Erectile Dysfunction

About Erectile Dysfunction (ED)

Key points:

• ED is common and treatable in 95% of cases.
• Risk of ED increases with age, but it is still possible for younger men to experience it.
• Impotence prevalence in men aged 40-70 is around 5-15%.
• ED is still possible for younger men, even though it is more common with age.
• 8% of 20-29 year olds and 11% of 30-39 year olds experiencing ED.
• Doctors will ask about your medical history and lifestyle to help diagnose ED.
• There are many different treatments available.
• You and your doctor should work together to set goals for your treatment and monitor your progress.

What is erectile dysfunction?

Erectile dysfunction (ED), also known as impotence, is a common sexual health condition that is more common in older men. It occurs when a man has difficulty getting or maintaining an erection firm enough for sexual intercourse. This can be caused by a lack of blood flow to the penis.

Impotence can lead to social and/or mental health issues, such as anxiety, low self-esteem, and relationship problems. However, the good news is that ED is treatable. There are different treatment options available, such as oral medication, therapy, and lifestyle changes. All men who experience ED should talk to their doctor about it.

There are three main types of ED:

• Vascular ED: This is the most common type of ED and is caused by lack of blood flow to the penis.
• Neurogenic ED: This type of ED is caused by nerve damage, which can be caused by a variety of factors, such as spinal cord injury, stroke, and diabetes.
• Psychogenic ED: This type of ED is caused by psychological factors, such as stress, anxiety, and depression.
• A man with ED may still be able to get an erection at other times, such as when he wakes up.

How is ED diagnosed?

To diagnose ED, your doctor will likely ask you about your medical history, symptoms, and lifestyle. They may also perform a physical exam and order some tests, such as blood tests and imaging tests.

How common is impotence (ED)?

Ecertile dysfunction is very common sexual problem that can occur in men of all ages and affects millions of people worldwide every year. The likelihood of ED increases by 10% with each decade of age. In other words, half of all men in their 50s are likely to experience mild or moderate impotence.

Worldwide prevalence of ED: expected to increase to 322 million men by 2025. Studies show that over 52% of men will experience erection problems in their lifetime. ED can be caused by a variety of factors, including physical health conditions, medications, psychological issues, and lifestyle choices.

There is a higher correlation between age and erectile dysfunction (ED), but ED is not just age-related. It can affect younger men under 40. In fact, studies have shown that up to 26% of men under the age of 40 experience ED.

How common in the UK?

A new study published in the journal "Sexual Medicine" in 2023 found that the prevalence of erectile dysfunction ED in the UK is increasing. The study found that around 13.5% of men in the UK aged 18 and over are now affected by ED, up from 12% in 2019. The study also found that the prevalence of impotence is increasing among younger men, with around 10% of men aged 18-34 now experiencing ED.

How does an erection work?

An erection occurs when there is increased blood flow to the penis, which happens during arousal. The increased blood flow causes the penis to become enlarged, elongated and firm.

When you are aroused, there is mental or sensory stimulation, which causes the muscles in the penis to relax. This allows blood flow into the penis, causing the penis to expand. An erection ends once the muscles in the penis contract, which causes the blood to be carried away from the penis, resulting in it becoming flaccid again.

What are the risk factors for ED from bicycling?

Bicycling is a great exercise, but excessive cycling can increase the risk of ED. When cycling, your weight presses on the perineum, which can reduce blood flow to the penis and damage the pudendal nerve. Both of these can lead to ED.

The risk of ED is higher for men who ride for more than 3 hours per week, to reduce the risk of ED from cycling, you should:

• Avoid cycling for more than 3 hours at a time.
• Take breaks every 20-30 minutes to stand up and stretch.
• Choose a comfortable bike seat that fits you well.
• Wear padded cycling shorts.

If you experience ED after starting to cycle, see a doctor to rule out other causes. ED from cycling is usually temporary and reversible. Talk to your doctor if you're concerned about the risk of impotence from cycling.

Is erectile dysfunction the same as premature ejaculation?

No. Both are types of male sexual dysfunction but they are different things. Unlike erectile dysfunction, premature ejaculation allows for an erection to occur and you are able to maintain an erection, you just have an orgasm before a satisfactory duration. With ED you are unable to even gain or maintain an erection.

Can erectile dysfunction be cured permanently?

Whether or not erectile dysfunction (ED) can be cured permanently depends on the underlying cause of the ED. If the ED is caused by a temporary or reversible condition, such as stress, anxiety, or a medication side effect, then it is possible that the ED may be cured permanently once the underlying condition is addressed.

However, if the ED is caused by a chronic condition, such as diabetes, heart disease, or neurological problems, then it is less likely that the ED can be cured permanently. However, even in these cases, there are treatments available that can help to improve or manage ED symptoms.

How can I treat erectile dysfunction?

There are different ED treatment options available such as natural/lifestyle treatments, counselling, vacuum constriction devices, surgery, male hormone replacement therapy and erectile dysfunction prescription medicines.

Here are some tips for preventing ED:

• Maintain a healthy weight.
• Exercise regularly.
• Eat a healthy diet.
• Quit smoking.
• Limit alcohol consumption.
• Manage stress.
• Get enough sleep.
• Treat any underlying medical conditions.

References:

https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/

https://www.sciencedirect.com/science/article/abs/pii/S1743609515304288?via%3Dihub

https://www.singlecare.com/blog/news/erectile-dysfunction-statistics/

https://pubmed.ncbi.nlm.nih.gov/8254833/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5313296/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503428/

https://www.bmj.com/content/321/7259/499

https://cks.nice.org.uk/topics/erectile-dysfunction/

http://www.bssm.org.uk/wp-content/uploads/2018/09/BSSM-ED-guidelines-2018-1.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118395/

https://www.nhs.uk/medicines/sildenafil-viagra/

https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/

What causes erectile dysfunction?

Erectile dysfunction can be caused by psychological or physical problems or even a combination of both. The primary cause of erectile dysfunction is ageing, however this does not mean to say that you will not experience this if you are young as there are other causes too.

40% of men aged 60+ experience ED so if you are in this age bracket there is nothing to worry about, if you are younger you should speak to your GP in order to help identify a cause. There are various psychological and physical causes that can be investigated.

Psychological vs Physical causes of erectile dysfunction

If a young male is experiencing erectile dysfunction, in most cases the cause is psychological but a physical cause should not be ruled out, therefore it is important to speak to your GP in order to identify the cause. Older men experience ED at a higher rate than younger males, so if you are experiencing erectile dysfunction and you are above 60 years old, there is nothing to be alarmed about.

The psychological causes of impotence include:

-Stress or tiredness

-Anxiety or mental health issues

-The pressure to perform sexually

-The physical causes of impotence include:

-Smoking, alcohol and recreational drug use

-Side effects from prescribed medication

-High blood pressure or narrowing of blood vessels in the penis

-Hormonal problems

-Being overweight

-Stress, depression and anxiety

The risk of erectile dysfunction occurring is increased by stress and/or depression/anxiety. A delicate balance of hormones and nerve impulses are required to gain and maintain an erection. Stress and depression both disrupt this balance, resulting in ED.

Depression can be caused by ED too, similarly to anxiety, due to a decrease in confidence and feelings of inadequacy.

-Low testosterone levels

Testosterone levels naturally decrease as men get older, which can cause erectile dysfunction. If you believe you have low testosterone levels, consult your GP as they may offer you male hormone replacement therapy.

-Porn-induced erectile dysfunction

Studies have shown that the overconsumption of pornography in younger males is a psychological factor that has resulted in erectile dysfunction. This can be treated by reducing the use of pornography and seeking appropriate professional assistance.

-Drinking and smoking

Alcohol and nicotine (the addictive substance in cigarettes) both restrict the blood flow to the penis, therefore heavy episodes of smoking or drinking can induce erectile dysfunction. This can be treated by reducing the amount you smoke and/or drink. Both smoking and drinking also have long term effects on a man's sexual performance.

-High blood pressure

Untreated high blood pressure over a long period of time can damage your arteries causing them to narrow, which restricts blood flow to the penis, which can result in erectile dysfunction

However, high blood pressure medications can also cause erectile dysfunction. These medications reduce the intensity of blood flow to the penis, which may result in erectile dysfunction.

This is a frustrating situation for many men as not treating high blood pressure can cause erectile dysfunction but so can the medications that treat high blood pressure.

-Psoriasis

Psoriasis is a skin condition that causes flaky, silvery, itchy patches of skin, which commonly appear on the elbows, knees, scalp and back. Psoriasis has been linked to erectile dysfunction for the following reasons:

Psoriasis may appear on the penis

Psoriasis can lower self-esteem

Psoriasis is a risk factor for cardiovascular disease, which can lead to ED

There is currently no cure for psoriasis but soothing creams are available to relieve the symptoms.

Oral medications for impotence (ED)

Oral erectile dysfunction tablets are the most popular treatment. They have been proven to be effective against physiologically induced erectile dysfunctions. These may be used for short term or long term treatment.

Examples include Viagra (sildenafil), Cialis (tadalafil), Daily Tablet Tadalafil and Levitra (vardenafil). The examples given all come under a drug class called PDE5 inhibitors, which work by increasing blood flow to the penis. It is important to note that taking these medications alone will not achieve an erection, to achieve an erection after taking these tablets, sexual stimulation and arousal is still required.

How well do oral treatments work for erectile dysfunction?

The success rate of ED treatment varies depending on the underlying cause of the ED and the specific treatment used. However, most men see a significant improvement in their ED symptoms with treatment.

According to a study published in the journal Urology, 70-80% of men with ED respond to oral medications such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). Other treatments, such as penile injections and vacuum erection devices, have even higher success rates, but they may be less convenient or less desirable for some men.

Natural/Lifestyle treatment

High blood pressure and high cholesterol are known risk factors of ED as they cause vessels to narrow, resulting in restricted blood flow, which causes ED. The most effective treatment for this is to prevent it in the first place. This can be done by making healthy lifestyle choices such as eating healthy and exercising.

A healthy diet - plenty of fruit, vegetables, whole grain foods, low fat meats and fish.

Exercising - at least 30 minutes of moderate intensity activity at least 5 times a week.

Alcohol - reduce alcohol intake to prevent not only short term ED but also long term ED, studies have shown impotence may persist with long term alcohol use.

Smoking - avoid or reduce the amount you smoke, smoking can clog your arteries restricting blood flow and nicotine can also restrict your blood vessels, resulting in ED.

Communication - whether that be with your partner, a doctor or in counselling. Good communication is one of the first steps in recovering from psychologically-induced erectile dysfunction.

Stress - trying to manage stress levels (e.g. by meditation or baths) has shown to reduce symptoms of ED and increase males’ sex drive.

Counselling

Erectile dysfunction can be frustrating and distressing, it can lead to a number of other problems such as anxiety, depression, low self esteem, low confidence levels and relationship difficulties. Counselling has been shown to be effective when used in combination with prescription medication.

Vacuum constriction devices

VCDs, also known as penis pumps work by creating a vacuum that draws blood into the penis, which causes it to swell and become erect. You should seek medical advice before using VCDs as use comes with risks and there is no solid clinical evidence that the treatment is effective.

Surgery

Surgery is often the last resort for when other treatment options have been unsuccessful. Penile implants may also help with ED, however these are only available privately, not on the NHS.

Testosterone replacement therapy (TRT)

As men get older, their testosterone levels decrease, which can result in ED. If you notice a change in your sex drive you should speak to your GP about getting your testosterone levels checked. If they are too low you may be eligible for testosterone replacement therapy.

Pros and cons of impotence (ED) treatments

Pros

• Improved sexual function: ED treatments can help men achieve and maintain erections, which can lead to a more satisfying sexual life for both partners.
• Increased spontaneity: ED can make it difficult to have sex spontaneously, so successfully treating ED can lead to increased spontaneity in sex life.
• Increased self-confidence: ED can cause men to feel embarrassed and ashamed, so successfully treating ED can lead to improved self-confidence and self-esteem.
• Stronger relationships: ED can strain relationships, so successfully treating ED can lead to stronger relationships.
• Improved mental health: ED can lead to mental health problems, such as depression and anxiety. Successfully treating ED can help to improve mental health.
• Reduced risk of heart disease: ED can be a sign of underlying health problems, such as heart disease. Treating ED can help to reduce the risk of heart disease and other serious health problems.

Cons

• Long-term treatment: Some ED treatments need to be taken on a long-term basis to maintain their effectiveness.
• Side effects: Some ED treatments can cause side effects, such as headache, flushing, and dizziness. The side effects of ED treatments are usually mild and go away on their own, but some men may experience more severe side effects.
• Drug interactions: Some ED treatments can interact with other medications, so it is important to talk to your doctor about any medications you are taking before starting ED treatment.
• Cost: ED treatments can be expensive, and some treatments may not be covered by insurance.
• Effectiveness: Not all ED treatments are effective for all men. Some men may need to try multiple treatments before they find one that works for them.

It is important to weigh the pros and cons of each ED treatment option before deciding which treatment is right for you. You should discuss the risks and benefits of each treatment option with your doctor.

Tips for men who are considering seeking treatment for ED:

• Talk to your doctor about your concerns. Your doctor can help you understand the different treatment options available and the potential risks and benefits of each treatment.
  
  
• Be honest with your doctor about your lifestyle and medical history. This information will help your doctor to recommend the best treatment option for you.
  
  
• Don't be afraid to ask questions. Your doctor is there to help you, and they want to make sure that you understand your treatment options and feel comfortable with your decision.

Remember, you are not alone. Millions of men experience ED every year, and there are effective treatments available. With the right treatment, you can improve your sexual function and live a full and satisfying life.

Symptoms

• The main symptom of erectile dysfunction is the inability of a man to get or maintain an erection.
• Not firm enough for intercourse.