From swear words to phallic imagery to sex-soaked action thrillers, male virility always seems at the forefront of the pop culture lexicon, and the penis is often enshrined as a part of that – a symbol of power, strength and, of course, manhood.
Is it any wonder that as a result, conversations around what happens when your erectile function is lacking are so often had on the fringes?
We understand more so than ever that erectile dysfunction and decreased libido is something experienced by most men at some point in their life, but the nature of the world doesn't always make it easy to talk about.
So let's talk about it! From risk factors to erectile difficulties, and sexual stimulation to medical treatments, this article has everything you need to know about navigating erectile dysfunction.
What is erectile dysfunction?
Erectile dysfunction, also known as impotence, occurs when men are unable to get an erection, or stay erect long enough to have penetrative sexual intercourse [1].
There are many components to getting an erection, but when it comes to erectile dysfunction, there are 2 factors that can be at play: the reflex erection and the psychogenic erection [3].
The reflex erection is basically physical stimulation. It's achieved by the penis being directly touching, either by yourself or by a sexual partner, activating the peripheral nerves and lower parts of the spinal cord, while the psychogenic erection is achieved by erotic or emotional stimuli, and uses the limbic system of the brain.
In other words, your reflex erection is when you or someone else touches your penis, and the psychogenic erection is when you see or think about something that stimulates sexual desire [3].
Problems with one or both of these can lead to erectile dysfunction, which is something scientists and doctors have only recently come to understand. For a long time, it was believed that erectile dysfunction was purely psychogenic, but recent studies have found that more than 80% of cases are caused by an underlying physical concern [3].
In other words, it's not all (or at least, it's not just) in your head.
So, what causes erectile dysfunction then?
There are many things that have been found to have an impact on erectile function and sexual dysfunction, and they range from medical conditions and health issues such as heart disease and digestive and kidney diseases to lifestyle factors, mental health concerns and circumstantial issues.
Physical illness
Many physical illnesses contribute to erectile dysfunction, particularly illnesses that affect blood flow and blood supply to and in the penis.
Conditions such as diabetes mellitus, kidney disease, peripheral vascular disease, high cholesterol, high blood pressure, hypertension, obesity and multiple sclerosis all have been found to create a high risk for erectile dysfunction [4].
On top of that, recent clinical studies have shown that erectile dysfunction can be a symptom of cardiovascular disease and coronary artery disease, and often increases the risk factor for heart attacks and other cardiovascular events [3].
There are also indicators that erectile dysfunction has a relationship with Lower Urinary Tract Symptoms (LUTS) in men with prostate cancer or benign prostate swelling [3].
Regardless of whether it's vascular disease, high blood pressure or high cholesterol, erectile dysfunction itself is presenting as a symptom of a more serious health issue, which is why it's imperative that ongoing erectile dysfunction is discussed with a doctor.
Physical lifestyle factors
Erectile dysfunction, particularly more occasional bouts of it, are often caused by lifestyle factors that affect blood flow.
These range broadly from general aging to alcohol consumption, cigarette smoking, vaping and recreational drugs, and while you can't reverse the march of time, reducing your consumption of alcohol, cigarettes and drugs can be a good place to start to see if it improves your sexual function [1].
Psychological factors
While 80% of cases are now thought to have a physical root to them, mental health considerations can impact your body's ability to generate sexual arousal.
From stress at work to depression and anxiety, psychological considerations are important to take into account, especially as they can form a self-perpetuating cycle with other risk factors.
After all, erectile dysfunction can have emotional consequences as it impacts healthy sex lives, and as a result, relationships, mood and quality of life [3].
Certain medications
Some medications, especially prescription drugs such as high blood pressure medications, anti-depressants and medications for prostate cancer, can worsen the symptoms of erectile dysfunction, even causing erectile failure [2].
If you have concerns about this, speak to your doctor about alternative treatments.
How is ED diagnosed?
Erectile dysfunction can range from occasional to ongoing, and while occasional moments of sexual dysfunction are often more symptomatic of lifestyle factors, any ongoing issues should be discussed with a doctor.
When you talk to your doctor, they'll have a look at your complete medical history, as well as your sexual history, seeking out any existing risk factors.
Your doctor's goal will be to work out if there is an underlying cause and treat that first, which will hopefully ultimately serve to also treat your erectile dysfunction [2]. If it doesn't though, your doctor will talk to you about medical treatment that can support your sexual function.
What per cent of males have erectile dysfunction?
Issues with erectile dysfunction and erectile failure are really common, particularly as men age, with many sources estimating that 1 in 5 men over the age of 40 is likely to experience ongoing problems with this sort of sexual function [1].
Other studies such as the Massachusetts Male Ageing Study found that 52% of men between 40 and 70 were found to have some degree of erectile dysfunction [5].
Because of the range of causes, how we treat ED is going to vary, but it's important to acknowledge that erectile dysfunction can drastically affect a man's quality of life, with most men experiencing symptoms of depression and anxiety related to sexual performance [5].
In this sense, the medical and psychosocial correlates, and the treatment of erectile problems should be handled sensitively.
Treating erectile dysfunction
Luckily, there are many treatments for erectile dysfunction that are designed to help you reclaim your erection and your sex life. These range from non-invasive treatments to minimally invasive treatments to surgical treatments [2].
Non-invasive treatments
If you're seeking treatment for erectile dysfunction, non-invasive treatments are the best place to start.
Pilot's clinical erectile dysfunction treatment helps improve blood flow in the penis and in turn, help men maintain firm erections throughout sex and has helped improve the sex lives of 94% of patients [7].
External devices such as vacuum penile pumps or rubber rings can also be useful. In the case of the former, it stimulates blood flow into erectile tissue which helps you to maintain an erection, while the rubber ring is better in cases where men have difficulties maintaining erections or with premature ejaculation. It rests around the base of the penis and helps keep it hard [2].
Minimally invasive treatments
Some treatments for erectile dysfunction are more invasive and usually recommended in situations where non-invasive treatments aren't working. The main types of this treatment include:
- Injections directly into the penis. These have been found to be a successful form of therapy to treat ED, and are most useful for men who fail to respond to oral medications [6]. They can create an erection within 5-10 minutes that will last for up to an hour [2].
- Testosterone supplementation or testosterone replacement therapy. These are only suitable for men who have low testosterone, and should only be used after an investigation by your doctor into what the cause of that low testosterone may be [2].
Surgical treatments
Surgical treatments are not common for erectile dysfunction and are really only utilised if you have contraindications to non or minimally invasive treatments, or have penile fibrosis or penile vascular insufficiency [3].
- Penile prosthesis surgery and penile implants. This is a device that's surgically implanted into the penis and helps you to get an erection by squeezing on a part of the device [3].
- Vascular surgery targets the veins and arteries that supply blood to the penis and is a major and rare surgery [2]. It's also been found to have mixed results, so isn't often recommended as a treatment for erectile dysfunction [6].
If you're unsure where to start but want to address your erectile dysfunction and improve sexual function, we're here to help. Our erectile dysfunction treatment plan is administered completely online.
Simply take an online consulatation with our Aussie practitioner and they will help you find the right course of action for any established or developing ED, and deliver you custom medical treatments discretely to get you back to where you want to be.
Photo credit: Unsplash + Tatiana Rodriguez
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