Erectile dysfunction (ED) is a medical condition where a man has a problem getting or maintaining an erection. Studies have shown that occasional ED is relatively common among adult males of any age. ED only becomes a concern if it is a frequent occurrence or an ongoing condition on its own.
For a healthy adult male, ED can be stressful and is a big blow to self-esteem. Males in their late teens and early twenties are usually more concerned with their sexual performance than older men. Experiencing an ED can be traumatic. It has also been the subject of countless jokes. The penis is a symbol of a males’ strength, and a flaccid penis at the wrong time can deflate the ego. Having a repeat of the experience can cast doubts on a person’s masculinity. At the same time, the partner may feel inadequate because of the male’s non-performance.
Until the 1990s, ED was not discussed in civil conversations. Not until the introduction of pills as ED cures was there an honest discussion about the topic.
Causes of Erectile Dysfunction
ED can be due to physical, medical, or psychological reasons. Both medical and psychological reasons can also cause it.
Medical and physical reasons
When a penis is aroused, nerves trigger a release of chemicals that increase the blood flow to the appendage. Inside the penis are two chambers made of muscle tissue. Called the corpus cavernosum, these chambers are not hollow, but these act like sponges. When the blood flows into these chambers, the tissues relax and trap the inflow of blood. The increased blood flow causes increased blood pressure in the chambers resulting in the penis getting firm and an erection.
An orgasm triggers a second set of signals that cause the corpus cavernosum to contract and releases the blood back into circulation, resulting in a deflated penis.
During ED, there is not enough blood that flows into the corpus cavernum. The lack of blood may be due to any of the following:
- Limited blood flow to the penis
- Damaged nerves which could not send the necessary signal for an erection
- Stress or other emotional reasons
- As a symptom of an early warning of a severe medical condition
- As a result of hormonal imbalance
Up to 90% of all ED cases are due to physical or medical reasons. The rest is due to psychological issues. Although rare, there are cases where a man may have always had ED. Called primary ED, this condition is usually psychological. There are anatomical deformities or physiological issues that can also cause primary ED. Secondary ED is when a man has experienced normal erections before, and now has problems getting hard. Secondary ED is usually physical or medical.
The following are some physical causes and medical conditions, which can cause ED:
- heart disease
- hypertension or high blood pressure
- high blood sugar due to diabetes
- atherosclerosis or hardening of the arteries
- High cholesterol levels
- thyroid conditions which cause metabolic syndrome
- Testosterone deficiency
- Smoking, alcoholism, recreational drug use, or substance abuse
- Treatments for prostate conditions
- Parkinson’s disease
- Multiple sclerosis
- Anatomical or congenital problems of the penis
- Complications from surgery
- Injuries to the spinal cord, lower back or the pelvic area
- Radiation therapy, specifically to the pelvic area
- Being over 50 years old
- Lack of exercise
Although medical conditions do not necessarily cause, ED, their treatment, and drug use related to these diseases can affect erection. The following medications are known to affect healthy erections:
- Anti-hypertension drugs
- Heart condition drugs like digoxin
- Anti-anxiety drugs
- Some painkillers
- Amphetamines, sleeping pills and other drugs acting on the central nervous system
- Drugs for treating prostate conditions
- Some cancer drugs, especially those used for chemotherapy
- Hormone drugs
- Anticholinergic drugs
- Cimetidine, a drug used for the treatment of peptic ulcer
Primary ED is usually due to psychological issues, including:
- A fear of commitment or intimacy
The above psychological problems can also cause secondary ED. Another psychological cause for ED is stress from work, school, or lifestyle. It is also possible to have ED due to stress, as well as to have stress as a side-effect of ED.
Besides stress, there are other psychological causes of ED, including:
- Conflicts with partners
- Work- or home-related stress
- Stress arising from social, religious, cultural, and other personal conflicts
- Anxiety-related to sexual performance
A man can also have both physical and psychological issues, which can lead to ED. One example is when a man is obese, which leads to ED. At the same time, his physical condition can lead to low self-esteem and emotional condition that can affect his erection.
Performance anxiety can be a concern if the man has experienced consecutive ED episodes. Anxiety can be particularly frustrating for men in their mid-twenties or younger.
A man who suffers from performance anxiety might find it difficult to break the cycle if he experiences ED more than once.
Diagnosis and Treatment of Erectile Dysfunction
ED is a symptom of some other condition. Understanding what caused it can lead to the correct diagnosis and proper treatment options. It is necessary to consult with your health care professional about your ED. The doctor will ask you about any cardiovascular problem or medical condition and your ED. It may be necessary to have a physical exam and lab tests before a referral to a Urologist.
During the consultation, the doctor will ask about you and your family’s medical history. The doctor will also ask about your daily health habits, and if you smoke or drink alcohol regularly. Answering the medical history questions is usually enough for the doctor to arrive at a diagnosis and recommend a treatment. For chronic health problems or some other underlying conditions, additional tests may be conducted.
The additional tests might include a physical exam, blood tests, urine tests, an ultrasound, and a physiological exam.
- Physical exam -- may include tests to determine if you have any heart condition, hypertension, thyroid problem, or diabetes.
- Blood tests. Among other things, the blood work helps determine your blood chemistry, cholesterol, and blood levels.
- Urinalyses. The test helps determine a person’s health.
- Ultrasound. The ultrasound is used to check for possible blood vessel blockage or any other physical problems which impact the blood supply to the penis.
- NPT. The nocturnal penile test determines if you have erections while you sleep at night. An older test is the postage stamp test, which is less reliable than the NPT.
After the lab exams, the doctor may suggest a pill, injections, or a mechanical device, besides losing weight and exercising. Commonly prescribed pills for ED include:
The above does not cause the arousal of the penis. Instead, it works by amplifying the nerve signal to the penile muscle. Once relaxed, healthy blood flow continues to the penis. You have to be aroused for the drug to work. Once a man is turned on, the penis begins to harden and rise.
What are the normal conditions
Under normal conditions, a man may experience erectile dysfunction be due to stress, anxiety, or a reaction to antihypertensive drugs. As a man grows older, the ED may become more frequent. At the age of 50, a man may no longer get hard strictly by fantasizing.
Even with ED, older men are still able to have sex. There is a correlation between keeping fit and having an active sex life after the age of 70.
Risks of Having Erectile Dysfunction
Erectile dysfunction occurs in up to 12% of men who are younger than 60 years old, up to 22% of men between the ages of 60 and 70, and up to 30% of men 70 years old and up.
Chronic ED is a symptom of many medical conditions, including atherosclerosis and heart conditions, but it does not lead directly to death. However, men younger than 50 years old should seek medical attention if they do not have erections for an extended period.
When to Seek Medical Attention
Chronic or ongoing ED is a symptom of a medical, physical, or psychological condition. Consult with a doctor if you suffer from ongoing ED.
It is usual for men to experience ED at some time in their life. If you experience frequent ED and it bothers you, causes undue stress and anxiety, or it interferes with your sexual relations, consult your doctor. The doctor can help clear up any misunderstanding or misinformation about ED. Some medications can assist with frequent ED.
If you are male, mid-20s, or younger, and have chronic ED, consult with your doctor. It may be the result of an undetected problem with your arteries or with your cardiovascular system. It can also be a symptom of diabetes.
A man can experience ED at any time in his life. There are drugs able to help those with ED. These ED drugs have different dosages and prescribed for different conditions and durations. Men without ED, those who have a healthy erection, are advised not to use prescription ED drugs. Normal men do not need erection-enhancing medicine.