Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 7/12/2020
When you hear the phrase “erectile dysfunction,” you probably have a pretty good idea what it means. Even if you’ve never been diagnosed or haven’t experienced an episode yourself, the name doesn’t leave much to the imagination.
As much as you may think you know about erectile dysfunction, however, you could be wrong.
Erectile dysfunction is a very common condition, affecting just over 30 percent of men at some point in their lifetime, according to the Cleveland Clinic.
Though this condition is incredibly common, there is a great deal of stigma against it which prevents many men who suffer from it from ever seeking help. The stigma against the disorder also contributes to the dissemination of misinformation about erectile dysfunction and its treatment. There are a lot of myths about erectile dysfunction out there on the ol' Information Superhighway.
If you have experienced some degree of erectile dysfunction in your life, you are not alone! There are a lot of possible causes of ED that range from physical to psychological, but there things you can to mitigate the issue.
When you see commercials for the little blue pill, they usually feature older men—white hair, wrinkled skin and all. Though erectile dysfunction is certainly common among older men, it can affect men of any age. To give you an example, consider the results of The Massachusetts Male Aging Study:
The prevalence of erectile dysfunction is about 52 percent.
At the age of 40, about 40 percent of men have suffered some degree of ED.
By the age of 70, about 70 percent of men have experienced erectile issues of some kind.
To view the issue from another angle, consider new data that suggests that a majority of Viagra users are young men. Between its release in 1998 and 2002, use of Viagra jumped by 312 percent among men between the ages of 18 and forty-five. There was also a 216 percent increase among men between 45 and fifty-five. The fact that so many young men are using Viagra might suggest a high prevalence of ED among the younger generation. There is some evidence to suggest, however, that many younger men who use Viagra do so recreationally, so you must take this data with a grain of salt.
So, do you need to worry about erectile dysfunction if you are starting to get older? According to research conducted at Johns Hopkins, only four percent of men over 50 and 17 percent in their 60s are totally incapable of achieving an erection. These statistics are promising because it means that even if you do develop erectile issues as you get older, the likelihood of complete erectile dysfunction is fairly low. You do need to consider other risk factors besides age, however. Keep reading to learn more.
Not only do many people assume that erectile dysfunction only affects older men, but it is also commonly assumed that ED is a normal result of aging. In reality, there are a number of risk factors for erectile dysfunction and any of them can affect men of any age. Here is a list of risk factors that have been associated with ED:
Obesity – Being overweight or obese increases your risk for a variety of chronic conditions which can then increase your risk for ED. It is also important to note that obesity can affect your circulation as well which may contribute to erectile issues.
Smoking – Cigarette smoking damages your body in some very significant ways. In correlation with ED, it damages the blood vessels which can impact circulation and your ability to perform sexually.
Medical Conditions – Many medical conditions can impact risk factors for ED such as blood pressure, circulation, hormone balance and more. Some of the diseases most often correlated with ED include type 2 diabetes and heart disease.
Medical Treatments – Not only can medical conditions increase your risk for ED, but so can certain medical treatments such as radiation or chemotherapy. Surgical treatments (such as prostate surgery) can also increase your risk.
Alcohol/Drug Use – Overuse of drugs and alcohol can negatively impact your health in many ways. In addition to dampening your mood, it can decrease libido and make it difficult for you to achieve/maintain an erection or to achieve orgasm.
Psychological Conditions – Research confirms that psychological factors play a significant role in erectile dysfunction—conditions like anxiety, stress and depression can increase the risk for ED. In fact, erectile dysfunction related to mental health problems has its own name: "psychological impotence."
Hormone Problems – Hormones play an important role in regulating numerous bodily functions, including erectile function. The primary hormone at work is testosterone, though low-T is more likely to cause issues with libido and fertility than ED alone.
While it would be inaccurate to say that erectile dysfunction is an older man’s problem, age is one of the biggest risk factors for the condition. In 2003, the results of a new study were published in the August issue of Annals of Internal Medicine which showed scientific evidence of declining sexual function in correlation with age. The study involved 31,000 participants aged 53 to 90 who were asked simple questions about their sexual function, specifically their ability to achieve and maintain an erection adequate for intercourse.
The results of the study showed that men in the higher age brackets were much more likely to describe their sexual function as “poor.” Overall, 74 percent of younger participants rated their sexual function as “good” or “very good,” and only 12 percent of those younger men admitted to having moderate or significant problems with their sexual function. In comparison, more than 25 percent of men over 50 reported issues of this severity and only 10 percent of men over 80 reported “good” or “very good” sexual function.
In addition to making correlations between age and sexual function, this study also made note of the ages at which men experienced their first episode of erectile dysfunction. Out of more than 30,000 participants, 40 percent reported their first experience of ED between age 60 and sixty-nine. About 26 percent had their first experience between 50 and 59, while only four percent had theirs between 40 and forty-nine. Only two percent had their first experience with ED before the age of forty.
Though some of these statistics may seem to contradict those from the previous section, it is important to view these numbers in the holistic sense. Something else this 2003 study looked at was the correlation between age, erectile function and other factors such as physical activity, alcohol intake and smoking habits. It was reported that men who exercised at least three hours per week had a 30 percent lower risk for ED than those who did not. Men who had a generally healthy lifestyle and no chronic disease showed the lowest risk for ED while those who were obese, smoked and watched a lot of TV had the highest risk.
The correlation between poor health and ED brings us into the next myth about erectile dysfunction: ED is not dangerous. In one sense, this is true. Having erectile dysfunction isn’t going to kill you. On the other hand, however, the fact that you are experiencing erectile issues could be an indication of underlying health problems.
When it comes to underlying health problems that contribute to ED, heart disease is one of the biggest concerns. Heart disease is actually a blanket term for a number of different conditions, most of which are characterized by certain cardiovascular problems such as atherosclerosis, irregular heartbeat or an anatomical defect. Atherosclerosis is the primary concern and also the factor most closely linked to erectile dysfunction. When cholesterol and other fatty substances accumulate along artery walls, it causes the artery walls to thicken, narrowing the opening and limiting the amount of blood that can flow through. Problems with circulation and blood pressure can affect numerous aspects of health but, most notably, could prevent you from achieving and maintaining an erection.
Not only could erectile issues by a symptom related to heart disease, but they could also be correlated with type 2 diabetes. Diabetes is a condition in which the body is unable to produce adequate insulin to control blood sugar levels or the body’s response to insulin becomes impaired. The result is chronically high blood sugar which can damage the arteries and affect circulation. Some of the other medical issues that have been linked to erectile dysfunction include the following:
Hypertension (high blood pressure)
Prostate cancer or enlarged prostate
Depression or anxiety
If you haven’t already talked to your doctor about your erectile issues, you should make an appointment sooner rather than later. In many cases, ED is primarily psychological, so it might not be an indication that something is medically wrong with you. That is not to say, however, that psychological issues aren’t just as viable as medical problems or that they don’t warrant treatment. Whatever the case may be, it is always worth talking to your doctor about your concerns. It is the only way to really figure out what is going on and what you can do about it.
If you have never talked to your doctor about your erectile dysfunction, you might assume that the ED drugs you see advertised on television are the best or only way to treat ED. This simply isn’t the case.
Erectile dysfunction drugs like Viagra (sildenafil) belong to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors. They work by increasing the nitric oxide levels in the body which then works alongside other substances to dilate the blood vessels, increasing circulation to the penis. When the penis fills with blood, the pressure traps the blood inside and results in an erection. Though these drugs work for many men, they fail to work for about 30 percent of men.
Though ED drugs help to produce an erection in about 70% of cases, they do come with the risk for certain side effects. Some potential side effects of ED drugs include the following:
Cialis users have reported back pain and muscle aches.
Viagra and Levitra have been correlated with vision changes.
Other common side effects include facial flushing, congestion and headache.
Every ED drug is slightly different, so you’ll need to talk to your doctor to determine which option is right for you, if any. Keep in mind that Viagra is the most effective ED drug, performing 50 percent better than placebo in 50mg and 100mg doses. On the opposite end of the spectrum, Stendra (avanafil) was the least effective drug – only 20 percent to 30 percent more effective than placebo – but had the lowest incidence of side effects.
Aside from ED drugs, some of the more commonly used treatment options include the following:
Injections – When oral ED medications don’t work, they can be directly injected into the penis to produce an erection within 5 to 20 minutes that lasts up to 60 minutes.
Suppositories – Inserted into the tip of the penis, suppository ED drugs are absorbed through the urethral wall to produce an erection within 10 minutes that lasts up to 60 minutes.
Vacuum restriction devices – These devices use pressure to draw blood into the penis, resulting in an erection that can be maintained for about 30 minutes if a rubber ring is placed around the base of the penis.
Penile implants – A surgical option, penile implants are small tubes that can be pumped full of air to bring the penis to erection.
Diet/lifestyle changes – Making changes to your diet and lifestyle may help to resolve some underlying issues and correct risk factors for erectile dysfunction.
Not only should you consider all of your treatment options before you default to ED drugs, but you should also consider whether addressing some underlying health issues might resolve your ED. Risk factors such as high cholesterol, high blood pressure, heart disease, diabetes, obesity and a lengthy list of others can contribute to ED, so making it your first step to address those issues might resolve your ED without the need for medications or other treatments.
Technically speaking, erectile dysfunction is a male disease—it only physically affects people who have male reproductive organs. The key word here, however, is “physically.” The effects of erectile dysfunction are not only physical, they are psychological and emotional. More than that, they can affect your partner just as much as they affect you.
As much as men tend to misunderstand erectile dysfunction, this condition can be even more difficult for a woman to understand, especially if her partner isn’t open and honest in talking about the issues. If you suffer from erectile dysfunction, you may be embarrassed or ashamed of the problem, but keeping those feelings bottled up won’t help either of you. The best way to resolve ED issues is to talk about them, both with your doctor and with your partner.
Think about this: If you find yourself unable to perform sexually, you might start to wonder what is wrong with you. The more you think about it, the more concerned you become and, in many cases, that worry turns to anxiety that then becomes a causative factor all on its own. Your fear of failure causes so much anxiety that you find yourself unable to perform. It's like it is a self-fulfilling prophecy of fail.
Now, think about it from your partner’s point of view: While you’re busy wondering why you are unable to perform, your partner is wondering whether it is their fault. They start to wonder if you aren’t attracted to them or if they’ve done something wrong. These worries, on top of your own worries, combine in a giant cloud of anxiety that hangs over both of you. If you don’t have a conversation to bring those issues to light, that cloud is only going to keep growing and darkening until it takes over. Difficult as it might be to start a conversation about your erectile issues, it is the best course of action to take, both for yourself and your relationship.
If you are having trouble working through the psychological impact of your erectile dysfunction, find help! Erectile issues are no more or less valid than clinical mental health problems. If it is affecting your life on a daily basis, it is significant, and you need to work through it. Ask your doctor for a referral to a therapist or talk about the other options that might be available.
By now you should have a more thorough understanding of what erectile dysfunction is and what it is not. Use this information to your advantage and talk to your doctor about your concerns. Together, you will be able to determine the cause for your erectile issues as well as the proper course of treatment.
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