An Overview of Erectile Dysfunction

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Erectile dysfunction (ED) is the inability to get an erection or to keep one that's firm enough or that lasts long enough for a man to have a satisfying sexual experience. Occasional bouts of ED aren't unusual. In fact, 43 percent of US men have erectile difficulties. Symptoms, of course, are rather obvious. And while age can be a risk factor, so can medication use, health conditions, lifestyle factors (like smoking), and other concerns. Treatment is available and may involve prescriptions, habit changes, or other options.

ED is especially prevalent as men get older: 44 percent of men aged 60 to 69 years old and 70 percent of men 70 years and older experience erectile difficulties, compared with 5 percent of men less than 40 years old. 

If you're dealing with ED—or impotence, as the condition sometimes is called, although that term is largely outdated—you may find it to be frustrating, embarrassing, or both. Know, though, that most cases can be resolved with medication, counseling, and even simple lifestyle changes, among other treatments.

How Erections Occur
Verywell / Emily Roberts

Symptoms and Diagnosis

The symptoms of ED come down to exactly what the term erectile dysfunction describes—failure to keep or maintain a firm erection. (Note that problems such as low libido and premature ejaculation are not considered symptoms of ED.)

Since all men encounter ED at some point in their lives, the frequency is the most useful factor to consider when determining whether or not the condition should be treated. 

According to the Cleveland Clinic, an erectile dysfunction that occurs as often as 20 percent of the time is typically not seen as a reason for concern (from a medical standpoint). By contrast, when ED occurs more than 50 percent of the time it's likely there may be underlying physical and/or psychological reasons for the problem. 

Therefore, when discussing the diagnosis of erectile dysfunction, what really must be determined is what else is going on. 

Causes and Risk Factors

When there's a physical cause of erectile dysfunction, it almost always has to do with either blood circulation or the nervous system. To understand why it's helpful to know how an erection happens.

The penis contains a complex web of blood vessels (the corpora cavernosa) that are organized much like a sponge, with space around each one to allow it to expand. An erection occurs when sexual stimulation—physical touch or an erotic thought—triggers the brain to signal muscles in the penis to relax.

This allows more blood to flow into the penis, filling the blood vessels and causing the penis to become rigid and erect. Normally blood stays trapped in the penis by a membrane called the tunica albuginea until the man has an orgasm and ejaculates.

Typically with ED, there's a breakdown of this process that can happen at any point, for any number of reasons. Here are some common causes of and risk factors for ED:

  • Age
  • Medications and treatments that may interfere with blood flow or nerve impulses to the penis
  • Medical conditions, especially those that affect circulation or the nervous system, including high blood pressure, diabetes, and neurological diseases 
  • Injury to the genital area
  • Lifestyle factors such as smoking, excessive drinking, using recreational drugs, and even bike riding for extended periods on certain types of bicycle saddles

Treatment

There are many reasons it's important to treat erectile dysfunction. Sexuality plays an important role in fulfilling relationships, family building, and overall happiness. And being able to achieve an erection is obviously necessary to orgasm and ejaculation, both of which have potential health benefits.

For example, during orgasm men (and women) experience a flood of brain chemicals that contribute to alleviating pain, inducing sleep, relieving stress, and bringing about feelings of well-being and connectedness.

Research suggests possible links to frequent ejaculation and a lower risk of prostate cancer. In one study of 32,000 men published in 2016 in the journal European Urology, for example:

  • Men who ejaculated at least 21 times per month while in their 20s were less likely to be diagnosed with prostate cancer than those who ejaculated four to seven times per month
  • Men who ejaculated more often in their 40s were 22 percent less likely to get a prostate cancer diagnosis

Since the causes of ED are so varied, it's impossible to generalize about how it's best treated. What's most effective for one man may not be helpful for another. The options most often include:

  • Lifestyle changes, like kicking a smoking habit, losing weight, and getting more exercise
  • Oral prescription medications, such as Viagra (sildenafilor hormone therapy
  • Intraurethral medication
  • Penile pumps or implants that can mechanically create an erection
  • Counseling

Natural remedies for ED have long been used in Chinese, African and other cultures, but they have not been scientifically studied or regulated and may cause side effects and/or interact with other medications.

A Word From Verywell

For obvious reasons, ED can be a sensitive subject, one that until relatively recently men were more likely to try to hide than to deal with. Fortunately, a deeper understanding of the variety of causes of erectile dysfunction has led to medications, therapies, and other treatments that can be more individualized and more likely to be effective—and more open discussion about addressing the concern.

If you're dealing with ED, understand that you are far from alone and the problem is nothing to be embarrassed about. Chances are a doctor can figure out what's going on and put together a treatment regimen that will restore your sexual health.

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Article Sources

  1. Pastuszak AW. Current Diagnosis and Management of Erectile Dysfunction. Curr Sex Health Rep. 2014;6(3):164-176. doi:10.1007/s11930-014-0023-9

  2. Cleveland Clinic. Erectile Dysfunction


  3. Cleveland Clinic. Erectile Dysfunction: Management and Treatment


  4. Mayo Clinic. Dietary supplements for erectile dysfunction: A natural treatment for ED?


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