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Erectile Dysfunction (Impotence)

by | Aug 5, 2023 | Info | 0 comments

Erectile Dysfunction (Impotence) Overview

Erectile dysfunction (impotence), also referred to as ED, is the inability to achieve and sustain an erection suitable for sexual intercourse. It is estimated that about 1 in 10 adult males suffer from ED on a long-term basis.

Approximately one in 10 adult males will suffer from ED on a long-term basis.

Many men do experience occasional failure to achieve erection, which can occur for a variety of reasons, such as drinking too much alcohol, stress, relationship problems, or from being extremely tired.

The failure to get an erection less than 20% of the time is not unusual and typically does not require treatment. However, the failure to achieve an erection more than 50% of the time generally means that there is a problem and treatment is needed.

ED does not have to be a part of getting older. While it is true that some older men may need more stimulation, they should still be able to achieve an erection and enjoy intercourse.

Prevalence of Erectile Dysfunction (Impotence)

According to the National Institute of Diabetes and Digestive and Kidney Diseases, around 30 million U.S. men have erectile dysfunction.

The prevalence of erectile dysfunction increases with age. The University of Wisconsin estimates that mild or moderate ED affects 10% more men for each decade of life. For example, 60% of men in their 60s might experience some form of erectile dysfunction.

However, erectile dysfunction can also occur among younger people. One 2013 study found that 1 in 4 men seeking their first treatment for erectile dysfunction was under 40 years old. Researchers observed a stronger correlation between smoking, drug use, and ED in these men when compared with older men. This suggests that lifestyle choices are an important factor for ED in younger men.

Although the risk of erectile dysfunction increases with age, erectile dysfunction isn’t inevitable. In general, the healthier you are, the better your sexual function.

If you have diabetes, work with your doctor to manage your blood sugar levels. This can help prevent damage that can lead to ED.


How an Erection Occurs

An erection is the result of increased blood flow into your penis. Sexual thoughts or direct contact with your penis usually stimulate this blood flow.

When a person with a penis is sexually excited, a muscle within the blood vessels in the penis relaxes. This allows for increased blood flow through the penile arteries, filling two chambers inside the penis.

As the chambers fill with blood, the penis grows rigid. Penile veins will constrict to help keep blood in the penis and maintain the erection. Erection ends when the muscles in the blood vessels constrict and the accumulated blood can flow out through the penile veins.


Defining Erectile Dysfunction (Impotence)

Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. It’s sometimes referred to as “impotence,” but this term is now used less often.

ED can occur because of problems at any stage of the erection process, and it can be occasional or frequent:

  • Occasional ED isn’t uncommon. Many people experience it during times of stress or as the result of a recent nutritional or lifestyle change.
  • Frequent ED, however, can be a sign of health problems that need treatment. It can also be a symptom of emotional or relationship difficulties that you may want to address with a professional.

Causes of Erectile Dysfunction (Impotence)

ED may affect up to 20 million people in the U.S. The condition’s prevalence is over 50% in those over 50 years old and increases with a person’s age.

Normal erectile function can be affected by problems with a person’s blood flow, nervous system, and hormone levels. A person may also experience ED due to psychological factors, such as anxiety over sexual performance.

Gay men report ED at a higher rate than heterosexual men, according to a 2019 review. However, the exact reasons for this remain unknown, and researchers recommend more study in the field.

Physical Causes

Most cases of ED are secondary. This means that erectile function has been normal but becomes problematic. Causes of a new and persistent problem are usually physical.

In rare cases, a person may have primary ED. This is where a person has never achieved an erection. The cause of primary ED may be psychological or the result of a physical condition.

A person should consult a medical professional if they experience persistent erection problems, as an underlying medical condition could be causing the issue. A proper diagnosis can help address any underlying medical issues and help resolve sexual difficulties.

Some of the most common physical causes of ED include: 

Atherosclerosis is a common cause of blood flow problems. Atherosclerosis causes a narrowing or clogging of arteries in the penis, preventing the necessary blood flow to produce an erection.

Numerous prescription medications can also cause ED. A person taking prescription medications should consult their doctor before stopping or changing their medications. Some drugs that may cause ED include:

  • Antidepressants, including monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants
  • Anxiety treatments
  • Anticholinergics
  • Certain cancer drugs, including chemotherapeutic agents
  • Drugs to control high blood pressure
  • Heart medications such as digoxin
  • Hormone drugs
  • Opioid painkillers

Physical causes account for 90 percent of ED cases, with psychological causes much less common.

Psychological Causes

Psychological factors can cause or contribute to ED, with factors ranging from treatable mental health illnesses to everyday emotional states that most people experience at some time. These are less common than physical causes, however.

Psychological factors can include:

A person may also be unable to attain a full erection due to specific sexual performance anxiety, a common psychological factor in people with ED. Sexual performance anxiety affects 9-25% of males, according to a review.

It is also important to note that there can be an overlap between medical and psychosocial causes. For instance, if a person is obese, blood flow changes can affect that person’s ability to maintain an erection, which is a physical cause. However, the person may also have low self-esteem, impacting erectile function, which is a psychosocial cause.

Medications that could cause Erectile Dysfunction (Impotence)

Erectile dysfunction 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 erectile dysfunction or increasing the risk of ED.

If you experience erectile dysfunction 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:

  • Antihistamines
  • Diuretics (pills that cause increase urine flow)
  • Antihypertensives (high blood pressure drugs)
  • Antihistamines
  • Parkinson’s disease drugs
  • Antiarrhythmics (drug for irregular heart action)
  • Tranquilizers
  • Muscle relaxants 
  • Antidepressants
  • Non-steroidal 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.


Signs and Symptoms of Erectile Dysfunction (Impotence)

Trouble getting an erection and difficulty maintaining an erection during sexual activities are the most common symptoms of erectile dysfunction.

Other sexual disorders related to ED include:

  • Anorgasmia, or the inability to achieve orgasm after ample stimulation
  • Delayed ejaculation
  • Premature ejaculation

Speak with your doctor if you have any of these symptoms, especially if they’ve lasted for 3 or more months. They can help determine whether your symptoms are caused by an underlying condition that requires treatment.

People may not always successfully achieve an erection. If this happens occasionally, it is not considered a medical problem. However, if a person is consistently unable to achieve an erection, then they may have ED.

There is no defined length of time frame over which a person must experience ED to receive a diagnosis. Some professionals suggest 6 months is suitable.

However, ED does not only refer to a complete inability to achieve an erect penis. Symptoms can also include struggling to maintain an erection for long enough to complete intercourse or an inability to ejaculate.

There are often emotional symptoms, such as embarrassment, shame, anxiety, and a reduced interest in sexual intercourse.

Diagnosis of Erectile Dysfunction (Impotence)

Testing for ED can involve a variety of steps, including a physical examination and examining your health and sexual history. Your doctor may order additional tests to determine if your symptoms are caused by an underlying condition.

Physical Exam

Expect a physical exam, where your doctor will:

  • Check your blood pressure
  • Examine your testicles and penis
  • Listen to your heart and lungs
  • Check nerve function in the pelvic region
  • Looks for signs of reduced blood in the pelvic region

They may also recommend a rectal exam to check your prostate.

Psychosocial History

Your doctor will ask you questions or request that you fill out a questionnaire about your symptoms, health history, and sexual history. The responses can help them evaluate the severity of your erectile dysfunction.

Some questions that they may ask include:

  • Are you having any problems with feeling sexual desire, ejaculating, or reaching orgasm?
  • How long have you been experiencing ED? Did it come on suddenly or gradually?
  • Are your erections firm? Is this affected by particular situations or types of stimulation?
  • Do you wake up in the morning or in the middle of the night with erections?
  • How’s your current relationship? What expectations do you and your partner have for each other? Have there been any changes?
  • Have you recently been experiencing a lot of stress?
  • What medications are you currently taking? Do you use tobacco, alcohol, or nonprescription drugs?
  • Do you have any underlying conditions or have you had any surgery on or injury to your pelvic area? 
  • How often do you have sex? Has this frequency changed recently?

Additional Tests

Your doctor may perform additional testing to help diagnose your ED. Tests can include:

  • Ultrasound: An ultrasound can be used to examine the blood vesseles of the penis to determine if there’s a problem with penile blood flow.
  • Nocturnal penile tumescence test: A portable, battery-powered device is used to evaluate the quality of your nocturnal erections. The device is worn on the thigh. It stores data your doctor can access later. However, it’s not used as often today as it had been in the past.
  • Injection test: During this test, a medication is injected into your penis to stimulate an erection. This allows your doctor to evaluate the firmness of the erection and how long it lasts. This type of test can also be combined with ultrasound to further asses the erection.
  • Urine tests: Urine tests can check for diabetes or other underlying health conditions.
  • Blood tests: Blood tests can check for conditions such as diabetes, heart disease, thyroid issues,, and low levels of testosterone.

These tests can help your doctor guide your treatment as well as determine if an underlying condition may be causing the erectile dysfunction.

Treatment of Erectile Dysfunction (Impotence)

Treatment for ED will depend on the underlying cause. You may need to use a combination of treatments, including medication or talk therapy.

Medications

Your doctor may prescribe medication to help you manage the symptoms of ED. You may need to try several medications before you find one that works. The following oral medications stimulate blood flow to your penis to help treat ED:

  • Avanafil (Stendra)
  • Sildenafil (Viagra) 
  • Tadalafil (Cialis)
  • Vardenafil (Levitra, Staxyn)

Alprostadil (Caverject, Edex, MUSE) is another medication that can be used to treat ED. It can be administered in two ways: as a penile suppository, or as a self-injection at the base or side of the penis.

In most cases, however, alprostadil is not used alone as an injection, and the combination drug Trimix (alprostadil, phentolamine, papaverine) is used instead.

Your doctor may recommend testosterone replacement therapy (TRT) if you have low levels of testosterone.

Medications used for other conditions may cause erectile dysfunction as well. Talk with your doctor about your medications and whether they could be causing erectile dysfunction symptoms.

Your doctor may be able to prescribe other medications. It is also important to note that you should not stop taking any prescribed medications without first talking with your doctor.

Medications for ED can cause side effects or interact badly with any medications you may already be taking. If you’re experiencing unpleasant side effects, talk with your doctor. They may be able to recommend a different medication.

Additionally, some cardiac medications can have very serious side effects if taken with some erectile dysfunction medications. For this reason, it’s very important to share with your doctor the names and dosages of every medication you’re taking before beginning anything new.

Talk Therapy

A number of psychological factors can cause ED, including:

If you’re experiencing psychological ED, you may benefit from talk therapy. Over several sessions, you and your therapist will discuss:

  • Major stress or anxiety factors
  • Subconscious conflicts that could be affecting your sexual well-being 
  • Your feelings around sex

If ED is affecting your relationship, consider speaking with a relationship counselor as well. Relationship counseling can help you and your partner reconnect emotionally, which may also help your erectile dysfunction.

Vacuum Pumps

This treatment uses the creation of a vacuum to stimulate an erection. Using the device draws blood into the penis, leading to an erection.

A vacuum pump device consists of a few different components:

  • A plastic tube, which you place over your penis
  • Pump, which works to create a vacuum by drawing air out of the plastic tube
  • An elastic ring, which you’ll move to the base of your penis as you remove the plastic tube

The elastic ring functions to maintain the erection, holding the blood in the penis and preventing it from returning to circulation. You can leave it in place for 30 minutes.

Alternative Ways to Manage Erectile Dysfunction (Impotence)

Erectile Dysfunction Exercises

Certain exercises can also help with erectile dysfunction.

Kegel Exercises

Kegel exercises are simple movements you can do to strengthen your pelvic floor muscles. Here’s how:

  1. Identify your pelvic floor muscles. To do this, stop peeing midstream. The muscles you use to do this are your pelvic floor muscles.
  2. Now that you know where these muscles are, contract them for 3 seconds. Then release them.
  3. Repeat this exercise 10 to 20 times in a row, three times per day.

A small 2005 study compared two groups of men with erectile dysfucntion. The first group of men performed regular pelvic floor muscle exercises with a physiotherapist. They also received feedback and advice on lifestyle changes. The second group only received advice on lifestyle changes.

Men in the first group saw their penile function improve significantly after 3 months of regular pelvic floor muscle exercises. Men in the second group saw little improvement after 3 months.

For the next 3 months, all participants were given at-home exercises to perform. After 6 months in total, 40% of all participants, including some men who had belonged to the second group, had regained normal erectile function.

A 2019 literature review also concluded that pelvic floor exercises were effective at treating both erectile dysfunction and premature ejaculation. However, the researchers didn’t identify an ideal exercise plan in terms of conditions such as frequency and intensity.

You may find that it’s easier initially to do Kegels while lying down. Eventually, you can start trying them when you’re sitting or standing.

Aerobic Exercise

Moderate to vigorous exercise is not only good for your overall health. It also can increase blood flow, possibly helping with ED. Examples include running and swimming.

A 2018 review of 10 studies examined the effect of aerobic exercise on ED. From their review, investigators concluded that 160 minutes of weekly exercise for 6 months could lead to a decrease in erectile problems.

Another 2018 study examined physical fitness and testosterone levels in 87 men with ED. Researchers found that testosterone levels were negatively correlated with levels of body fat and abdominal fat. This suggests that exercise may increase testosterone in addition to reducing body fat.

Before you start a new exercise plan, always discuss it with your doctor. This is particularly important for people with heart disease or another underlying condition that could be aggravated by vigorous activity.

Yoga

Yoga can help to relax your mind and body. Since stress or anxiety can cause or contribute to erectile dysfunction, practicing yoga may be an effective way to ease ED symptoms.

In fact, an older 2010 study of 65 men between 24 and 60 years old found that sexual function increased significantly after a 12-week program of yoga sessions.

Erectile Dysfunction Foods

Erectile dysfunction is often related to problems with blood flow. Maintaining your blood vessel health may be beneficial in both preventing and treating ED. You can achieve this by making certain lifestyle choices, such as eating a healthy diet.

A small 2021 study indicates that a plant-based diet can help treat erectile dysfunction. 

Erectile Dysfunction Natural Treatments

For some people, natural remedies may help treat erectile dysfunction.

Herbs and Supplements

Certain herbs and supplements have been studied to treat erectile dysfunction, with varying degrees of success, including:

  • L-arginine
  • Dehydroeplandrosterone (DHEA)
  • Shatavari
  • Ginseng, such as Korean red ginseng
  • Horny goat weed
  • L-carnitine
  • Yohimbe
  • Zinc

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