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All you need to know about erectile dysfunction

Up to 50% of men under the age of 50 are affected by erectile dysfunction. Understand the symptoms, causes and treatments in this article.

Erectile dysfunction or impotence is very common, particularly in men over 40, affecting up to half of the men above this age (1), and can be very stressful for both men and their partners. The good news is that in many cases, it can be treated either medically or with lifestyle changes. Find out everything you need to know about the causes, symptoms, and treatments of erectile dysfunction.

What is erectile dysfunction?

Erectile dysfunction (ED) is a sexual disorder described as the inability to get or maintain an erection firm enough to be able to have sex. Occasional ED isn't uncommon and can often occur as a result of stress, anxiety, tiredness, or from drinking too much alcohol. However, for many men, ED is a longer-term issue caused by physical or emotional problems. Long-term ED can not only harm a man's sex life, but it can also affect their confidence and self-esteem.

When a man develops an erection, muscles in the penis relax, allowing increased blood flow to the area. As this happens, the penis becomes rigid. An erection ends when the muscles contract, and the blood flows out again. ED can occur because of problems at any of these stages.

What are the symptoms of erectile dysfunction?

You may have ED if you regularly have:

  1. Trouble getting an erection
  2. Difficulty maintaining an erection
  3. Reduced interest in sex

Other sexual disorders related to ED are premature ejaculation, delayed ejaculation, and anorgasmia (the inability to achieve orgasm).

If you have any of these symptoms regularly, it is advised you speak to your doctor to investigate the potential underlying cause and determine whether treatment is required.

What causes erectile dysfunction?

There are many different causes for erectile dysfunction, and often there can be several factors playing a role. Here are some of them:

  • Health conditions - cardiovascular disease, diabetes, high blood pressure, and kidney disease are just some of the health conditions which can cause ED.
  • Hormonal imbalances - low testosterone and other hormonal imbalances in the body can lead to erectile problems.
  • Mental health problems - anxiety, depression, and chronic stress can all be linked to ED. Often these can be a secondary reaction to an underlying physical cause.
  • Lifestyle factors - drinking, smoking, and obesity are all potential causes of ED.
  • Age - ED is increasingly common as men age, particularly after 40.
  • Previous injury - damage to the pelvic area through injury or past surgery can result in ED.
  • Relationship problems - this can affect a couple's sex life by reducing libido (sexual desire), as well as causing stress and other emotional issues.
  • Peyronie’s disease - this condition causes scar tissue to develop in the penis, affecting erectile function.

How is erectile dysfunction diagnosed?

Occasional ED is common and shouldn't cause concern. If ED starts to occur regularly, it is a good idea to book an appointment with your GP. They will ask you about your lifestyle, relationships, and any problems you might be having. They will also carry out health checks, such as blood pressure. They may then examine your genitals and penis to look for any potential physical cause. If you have other symptoms, such as needing to pee more often, they may also examine your prostate or rectum.

Depending on the results of these checks, additional tests may be required, such as an ultrasound of the area, or urine or blood test.

How is erectile dysfunction treated?

The treatment for ED will vary depending on the underlying cause and may require a combination of treatments. Here are some examples of treatments.

Cause

Treatment

Narrowing of penis blood vessels due to high cholesterol or blood pressure

Medicine to lower blood pressure, statins to lower cholesterol

Hormone imbalance

Hormone medication to balance hormones (e.g., testosterone)

Side effects of medication

Change of medication

Another standard treatment for ED is a medication called sildenafil (Viagra). This drug increases blood flow to the penis and helps up to two-thirds of men to have improved erections when taking it. In the UK, you do not need a prescription to get sildenafil, and it can be purchased discreetly online or in a pharmacy.

Your doctor may also recommend some lifestyle changes such as a healthy diet or exercise if they believe lifestyle may be playing a role in your ED.

ED could have a psychological cause if you can get an erection some of the time (e.g., in the morning) but not during sex. If your doctor thinks your ED may be the result of a psychological problem, they may recommend counseling, cognitive behavioural therapy, sex therapy, or other combinations of psychotherapy. You can also choose to pay for these services privately as waiting times are long with the NHS.

What can I do?

While medical treatment may be necessary in some cases, there are things you can try to see if the situation improves:

  • Lose weight if you are overweight - being overweight or obese is a significant risk factor for ED, with one study showing 79% of men with erectile disorders having a BMI of 25 or higher (3). If you are overweight and experiencing erectile problems, getting your BMI within the healthy range of 18-25 could improve things.
  • Quit smoking - there is overwhelming evidence that smoking worsens erectile function as smoking damages the blood vessels in the body, including the penis (4). Quitting smoking should be a priority not just to improve sexual performance, but also for overall health.
  • Eat a healthy diet - eating healthy food reduces your risk of cardiovascular problems resulting from high cholesterol (5). As blood flow problems often cause ED, maintaining healthy blood vessels through a diet of fruits, vegetables, whole grains, and healthy fats could improve erectile function.
  • Exercise regularly - exercise increases blood flow around the body and has significant benefits for our cardiovascular health (6). More specifically, pelvic floor or kegel exercises could improve erectile function by strengthening the bulbocavernosus muscle - a necessary muscle for achieving an erection and ejaculation.
  • Reduce stress -  stress and anxiety can interrupt how the brain sends messages to the penis to allow extra blood flow. One study found men following an 8-week stress reduction programme showed significant improvement in erectile function (7). Meditation, exercise, and spending time outdoors can all help lower stress levels. You may also wish to talk to a professional who can help you manage long-term stress.
  • Reduce alcohol consumption - ED is common in men who drink heavily (8). Alcohol not only reduces libido, but it also decreases blood volume and increases angiotensin, a hormone associated with ED. Sticking to below the recommended 14 units of alcohol per week could see an improvement in erectile function.
  • Avoid cycling - there is some evidence that cycling for long periods can cause compression of the genitals, leading to impaired vascular function (9). If you are an avid cyclist, it could be worth cutting back to see if this improves your ED.

What next?

If you have been experiencing ED regularly, it is recommended you visit your doctor so they can look into the possible cause or causes. Our Erectile Dysfunction Blood Test could also be a good idea to check your testosterone levels are optimal. You can read more about testosterone and men’s health in our guide.


References 

1.    https://www.baus.org.uk/patients/conditions/3/erectile_dysfunction_impotence/
2.    https://www.ncbi.nlm.nih.gov/pubmed/16651047
3.    https://www.ncbi.nlm.nih.gov/pubmed/24720114
4.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485976/
5.    https://www.ncbi.nlm.nih.gov/pubmed/8254833
6.    https://www.ajconline.org/article/S0002-9149(14)02270-X/fulltext
7.    https://www.ncbi.nlm.nih.gov/pubmed/23822751
8.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917074/
9.    https://www.ncbi.nlm.nih.gov/pubmed/20102446