Erectile Dysfunction

Erectile dysfunction (ED) is a common type of male sexual dysfunction. It is when a man has trouble getting or keeping an erection. ED becomes more common as you get older. But it’s not a natural part of aging.

Some people have trouble speaking with their doctors about sex. But if you have ED, you should tell your doctor. ED can be a sign of health problems. It may mean your blood vessels are clogged. It may mean you have nerve damage from diabetes. If you don’t see your doctor, these problems will go untreated.

Your doctor can offer several new treatments for ED. For many men, the answer is as simple as taking a pill. Getting more exercise, losing weight, or stopping smoking may also help.

Prevention

Men can prevent many of the causes of ED by making healthy lifestyle choices, such as being physically active, quitting smoking, and following a healthy diet.

PHYSICAL ACTIVITY

Physical activity increases blood flow throughout the body, including the penis. Men should talk with a health care provider before starting new activities. Beginners should start slow, with easier activities such as walking at a normal pace or gardening. They can work up to harder activities such as walking briskly or swimming. Men should aim for at least 30 minutes of activity most days of the week.

QUITTING SMOKING

Smoking is associated with heart and blood vessel disease, which can lead to ED. Even when heart and blood vessel disease and other possible causes of ED are taken into account, smoking still increases the chances that a man will have ED.

EATING, DIET, AND NUTRITION

To help maintain erectile function, men should eat a healthy diet of whole-grain foods, fruits and vegetables, low-fat dairy foods, and lean meats. A diet that contributes to being overweight and heart and blood vessel disease can also contribute to ED. Men should avoid foods high in fat and sodium, the main ingredient in salt. They should also avoid drinking too much alcohol or using illegal drugs.

Risk Factors

Men with an underlying disease that can cause ED are more likely to develop ED. ED affects men of all races and in all regions. Researchers estimate that ED affects as many as 30 million men in the United States. While the likelihood of ED increases with age, the aging process does not cause ED.

FOR EXAMPLE, ED OCCURS IN

• about 12 percent of men younger than 60
• 22 percent of men age 60 to 69
• 30 percent of men age 70 or older

Causes

A variety of physical and psychological or emotional issues can cause ED. Physical causes include damage to the nerves, arteries, smooth muscles, and fibrous tissues in the penis.

DISEASES AND DISORDERS THAT CAUSE DAMAGE AND CAN LEAD TO ED INCLUDE

• high blood pressure
• diabetes, a complex group of diseases characterized by high blood glucose, also called high blood sugar or hyperglycemia
• atherosclerosis, the buildup of a substance called plaque on the inside of arteries
• heart and blood vessel disease
• chronic kidney disease
• multiple sclerosis, an autoimmune disease that attacks the nerves
• injury from treatments for prostate cancer, including radiation and prostate surgery
• injury to the penis, spinal cord, prostate, bladder, or pelvis
• surgery for bladder cancer
• Peyronie’s disease, a disorder in which scar tissue, called a plaque, forms in the penis

Lifestyle choices, such as smoking, drinking too much alcohol, using illegal drugs, being overweight, and not exercising, can lead to ED.

PSYCHOLOGICAL OR EMOTIONAL ISSUES, SUCH AS THE FOLLOWING, CAN ALSO CONTRIBUTE TO ED:

• anxiety
• depression
• fear of sexual failure
• guilt
• low self-esteem
• stress

Even when ED has a physical cause, psychological or emotional factors may make the condition worse. For example, a physical problem that slows a man’s sexual arousal can create anxiety, which can worsen the ED.

In addition, ED can be a side effect of many common medications, such as blood pressure medications, antihistamines, antidepressants, tranquilizers, appetite suppressants, and ulcer medications.

A small number of ED cases result from a reduced level of the male hormone testosterone.

Symptoms

Erectile dysfunction is a condition in which a man is unable to get or keep an erection firm enough for sexual intercourse.

ED IS PRESENT WHEN A MAN

• can get an erection sometimes, though not every time
• can get an erection, yet it does not last long enough for sexual intercourse
• is unable to get an erection at any time

ED is sometimes called impotence; however, health care providers use this term less often now.

Diagnosis

A HEALTH CARE PROVIDER DIAGNOSES ED WITH A

• medical and sexual history
• physical exam

OTHER TESTS THAT MAY BE HELPFUL TO THE HEALTH CARE PROVIDER INCLUDE

• blood tests
• a nocturnal, or nighttime, erection test
• an injection test
• a Doppler ultrasound
• a mental health exam

Treatment

A HEALTH CARE PROVIDER TREATS ED BY

• treating the underlying cause of the ED:
  • lifestyle changes
  • changing medications that treat other health conditions
  • counseling
• prescribing ED medications:
  • oral medications
  • injectable medications
• prescribing a vacuum device
• performing surgery:
  • implanted devices
  • artery reconstruction

Recovery

Many men overcome erection problems with lifestyle changes, medical treatment, or both. For more severe cases, you and your partner may have to adjust to how ED affects your sex life. Even with treatment, counseling can help you and your partner overcome the stress ED may put on your relationship.