Erectile dysfunction (ED) is the inability of a man to maintain a firm erection long enough to have sex. Although erectile dysfunction is more common in older men, this common problem can occur at any age. Having trouble maintaining an erection from time to time isn't necessarily a cause for concern. But if the problem is ongoing, it can cause stress and relationship problems and affect self-esteem.
Formerly called impotence, erectile dysfunction was once a taboo subject. It was considered a psychological issue or a natural consequence of growing older. These attitudes have changed in recent years. It's now known that erectile dysfunction is more often caused by physical problems than by psychological ones, and that many men have normal erections into their 80s.
Although it can be embarrassing to talk with your doctor about sexual issues, seeking help for erectile dysfunction can be worth the effort. Erectile dysfunction treatments ranging from medications to surgery can help restore sexual function for most men. Sometimes erectile dysfunction is caused by an underlying condition such as heart disease. So it's important to take erectile trouble seriously because it can be a sign of a more serious health problem.
Symptoms
Erectile dysfunction is the inability to maintain an erection sufficient for sexual intercourse at least 25 percent of the time.
An occasional inability to maintain an erection happens to most men and is normal. But ongoing erection problems are a sign of erectile dysfunction and should be evaluated. In some cases, erectile dysfunction is the first sign of another underlying health condition that needs treatment.
Causes
Male sexual arousal is a complex process involving the brain, hormones, emotions, nerves, muscles and blood vessels. If something affects any of these systems — or the delicate balance among them — erectile dysfunction can result.
Anatomy of an erection
The penis contains two cylindrical, sponge-like structures (corpus cavernosum) that run along its length, parallel to the tube that carries semen and urine (urethra).
When a man becomes sexually aroused, nerve impulses cause the blood flow to the cylinders to increase several times the normal amount. This sudden influx of blood expands the sponge-like structures and produces an erection by straightening and stiffening the penis.
Continued sexual arousal maintains the higher rate of blood flow into the penis and limits the blood flow out of the penis, keeping the penis firm. After ejaculation or when the sexual excitement passes, the excess blood drains out of the spongy tissue, and the penis returns to its nonerect size and shape.
Physical causes of erectile dysfunction
At one time, doctors thought erectile dysfunction was primarily caused by psychological issues. But this isn't true. While thoughts and emotions always play a role in getting an erection, erectile dysfunction is usually caused by something physical, such as a chronic health problem or the side effects of a medication. Sometimes a combination of things causes erectile dysfunction.
Common causes of erectile dysfunction include:
Heart disease
Clogged blood vessels (atherosclerosis)
High blood pressure
Diabetes
Obesity
Metabolic syndrome
Other causes of erectile dysfunction include:
Certain prescription medications
Tobacco use
Alcoholism and other forms of drug abuse
Treatments for prostate cancer
Parkinson's disease
Multiple sclerosis
Hormonal disorders such as low testosterone (hypogonadism)
Peyronie's disease
Surgeries or injuries that affect the pelvic area or spinal cord
In some cases, erectile dysfunction is one of the first signs of an underlying medical problem.
Psychological causes of erectile dysfunction
The brain plays a key role in triggering the series of physical events that cause an erection, beginning with feelings of sexual excitement. A number of things can interfere with sexual feelings and lead to — or worsen — erectile dysfunction. These can include:
Depression
Anxiety
Stress
Fatigue
Poor communication or conflict with your partner
The physical and psychological causes of erectile dysfunction interact. For instance, a minor physical problem that slows sexual response may cause anxiety about maintaining an erection. The resulting anxiety can worsen erectile dysfunction.
A variety of risk factors can contribute to erectile dysfunction. They include:
Getting older. As many as 80 percent of men 75 and older have erectile dysfunction. Many men begin to notice changes in sexual function as they get older. Erections may take longer to develop, may not be as rigid or may take more direct touch to the penis to occur. But erectile dysfunction isn't an inevitable consequence of normal aging. Erectile dysfunction often occurs in older men mainly because they're more likely to have underlying health conditions or take medications that interfere with erectile function.
Having a chronic health condition. Diseases of the lungs, liver, kidneys, heart, nerves, arteries or veins can lead to erectile dysfunction. So can endocrine system disorders, particularly diabetes. The accumulation of deposits (plaques) in your arteries (atherosclerosis) also can prevent adequate blood from entering your penis. And in some men, erectile dysfunction may be caused by low levels of testosterone (male hypogonadism).
Taking certain medications. A wide range of drugs — including antidepressants, antihistamines and medications to treat high blood pressure, pain and prostate cancer — can cause erectile dysfunction by interfering with nerve impulses or blood flow to the penis. Tranquilizers and sleeping aids also can pose a problem.
Certain surgeries or injuries. Damage to the nerves that control erections can cause erectile dysfunction. This damage can occur if you injure your pelvic area or spinal cord. Surgery to treat bladder, rectal or prostate cancer can increase your risk of erectile dysfunction.
Substance abuse. Chronic use of alcohol, marijuana or other drugs often causes erectile dysfunction and decreased sexual drive.
Stress, anxiety or depression. Other psychological conditions also contribute to some cases of erectile dysfunction.
Smoking. Smoking can cause erectile dysfunction because it restricts blood flow to veins and arteries. Men who smoke cigarettes are much more likely to develop erectile dysfunction.
Obesity. Men who are obese are much more likely to have erectile dysfunction than are men at a normal weight.
Metabolic syndrome. This syndrome is characterized by belly fat, unhealthy cholesterol and triglyceride levels, high blood pressure, and insulin resistance.
Prolonged bicycling. Over an extended period, pressure from a bicycle seat has been shown to compress nerves and blood flow to the penis, leading to temporary erectile dysfunction and penile numbness.
When to seek medical advice
If erectile dysfunction is more than a temporary, short-term problem, see your doctor. Your own doctor, or a doctor specializing in erectile dysfunction, can help you determine the underlying cause or causes of erectile dysfunction and then help you find the right type of treatment.
Although you might view erectile dysfunction as a personal or embarrassing problem, it's important to seek treatment. In most cases, erectile dysfunction can be successfully treated. Also, see your doctor if the therapy or medication prescribed to treat erectile dysfunction isn't working for you. Don't try to combine medications or therapies on your own or make changes from prescribed doses.
Tests and diagnosis
Your doctor will ask questions about how and when your symptoms developed, what medications you take and any other physical conditions you might have. Your doctor will also want to discuss recent physical or emotional changes.
If your doctor suspects that physical causes are involved, he or she will likely want to take blood tests to check your level of male hormones and for other potential medical problems, such as diabetes. Your doctor may also want to try eliminating or replacing certain prescription drugs you're taking one at a time to see whether any are responsible for erectile dysfunction.
More specialized tests may include:
Ultrasound. This test can check blood flow to your penis. It involves using a wand-like device (transducer) held over the blood vessels that supply the penis. The transducer emits sound waves that pass through body tissues and reflect back, producing an image to let your doctor see if your blood flow is impaired. The test often is done before and after injection of medication into the side of the penis to see if there's an improvement in blood flow.
Neurological evaluation. Your doctor usually assesses possible nerve damage by conducting a physical examination to test for normal touch sensation in your genital area.
Dynamic infusion cavernosometry and cavernosography (DICC). This procedure involves injecting a dye into penile blood vessels to permit your doctor to view any possible abnormalities in blood pressure and flow into and out of your penis. It's generally done with local anesthesia by a urologist who specializes in erectile dysfunction.
Nocturnal tumescence test. If your doctor suspects that mainly nonphysical causes are to blame, he or she may ask whether you obtain erections during masturbation, with a partner or while you sleep. Most men experience many erections, without remembering them, during sleep. A simple test that involves wrapping a special perforated tape around your penis before going to sleep can confirm whether you have erections while you're sleeping. If the tape is separated in the morning, your penis was erect at some time during the night. Tests of this type confirm that there is not a physical abnormality causing erectile dysfunction, and that the cause is likely psychological.
Prevention
Although most men experience episodes of erectile dysfunction from time to time, you can take these steps to decrease the likelihood of occurrences:
Work with your doctor to manage conditions that can lead to erectile dysfunction, such as diabetes and heart disease.
Limit or avoid the use of alcohol.
Avoid illegal drugs such as marijuana.
Stop smoking.
Exercise regularly.
Reduce stress.
Get enough sleep.
Get help for anxiety or depression.
Coping and support
Whether the cause is physical factors or psychological factors or a combination of both, erectile dysfunction can become a source of mental and emotional stress for a man — and his partner. If you experience erectile dysfunction only on occasion, try not to assume that you have a permanent problem or to expect it to happen again during your next sexual encounter. Don't view one episode of erectile dysfunction as a lasting comment on your health, virility or masculinity.
In addition, if you experience occasional or persistent erectile dysfunction, remember your sexual partner. Your partner may see your inability to have an erection as a sign of diminished sexual desire. Your reassurance that this is not the case can help.
Try to communicate openly and honestly about your condition. Treatment is often more successful if couples work together as a team. You may even want to see a counselor with your partner. This can help you address concerns you both have about erectile dysfunction and can be an effective treatment.
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