Erectile Dysfunction

What is erectile dysfunction (ED)?

Erectile dysfunction (ED) is when you regularly have difficulty getting an erection or keeping enough of an erection to have satisfying intercourse. All men will have this on occasion. But when it happens more often than not, this is a symptom of ED, or impotence. 

You may have heard of it, but you may not realize how common it is. Almost 20% of men over age 20 report some degree of ED. It’s less common in younger men: For men between ages 20 and 39, that number is 5%. But it increases with age. About half of men over age 65 report experiencing ED. 

Thankfully, treatments are available for ED. They’re generally safe and effective in about 70% of cases. There are also other types of problems with sex. And some people have these along with ED: 

• Low libido: when you have little or no interest in sex 

• Premature ejaculation: ejaculating too soon after sex begins 

• Anejaculation: being unable to ejaculate at all (even though you can get and keep an erection) 

Treatments for ED won’t help with low libido, premature ejaculation, or other ejaculation problems.

What are the different types of erectile dysfunction?

ED can be broadly broken down into two types: organic and psychogenic. Keep in mind that ED is often the result of many factors. That means more than one type may be at play at any given time. 

Organic ED

Organic ED has some physical causes. The older a person is, or the more health problems they have, the more likely they are to have organic ED. Some of the types of organic ED include:

• Vascular ED: This happens when a person has high blood pressure, clogged or leaky blood vessels, or some other blood vessel dysfunction. This is the most common type of ED in older men.

• Hormone-related ED: Endocrine causes of ED happen when hormones like testosterone, thyroid hormone, or prolactin aren’t made in the right amounts or don’t work properly.

• Neurologic ED: This occurs when the nerves that coordinate erection aren’t working as they should. Common conditions can lead to neurologic ED including diabetes, multiple sclerosis, head trauma, or any condition that affects the brain, spinal cord, or nerves.

• Iatrogenic ED: This type of ED is unintentionally caused by medical or surgical treatment. Radiation therapy and medications are two common causes of iatrogenic ED. Surgery that damages the nerves, blood supply, or structure of the penis can also result in iatrogenic ED.

• Structural ED: Structural ED happens when a physical attribute of the penis, blood supply, or nerves prevents a satisfactory erection. Some causes of structural ED are Peyronie’s disease, penile trauma, chronic inflammation, and cancer.

Psychogenic ED

Psychogenic ED is due to the psychological difficulties a person is dealing with. To get a satisfactory erection, your mind and body have to work together. So, various mental health challenges can affect your sexual performance, including: 

• Depression: Depression can lead to reduced desire. And desire is needed in order to be excited enough to get an erection. Men with depression are 40% more likely to have ED as those without it.

• Anxiety: General anxiety and performance anxiety can make it difficult to achieve and maintain an erection. Men with anxiety disorders have been considered more at risk for developing ED.

• Relationship issues: Partner-related concerns may cause ED. Feelings like guilt, unresolved conflicts, anger, bitterness, or that you can’t satisfy your partner can make erections difficult.

What causes erectile dysfunction?

ED can happen to anyone at any age. That said, you’re more likely to get ED as you get older. 

You’re also more likely to get ED if you:

• Smoke: Smoking damages the nerves and blood vessels that are critical for an erection.

• Drink alcohol heavily: Alcohol is a central nervous system depressant. It can suppress sexual arousal, which is necessary for developing an erection. Alcohol can also negatively impact your ability to have an orgasm.

• Have high blood pressure or heart disease: A healthy blood supply to the penis is necessary for an erection. High blood pressure and heart disease may be signs that those vessels are damaged.

• Have diabetes: Diabetes can damage the nerves and blood vessels that supply the penis. 

• Have depression, anxiety, or high stress levels: Depression, anxiety, and stress can negatively impact the balance of hormones and neurotransmitters required for getting and maintaining an erection. 

Other causes of ED include: 

• Hormonal imbalances (like Low-T, hypothyroidism, and hyperprolactinemia)

• Steroids used for body building and Cushing syndrome

• Nerve, central nervous system, or spinal cord disorders 

• Pelvic trauma, surgery, or radiation (can cause damage to the tissues needed for an erection)

• Certain medications (including some for high blood pressure, depression, and anxiety)

Erectile dysfunction symptoms

The symptoms of ED are straightforward, but ED isn’t an all-or-nothing experience. It exists on a spectrum from mild to complete. Here are some common ways in which people experience ED: 

• Regular inability to get or keep an erection when they want to have sex

• Regular inability to get or keep an erection firm enough and long enough for satisfying sex

• Complete inability to get an erection at any time

• Sometimes may also have a low libido, or reduced interest in sex

How is erectile dysfunction diagnosed?

The most effective treatments for ED require a diagnosis and a prescription. But for many men, visiting a healthcare professional and talking about ED can be embarrassing or uncomfortable. It may help to know that healthcare professionals are used to it (they’ve definitely heard it all). And if you really don’t want to do a face-to-face visit, there are several services that can provide a diagnosis and prescription online. 

Most of the time, ED isn’t serious beyond its impact on people’s personal lives and relationships. But sometimes, ED can be a sign of an underlying health problem, such as: 

• Heart disease 

• High blood pressure

• High cholesterol

• Diabetes 

• Depression

When you see a healthcare professional about ED, they’ll ask some questions and run some simple tests to see whether you have an undiagnosed health condition that could be causing your condition. Getting treatment for that could also improve your ED symptoms without medication — so it might be a win-win. 

Other causes of ED may be reversible, too, such as: 

• Having a heavier bodyweight

• Smoking cigarettes

• Drinking too much alcohol

• Certain medications

• Stress

• Relationship difficulties

• Hormonal disorders 

If ED is a problem for you, don’t let awkwardness stop you from seeking help. It could help much more than your sex life. 

Medications for erectile dysfunction

The most common medications for ED are: 

• Sildenafil (Viagra)

• Tadalafil (Cialis)

• Vardenafil (Staxyn)

• Avanafil (Stendra)

These all belong to a class of drugs known as PDE5 (phosphodiesterase-5) inhibitors. They’re safe and effective, and there’s very little difference between them in terms of how well they work.

Possible side effects are similar for all PDE5 inhibitors:

• Headache

• Flushing

• Nasal congestion

• Indigestion

• Abnormal vision

• Muscle pain

The American College of Physicians recommends that the choice of medication is up to you: It will depend on cost, your lifestyle, and your relationship status.

It’s worth bearing in mind that Viagra is by far the cheapest drug and the one with the longest safety record. 

Viagra (sildenafil)

Viagra is cheap and good for occasional use. But you’ll need to wait 1 to 2 hours after a meal before taking it. It works in as little as 11 minutes and takes 1 hour to reach its maximum effect. The effects typically last 3 to 5 hours. 

Staxyn (vardenafil)

This is an expensive ED medication without many additional benefits over Viagra. It starts to work in as fast as 14 minutes and takes 45 minutes to reach its maximum effect. It can last 4 to 5 hours. Vardenafil can’t be taken with a meal. 

It may be an option if sildenafil hasn’t worked for you.

Cialis (tadalafil)

This expensive medication for ED has much longer-lasting effects than do other ED medications. And it can be taken with a meal. Another plus for tadalafil is that it can be taken as a daily dose for those who have a frequent need for it. 

Stendra (avanafil)

Avanafil is the newest ED medication. It works in a similar way to other ED medications. A main advantage is that, at higher doses, it has the fastest onset: 15 minutes or less. It also isn’t affected by food, so you can take it at any time.