fruits
Often, the solution lies in avoiding/treating factors that contribute to reduced erectile function. Factors like alcohol, stress, obesity, drugs, and various diseases can cause poorer erectile function. The solution often involves acting in a way that reduces the risk and effects of these factors. You can find more information about risk factors and treatments here. Examples of things you can do on your own include:
- Avoiding alcohol before sexual activity
- Avoiding drugs
- Talking about your thoughts and feelings about sex if it causes stress
- Engaging in relaxation exercises before sex
- Regular exercise
- Eating a diverse and varied diet
- Ensuring you are adequately treated for any existing conditions
Note: You should never try medication for erectile dysfunction without consulting your doctor first. Wrong medication can be life-threatening!
When consuming large amounts of alcohol in a short period, several things happen that hinder an erection:
- Downregulation of the central nervous system -> slower transmission of information from the brain to the penis -> decreased sensitivity in the penis -> difficulties with erection
- Alcohol is diuretic -> dehydration -> can lead to elevated levels of angiotensin -> constricts blood vessels -> limited blood flow to the penis -> difficulties with erection
- Alcohol reduces levels of free-circulating testosterone -> decreased production of nitric oxide (NO) -> lower levels of NO, which plays a key role in filling the blood vessels in the penis with blood -> poorer blood filling -> difficulties with erection
Investigation of erectile dysfunction is done by a doctor. An investigation always begins with seeking medical care for one's symptoms, after which the doctor's task is to identify possible underlying causes in order to understand how to best treat it. It is important to early exclude physical conditions such as atherosclerosis and various hormonal disorders, as they may be associated with an increased risk of serious illnesses such as heart problems if not detected in time.
The investigation is conducted with the following focus:
- Assessing the erection and erectile difficulties
(When do the difficulties arise?)
(How long do they last?)
(How often do they occur?)
(How does it affect the sex life?)
(How long have you been experiencing these symptoms?)
(Did it start suddenly or gradually?)
- Did it start in connection with an injury/surgery/medication?
- Mapping underlying risk factors such as diseases and lifestyle
(Alcohol and drug habits)
(Smoking)
(Medications)
(Sexual habits and relationship status)
(Blood tests)
(Questionnaires)
(Possible investigation of different diseases that can cause erectile difficulties)
Erectile dysfunction is treated with medication, therapy or assistive devices.
Medication is the first-line option for erectile difficulties. The common denominator among them is that they make it easier to achieve an erection, but none of them treat the underlying cause of the erectile difficulty from the beginning. Medication comes in the form of either tablets or locally acting medications.
Tablets such as sildenafil, avanafil, tadalafil, and vardenafil all have in common that they dilate the blood vessels in the penis. The effect is not that they cause an erection in themselves, but that it becomes easier to achieve an erection when sexually aroused. Their main differences lie in how quickly they take effect, how long the effect lasts, and what side effects may occur. It is individual to each person which one is perceived to work best, and the easiest way to know is to try them until one is satisfied.
The tablets belong to the group of PDE5 inhibitors and are sold under names such as Viagra, Cialis, and Spedra.
Locally acting medications such as Alprostadil are used to relax the muscles around the penis. This dilates the arteries in the penis, resulting in the filling of blood vessels and the occurrence of an erection. Unlike tablets, locally acting medications cause an erection regardless of sexual stimulation.
Locally acting medications come in three forms:
- Cream
- Wax suppositories inserted into the urethra
- Injection
NOTE! You should not attempt treatment with medications without consulting your doctor!
For many, therapy can be helpful if the difficulties stem from psychological/mental issues. Depending on the needs and questions, therapy can be provided by:
- Sexologist
- Psychologist
- Psychotherapist
- Psychiatrist
There are assistive devices that can work well for erectile difficulties. Two of these are:
- Penis ring - a ring placed over the penis to prevent blood reflux -> longer erection.
- Vacuum pump - works by inserting the penis into a cylinder connected to a pump. When pumped, the penis fills with blood -> erection.
Remember that the above treatments help to address the erectile difficulty but do not treat the underlying cause!