What is erectile dysfunction
Erectile dysfunction is the inability to develop and maintain an erection for satisfactory sexual intercourse or activity in the absence of an ejaculatory disorder such as premature ejaculation. Erectile dysfunction is the preferred term rather than impotence. There are no universally agreed criteria for how consistent the problem has to be and for what duration it needs to be present to fulfill the definition. A period of persistence of longer than 3 months has been suggested as a reasonable clinical guideline.
Since the 1990s, there has been increasing recognition that erectile dysfunction (ED) is a common problem. Increasing awareness of effective treatment strategies on behalf of patients, effective advertising by drug companies, and acknowledgement by health care providers that screening may help identify cardiovascular and other medical risks have led to higher rates of reporting, diagnosis, and treatment of ED.
Does erectile dysfunction mean poor libido?
ED refers specifically to problems achieving or maintaining an erection. Other forms of male sexual dysfunction include poor libido and problems with ejaculation. Men with ED often have a healthy libido, but their bodies fail to respond in the sexual encounter by producing an erection. Usually there is a physical basis for the problem.
How common is erectile dysfunction
ED varies in severity; some men have a total inability to achieve an erection, others have an inconsistent ability to achieve an erection, and still others can sustain only brief erections. The variations in severity of ED make estimating its frequency difficult, but it is estimated to affect about 50% of men over the age of 40. Many men also are reluctant to discuss ED with their doctors due to embarrassment, and thus the condition is underdiagnosed. Nevertheless, experts have estimated that ED affects 18 to 30 million men in the United States.
While ED can occur at any age, it is uncommon among young men and more common in the elderly. By age 45, most men have experienced ED at least some of the time. According to the Massachusetts Male Aging Study, complete impotence increases from 5% among men 40 years of age to 15% among men 70 years and older. Population studies conducted in the Netherlands found that some degree of ED occurred in 20% of men between ages 50-54 and in 50% of men between ages 70 to 78. In 1999, the National Ambulatory Medical Care Survey counted 1,520,000 doctor-office visits for ED. Other studies have noted that approximately 35% of men 40 to 70 years of age suffer from moderate to severe ED, and an additional 15% may have milder forms. Further studies report similar findings.
Discussing erectile dysfunction with your partner
It’s natural to feel angry or embarrassed when confronted with ED. Remember too that your partner is also affected. Talking openly about ED with your partner will help them understand the diagnosis and treatment options (and will reassure your partner that you haven’t lost interest).
Erectile dysfunction symptoms
Symptoms of ED include erections that are too soft for sexual intercourse, erections that last only briefly, and an inability to achieve erections. Men who cannot have or maintain an erection at least 75% of the time that they attempt sex are considered to have ED.
Is erectile dysfunction a sign of heart disease?
ED can be a warning sign of serious underlying disease. Research has found that ED is a strong predictor of heart attack, stroke, and even death from cardiovascular disease. All men with ED should be evaluated for cardiovascular disease. Notably, this does not mean every man with ED will develop heart disease, or that every man with heart disease has ED; however, ED patients should be aware of the link.
Drugs for erectile dysfunction
Oral medications are often the first line of treatment for ED. For most men who have trouble keeping an erection firm enough for sex, these medications work well and cause few side effects.
Sildenafil (Viagra), Vardenafil (Levitra, Staxyn), Tadalafil (Cialis) and Avanafil (Stendra) are oral medications that reverse ED by enhancing the effects of nitric oxide, a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.
Although they work in similar ways, each oral medication has a slightly different chemical makeup. These minor differences affect the way each medication works, such as how quickly it takes effect and wears off, and the potential side effects. Your doctor will consider these factors as well as any health problems you have and possible interactions with other medications you take.
- Sildenafil (Viagra). This medication is most effective when taken on an empty stomach one hour before sex. It’s effective for up to six hours.
- Vardenafil (Levitra, Staxyn). This medication also is most effective when taken one hour before sex and can be taken with or without food. It’s effective for up to seven hours.
- Tadalafil (Cialis). This medication is taken with or without food about one to two hours before sex. It’s effective for 36 hours. It can be taken in a small dose daily or in a larger dose as needed.
- Avanafil (Stendra). This medication is taken with or without food 15 to 30 minutes before sex, depending on the dose. It lasts up to six hours.
VIAGRA at 100 mg or 50 mg helped about 8 out of 10 men get and keep erections hard enough for sex.
A 20 mg Cialis dose works in as little as 30 minutes in some men.
For most men, the recommended starting dose of Levitra is 10 mg pill.
Is erectile dysfunction inevitable
Age does appear to play a role in ED. The older you get, it may take you longer to get an erection, and it may not be as firm as it was when you were younger.
But getting older does not cause ED, it only increases your chances of getting it. In fact, ED can affect men of all ages.
A recent study showed 1 in 4 patients going to the doctor for the first time for ED was under age 40. And almost half of them had severe ED when compared to older patients. The younger patients smoked cigarettes and used illicit drugs more than the older men, as well.
Is it possible to prevent erectile dysfunction?
Prevention of some of the causes that contribute to the development of ED can decrease the chances of developing the problem. For example, if a person decreases their chances of developing diabetes, heart disease, and hypertension, they will decrease their chances of developing ED. Other things like stopping smoking, eating a healthy diet (heart-healthy with adequate vitamin intake), and exercising daily may also reduce a person’s risk.
How is erectile dysfunction treated
If you think you have ED, a good first step is to talk with your doctor. The treatment you need will depend on what’s causing it.
You may find that simple lifestyle changes will help, like losing weight, drinking less alcohol, or quitting smoking.
If a medication is causing your ED, your doctor may lower your dose or try a different drug altogether.
There are also other treatments. They include:
If anxiety or stress is causing your ED, it may help to talk to a professional therapist.
Life-changing problems or even everyday stress can trigger ED. Talking about these things with a licensed therapist can ease sexual anxiety and help you feel more confident in your relationship.
Usually you’ll only need a handful of sessions. You may want to include your partner, as well.
ED medicines can be pills, drugs inserted into the tip of the penis, or injections into the penis.The first things doctors usually prescribe to men with ED are pills like:
- Avanafil (Stendra)
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra, Staxyn)
They are taken anywhere from 15 minutes to 36 hours before having sex, depending on the drug. You shouldn’t use these more than once a day. Staxyn dissolves in the mouth. The other medications are swallowed. These pills work for about 80% of men who take them. But if your erection lasts more than 4 hours, seek emergency medical help.
A vacuum device improves firmness by boosting blood flow to the penis. About 80% of men who use the device correctly get an erection hard enough for sex. A vacuum device can be cumbersome. It also will hinder spontaneity. The elastic ring may lead to skin irritation, bruising, loss of feeling or sensitivity, or pain. Vacuum devices are available with or without a prescription. Talk to your doctor before getting one.
If all other ED treatments have failed, your doctor may recommend surgery.
Vitamins and supplements for erectile dysfunction
There are many vitamins and supplements on the market that claim to help ED. Some promise better sexual function as well as increased energy and vitality. However, these supplements usually don’t work. They may also be unsafe. Some supplements that are marketed as “natural” may even contain drugs. ED supplements can still interact with other medications you’re taking. They may also cause side effects. Talk to your doctor before using any vitamins or supplements for ED.
Why does erectile dysfunction happen
ED can have a range of causes, both physical and psychological. Physical causes include:
- narrowing of the blood vessels going to the penis – commonly associated with high blood pressure (hypertension), high cholesterol or diabetes
- hormonal problems
- surgery or injury
Psychological causes of ED include:
- relationship problems
Sometimes ED only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection but you are unable to get an erection with your sexual partner.
If this is the case, it is likely the underlying cause of ED is psychological (stress related). If you are unable to get an erection under any circumstances, it is likely that the underlying cause is physical.
ED can also be a side-effect of using certain medicines.
Lifestyle choices can cause erectile dysfunction
Lifestyle choices, such as smoking, alcohol abuse, and obesity can impair blood circulation and lead to ED. Smoking, excessive drinking, and drug abuse may damage the blood vessels and reduce blood flow to the penis. Smoking makes men with atherosclerosis even more vulnerable to ED. Smokers have almost twice the risk of ED compared with nonsmokers. Being overweight and getting too little exercise also contribute to ED. Men who exercise regularly have a lower risk of ED.
Sexual dysfunction and long-term opioid use
Many factors can influence ED, including smoking and depression. One study concluded that 20 percent of patients receiving high-dose long-term opioids had evidence of sexual dysfunction. Long-term opioid use may also cause female sexual dysfunction, but evidence is scarce
Erectile dysfunction diagnosis
To diagnose ED, the doctor will ask questions about the symptoms and medical history. A complete physical exam is done to detect poor circulation or nerve trouble. The physician will look for abnormalities of the genital area that could cause problems with erections.
When to call your doctor
Pick up the phone if your ED worries you so much that it causes anxiety or threatens your sexual relationship. At the very least, your doctor can clear up misinformation, which often makes sexual problems worse. Sometimes taking medication for a short time can get you through a rough patch, too.
Also talk to the doctor if it’s painful to get an erection or difficult because your penis is curved (a condition called Peyronie’s disease).
If the problem doesn’t go away, it could be an early warning sign of a more serious, larger condition. For example, the penile artery can get narrower because of coronary artery disease or diabetes.
To help your erections, your doctor may suggest taking medication as a pill or as an injection in your penis, or using a mechanical device. And you’ll need to deal with the underlying medical condition, too.