What causes erectile dysfunction and what can you do about it?

Erectile Dysfunction (ED) is not something men are comfortable talking about – even though it is extremely common. It affects every second man over the age of 50,  and studies have shown that almost 90% of men aged over 75 will experience it.

So what is it?

Erectile Dysfunction or ED is defined as the inability to get or maintain an erection that will allow you to have sexual intercourse.

It can have a significant impact on a man’s self-confidence and it can also affect their personal relationships, yet many men are reluctant to talk about it with their partners. A recent survey showed that 67% of men under the age of 40 would not discuss it. That figure improved with age with one in five of those aged over 60 willing to discuss it with their partner.

Discussing it in ones thing – seeking help is another and it’s estimated that only 30% of men talk to their doctor about it.

But there are three good reasons why they should:

1. It can be an indicator of an underlying health condition
2. It can be treated
3. It is unlikely to get better without treatment.

Causes of Erectile Dysfunction

In many cases lifestyle and ageing are the main reason for ED.

Some of the most common causes include:

1. Ageing
2. Lifestyle – tiredness, drinking too much alcohol, stress, poor diet, smoking
3. Being overweight or obese
4. Underlying health conditions such as heart disease (cardiovascular disease), high blood pressure, metabolic syndrome, multiple sclerosis, Parkinson’s disease or diabetes
5. Psychological issues – eg performance anxiety
6. Depression/anxiety
7. Certain medications and recreational drugs – including cocaine and marijuana
8. Prostate surgery
9. Low levels of testosterone
10. Endothelium & Smooth Muscle Dysfunction (a reduced ability for blood to flow into the penis)
11. Peyronie’s Disease (scar tissue that causes the penis to bend making it difficult to have sex).

What’s Normal and What’s not?

 You need two things to get an erection – a good blood and nerve supply.

When a penis is in a flaccid or unaroused state the arteries that supply it allow enough blood in to keep the penis healthy. But when it’s aroused the nerves send signals to the brain to tell it to open the arteries to let more blood into the penis and for the veins to slowdown the flow out. This allows the spongy tissue in the penis to fill with blood and the result is an erection.

After an orgasm, the reverse happens. Signals are sent again that tell the veins to open and let more blood out and the arteries reduce blood flow into the penis, and the penis returns to normal.

If those signals are  interfered with or the blood vessels aren’t functioning well the ability to get or maintain an erection will be affected.

Conditions like heart disease and diabetes affect the blood supply. They can cause restrictions in the small blood vessels within the penis which in turn means a softer erection. In men who have no other causes studies have found that ED can be a predictor of heart disease, starting 3-5 years before other cardio-vascular symptoms like high blood pressure are diagnosed.

Some Treatment Options

Fortunately, these days there are a number  treatments that may help with ED.

1. Lifestyle changes including quitting smoking, losing weight and getting more exercise are important. Eating a well balanced diet and drinking less alcohol is also vital.
2. Medications such as Viagra, which temporarily improve blood flow, can work for many men but have their limitations over time and in terms of spontaneity.
3. Pumps – these are quite effective but may cause bruising and make the erection an unusually dark colour. They also affect spontaneity.
4. Injections or pessaries – an injection into the penis of a drug that improves blood flow may help. A pessary of the same vasodilating drug can be inserted into the urethra (where the urine comes out).
5. Implant surgery – there are two main types, inflatable and malleable rods. Surgery carries its own risks and the there can be issues in terms of concealing the penis as well as malfunctions. These are considered a last resort these days.
6. Hormone therapy – if low levels of testosterone are a cause, using a daily gel may help.
7. Novel non-invasive treatments like the P-Shot or shockwave therapy. The P-shot involves injecting your own platelet rich plasma (PRP) into strategic parts of the penis (after its numbed). The PRP contains growth factors and stem cells that may help regenerate blood vessels and tissue. It can also help with size issues too. Shockwave therapy involves passing sound waves through the penis – there is no pain. It too is said to aid in regenerating tissue and improving blood flow.  Evidence for these treatments is being collected but they are showing promise. There is no downtime from either.

If you are concerned about ED always see your GP.

Doctors on the site who can help are Dr Shirin Lakhani, Dr Unnati Desai and Dr Sherif Wakil.

You can find them here, in the Doctor’s section.