Men with erectile dysfunction (ED) are unable to get or keep an erection that is sufficient for sex. ED is one of the most commonly reported conditions in men, but exactly how common it is in men of different ages has been tough to measure.
This study from the Journal of Sexual Medicine reported ED in about 26% of men younger than 40. The Massachusetts Male Aging Study is a common reference for ED statistics, since even though it was done in 1994, it was the most extensive ED study done since 1948. The study found that 52% of men experience some degree of ED in their life, and that the risk does increase with age.
With negative effects on sexual, physical and mental health for men as well as their partners, it’s no wonder a solution to this problem is highly sought-after. Fortunately, there are many treatment options available and more research going into finding new therapies.
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Medical review by Dr. Davis LiuAnxiety is one of the most common causes of ED. Why? In the midst of a stress response, your body cuts off blood flow to your penis. Sexual performance anxiety, an aspect of male erectile dysfunction (ED), can be a common source of distress and shame.
An erection happens when blood flows to your penis. When this blood flow isn’t happening as much as necessary or not happening at all, getting or keeping an erection may not happen. So why does this blood flow get interrupted? Many things can cause or contribute to this. These are some of the most common things that contribute to ED:
Other health conditions, particularly cardiovascular diseases. Any condition that disrupts blood flow, such as heart failure, heart attack, coronary artery disease (artery narrowing), hypertension (high blood pressure), hyperlipidemia (high cholesterol), and diabetes, can contribute to ED because they make it tougher for your blood to go where it needs to go.
Certain medications. Antidepressants and antipsychotics, antihistamines (allergy medications), blood pressure medications, and benzodiazepines (anti-anxiety drugs) are some examples of drugs that have been shown to cause or contribute to erectile dysfunction.
Lifestyle factors. Certain modifiable behaviors have been linked to erectile dysfunction. Cigarette smoking has been shown in many studies to be strongly related to ED symptoms. Additionally, 79% of men with ED are overweight (BMI greater than or equal to 25) and the risk goes up as BMI increases.
The best treatment option for your ED depends on what’s causing it, so talking with your doctor or nurse practitioner to figure out what that might be is a big step in resolving it. The following are some of the most common treatment options:
Lifestyle changes. It’s possible your ED may improve by making some lifestyle changes, meaning you could avoid adding medications that cost money and cause potentially unnecessary side effects.
Quitting smoking. If you smoke cigarettes, that may be what’s hurting your sex life the most, especially if you also have heart disease or high blood pressure. The good news is that quitting smoking can significantly improve your symptoms, especially if you quit at a younger age. As for how long after quitting smoking you can expect improvement, one study showed less symptoms in more than 50% of men at six months after quitting.
Physical exercise. As if you need another reminder that exercise is beneficial, it has been shown to improve erectile function in multiple ways including improving your glucose and lipid levels and controlling blood pressure. Another motivator: exercise may cause some similar effects as drugs used to treat ED.
Medication review. If you’re someone that has a list of medications so long that you’ve lost track of what everything is for, it may be time to sit down with your doctor and confirm that you still need all of those drugs. You just might be able to cut some out and see improvement in ED symptoms.
Oral medications. PDE-5 inhibitors are a common first choice in treating erectile dysfunction. Right now there are four approved drugs in this class: sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra). They are all pills and are all available generically except for avanafil.
PDE-5 inhibitors work by keeping the blood vessels in your penis open enough so that blood can easily flow through them. These drugs are taken as needed, 30 minutes to an hour before sex. Tadalafil (Cialis) may also be taken daily at a lower dose, regardless of if you plan to have sex that day or not. You still have to be in the mood for an erection to happen with these drugs, so there’s no need to worry about an unwanted surprise.
Injection for erectile dysfunction. Alprostadil (Caverject) is a medication that is injected into one side of the penis. This drug causes an erection quickly, and should be used right before sex. The same drug is also available as an intraurethral pellet, placed into the urethra with an applicator, but this form is not as effective as the injection.
Devices for erectile dysfunction. There are a couple of non-drug options for treating ED, including vacuum devices that create a suction which pulls blood into your penis to create an erection. This device can also be used in combination with drugs like PDE-5 inhibitors. One other option is a prosthesis which is put in surgically. This option comes with risks including infection and scarring, and is generally reserved as a last-resort option.
New and emerging therapies. New therapies have been studied in the last few years in small numbers and in animal models. Stem cell therapy has been shown to heal damaged nerves. Platelet-rich plasma appears to promote the growth of new blood vessels which can function like they’re supposed to, replacing the damaged ones which are often the cause of ED. Both of these options need a lot of further study with more subjects.
A lot of questions have been raised about whether COVID-19 contributes to erectile dysfunction. One very small study showed that the virus may linger in the penis longer than in other parts of the body, and can cause damage to cells which may prevent erections. The pandemic is still recent, and has taken a great toll on the mental health of the population as a whole (which we know contributes to ED), so reliable studies proving that COVID causes ED have really not come about yet.
The best way to avoid the many harmful effects of COVID, possibly including erectile dysfunction, is of course to take measures to keep yourself from getting infected. Find out where to get vaccinated here.
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