Erectile dysfunction (ED) is the inability to maintain an erection firm enough for satisfying sexual activity. While occasionally having difficulty maintaining an erection is normal, if it happens frequently and it consistently disrupts your sex life, your doctor may diagnose you with ED. In this article, we’ll look at the prevalence the treatment of erectile dysfunction (ED). We’ll also take a look at the most common causes and treatment options.
Prevalence
Experts widely agree that ED is common and that the risk of developing ED increases with age. Some studies cite that ED is the most common form of sexual dysfunction that affects men.
But estimates on just how common ED is vary widely. One 2018 review Trusted Source estimated that ED affects about a third of men. And a 2019 review Trusted Source found that the global prevalence of ED ranges between 3 percent and 76.5 percent.
The Massachusetts Male Aging Study Trusted Source, which was completed in 1994, is often cited by experts in discussions of prevalence, even though the research is older. This study found that around 52 percent of men experience some form of ED, and that total ED increases from about 5 to 15 percent between ages 40 and 70.
Though the risk of ED increases with age, it’s still possible for young men to experience ED. A study published in the Journal of Sexual Medicine found that ED affected about 26 percent of men under the age of 40.
As all this research shows, even though experts agree that ED is common, prevalence can be hard to measure in large populations. This may be because doctors and researchers use different definitions of how often erection issues must occur in order to be considered ED.
There’s also a lot of variation among screening tools and questionnaires used by researchers.
What’s normal
Occasionally experiencing erection problems isn’t necessarily a cause for concern. And it doesn’t necessarily mean you have ED. The Cleveland Clinic estimates that it’s normal to have trouble getting or keeping an erection for up to 20 percent of sexual encounters. Having trouble getting an erection more than 50 percent of the time can indicate a medical issue.
Talk to your doctor if you’re concerned about the quality of your erections.
Causes Of Erectile Dysfunction
When you become sexually excited, the muscles in the penis relax and blood flow to the penis increases. Blood fills two chambers of spongy tissue that run along the length of the penis called the corpora cavernosa.
ED occurs when there’s a problem with this process. According to the Mayo Clinic, causes can be physical or mental, and can include:
- alcohol use
- illicit drug use
- smoking
- diabetes
- high cholesterol
- heart disease
- blocked blood vessel
- obesity
- metabolic syndrome
- some medications, such as blood pressure medications
- sleep disorders
- scar tissue inside the penis
- Parkinson’s disease
- multiple sclerosis
- anxiety
- stress
- depression
- relationship issues
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Risk factors
People who have one of the following risk factors Trusted Source have a higher chance of developing ED:
- Age. Age is one of the primary risk factors of ED. Whiles estimates vary, ED is generally more common among older men than younger men.
- Diabetes. Diabetes can cause nerve damage and problems with circulation, both of which can contribute to ED.
- Obesity. Men who are overweight have a significant risk of developing ED. As many as 79 percent Trusted Source of people with ED have a body mass index (BMI) over 25.
- Depression. Research shows a strong correlation between depression and ED. In some cases, it isn’t clear if ED leads to depression or depression leads to ED.
- Other risk factors. Men who are physically inactive, have metabolic syndrome, smoke, have high blood pressure, cardiovascular disease, high cholesterol, or low testosterone are also at an increased risk of developing ED.
Treatment Of Erectile Dysfunction
Way Of Living Changes
A variety of personal habits and lifestyle choices have been linked to ED. In some ways, this is a good thing, since habits can be altered and choices reconsidered.
What’s more, many of the lifestyle factors that contribute to sexual problems are ones that affect overall health and well-being, both physical and mental. Addressing these factors, therefore, can have benefits beyond improving erectile dysfunction.
Daily Exercise Treatment Of Erectile Dysfunction
Regular physical activity improves blood circulation and decreases the risk of heart disease, diabetes, and obesity, all of which can have an impact on sexual function.
In fact, research shows that men who exercise more in midlife have a 70% lower risk of erectile dysfunction than sedentary men.5 In addition to preventing ED, physical activity has been found to improve ED.
Extra Weight
Excess body fat may play a role in erectile dysfunction by promoting inflammation and converting testosterone to estrogen. According to one study, a third of obese men with erectile dysfunction regained sexual function after participating in a two-year weight loss program.
Say No To Smoking
Smoking affects circulation in ways that can inhibit blood flow to the penis and affect the ability to achieve or sustain an erection. This is why male smokers are at an increased risk of developing ED, regardless of their age or underlying medical conditions.
That said, it remains unclear whether stopping smoking once a person has started will necessarily improve ED. Research suggests this may be only true in younger men who have a limited smoking history.
Regardless, smoking cessation has many other health benefits, such as reducing heart disease and diabetes—two major causes of ED.
Healthy Food For Treatment Of Erectile Dysfunction
People who eat diets rich in whole-grain foods, vegetables, and fruits and low in red meat, full-fat dairy products, and sugary foods and drinks have a reduced risk of ED.
Similar to smoking, adopting healthy eating habits has other health benefits too, especially with regards to improving your heart health.
Take Care of Teeth
Perhaps a less obvious lifestyle strategy is to see your dentist for regular teeth care. This is because, according to a review article of five studies involving more than 200,000 men, chronic gum disease (periodontitis) might be associated with a more than twofold increase in the risk of erectile dysfunction.
Prescription Medications
The oral medications for erectile dysfunction—phosphodiesterase-5 (PDE5) inhibitors—work by enhancing the effects of nitric oxide, a naturally-occurring substance that relaxes blood vessels to allow blood to flow into the penis. With this effect in place, it’s possible to get an erection in response to sexual stimulation and to sustain it.
Viagra (sildenafil): May be effective within 30 to 60 minutes can last up to 12 hours
Cialis (tadalafil): May be effective within 60 to 120 minutes and may last up to 36 hours
Levitra or Staxyn (vardenafil): May be effective within 30 to 60 minutes and can last up to 10 hours
Stendra (avanafil): May be effective within 15 to 30 minutes and can last up to 12 hours
Keep in mind—for Viagra, Levitra, and Stendra—eating a high-fat meal may delay the absorption of the drug, which can prolong the time it takes to get an erection and diminish the drug’s overall effectiveness.
Be sure to talk about PDE5 inhibitors with your doctor, making sure that they know your entire medical history and all other medications and supplements that you take.
If a PDE5 inhibitor is ineffective or contraindicated, your physician may suggest you try penile injections. This is where a liquid medication such as Caverject (alprostadil for injection) or TriMix (papaverine, phentolamine and alprostadil [PGE]) is injected into your penis with a fine needle.
Another treatment option includes penile suppositories like Muse (alprostadil urogenital) that are inserted into the urethra.
Both of these methods will bring on an erection within five to 15 minutes without a need for major sexual stimulation.
Prescribed medications like selective serotonin receptor inhibitors (SSRIs) or phosphodiesterase inhibitors such as Viagra (sildenafil)—especially when taken together—can be effective for PE. Studies have found that combining phosphodiesterase inhibitors and behavioural therapy is successful.
They also won’t cause you to develop an erection on their own. Instead, they just make it easier to get an erection when you’re already in the mood for sex.
There are five PDE5 inhibitors approved by the U.S. Food and Drug Administration (FDA) for treatment of ED:
- Viagra (sildenafil) tablets, approved 1998
- Cialis (tadalafil) tablets, approved 2003
- Levitra (vardenafil) tablets, approved 2003
- Staxyn (vardenafil) dissolvable tablets, approved 2010
- Stendra (avanafil) tablets, approved 2012
Other treatments of erectile dysfunction include:
- Numbing cream
- Lidocaine spray
- Using more than one condom
- Masturbating a few hours before having sex
- Natural remedies can also be considered when treating premature ejaculation:
- Ayurvedic herbal medicine or Generic Medicine
- Chinese herbal medicine like Yimusake tablets or Qilin pills
- Zinc supplements
- Dietary changes
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Testosterone Replacement Therapy
A doctor may prescribe testosterone replacement therapy if a man is found to have a low testosterone level, along with other symptoms, such as low libido and ED.
That said, testosterone deficiency is uncommonly the primary cause of ED. Before you take testosterone, your doctor will have you tested to make sure that you do indeed have a deficiency.
Reviewing Current Medications
Taking a step back, besides taking a prescription, it’s equally if not more important to first review your current list of medications with your doctor. It is very possible that one or more of them may be causing or contributing to your erectile dysfunction.
While you may not necessarily be able to stop that medication, recognizing it as a potential culprit may at least help you and your doctor understand the “why” behind your erectile dysfunction.
Medications that classically cause erectile dysfunction as a side effect are antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), such as Zoloft (sertraline).
Other potential medications linked to erectile dysfunction include certain blood pressure medications and pain medications.
Pumps and Implants
A mechanical device may be worth trying if medication and other interventions don’t work.11
One option is a vacuum pump, a plastic tube that is placed over the penis. When air is sucked out of the tube it creates pressure that causes blood to be forced into the penis. A ring can then be temporarily placed at the base of the penis to stop the blood from draining away too quickly.
A penile implant is another option, of which there are two types. One type, called a semi-rigid penis implant, keeps the penis erect all the time, though it can be bent downward when you aren’t having sex. The other type, an inflatable two- or three-piece penis implant, includes a pump that’s implanted in the scrotum and can be squeezed in order to make the penis erect.
Low-Intensity Shock Wave Therapy
While not a conventional therapy, an emerging treatment for erectile dysfunction is low-intensity shockwave therapy.19 This treatment is still in the research phase, but entails delivering sound waves to the penis, which is believed to ultimately increase blood flow and, thus, improve erectile dysfunction.
Counselling
Research suggests that combining a psychological intervention with medication improves sexual satisfaction and symptoms of erectile dysfunction better than either therapy alone. This makes sense considering that even though ED is most often caused by a medical condition (e.g., heart disease or high blood pressure), stress and mental health problems, such as anxiety and depression, can exacerbate it.
Moreover, suffering from ED often has emotional consequences, which may negatively impact relationships or a person’s self-esteem.
If you are considering therapy for ED, consider seeing a certified sexual therapist or joining group psychotherapy, both of which have been shown to be beneficial for the patient and their partner.
Natural Remedies
Research has found that, to some extent, acupuncture can improve ED. While the precise mechanism remains unclear, experts suspect that acupuncture may help regulate nerve sensitivity and improve blood flow to the penis.
There are lots of herbs and nutritional supplements claiming to improve sexual function in general and to treat ED in particular. However, there’s very little research to prove that any of them actually work.
Options like red Korean ginseng, horny goat weed, L-arginine, L-carnitine, zinc, and niacin all have potential side effects when taken in high doses.
In addition, when research has shown a nutrient such as zinc or niacin to improve sexual function, it’s usually in people who are deficient in it. So before you stock up on over-the-counter supplements for ED, speak with your doctor. They can test you for deficiencies and steer you toward the most effective and safest way to treat your erectile dysfunction.
Conclusion
There are obviously a lot of treatment options available for ED, which in no small part is due to the fact that a healthy sex life is important for many people’s sense of well-being. That said, try not to get overwhelmed with all the different choices. It may take a bit of time and patience on your part, but under the guidance of your doctor, you can find the treatment that works best for you.
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