Erectile dysfunction – also known as ED, or impotence – is when a man can’t get or maintain an erection long enough to have sex.
If you’re currently experiencing erectile dysfunction, you’re not alone. A 2018 scientific review estimated that around one-third of allmenin the world will suffer from erectile dysfunction at some point in their lives, with a 2019 review suggesting that number might be closer to 76.6%. Back home, a study by the Irish Heart Foundation revealed that 20% of men in Ireland aged 50-59 suffer from ED, climbing to 38% of men aged 60 to 69, and 57% of men over 70.
Here's your guide to everything you need to know about erectile dysfunction, including how to make it better.
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Symptoms
The most common symptoms of erectile dysfunction are:
- Sometimes you’re able to get an erection, sometimes not.
- Your erections aren’t as hard as usual or aren’t hard enough to have sex.
- You can get an erection, but you can’t keep it long enough to have sex.
- You lose your erection halfway through sex or foreplay.
- Sex doesn’t feel satisfying.
- You can get an erection through masturbation, but not through sex.
- You need increasing amounts of stimulation (like extreme porn, or different partners) to get an erection.
- You suffer psychological effects, (link to psychological impact blog) like feeling depression, guilt, anxiety or anger, due to not being able to have sex.
Causes
Erectile dysfunction can be caused by psychological issues, or physical issues. Sometimes it’s a combination or both. Here are the usual suspects.
Psychological causes of erectile dysfunction
According to research, 20% of erectile dysfunction cases are caused by psychological issues. Mental or emotional problems – even minor ones -- can interfere with your ability to get or keep an erection. Psychological ED triggers can include:
- Stress.
- Depression.
- Nerves or performance anxiety.
- Relationship problems.
- Emotional abuse.
- PTSD.
- Sexual abuse.
- Low self-esteem.
- Addiction to pornography.
Erectile dysfunction can also cause psychological problems, like depression and anger, which create a spiral of problems that prolong the ED.
Learn more about the psychological impact of erectile dysfunction here.
Physical causes of erectile dysfunction
Most cases of ED are caused by physical issues. Many of these are age-related, but some can be caused by illness or just living a party lifestyle. The most common physical causes are:
- Diabetes.
- Heart disease.
- High cholesterol.
- Surgery for bladder or prostate cancer.
- Surgery or trauma to the spinal cord.
- Low testosterone.
- Multiple Sclerosis.
- Peyronie’s Disease.
- High blood pressure (hypertension).
- Obesity.
- Alcohol and smoking.
- Other medications.
When to see a doctor
Most men will experience some erectile dysfunction at some point. You don’t have to call an ambulance if you fail to perform one night. But if you suffer from erectile dysfunction that gets worse, or doesn’t go away after a few weeks, it’s a good idea to see a GP. This isn’t just to get help for the erection problems, it’s also because ED can be a symptom of serious illnesses like heart disease, high blood pressure or diabetes, that can be life-threatening.
The good news just keeps coming, right?
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As well as checking your overall health, a doctor can also discuss the different treatment options erectile dysfunction.
Diagnosis
Erectile Dysfunction is diagnosed by a doctor after taking a full patient history, and (if in person) a physical examination of your penis and testicles. Your overall health will be assessed, with a blood-pressure reading and possibly a blood test to check your testosterone and cholesterol levels, and to look for diabetes.
During the appointment you’ll be asked if there might be any psychological reasons for your erectile problems, like ongoing stress, depression, or emotional issues. If a psychological cause is suspected, you might be referred to a counsellor or therapist.
If the physical examination shows any issues, you’ll be referred to a specialist, usually a urinology consultant.
Treatments
NOW we can get to the good news.There are many different treatment options for erectile dysfunction, and around 80-90% of cases can be successfully treated. Read that again.
The most common treatments are:
Lifestyle changes
If you’ve simply been burning your candle at both ends, so to speak, you’ll be put on a healthy regime. Many cases of ED are caused by a general lack of fitness. Your GP will suggest that you start with:
- Losing weight.
- Reducing alcohol and tobacco.
- Increased exercise.
- Stress management.
- Counselling.
Read more about natural remedies for erectile dysfunction here.
Medication
If you’re in good shape and there aren’t any obvious reasons why you’ve developed ED, your doctor might suggest medication. These are suitable for most people, although men with heart problems can’t take PDE-5 inhibitors.
- Pills such as Phoshodiesterase-5 (PDE-5) Inhibitors. (For example, the classic little blue pill.) They work by temporarily increasing blood flow to your penis.
- Vasodilators that work by widening the blood vessels in your penis. Can be applied as a cream, suppository or injection.
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Penis pump
If you’re the gadget-loving type, you can try a Penis Pump. This is a handheld device that creates a vacuum around the penis, herding blood inside like a lusty sheepdog. The effects are almost immediate.
Penile Implant
Penile Implants (also known as Penile Prostheses) are recommended only for men who’ve permanently lost their ability to achieve an erection – for example, after bladder or prostate cancer treatment. Implants are fitted during surgery.
Low Intensity Shockwave Therapy (LiST)
An emerging treatment for erectile dysfunction is shockwave therapy. And yes, it’s exactly what you dread it could be: electric shocks delivered straight into your manhood. So far it’s still in clinical trials, but it is showing promising effects for men suffering from vascular ED. Definitely don’t try this at home.
Read more about all the treatments for erectile dysfunction here
Preventing Erectile Dysfunction
Generally, erectile dysfunction is a side effect of getting older. It’s much more likely to happen to men after the age of 40. Unless you plan on living fast and dying young, you can’t avoid the risk of ED completely.
However, there are steps you can take to minimise your risk of ED.
Maintain a healthy weight
Erectile dysfunction is much more common in men who are overweight. Maintain a healthy BMI.
Don’t smoke
The longer you smoke, the greater your chances of experiencing erectile dysfunction. If you smoke, quit now. Today. Certainly before tonight. And don’t just switch to vaping; new research is suggesting vapes might also be a risk factor for erectile dysfunction.
Exercise
Protect your heart, protect your parts. Most erectile dysfunction is caused by vascular issues, so do everything you can to keep your blood pumping. Regular exercise is excellent. Plus, strength training (with weights) can also give your testosterone levels a boost. There’s little evidence that cycling causes ED, but one study suggested that reclining bikes might be healthier for your penis than upright bikes.
See your doctor
Start attending all those “Well Man” check-up appointments you usually ignore. A major cause of erectile dysfunction is having to have radical treatment for prostate problems.
Limit your use of pornography
Try not to become addicted to pornography. Evidence is mounting that excessive masturbation – specifically when watching porn – might be causing men to develop ED at a young age. There’s no clear clinical link yet, but recent statistics suggest some correlation. In 1992, about 5% of men experienced ED at age 40, according to the U.S. National Institutes of Health. But in 2012, a Swiss study found the condition among a third of men aged 18 to 25.
How do I help my partner with erectile dysfunction?
If your partner suffers from erectile dysfunction, they’ll rely on you to be supportive, understanding and kind. There are several ways you can help them, including a sexual therapy technique known as Sensate Focus.
Read more about how to help your partner with erectile dysfunction here.
Further reading
This blog was written by Kate Taylor, a Sex Expert, Sex and Dating Features Writer, columnist and author of five books, for HealthHero.ie.
