About Erectile dysfunction (ED) in Men

Erectile dysfunction (ED), or male impotence, is an inability to attain and sustain an erection hard enough for sexual activity. It may affect at almost any age, but is found to be more common in elders. ED is an incurable condition; however, it can be treated.

What is ED?

  • A man is considered to have ED if he faces difficulty in attaining or sustaining a strong enough erection to successfully perform sexual activity.
  • More than 18 million men in US are affected with ED.
  • This condition is more common in elders, but can happen at any age, even to those who never had any sexual issues in prior.
  • Although incurable, ED is treatable in most case with oral medications.
  • It can greatly affect a man’s sexual health, causing disharmony in a relationship.

What are the causes of ED?

Normally, an erection is a complex process that involves the mechanism of the brain, nerves, hormones, emotions, muscles and blood vessels. ED can result from an issue with any of these. Similarly, stress and psychological concerns can cause ED.

In some cases, a combination of physical and psychological issues can cause ED. For example, a minor physical condition that might cause anxiety can affect the ability to maintain an erection.

Physical causes of ED

  • Heart disease
  • Atherosclerosis (clogged blood vessels)
  • High cholesterol
  • Hypertension
  • Diabetes
  • Obesity
  • Multiple sclerosis
  • Parkinson’s diseases
  • Peyronie’s disease (development of scar tissue inside the penile organ)
  • Sleep disorders
  • Tobacco use
  • Alcoholism and other forms of substance abuse

Iatrogenic causes of ED

  • Certain prescription medications used for treating hypertension, prostate issues
  • Surgeries that affect the spinal cord or pelvic area

Psychological causes of ED

The human brain plays a vital role in triggering a series of physical events that can help one attain an erection, which usually starts with the feeling of sexual excitement. Therefore, any psychological disturbance can cause ED, which include:

  • Anxiety, depression or any other mental illness
  • Prolonged stress
  • Feeling of guilt
  • Relationship issues caused by stress, poor communication or any other concerns

What are the risk factors of ED?

Ageing can be one of the common risk factors. As a man grow older, erections take longer to develop and might be not as firm enough to perform sexual activity.

Common risk factors associated with ED include:

  • Chronic medical conditions such as diabetes and cardiovascular disease
  • Obesity
  • Spinal cord injury, damaging the blood vessels and nerves that control erections
  • Prolonged tobacco use Chronic drug and alcohol use
  • Prolonged stress, anxiety or depression
  • Certain medical procedures – such as radiation therapy for cancer or prostate surgery
  • Certain medications – such as antidepressants, antihypertensive drugs, prostate medications or antihistamines

What are the complications of ED?

  • Unsatisfactory sexual life
  • Low self-esteem or embarrassment
  • Constant stress or anxiety
  • Disharmony in relationship
  • Inability to satisfy your partner’s desires
  • Depression or irritability

When to see your doctor?

Usually, the symptoms of erectile dysfunction include trouble getting and keeping an erection, which may or may not be associated with reduced sexual desire. Your primary care physician is the right person to start with if you suspect any signs of feeble erections.

Check with your doctor if:

  • You have diabetes, cardiovascular disease or any other health issue that is often related to ED.
  • You have an issue with getting and sustaining an erection even after undergoing proper sexual stimulation.
  • You have concerns about low sexual desire and experiencing other sexual issues such as premature ejaculation.

How is ED diagnosed?

For most men, a simple physical examination and medical history is enough for a physician to diagnose ED and advise a treatment. If you have any chronic medical condition or your physician suspects that an underlying medical condition might be the cause, you may need to undergo further investigations or a consult a specialist.

Investigations for underlying medical conditions might include:

  • Physical exam: A careful examination of your penile organ and testicles, and examining your nerves for sensation.
  • Lab works: Lab works are advised to check for any signs of cardiovascular disease, diabetes, low testosterone and other health issues associated with ED.
  • Ultrasound: An ultrasound is often performed by a specialist to rule out any underlying factors.
  • Psychological exam: You might have to undergo a series of questions for depression and other psychological disturbances that are associated with ED.

How to talk about ED with your partner?

Disclosing the fact and talking about ED with your partner is not easy; however, it can be of great help for both of you. Remember that ED, although incurable, is treatable for most men.

Make sure you are open, honest as well as sensitive when it comes to your partner’s needs and queries. Please note that you stick to the facts and talk about ED as a common medical problem and reassure your partner that ED is treatable.

What are the ED treatment options?

The first thing your primary care physician will do is to make sure you receive the appropriate treatment for any medical conditions that could be causing your ED. Depending on the cause and complexity of your ED and any underlying medical conditions, you might have various ED treatment options. Your provider will explain the risks and benefits of each ED treatment and will surely consider your preferences. Remember, your partner’s preferences may also play a role in your choice of ED treatment.

Oral medications:

All four oral medicines boost the effects of nitric oxide, which is a natural chemical your body produces that helps relax muscles in the penile organ. Eventually, the blood flow increases and you get an erection during sexual stimulation.

Remember, sexual stimulation is imperative to release the nitric oxide from your penile nerves. These ED medications amplify that signal, allowing men to attain and sustain an erection. Oral ED medications are not aphrodisiacs.

ED drugs are not advised to those who take nitrate drugs (used for chest pain or angina), isosorbide mononitrate and isosorbide dinitrate and those who have serious heart disease or heart failure and a very low blood pressure (hypotension).

Other options

  • Alprostadil self-injection.
  • Alprostadil urethral suppository.
  • Testosterone replacement.
  • Penile pumps, surgery and implants.

Psychological counseling

If you have erectile dysfunction caused by constant stress, anxiety or depression, or constant relationship tensions, your physician might suggest that you visit a psychologist or a counselor. Counseling can help men cope with ED caused by psychological disturbances.


Researchers have found that exercise can greatly improve erectile ability. However, some men may not reap the benefits of exercise, especially those with established heart disease or other chronic medical problems.

Mild to moderate exercises can be of great help; they may even reduce the risk of ED. Increasing your physical activity might also reduce the risk of ED over time. One should discuss an exercise regimen with their doctor.

Do lifestyle changes help treat or prevent ED?

For most men, ED is caused by lifestyle choices, which include smoking, obesity, sedentary habits and alcohol or drug abuse. Here are a few steps that might be helpful:

  • Quit smoking. Speak to doctor about effective ways of quit smoking.
  • Shed extra pounds. Obesity is linked to ED. Losing weight can help improve erections in men.
  • Exercise. As stated above, incorporating exercise in your daily regimen can boost circulation and eventually improve ED.
  • Stay away from drugs and alcohol.
  • Consider psychological counseling and work on improving your relationship to lead a happy and healthy love life.