Erectile dysfunction affects the sexual health of many men, but what causes it? And how is it treated? We spoke to Larry I. Lipshultz, MD, Professor of Urology, Chief of Male Reproductive Medicine and Surgery Division and Clinical Director of Laboratory for Male Reproductive Research and Testing at the Baylor College of Medicine, to find out more.
1. What is Erectile Dysfunction? Dr. Lipshultz explains, ‘Erectile dysfunction (also known as impotence) is defined as an inability to achieve or sustain an erection that is adequate for sexual intercourse, an inability to ejaculate, or both. According to the National Institutes of Health, approximately 5% of men 40 years old and between 15 and 25% of men age 65 experience ED on a long-term basis. For a greater percentage of men, problems with an erection and sexual performance is an occasional occurrence and situational, mainly associated with drinking alcohol, emotional trauma, or physical exhaustion, for example.’
2. What Are the Symptoms of ED? ‘The obvious symptom of erectile dysfunction is the failure to get and maintain an erection when required,’ says Dr. Lipshultz. ‘Failure to achieve an erection less than 20% of the time is not unusual; however when that percentage is 50% or greater that means it is a sign of something more serious. A sign that ED has a psychological cause is generally when men can achieve full erections when asleep (known as “nocturnal erections”) but experience problems with an erection at other times, such as when they are looking to be sexually active.’
3. What Causes ED? Dr. Lipshultz notes, ‘Most causes are related to physical or environmental factors, which may include but are not limited to the use of certain medications, presence of chronic health problem, poor habits (lifestyle and nutrition), fatigue, injury or damage, exposure to environmental toxins, and poor blood flow to the penis. ED may also be the result of medical conditions such as diabetes, high blood pressure or heart disease, low testosterone as well as procedures to treat BPH (enlarged prostate). ED is also a side effect of many of the treatments for prostate cancer. Erectile dysfunction in young men is often the result of vascular disorders such as heart disease, diabetes either juvenile or type 2, side effects of certain drugs and medications, and inadequate hormones like in hypogonadism, neurological problems or severe trauma.
4. Are There Non-Physical Causes of ED? ‘Another important cause of ED in young men is psychological impotence,’ Dr. Lipshultz points out. ‘Psychological causes of erectile dysfunction make up about 10 to 20% of cases. Depression or anxiety about past sexual performances, fear of not performing sexually and pressure to perform can both impact whether you achieve and maintain an erection sufficient for intercourse. Basically, if you “think” you cannot perform sexually, chances are this will hinder your sexual performance. Counselling can be effective in overcoming any psychological issues, and in fact it is often recommended that both the man and his sexual partner attend counselling for best results. Whether erectile problems are associated with physical or psychological causes, a wide variety of treatments are available.’
5. How is ED Treated? Dr. Lipshultz details, ‘The success of treatment depends on several factors, including age, the causes, overall health, use of other treatments, and the state of erectile function before any sexual problems started. ED in men can be treated with a variety of options, including pills and drugs such as sildenafil (Viagra), vardenafil (Levitra, Staxyn), avanafil (Stendra), and tadalafil (Cialis), devices such as and vacuum erection devices (penis pumps) and constriction bands, injections or suppositories containing alprostadil (MUSE), penile/penis implants, natural remedies (herbal and nutritional supplements), and counseling. More than one treatment for can be used at the same time, but men should always consult their healthcare provider before starting or combining treatments.’