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What is Erectile Dysfunction?
Erectile dysfunction (ED) is the inability to achieve or maintain an erection firm enough for sexual intercourse. It is a common condition that affects as many as 30 million men in the United States.
Erectile dysfunction can have both physical and psychological causes. Physical causes are more common in older men and often due to underlying health conditions like heart disease, diabetes, obesity, high blood pressure, high cholesterol, and prostate cancer treatment. Psychological causes are more common in younger men and include anxiety, stress, depression, and relationship problems.
While ED becomes more prevalent with age, it is not an inevitable part of aging. There are many treatment options available to help men of any age overcome ED and resume a satisfying sex life. The most common medical treatment is prescription medication like Viagra, Cialis, and Levitra. However, lifestyle changes, counseling, vacuum devices, and surgery can also help treat the root causes and symptoms of ED.
Symptoms of ED
Erectile dysfunction (ED) can manifest in different ways. The main symptom is the inability to get or maintain an erection firm enough for satisfactory sexual activity. This may occur occasionally or frequently.
Other common symptoms of ED include:
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Reduced sexual desire – Men with ED often experience a lack of interest in sex or decreased libido. They may not get aroused or experience sensations of pleasure during sexual activity.
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Premature ejaculation – Some men with ED find they ejaculate very quickly, sometimes before or shortly after penetration, making it difficult to enjoy intercourse. Premature ejaculation can accompany ED or occur independently.
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Other sexual difficulties – In addition to erectile issues and premature ejaculation, ED can contribute to problems with orgasm, pain during intercourse, and overall dissatisfaction with sexual performance. Men may have difficulty reaching orgasm despite achieving an erection.
The symptoms of ED can range from mild and occasional to complete inability to get an erection. The severity may depend on underlying medical conditions. Psychological factors like stress and anxiety can also aggravate ED symptoms.
Psychological Effects of Erectile Dysfunction
Erectile dysfunction can have a major impact on a man’s psychological health and emotional wellbeing. Some common psychological effects of ED include:
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Embarrassment – Many men feel embarrassed or ashamed about not being able to get or maintain an erection. They may view themselves as less masculine or worry their partner will judge them. This embarrassment can prevent men from seeking treatment.
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Performance anxiety – Men with ED often experience anxiety about sexual situations and their ability to perform. They may fear being unable to get an erection and satisfying their partner. This performance anxiety creates stress that makes ED worse.
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Lower self-esteem – Inability to achieve an erection can make men feel deficient and damage their self-confidence. They may see ED as a personal failure and feel inadequate. This blow to their self-esteem can lead to depression.
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Relationship issues – ED can strain relationships by impacting intimacy and causing tension between partners. Men may avoid intimacy out of fear of disappointing their partner. Partners may feel rejected or unattractive. Communication and honesty are key to overcoming relationship challenges.
Psychological struggles are common with ED. However, seeking treatment and being open with one’s partner can help manage issues like embarrassment, performance anxiety, lowered self-worth and relationship problems. Psychological counseling is often a component of ED treatment plans.
Medical Causes
Erectile dysfunction can be caused by various medical conditions that affect the blood vessels, nerves, hormones, and emotions. Some of the most common medical causes include:
Vascular Disease
Vascular diseases like atherosclerosis (hardening of the arteries) and high blood pressure can restrict blood flow to the penis. This interferes with the ability to get and maintain an erection. Men with cardiovascular disease are more likely to experience ED.
Diabetes
Diabetes is a major risk factor for ED because it damages the blood vessels and nerves that control erections. About 35-75% of diabetic men suffer from some degree of ED. High blood sugar levels from poorly controlled diabetes can accelerate nerve damage.
Obesity
Being overweight or obese increases the risk of ED. Excess fat in the abdominal area can raise hormones that disrupt erectile function. Obesity also contributes to other ED risk factors like diabetes, heart disease, and high blood pressure. Losing weight can help treat ED.
Injuries
Injuries to the nerves, arteries, muscles, and tissues of the pelvic area from surgery, trauma, or radiation therapy can cause ED. Injuries to the spinal cord and trauma to the penis are also linked to erectile dysfunction.
Surgeries
Surgeries in the pelvic area, such as for prostate cancer, bladder cancer, or colon cancer, can sometimes damage nerves and blood vessels involved in getting an erection. The location and complexity of the surgery affects the risk of ED.
Lifestyle Factors
Erectile dysfunction can often be caused or exacerbated by lifestyle factors like alcohol and drug use, smoking, stress, and a sedentary lifestyle.
Alcohol and Drug Use
Chronic and excessive use of alcohol or other recreational drugs can damage the nerves and blood vessels needed for an erection. Alcohol is a depressant that decreases blood flow while illicit drugs like heroin, cocaine, and methamphetamine can restrict blood flow and damage the nerves controlling erections.
Reducing or quitting alcohol and recreational drug use may help improve symptoms of ED. Speak to your doctor about treatment programs and support groups that can help you stop using substances in a healthy way.
Smoking
Smoking cigarettes or using other tobacco products has been directly linked to ED. The chemicals and tar in cigarette smoke can damage the blood vessels and restrict blood flow needed for erections. Men who smoke are about twice as likely to experience ED compared to non-smokers.
Quitting smoking and avoiding secondhand smoke may help prevent ED or improve sexual function. Talk to your doctor about nicotine replacement products, prescription medications, counseling, or other programs to help you quit smoking.
Stress
Being under constant stress and anxiety can contribute to ED by releasing hormones like cortisol and adrenaline that constrict blood vessels and impact nerve signals involved in the erection process. Chronic stress may also lead to other unhealthy habits like smoking, alcohol/drug use, and a sedentary lifestyle that compound ED issues.
Stress management through regular exercise, meditation, therapy, medication, social support, or other relaxation techniques may help lower cortisol levels and alleviate ED symptoms. Focus on activities that bring you joy and peace of mind.
Sedentary Lifestyle
Lack of regular physical activity can increase your risk for ED. Exercise helps maintain blood vessel health, improve circulation, shed excess weight, and reduce inflammation – all factors that can improve erectile function. Men who live a sedentary lifestyle are more likely to experience ED than their active counterparts.
Aim for 30-60 minutes of moderate aerobic and strength-training exercises most days of the week. Even short daily walks can benefit vascular health. Check with your doctor before significantly increasing your activity levels. Moving your body regularly can help prevent and treat ED.
Diagnosing ED
Erectile dysfunction is diagnosed through a medical evaluation by a healthcare provider. The evaluation typically involves:
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Medical and sexual history – The provider will ask about your symptoms, medical conditions, medications, drug use, and sexual history to help determine the cause. Details about when ED started, situations where it occurs or doesn’t, and your level of sexual desire can be helpful.
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Physical exam – This involves checking vital signs, examining the genitals, nervous system function, and fitness level.
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Blood tests – These check testosterone levels, cholesterol, blood sugar, and other lab tests to uncover medical conditions contributing to ED.
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Other specialized tests – If the cause remains unclear, additional tests may be ordered. These can include:
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Nocturnal penile tumescence test – This overnight test checks for erections during sleep, which helps distinguish between physical and psychological causes.
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Ultrasound – This imaging test checks for vascular causes and blood flow to the penis.
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Psychological exam – A mental health assessment may be done to identify stress, depression, anxiety or other factors impacting function.
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Getting an accurate diagnosis through medical evaluation is important to identify the underlying cause of ED. This will guide the most effective treatment approach.
ED Medications
There are several FDA-approved prescription medications that can help treat ED:
Sildenafil (Viagra)
- First ED medication approved by the FDA in 1998
- Taken as needed approximately 30-60 minutes before sex
- Effective for 4-5 hours
- Common side effects are headache, flushing, nasal congestion
Tadalafil (Cialis)
- Approved by FDA in 2003
- Can be taken daily or as needed
- Effective for up to 36 hours
- Sometimes called “the weekend pill” due to long duration
- Common side effects are headache, indigestion, back pain
Vardenafil (Levitra)
- Approved by FDA in 2003
- Taken as needed approximately 60 minutes before sex
- Effective for 4-5 hours
- Common side effects are headache, flushing, nasal congestion
Avanafil (Stendra)
- Approved by FDA in 2012
- Taken as needed approximately 15-30 minutes before sex
- Effective for up to 6 hours
- Common side effects are headache, flushing, nasal congestion
All of these medications work by increasing blood flow to the penis to help achieve and maintain an erection. They may be more effective for some men compared to others, so it’s recommended to discuss options with a healthcare provider. Proper dosage and instructions should be followed carefully.
How Medications Help with ED Symptoms
Erectile dysfunction (ED) medications work to improve symptoms of ED in a few key ways:
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Increasing blood flow – Medications like Viagra, Cialis, and Levitra work by inhibiting the enzyme PDE5, which allows blood vessels to dilate and increase blood flow to the penis. This makes it easier to get and maintain an erection.
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Relaxing muscles – These medications help relax the smooth muscle tissues in the penis, allowing more blood to flow in. Muscle relaxation allows the corpora cavernosa chambers in the penis to fill with blood.
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Boosting nitric oxide – Nitric oxide is a compound that helps trigger the series of chemical reactions necessary for an erection. PDE5 inhibitors help prevent the breakdown of nitric oxide, promoting higher levels.
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Enhancing arousal signals – Medications can amplify the effects of sexual stimulation in the brain, enhancing arousal signals. This reinforces the chemical pathways for getting an erection.
By improving blood flow, relaxing muscles, increasing nitric oxide, and boosting arousal signals, ED medications can significantly help alleviate symptoms and make it easier to get and maintain an erection firm enough for sex. This allows men suffering from ED to restore their sexual function and confidence.
Effectiveness of Medications
ED medications are generally very effective at improving erectile function for men with ED, though there are some differences in effectiveness depending on the specific medication and cause of ED.
The PDE5 inhibitor medications like Viagra, Cialis, Levitra, and Stendra have been extensively studied and shown to be highly effective for most men. On average, they help achieve improved erections around 70% of the time. However, effectiveness rates in clinical trials do vary:
- Viagra has been found to be effective in 63-82% of men in studies.
- Levitra is effective in 71-87% of men based on studies.
- Cialis is effective in 80-85% of men according to clinical trials.
- Stendra achieves improved erections in 57-83% of men studies show.
The minor differences in effectiveness come down to the subtle variances in the medications’ chemical structures, half-lives, and mechanisms of action. But all the PDE5 inhibitors demonstrate high success rates.
These medications also tend to work well despite the underlying cause of ED. They have proven efficacious whether the ED is due to narrowing of blood vessels from diabetes, hypertension, Peyronie’s disease, or prostate surgery as examples. The medications help widen blood vessels to overcome these issues.
One exception may be with severe damage to nerves involved in erections after major prostate surgery. PDE5 inhibitors may not be as effective in these cases. Additional treatments like injections may be required. But still, the oral medications provide substantial benefit.
Overall, ED medications provide a big improvement in symptoms for most men and have revolutionized treatment. Their introduction over 20 years ago has helped millions of men have a more fulfilling sex life again. With appropriate treatment selection and dosage, most men with ED can experience excellent results.
Other ED Treatment Options
In addition to medications, there are other treatment options that can help manage ED symptoms:
Penis Pumps
Penis pumps involve using a vacuum device to draw blood into the penis to cause an erection. A tension ring is then applied at the base of the penis to maintain the erection. Penis pumps may help men with mild ED achieve and maintain an erection.
Counseling/Therapy
For some men, ED may have psychological causes like stress, anxiety, or depression. Counseling and sex therapy from a psychologist or psychiatrist may help reduce ED symptoms by addressing the mental health issues contributing to ED.
Lifestyle Changes
Making healthy lifestyle changes can also help with ED symptoms. Quitting smoking, losing weight, eating healthy, exercising regularly, limiting alcohol, and improving sleep habits are all lifestyle changes that can potentially improve erectile function.
Surgery
For men with a specific anatomical cause for ED, surgery may be an option in some cases. Procedures like vascular reconstruction surgery aim to increase blood flow to the penis. Penile implants are also a surgical option for men with severe ED.