Erectile Dysfunction Causes To Know—and Ways To Treat the Condition

Some people have an "off" night occasionally. While it may be frustrating, it usually isn't any cause for concern. But what if someone, time and time again, is having trouble getting and keeping an erection? Known as erectile dysfunction (ED), that continued inability to have an erection may not only be stressful, but it may also be a sign of an underlying health condition.

Here's what to know about ED, including its symptoms, causes, and treatment, as well as how to prevent it and talk to your partner about it.

What Is Erectile Dysfunction?

Erectile dysfunction is the inability to get and maintain an erection adequate for penetrative sex. ED affects as many as 30 million people in the U.S., making it the most commonly reported sex problem for people with penises. Even though it's common, ED is not a normal part of aging.

Symptoms

Any of the following symptoms can be a sign of ED:

• Having an erection sometimes but not every time you want to have sex
• Having an erection but not having it last long enough for penetrative sex
• Being unable to get an erection

Causes

Erectile dysfunction can result from a problem involving the vascular, nervous, or endocrine systems. The causes of ED can be physical, psychological, or a combination of both.

Physical Causes

Often, ED is a symptom of another health problem. So even though people may find it embarrassing to approach their healthcare provider with concerns, doing so can help uncover a more serious underlying condition.

There are a lot of factors affecting your different systems that can be behind ED:

Vascular system

"The most common cause for ED is not getting enough blood flow into the penis, which could be due to atherosclerotic disease of the cavernosal arteries responsible for supplying blood to the penis," said Darshan Patel, MD, assistant professor of urology at UC San Diego Health. "Because the arteries of the penis are half the size of the arteries to the heart, they can clog about three to five years sooner and are a warning sign of a future heart attack or stroke."

High blood pressure and high cholesterol also contribute to the narrowing of the arteries that allow blood into the penis, leading to ED, according to Tobias Kohler, MD, professor of urology at the Mayo Clinic and secretary of the Sexual Medicine Society of North America (SMSNA). On the other hand, medications used to treat these conditions, like beta-blockers and thiazide, can cause ED.

Nervous system

Trauma or damage to the nerves that feed into the penis also causes problems with erections. Spinal cord injuries and conditions like multiple sclerosis, Parkinson's, and spina bifida affect these nerves, making it more challenging to sustain intercourse.

Diabetes is another condition that can lead to nerve damage. Known as diabetic neuropathy, the nerve damage can affect the genitals and urinary tract. In fact, those who have diabetes are more than three times more likely to develop ED than those who do not have diabetes.

Other physical causes

These are some of the other potential causes of ED:

• Injury from treatments for prostate cancer (i.e., radiation therapy and prostate surgery)
• Chronic kidney disease
• Peyronie's disease (the development of scar tissue inside the penis)
• Some prescription medications (antidepressants, antihistamines, chemotherapy, etc.)

Something that could be the cause but likely isn't? Low testosterone. Low testosterone can cause symptoms such as decreased sex drive, decreased energy, and erectile dysfunction. Symptoms may be alleviated with testosterone replacement.

Psychological Causes

Worrying about your sexual performance or psyching yourself out makes the situation worse. "If a guy has a bad night, he may start freaking out that something is wrong, and he gets scared. Fear causes your body to release adrenaline, and then its light's out. Nothing's going to work," said Dr. Kohler.

Adrenaline sends blood to your heart, brain, and lungs and away from organs like the penis as part of the fight-or-flight response. Besides fear of sexual failure and anxiety about sexual performance, guilt about certain sexual activities, as well as low self-esteem, are other psychological/emotional factors that can lead to or worsen ED.

Depression, anxiety, and stress also lead to lower sex drive, less energy, and problems with erections. Unfortunately, medications to treat those conditions have side effects that can exacerbate the issue. Talk to your healthcare provider if this is the case.

Risk Factors

"The most common risk factors for ED are linked to lifestyle choices that can disrupt blood flow and circulation, like smoking, excessive alcohol use, poor diet, stress, and lack of exercise," said Dr. Patel.

Age is another important risk factor. "As you get older, the blood vessels themselves are not as robust, and you're more at risk for other medical problems," said Dr. Kohler.

Treatment

If you experience symptoms of ED, it's important to see your healthcare provider or a urologist. They'll complete a physical exam and ask you to provide a thorough medical history. "Typically, that's all that's needed to diagnose ED, but if your doctor suspects an underlying medical complication, you might need further testing or be referred to a specialist," said Dr. Kohler. Sometimes, treating an underlying condition is enough to reverse ED. If it's not, you may want to consider making some lifestyle changes.

Lifestyle Changes

When treating ED, Dr. Kohler and Dr. Patel said patients get the biggest bang for their buck by improving their overall health first. Reaching a healthy weight, exercising regularly, eating healthy, limiting alcohol intake, and quitting smoking can lead to the most lasting improvements.

Medications

Beyond lifestyle changes and treating the underlying cause, many other safe and effective ED treatments are available, including medications. The following medications work by relaxing smooth muscles and increasing blood flow in the penis during sexual stimulation:

• Avanafil (Stendra)
• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra, Staxyn)

You should not take any of these medicines to treat ED if you are taking nitrates to treat a heart condition.

Besides medication, someone might also get treated for ED with the following:

• Penile injection therapy: Patients are taught to self-inject a medication called alprostadil through a small needle at the base of the penis five to 10 minutes before sexual activity. This medicine can also be inserted as a suppository into the urethra.
• Vacuum erection devices: A clear plastic cylinder with an opening at one end is placed over the penis. A pump then connects to the cylinder, drawing out air and creating a vacuum. Once the penis is erect, the user places an elastic ring at the base of the penis, reducing blood flow out.
• Penile implant surgery: A penile implant or prosthesis is surgically inserted into the penis. Before having sex, you use a pump in the scrotum to fill the penis with fluid. After, you can deflate the device to return to your normal state. Surgery is the most reliable therapy for providing patients with the ability to get an erection on demand and is generally recommended after other treatment options have failed, according to Dr. Kohler.

"Many clinics also market supplements specifically for erectile dysfunction or low testosterone, but it's important to know there's not much research behind their effectiveness," Dr. Patel said. "For the most part, these supplements just contain lower doses of things like Viagra."

Therapy or Counseling

If the cause of your erectile dysfunction is psychological, you should consider seeking therapy or counseling as a treatment. This may involve treating symptoms of anxiety or depression as well as any stress you may have regarding sex.

Prevention

"I tell patients if you take good care of your health, your penis will take good care of you," said Dr. Kohler. "Things like eating a healthy diet, exercise, and quitting smoking are powerful for both preventing dysfunction and curing it. With care, you can have great sexual function into your 70s and 80s."

Here are more tips from Dr. Kohler and Dr. Patel on what you can do to prevent ED:

• Get regular check-ups with your healthcare provider to monitor your blood pressure and cholesterol
• Get adequate sleep
• Reduce stress at work and home
• Address mental health issues with a healthcare provider or therapist

Advice for Couples

Erectile dysfunction can put a strain on a relationship, especially when partners don't talk openly about what's going on. Dr. Patel said many resources could help start the conversation, like online forums, podcasts, and sex therapy.

If you're the partner of a loved one struggling with erectile issues, consider the following tips from Dr. Kohler:

• Formulate a plan. Dr. Kohler advised couples to be bold, have courage, and set up an appointment with a healthcare provider. Come with an open mind, ready to discuss what's happening, and set up a treatment plan.
• Help your partner talk to their healthcare provider. You may be able to remember changes or symptoms your partner has forgotten that are important for the healthcare provider to know.
• Help your partner with therapy. You can help your partner to adhere to the plan you've developed with the healthcare provider.
• Understand the physiology and psychology of sexual function. Once you know more about the underlying causes, you can help your partner understand why ED happens and make it less embarrassing. You can also learn more about your role in treatment options.

A Quick Review

Erectile dysfunction is a common issue that many people struggle with. A wide array of causes include lifestyle changes, underlying health conditions, or psychological causes. If you have had difficulty getting and/or maintaining an erection, discuss your symptoms and medical history with a healthcare provider. They will be able to determine the cause and ultimately help you formulate a treatment plan.