The physical cause of ED is either limited blood flow to the penis (which prevents it from hardening), an inability to retain blood, or nerve damage. Stress and emotions can also play a role in ED. However, it can also be a symptom of serious illnesses like heart disease, high blood pressure, high blood sugar, or atherosclerosis, which is the hardening of arteries.

During sexual arousal, nerves signal the release of chemicals that increase blood flow into two spongy muscle chambers in the penis. Upon orgasm, nerves release another set of chemical signals that release the blood back into circulation.

Here are the known risk factors for ED:

• Diabetes
• Cardiovascular disease
• Smoking
• Drug use
• Drinking too much alcohol
• Obesity
• Sedentary lifestyle
• High blood pressure
• Being over the age of 50
• Emotional concerns (anxiety, depression, severe stress)

While there is no specific ED test, men can undertake genital-focused (penis and testicles) tests to check for ED. The test may also check your heart and blood pressure, as well as examine your family history. Depending on your age, your doctor may also perform a rectal exam to check your prostate gland.

Here are some advanced ED tests to guide treatment:

• Blood work to check male hormone levels and blood sugar
• Ultrasonography to check blood flow
• A vascular stimulant shot directly into the penis to cause an erection
• Pelvic X-rays
• Nocturnal penile tumescence (NPT), an overnight test for sleep erection

ED is usually treatable with either medication or surgery. Treating the underlying causes and making lifestyle changes can also help reverse symptoms without the need for medication. Psychological and emotional causes of ED are treatable with counseling or psychological therapy.

You may be dealing with ED when you have the following symptoms:

• Inability to get an erection
• Inability to maintain an erection
• A reduced desire for sexual activity

Doctors may start assessing your risk factors for any lifestyle changes that you can implement. This involves changing food habits, incorporating exercise, limiting/omitting alcohol and drug use, or beginning counseling to treat the psychological or emotional causes of ED. Doctors will often try using non-invasive treatments first, like medications and hormone therapy.

Here are the most common non-invasive ED treatments:

• Testosterone therapy
• Penile injections
• Intraurethral medication
• Oral drugs (PDE5 inhibitors) like Viagra, Cialis, Levitra, or Stendra

Short for phosphodiesterase type 5 inhibitors, these are medications that block PDE5, an enzyme in blood vessel walls, causing them to relax and increase blood flow.

One non-invasive device that can help with ED is a vacuum erection device. It’s a plastic tube worn over the penis. It has a pump that creates a low-pressure vacuum seal around the erectile tissue, causing an erection. It has an elastic ring that slips onto the base of the penis, holding the blood in and maintaining erections for up to 30 minutes.

Other ED devices are penile implants that require surgery. They are usually recommended for aging men for whom oral PDE5 inhibitors or ICI or IU therapy have proven ineffective. Penile implants are placed entirely inside the penis and have the highest rates of success among treatment options for ED.

• Bendable implant: Made with two semi-rigid silicone rods, these can bend downward for urinating or upward for sex.
• Inflatable implant: Cylinders filled with fluid placed lengthwise into the penis, with tubing that leads to a pump inside the scrotum. Pressing the pump results in the cylinders inflating the penis for a natural-looking erection. This type of implant lets men control the firmness and size of their erections.

Kegels or exercises strengthening pelvic floor muscles greatly benefit those with ED. The pelvic floor muscles are essential in sustaining blood flow to the penis by putting pressure on the penile veins. The pressure keeps blood from leaving the penis, maintaining an erection.

Here are some ED exercises to try at home:

• Pelvic floor muscle activation: Lie down with knees bent, arms to your sides, and feet flat on the floor. Squeeze the pelvic floor muscles for three seconds, inhale, then release.
• Sitting pelvic floor activation: Sit with arms on your sides with your feet flat on the floor. Use the same technique as above, making sure not to contract your buttock, stomach, and leg muscles.
• Standing pelvic floor activation: Stand straight with your arms to the side. Use the same technique as above.

Treatment for ED also begins with caring for your heart and vascular health. This means aerobic exercises are beneficial for men with ED. Studies show that 40 minutes of moderate to vigorous aerobic exercise four times a week contributed to decreased ED symptoms.

Male infertility comes from low sperm production, sperm abnormalities, or blockages in the sperm delivery system. ED is not a direct cause of male infertility, but they may have similar root causes.

Schedule a virtual clinic visit or in-person appointment with a St. Joseph Health urologist to start your urologic health journey.

Sources:

• Medical News Today | Erectile Dysfunction: Treatments and Causes
• Healthline | Erectile Dysfunction (ED): Causes, Treatment, Symptoms, and More
• Urology Care Foundation | Erectile Dysfunction (ED): Symptoms, Diagnosis & Treatment
• NCBI | Physical Activity To Improve Erectile Function: A Systematic Review of Intervention Studies

Men can have trouble getting an erection at younger and older ages, but older men have an increased risk of erectile dysfunction. About 45% of men aged 65 to 74 develop ED.

Erectile dysfunction is not as common for younger men to experience; it affects about a quarter (26%) of men under the age of 40. Some studies have shown the prevalence of ED to be only 8% for men aged 20 to 29.

While ED itself is primarily a result of a lack of blood flow to the penis, there are multiple causes of the condition. Heart disease, high cholesterol, obesity, coronary artery disease, diabetes mellitus, high blood pressure, metabolic syndrome, low testosterone levels, kidney disease, and prostate cancer are the most common risk factors of ED.

A man with erectile dysfunction may feel many different things. The condition often leads to low self-esteem, feelings of undesirableness, unattractiveness, embarrassment, or unworthiness. Speaking with a mental health professional, health care professional, or being honest with your sexual partner can sometimes help these feelings go away.

ED is treatable and even reversible. A 2014 study in The Journal of Sexual Medicine found a 29% remission rate in men with ED. Ask a men’s health specialist or urologist about medications and lifestyle changes that can improve sexual function.

Sources:

• The worldwide prevalence and epidemiology of erectile dysfunction, International Journal of Impotence Research
• Erectile dysfunction, Cleveland Clinic
• New insights into hypertension-associated ED, Current Opinion in Nephrology and Hypertension
• Obesity and erectile dysfunction, Polski Merkuriusz Lekarski
• Erectile dysfunction and depression, The Journal of Sexual Medicine
• 1 patient out of 4 with newly diagnosed erectile dysfunction is a young man, The Journal of Sexual Medicine
• Undertreatment of erectile dysfunction: claims analysis of 6.2 million patients, The Journal of Sexual Medicine
• Erectile dysfunction treatment and causes, University of Wisconsin Health
• Epidemiology of ED, Boston University School of Medicine
• Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study, The Journal of Urology
• Management of erectile dysfunction: A cost-effectiveness analysis, The Journal of Urology
• Penile implants, Coloplast
• Prevalence of ED in the general population, Current Medical Research and Opinion
• Erectile dysfunction may be a warning sign for more serious health problems, American Heart Association
• Erectile dysfunction and infertility, Reproductive Partners Medical Group, Inc.
• Sexual dysfunction and male infertility, Nature Reviews Urology
• Economic cost of male erectile dysfunction, PharmacoEconomics
• The costs of caring for erectile dysfunction in a managed care setting, The Journal of Urology
• Should U.S. government insurance programs pay for erectile dysfunction drugs?, Clinical Pharmacology and Therapeutics
• A study of sexuality and health among older adults in the United States, The New England Journal of Medicine
• Long-term safety and effectiveness of sildenafil citrate in men with erectile dysfunction, Therapeutics and Clinical Risk Management
• Viagra wears off after two years, BMJ

Erectile dysfunction (ED) is a common side effect of a number of prescription drugs. While these medications may treat a disease or condition, in doing so they can affect a man's hormones, nerves or blood circulation, resulting in ED or increasing the risk of ED.

If you experience ED and think that it may be a result of the medication you are using, do not stop taking the medication. If the problem persists, contact your doctor and he or she may be able to prescribe a different medication. Common medications that may list ED as a potential side effect include:

• Diuretics (pills that cause increase urine flow).
• Antihypertensives (high blood pressure drugs).
• Antihistamines.
• Antidepressants.
• Parkinson's disease drugs.
• Antiarrhythmics (drug for irregular heart action).
• Tranquilizers.
• Muscle relaxants.
• Nonsteroidal anti-inflammatory drugs.
• Histamine H2-receptor antagonists.
• Hormones.
• Chemotherapy medications.
• Prostate cancer drugs.
• Anti-seizure medications.

Other substances or drugs that can cause or lead to ED include these recreational and frequently abused drugs:

• Alcohol.
• Amphetamines.
• Barbiturates.
• Cocaine.
• Marijuana.
• Methadone.
• Nicotine.
• Opiates.

These drugs not only affect and often suppress the central nervous system, but can also cause serious damage to the blood vessels, leading to permanent ED.

Source:

“Erectile Dysfunction (Ed): Causes, Diagnosis & Treatment.” Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/10035-erectile-dysfunction.