Medically reviewed by Angela Sheddan, DNP, FNP-BC
Written by Our Editorial Team
Last updated 3/02/2021
Just because something is relatively common doesn’t make it easy to deal with. Many men struggle with getting or maintaining an erection, especially as they get older. But when it’s you that’s dealing with ED, it can feel disastrous.
Before you can understand solutions, you have to fully understand the problem.
When it comes to ED, the problem is bigger than just frustration at your inability to get or maintain an erection.
While those are troublesome and should not be minimized, they are the results of the problem — not the problem itself.
An erection happens when you are stimulated (physically or psychologically), nitric oxide is released causing the smooth muscle in your penis to relax.
When this happens, blood is allowed to rush in, engorging your penis and making it hard.
Your penis becomes soft again after phosphodiesterase type 5 (PDE5) is released, reversing the process.
A problem at any point during this process can cause ED.
It’s also worth noting that ED is relatively common, and the likelihood increases that you’ll be affected by it as you age.
One study found that about 50 percent of men had ED at age 50, 60 percent at age 60, and so on. But it can happen much younger, too.
As many as one in four men seeking medical treatment for ED is under age 40, according to scientific literature.
The causes of ED can be thought of as either physical or psychological, though both can play a role.
More than 80 percent of ED cases have a physical component, so it’s highly unlikely this is “all in your head.”
Hypertension, heart disease, diabetes, depression and anxiety, and changes in the endocrine (hormonal) system can all affect your ability to achieve and maintain an erection. Smoking, drinking, and using drugs can also increase your risks of ED.
In part because ED has been a problem since the beginning of time, there is a large body of research on the condition, it’s causes, and potential solutions. ED won’t kill you, but because the ability to get an erection is such an iconic sign of man’s virility, it’s been an important topic of research. And thank goodness.
Had research stopped advancing in the time of ancient Egypt, men still might be applying wood oil mixed with baby crocodile hearts to their penises in an effort to get them hard. Really.
Fortunately, we’ve come a long way. And there are several treatments available for ED. The most common are the least invasive — several effective prescription medications. But surgical options also exist.
PDE5 inhibitors are oral prescription medications that are the current mainstay for ED treatment. They stop PDE5 from reversing the erection process.
Several of these medications have been approved by the FDA, including: Viagra® (sildenafil), Levitra® (vardenafil), Cialis® (tadalafil), and Stendra® (avanafil).
The first of these to hit the market, Viagra, was released in 1998 and changed the game when it came to ED treatment.
Generally speaking, PDE5 inhibitors are safe and effective, each with a slightly unique profile.
For example, sildenafil (generic Viagra) is most effective one to two hours after taking, lasts three to five hours, and can be taken with or without food, whereas tadalafil is most effective two to four hours after taking and lasts 36 hours.
They also come with their own unique potential side effects — such as headaches, heartburn, and congestion — and medication interactions.
Referred to as vacuum constriction devices (VCD) or vacuum erection devices (VED), these are exactly what they sound like.
VEDs involve placing a plastic tube over the penis and then emptying that tube of air, by creating negative pressure, or a vacuum.
While these devices can be effective, men often don’t stick with them because of unpleasant side effects.
The potential unpleasant effects of a penis vacuum include: pain and bruising, inability to achieve orgasm, coldness or numbness. Further, they’re just sort of a hassle.
Known as intracavernosal injections, or ICI, this treatment is less common.
It involves injecting medication directly into the penis. And while initial satisfaction is high, men typically abandon this treatment due to cost, desire for something more permanent, and the discomfort of giving yourself a shot in the penis.
Penile implants are another option for ED. This type of surgery is generally saved for people with penile defects due to trauma or those with certain medical diseases.
Typically, a penile implant involves an inflatable device being inserted into the penis, which a man can control with a hand pump.
Another surgical option, penile revascularization surgery, involves restoring blood flow to the penis much in the same way you would have bypass surgery for heart disease.
While the success rate for this surgery is high, it’s rare, mainly because research has found that the type of ED this surgery treats is rare.
ED treatment is always evolving, and several additional treatment options may be on the horizon. For example, some research suggests stem cell therapy may hold promising benefits.
A very small study of seven diabetic men found that six of the seven regained morning erections after six months of stem cell injections.
Low-intensity shock wave lithotripsy is another emerging treatment for ED.
This involves sending low-intensity shocks into the penis, where it’s believed the microtrauma can increase blood flow and improve erectile function.
One can’t forget the psychological aspect of ED. Receiving counseling can be especially effective when there is a partner involved.
According to research, men with stress-related ED find resolution 50 percent to 70 percent of the time when their partner is involved in therapy with them.
In addition to treating your lack of erection, you can manage the things that increase your risk of ED. Managing ED risk factors can improve your overall health.
Metabolic syndrome, diabetes, heart disease, high blood pressure, obesity, and smoking are all risk factors for ED, so it’s easy to see how managing these could be good for you, to say the very least.
Maintaining a healthy weight, eating a balanced diet, getting regular exercise and a good night’s sleep, and stopping smoking can all go a long way in preventing and treating erectile dysfunction, while also preventing other diseases.
If you’re struggling with erections, you’re not alone.
Erectile dysfunction is so common, there have been countless scientific papers published on the topic and everyone is in search of the silver bullet solution.
Fortunately, there are several treatment options available that can help you get your vigor back in the bedroom.
By managing ED risk factors and talking with a doctor about medical treatments, there’s a good chance you can overcome your erection troubles and get back to a satisfying sex life.