10 Things You Need to Know About Erectile Dysfunction

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Erectile dysfunction (ED) is way more common than you might think—it affects half of men over 40. While there are many detailed tests available to diagnose ED, most cases can be picked up during a visit with the doctor with two questions: “How’s your sex life? Everything working all right?”
Here are ten other things that may surprise you about ED.

  1. The most common cause in men over 50 is vascular disease. In fact half of all cases in men over 50 are from vascular disease (relating to blood vessels). This includes coronary artery disease/heart attack,peripheral vascular disease, and high blood pressure. Radiation treatment from prostate cancer can also damage the vessels.
  2. What other “organic” causes of ED are common? In addition to vascular causes there are neurogenic (related to the nervous system), Peyronie’s disease, medication side effects, and endocrinologic causes (low testosterone).
  3. How do I know if vascular damage is why I have ED? You’ll need a referral to a urologist. It sounds awful but a direct injection of prostaglandin E1 (Caverject) into one of the corpora cavernosa is the way to make this diagnosis. Corpora cavernosa are three expandable erectile tissues along the length of the penis, which fill with blood during erection. If the vasculature is normal, an erection should develop in minutes. If an erection occurs (indicating you don’t have vascular damage) this test also lets you know that penile injections are a possible therapy. 

  4. What Medications can cause ED? One in five cases of ED is a medication side effect. Always look for these, it’s such an easy fix. Here are the most common offenders:
  5. Is it all in my head? Contrary to what most people think, the least likely form of ED is what we call “pure psychogenic ED.” Pure psychogenic ED is relatively uncommon. Some clues are the presence of good nighttime and morning erections and normal findings on all other tests. A sidenote is that almost 100% of men with severe depression have ED.
  6. What if I have both, an organic and psychogenic cause? Men with an organic cause of ED can ALSO have a psychogenic component and a clue to that is highly variable erections that can be absent one day but normal the next.
  7. What Treatment options improve ED? Oral PDE-5 inhibitors are the usual treatment. Sadly, they are all expensive brand name drugs that include Viagra (sildenafil), Levitra (vardenafil), Cialis (tadalafil), and Stendra (avanafil).
  8. What are the main differences between the ED meds? How fast they work and how long they last. Viagra and Levitra both have a half-life of approximately 4 hours while Cialis is 17.5 hours. Viagra and Levitra don’t work as well when taken along with high-fat foods, and Cialis is unaffected by fat intake. Stendra has a slightly faster onset and shorter duration than Viagra and Levitra.
  9. Can I take ED meds if I have heart issues? Not if you’ve had a stroke or heart attack in the last 6-8 weeks or are having chest pain. But for those with stable heart issues several studies examining the cardiac effects of  Viagra and Cialis have been reassuring showing no increased risk of cardiovascular events in comparison with placebo.
  10. Exercise. For those with ED related to vascular disease, interval and continuous aerobic training has been shown to improve ED.

Dr O.

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