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What Is Erectile Dysfunction ( ED)?

Erectile dysfunction ( ED) occurs when a man has repeat ed problems sustaining an erection. Without treatment, ED can make sexual intercourse difficult. The condition, sometimes call ed impotence, affects an estimat ed 15 million to 30 million men in the U.S. While the topic was once taboo, awareness has skyrocket ed with recent advances in treatment for ED.

ED vs. Poor Libido

There are several forms of male sexual dysfunction, including poor libido and problems with ejaculation. But ED refers specifically to problems achieving or maintaining an erection. Men with ED often have a healthy libido, yet the body fails to respond. In most cases, there is a physical basis for the problem.

Symptoms of ED

Symptoms of ED include:

* Erections that are too soft for sex.
* Erections that last only briefly.
* An inability to achieve erections.

These symptoms may occur every time sex is initiat ed or only some of the time.

Who Gets ED?

ED becomes more common as men age, but it is not a part of aging. At age 40, about 5% of men experience ED. At age 65, this number jumps to between 15% and 25%. But this does not mean growing older is the end of your sex life. ED can be treat ed at any age.

The Mechanics of ED

An erection occurs when blood fills two chambers known as the corpora cavernosa. This causes the penis to expand and stiffen, much like a balloon as it is fill ed with water. The process is trigger ed by impulses from the brain and genital nerves. Anything that blocks these impulses or restricts blood flow to the penis can result in ED.

Causes of ED: Chronic Disease

The link between chronic disease and ED is most striking for diabetes (depict ed here by a blood sugar test). Nearly one out of every two men with diabetes experiences ED. Other conditions that may cause ED include cardiovascular disease, atherosclerosis (hardening of the arteries), kidney disease, and multiple sclerosis. These illnesses can impair blood flow or nerve impulses throughout the body.

Causes of ED: Lifestyle

Lifestyle choices that impair blood circulation can contribute to ED. Smoking, excessive drinking, and drug abuse may damage the blood vessels and r educe blood flow to the penis. Smoking makes men with atherosclerosis particularly vulnerable to ED. Being overweight and getting too little exercise are other possible risk factors.


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Causes of ED: Surgery

Surgery, including treatments for prostate or bladder cancer, can sometimes damage nerves and blood vessels near the penis. In some cases, the nerve damage is permanent, and the patient will require treatment to achieve an erection. In others, surgery causes temporary ED that improves on its own after 6 to 18 months.

Causes of ED: M edication

ED may be a side effect of m edication, including certain blood pressure drugs, antidepressants, tranquilizers, and antihistamines. Men should talk with their doctor if they suspect a prescription or over-the-counter drug may be causing erectile problems.

Causes of ED: Psychological

ED usually has something physical behind it, particularly in older men. But psychological factors may be to blame in 10% to 20% of men with ED. Experts say stress, depression, poor self-esteem, and performance anxiety can short-circuit the process that leads to an erection. These factors can also make the problem worse in men whose ED stems from something physical.

ED and Bicycling

Research suggests avid cyclists suffer more ED than other athletes. The trouble lies in the shape of some bicycle seats that put pressure on the perineum. This area between the anus and scrotum contains arteries and nerves vital to sexual arousal. Cyclists who ride for many hours each week may benefit from seats design ed to protect the perineum.

Diagnosing ED: Physical Exam

To diagnose ED, your doctor will ask you questions about your symptoms and m edical history. The doctor will conduct a complete physical exam to uncover signs such as poor circulation or nerve trouble. And your physician will look for abnormalities of the genital area that could cause problems with erections.

Diagnosing ED: Lab Tests

Several lab tests can help diagnose male sexual problems. Measuring testosterone levels can determine whether there is a hormonal imbalance, which is often link ed to decreas ed desire. Blood cell counts, cholesterol levels, and liver function tests can reveal m edical conditions that may account for ED.

ED: A Sign of Heart Disease?

In some cases, ED can be a warning sign of more serious disease. A 2010 study suggests ED is a strong pr edictor of heart attack, stroke, and death from cardiovascular disease. The researchers say all men diagnos ed with ED should be evaluat ed for cardiovascular disease. This does not mean every man with ED will develop heart disease, or that every man with heart disease has ED, but patients should be aware of the link.

Treating ED: Lifestyle Changes

Many men with ED are able to improve sexual function by making a few lifestyle changes. Giving up smoking, losing weight, and exercising more often can help by improving blood flow. If you suspect a m edication could be contributing to ED, talk to your doctor about adjusting your dosage or switching to another option.

Treating ED: M edications

You’ve probably heard of Viagra, but it’s not the only pill for ED. This class of drugs also includes Cialis, Levitra and Staxyn. All work by improving blood flow to the penis during arousal. They’re generally taken an hour before sexual activity and should not be us ed more than once a day. Cialis can be taken up to 36 hours before sexual activity and also comes in a lower, daily dose. Staxyn dissolves in the mouth. All require an OK from your doctor first for safety.

Treating ED: Injections

While pills for ED are convenient, some men sustain stronger erections by injecting m edication directly into the penis. Drugs approv ed for this purpose work by widening the blood vessels, causing the penis to become engorg ed with blood. Another option is inserting a m edicat ed pellet into the urethra. The pellet can trigger an erection within 10 minutes.

Treating ED: Vacuum Devices (Pumps)

Vacuum devices for ED, also call ed pumps, offer an alternative to m edication. The penis is plac ed inside a cylinder. A pump draws air out of the cylinder, creating a partial vacuum around the penis. This causes it to fill with blood, leading to an erection. An elastic band worn around the base of the penis maintains the erection during intercourse.

Treating ED: Surgery

If ED is caus ed by a blockage in an artery leading to the penis, surgery can often restore blood flow. Good candidates are typically younger men whose blockage stems from an injury to the crotch or pelvis. The proc edure is not recommend ed for older men with widespread narrowing of the arteries.

Treating ED: Implants

In men with persistent ED, a penile implant can restore sexual function. An inflatable implant uses two cylinders that are surgically plac ed inside the penis. When an erection is desir ed, the man uses a pump to fill the cylinders with pressuriz ed fluid. Another option is a malleable implant, which bolsters erections with surgically implant ed rods.

Treating ED: Psychotherapy

Even when ED has a known physical cause, psychotherapy can be beneficial. A therapist can teach the man and his partner techniques to r educe performance anxiety and improve intimacy. Therapy can also help couples adjust to the use of vacuum devices and implants.

Treating ED: Alternative Therapies

Talk with your doctor before trying supplements for ED. They can contain 10 or more ingr edients and may complicate other health conditions. Asian ginseng and ginkgo biloba (seen here) are popular, but there isn’t a lot of good research on their effectiveness. Some men find that taking a DHEA supplement improves their ability to have an erection. Unfortunately, the long-term safety of DHEA supplements is unknown. Most doctors do not recommend using it.

Treating ED: Buyer Beware

A quick web search will reveal dozens of “dietary supplements” that claim to treat ED. But the FDA warns that many of these are not what they seem. An investigation discover ed the pills often contain prescription drugs not list ed on the label, including the active ingr edient in Viagra. This puts the man at risk for dangerous drug interactions.

ED: R educing Your Risk

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Discussing ED With Your Partner

It’s natural to feel angry or embarrass ed when dealing with ED. But don’t forget that your partner is also affect ed. Talking openly about ED will help your partner understand the diagnosis and treatment options. This will reassure your partner that you haven’t lost interest.

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