Unlocking the Big Secrets of Erectile Dysfunction (ED)

Erectile dysfunction (ED) is a common issue that affects many men, particularly as they grow older. In America, 30 million men are affected, and up to 70% are in their 70s. However, ED is not limited to older men but can also affect younger men. Recent studies suggest an increase in the prevalence of ED among younger males.

Men experiencing ED must consult a healthcare provider to determine the underlying cause and explore available treatment options. Treatment may involve addressing underlying medical conditions, counseling, lifestyle changes (such as losing weight or quitting smoking), or medication. Some popular medication options for ED include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). Learn the historical development of ED therapy.

It’s important to note that ED is a manageable condition, and seeking help is the first step toward regaining sexual function. A healthcare provider can help individuals explore the available options and develop a personalized treatment plan that works for them. Ultimately, the goal is to regain sexual function and improve the overall quality of life.

What is Erectile Dysfunction?

A normal penis is capable of fast erection (speed), sufficient length (more than 10cm when erected), and hardness (level IV for easy insertion).

Normal nocturnal penile erection (NPT) occurs 3 to 6 times a night, lasting 15 to 40 minutes. It is not easy to detect during rapid eye movement sleep and is unaffected by emotions and sympathetic nerves. It objectively reflects the state of male erectile function.

1. Physiological erection

The cavernous body of the penis consists of smooth muscle cells and connective tissue to form a trabecular cavernous body, and the cavernous body of the penis contains both sympathetic and parasympathetic nerve fibers.

Smooth muscle relaxation, arterial blood flow and velocity, and venous blood outflow resistance are the three major elements of penile erection.

Insufficient sexual stimulation, the central erection signal inhibits the release of NE through the sympathetic nerve, the parasympathetic nerve releases NO and Ach, the somatic nerve signal is transmitted down, the smooth muscle cells of the small arteries and vascular sinuses in the penis cavernous body relax, the cavernous sinus dilates, and the arterial blood The flow increases, the pressure of the cavernous body increases, the subalpine vein and the perforating vein are compressed, and the penis is fully erect.

The smooth muscle of the cavernous sinus of the penis relaxes, the sinus dilates, the pressure of the cavernous body increases, the sub-white membrane vein and the perforating vein are compressed, and the penis is fully erect.

The smooth muscle of the cavernous sinus of the penis relaxes, the sinus dilates, the pressure of the cavernous body increases, the sub-white membrane vein and the perforating vein are compressed, and the penis is fully erect.

2. Classification of penile erection

Erections induced by stimulation of the cerebral cortex are called central erections, including psychogenic and nocturnal erections. Exploring the science behind nocturnal erections.

Erection mediated by local effective stimulation of the penis is called a reflex erection. Psychological erection and reflex erection often work together or independently. Penile erection also includes artificially induced erection.

3. Necessary Conditions for penile erection

Penile erection is a neuromuscular activity controlled by the central nervous system, which requires the close coordination of nerves, endocrine, blood vessels, corpus cavernosum, and mental and psychological factors.

  • Normal penile structure
  • Appropriate serum testosterone level
  • Continuous sexual stimulation of sufficient intensity
  • Nerve conduction system with normal structure and function
  • Adequate penile arterial blood flow and normal occlusive function of cavernous bodies and veins

4. Indexes for evaluating penile erectile function

The hardness and durability of penile erection are the most clinically concerned indicators. Poor penile erection hardness or weakness in the middle often leads to failure of sexual life and erectile dysfunction. Strengthening the PC muscle for improved persistence of erection.

Erectile Dysfunction Symptoms

The symptoms of erectile dysfunction (ED) can vary from person to person but may include:

Erectile dysfunction can also cause psychological symptoms such as anxiety, depression, and low self-esteem, affecting a man’s overall quality of life.

It is important to note that an occasional inability to get or maintain an erection does not necessarily mean a man has ED. However, if these symptoms persist or become frequent, it is important to seek medical attention to determine the cause of the problem.

The Side Effects of Erectile Dysfunction

Erectile dysfunction itself is not typically associated with any direct physical side effects. However, ED can hurt a person’s mental health and relationships, causing stress, anxiety, and depression.

  • ED can create a sense of embarrassment and shame for men who experience it, which can cause them to isolate themselves and avoid intimate situations. This can lead to feelings of loneliness and isolation, further exacerbating the emotional impacts of the condition.
  • ED can also contribute to relationship problems. When one partner experiences ED, their partner may assume they are no longer attracted to them or that they are not interested in having sex. This can create resentment and anger and cause a breakdown in communication and intimacy, leading to a loss of intimacy and emotional connection.
  • ED can lead to low self-esteem in men. Men who experience ED may feel that they are less of a man, which can impact their confidence and self-worth. This can have a ripple effect on other aspects of their life, including work and social relationships.

In addition, persistent ED may indicate an underlying medical condition. Evidence suggests that men with ED might be at higher risk of developing cardiovascular diseases, such as heart attacks, heart failure, and strokes.

This is because the same underlying risk factors contributing to ED, such as high blood pressure, high cholesterol, obesity, and diabetes, can also damage blood vessels and increase the risk of cardiovascular events. Furthermore, ED can be an early warning sign of these conditions, as artery damage that causes ED can also affect blood flow to the heart and brain.

Erectile Dysfunction Causes

There are many possible causes of ED, and they can include both physical and psychological causes.

Physical Causes of ED

1. Diabetes

Men with symptoms of diabetes are more likely to develop erectile dysfunction compared to healthy men, according to a systematic evaluation and meta-analysis published in 2017 in Diabetic Medicine. After evaluating 145 studies, including more than 88,000 men, the prevalence of erectile dysfunction in men with diabetes was 52.5%. Learn more about how diabetes contributes to ED.

2. High blood pressure

Studies have shown that hypertension and erectile dysfunction are closely related conditions. Approximately 30% of patients with hypertension complain of erectile dysfunction, and erectile dysfunction in young men is associated with an increased risk of future cardiac events.

The risk of cardiovascular disease is increased by about 80% in overall erectile dysfunction cases. Symptoms of erectile dysfunction may also be an adverse side effect of medications used to treat hypertension. Erectile dysfunction is also an early sign of hypertension. Explore how hypertension affects sexual health.

3. Lower urinary tract problems

Large epidemiological studies have shown a link between erectile dysfunction and lower urinary tract symptoms. Both conditions frequently occur as men age, and studies have shown that sexual enjoyment declines and sexual activity decreases as lower urinary tract problems increase. Lower urinary tract symptoms usually include increased urgency to urinate, increased frequency of urination, and inability to empty the bladder during urination.

4. Certain medications

Some medications, such as SSRIs (for depression), beta-blockers (for hypertension), and medications used for insomnia, anxiety, and prostate problems, hurt sexual dysfunction because they cause decreased libido, arousal disorders, erectile dysfunction, delayed ejaculation, and delayed or absent orgasm.

5. Obesity

Obesity is a major cause of erectile dysfunction because it leads to hormonal imbalances, insulin resistance, endothelial dysfunction (problems with the cells lining the blood vessels), and the psychological component of sexual dysfunction. Studies conducted in Poland have shown that 79% of men with erectile dysfunction have a BMI of 25 or higher.

Researchers suggest that a BMI in the 25-30 range is associated with a 1.5-fold increased risk of developing symptoms of sexual dysfunction and a 3-fold increased risk of developing symptoms of sexual dysfunction in the 30+ range. In the United States alone, diabetes and obesity cause 8 million cases of erectile dysfunction, and the risk increases with BMI. Find out more about the effect of obesity on male sexual function. 

6. Lack of physical activity

A sedentary lifestyle can lead to significant health risks, including heart disease and diabetes, both associated with erectile dysfunction. In addition, a lack of physical activity and exercise can lead to increased inflammation, decreased circulation, and psychological factors associated with sexual dysfunction.

7. Increased age

The prevalence of erectile dysfunction increases with age. This may be due to many factors. For example, cardiovascular problems occur more frequently in the elderly, which may lead to impaired penile blood flow and erectile dysfunction.

Metabolic syndromes and psychological factors are also more prevalent in older men, major determinants of erectile dysfunction. In addition to these factors, older adults are more likely to take medications that may cause sexual dysfunction, and they are more likely to have hormonal imbalances and related health problems, such as hypogonadism.

8. Smoking

It is well established in the scientific literature that cigarette smoke damages the endothelium and impairs the physiological process of erectile function. Studies have shown that ex-smokers are at increased risk for erectile dysfunction compared to men who have never smoked. The good news is that studies have also shown that this damage is not permanent, making quitting smoking extremely important. Explore the effects of smoking on ED.

9. Alcohol consumption

Excessive alcohol consumption can have negative effects on erectile function. Alcohol can impair the nervous system, which is responsible for initiating and maintaining an erection. It can also increase the estrogen level in the body, which can decrease testosterone production and cause sexual dysfunction. In addition, alcohol use can lead to depression and anxiety, hurting sexual function and libido. Tips for reducing alcohol consumption and improving ED. 

Emotional Causes of ED

1. Stress and anxiety

High levels of stress hormones, like cortisol, can negatively impact sexual function. Stress and anxiety can be caused by work, family, financial, or health problems.

2. Low self-esteem

Factors such as low self-esteem or a negative perception of one’s body can significantly impede one’s capability to participate in sexual encounters or glean positive experiences. Low self-esteem can stem from various sources, including internalized negative self-dialogue, past traumatic experiences, or undue societal pressures.

3. Performance anxiety

This is when a man worries about his sexual performance or satisfying his partner. Unrealistic expectations, past failures, or fear of rejection can cause performance anxiety. It’s common in people who are experiencing sexual encounters for the first time or who feel overwhelmed by expectations regarding sexual performance.

4. Pornography addiction

This can affect a man’s sexual arousal and satisfaction. Pornography addiction can be caused by excessive or compulsive use of pornographic material that creates unrealistic standards or desensitizes the brain to natural stimuli.

5. Depression and Anxiety Disorders

This can affect a man’s mood, energy, and interest in sex. Depression can be caused by chemical imbalances in the brain, genetic factors, or life events.

6. Relationship problems

Negative feelings towards a partner can lead to a lack of sexual attraction and difficulty achieving or maintaining an erection. Relationship problems can be caused by poor communication, lack of trust, conflict, or infidelity.

7. Sexual indifference

This is when a man has low or no sexual desire for his partner or sex. Boredom, fatigue, medication side effects, or hormonal changes can cause sexual indifference.

8. Trauma and Abuse

Trauma or abuse, especially sexual abuse, can trigger ED. Mental health services can provide support to individuals struggling with trauma-related ED.

9. Bad sexual experiences

Prior negative sexual experiences, such as embarrassment or shame associated with sex, may also lead to ED. Find out more about psychological factors and ED.

Erectile Dysfunction Diagnosis

To diagnose ED, a doctor will ask you about your symptoms, medical and sexual history, and mental health. You may find it difficult to talk about ED, but being honest and open with your doctor is important.

Physical examination: The doctor will also physically examine your penis, testicles, and nerves. This may include checking for abnormalities, injuries, or infections affecting your sexual function. The doctor may also order tests to check for underlying conditions that may cause or contribute to ED. These tests may include:

Blood tests: Blood tests can measure hormone levels, blood sugar, cholesterol, and other factors contributing to ED.

Urine tests: Urine tests may be used to determine if there are any underlying medical conditions, such as kidney disease or diabetes, that are causing ED.

Ultrasound: An ultrasound can examine blood flow to the penis and check for signs of any physical damage or abnormalities.

Penile injection test: A medication is injected into the penis to produce an erection, and the quality of the erection is evaluated.

Nocturnal penile tumescence (NPT) test: To check for normal erections during sleep.

Psychological evaluation: To check for signs of stress, anxiety, depression, or other mental health issues that may affect your sexual performance.

Questionnaire

Your doctor will ask questions or request that you complete a questionnaire about your symptoms, health history, and sexual history. The responses can help them evaluate the severity of your ED. Some questions that they may ask include:

  • How confident is the penis in getting and maintaining an erection?
  • After being sexually stimulated, how many times did the penis go hard into the vagina?
  • During intercourse, how many times have you been able to maintain an erection after entering the vagina?
  • During intercourse, how difficult is it to maintain an erection until the end of intercourse?
  • Do you feel satisfied when you try to have intercourse?

Based on the results of these tests, the doctor will determine the cause and severity of your ED and recommend the best treatment options for you.

Erectile Dysfunction Treatment

The ultimate goal of ED treatment is to improve penile erectile function, increase sexual satisfaction and quality of life for both partners, delay the progression of ED, and prevent the progression of associated diseases.

Drug and surgical treatment

Oral medication

Oral medications for ED are mainly PDE5, which has become the preferred treatment for ED and is easily accepted by most people because it is easy, safe, and effective.

Androgen Supplementation Therapy

Patients with primary or secondary male hypogonadism of various causes often have a combination of ED. Androgen therapy for these patients can enhance libido and improve erectile function. In ED patients with low testosterone levels, androgen supplementation can improve erectile function in those who do not respond to PDE5 for the first time and may have an enhanced effect when combined with PDE5. Explore how PDE5 inhibitors improve sexual performance.

Antioxidants and drugs that improve microcirculation

With aging and certain metabolic diseases such as diabetes, the body is mostly in a state of oxidative stress, resulting in a decrease in NO and an increase in vascular endothelin 1 (ET-1), causing a decrease in the diastolic and increased contractility of the smooth muscle of the penile corpus cavernosum.

It also causes functional and organic damage to the blood endothelium of small blood vessels, thus aggravating the degree of ED. When the effect of PDE5 alone is poor in these people, consideration can be given to the Combined application of antioxidants and drugs that improve microcirculation.

Physiotherapy

Physiotherapy (e.g., negative pressure suction and micro-energy etc.) is often used as an adjunct to ED treatment. It can be chosen or combined with appropriate physiotherapy for patients not doing well with oral medications alone. Commonly used physical treatments include vacuum erection devices (VED), low-intensity extracorporeal shock wave therapy (LI-ESWT), low-intensity pulsed ultrasound (LIPUS), and electrophysiological techniques.

Penile cavernosal injection (ICI) therapy

ICI therapy is considered a second-line option for ED treatment when patients fail to take oral medications. Commonly used drugs include prostaglandin E1, poppies, phentolamine, etc. Combination therapy is often used, aiming to improve efficacy while reducing the adverse effects of each drug. Currently, the combination of poppy bases, prostaglandin E1, and phentolamine has the highest efficiency, up to 92%.

Transurethral drug delivery

Transurethral administration of vasoactive drugs is mainly based on reducing penile trauma, and currently, the commonly used drug is posted. There are two different methods of administration.

The first is a mixture with an osmosis-promoting cream applied to the external urethral orifice to facilitate prostaglandin absorption, for which there are very limited clinical use data.

The second method of administration is placing the prostaglandin preparation into the urethra, which in 30%-65.9% of patients can obtain an erection sufficient for sexual intercourse.

Surgical Treatment

Surgery is the third-line treatment for ED and is used in patients with moderate to severe ED who have failed first- and second-line therapy. Penile vascular surgery should be performed with a strict selection of surgical indications and adequate preoperative communication because of the poor long-term outcome.

In the absence of contraindications, penile prosthesis surgery has good safety and efficacy, but care should still be taken to guard against intraoperative and postoperative complications. Discover the power of penile prosthesis surgery in restoring intimacy.

Medications used to treat ED may cause side effects or interact adversely with your medications. If you experience unpleasant side effects, discuss them with your doctor. They may be able to recommend a different medication.

In addition, some heart medications can have very serious side effects if taken with some ED medications. Therefore, it is very important to share the name and dosage of each medication you take with your doctor before you start taking any new medication.

Exercise

Exercise can help improve erectile dysfunction by increasing blood flow, reducing stress, and improving overall health. Some of the exercises that may benefit ED are:

Kegel exercises

Kegel exercises are a type of pelvic floor muscle exercise that can help improve bladder control and may improve sexual function. They may also improve erectile dysfunction by strengthening the cavernous and bulbocavernosus muscles involved in erection.

In one study, it was found that men treated with pelvic floor muscle exercises taught by a physical therapist showed significant improvements compared to a control group that was only advised to make lifestyle changes.

After six months of pelvic floor exercises and lifestyle changes, 40 percent of men regained normal erectile function, and 35.5 percent showed improvement. Find out more about how kegel exercises can help improve ED.

  • To begin with, the pelvic floor muscles need to be located. This can be done by quickly contracting them while urinating and sensing the muscles tighten.
  • Once the pelvic floor muscles are located, a comfortable position can be chosen for exercising, such as lying down, sitting, standing, or walking.
  • The next step is to exercise the pelvic floor muscles by contracting and relaxing them. Each contraction should be held for 5 seconds, followed by a 5-second relaxation period. This exercise sequence should be repeated 10 times or more.
  • Exercising at least 3 times daily for about 10 minutes each time is advisable. Exercising regularly is essential to achieving the desired pelvic floor muscle strength and tone, which can positively impact overall sexual health.

Aerobic exercises

Aerobic exercises are excellent for maintaining a healthy body. They refer to physical activities that increase your breathing and heart rate, providing your body with oxygen-rich blood. The benefits of performing aerobic exercises are numerous.

These exercises help strengthen your heart muscle, improve your lung function, and increase circulation and healthy blood flow. They have been shown to reduce the risk of various chronic illnesses, including heart disease, type 2 diabetes, stroke, and certain types of cancer.

Aerobic exercises include walking, jogging, biking, swimming, or dancing. The key is to choose an activity that you enjoy and that you are physically able to do. Aim to do at least 150 minutes of moderate-intensity exercise each week.

This can be broken up into smaller sessions throughout the week to make it easier to fit into your schedule. These exercises have long-term health benefits and can help improve your quality of life. Discover aerobic exercises that could help with ED.

Strength training

Strength training exercises are beneficial for building muscle mass and boosting your metabolism and overall health. These exercises can also enhance your sexual function by increasing testosterone levels in your body.

Examples of effective strength training exercises include lifting weights, doing push-ups, or using resistance bands. To reap the full benefits of strength training, aim to incorporate at least two sessions per week into your exercise routine. This consistent effort can help you achieve stronger muscles, improved physical health, and better sexual function.

Diet

The study published in the Journal of Sexual Medicine examined data related to erectile dysfunction and dietary factors. Researchers found that dietary patterns high in fruits, vegetables, fish, nuts, and whole grains and low in red meat and processed meats were more common among men unaffected by erectile dysfunction.

According to the researchers, these dietary choices were consistent with the guidelines of the Mediterranean diet and were associated with lower all-cause and disease-specific survival rates.

In clinical trials, following the Mediterranean diet was more effective in improving erectile dysfunction or restoring erectile function in patients with metabolic syndrome or obesity. Learn more about the Mediterranean diet for ED.

The following is a breakdown of the types of foods best suited to improve erectile dysfunction and health conditions that may contribute to symptoms of sexual dysfunction:

  • Organic grass-fed beef, wild salmon, organic chicken, and other organic meats
  • Foods high in fiber, including fresh fruits and vegetables
  • Sources of healthy fats, including nuts, seeds, avocados, and coconut oil
  • Gluten-free grains, including oats, amaranth, brown rice, quinoa, and paintbrush

Herbs and supplements

Certain herbs and supplements have been studied for treating ED with varying degrees of success. Discover the top 10 best male enhancement supplements in 2023.

Saw Palmetto

The benefits of saw palmetto include its ability to help the body maintain normal testosterone levels by inhibiting the conversion of testosterone to DHT. This sex steroid plays a role in developing health problems associated with erectile dysfunction, including decreased libido and prostate enlargement.

Yohimbine Bark

Yohimbine Bark is an herbal supplement to improve erectile dysfunction, hormonal imbalances, and low libido. It increases blood flow to the penis by promoting the relaxation of penile tissues and opening blood vessels. This helps men to obtain and maintain an erection.

Red Ginseng

Ginseng is beneficial for sexual dysfunction because it affects the central nervous system, allowing the brain to send the necessary signals to initiate an erection. Red ginseng may also help to relax the penile tissue and allow blood to flow to the area. Discover Botanicals and natural products for ED.

L-Arginine

L-arginine is an essential amino acid that improves blood flow and circulation. It is converted into nitric oxide in the body, which causes your blood vessels to open wider. This is especially helpful for men suffering from erectile dysfunction, as the opening of blood vessels in the penis is what allows erections to occur. L-arginine may also help improve conditions that often lead to sexual dysfunction, including high blood pressure, cardiovascular disease, and inflammation. Exploring L-Arginine role in managing ED.

Niacin

Niacin, or vitamin B3, is a natural vasodilator that helps improve blood flow. Taking 250 mg of niacin 3 times daily can help men with erectile dysfunction achieve and maintain an erection. In addition, niacin is known to help improve brain function, improve diabetes symptoms, and reduce the risk of cardiovascular disease – all health conditions commonly leading to erectile dysfunction. Exploring the niacin-ED connection.

A study in the Journal of Sexual Medicine found that men with erectile dysfunction experienced significant improvements in erectile function after taking 1,500 mg of niacin over 12 weeks.

Acupuncture

There is some evidence that acupuncture can help treat erectile dysfunction. Although the results are mixed, one study found that after 4-10 acupuncture treatments, 13 of 19 patients in the intervention group had full erections without further treatment, and their symptom scores improved by 41.9%. Acupuncture also helped improve health conditions associated with erectile dysfunction, including anxiety, depression, fatigue, and inflammation. A guide to acupuncture for men’s sexual health.

Psychological Counseling

Counseling or therapy is an appropriate treatment for ED caused by psychological factors such as stress, anxiety, depression, or relationship problems. You or your partner can ask your local hospital or university medical center if they have a sex therapy clinic or if they can recommend a therapist. You can also ask your primary care doctor, urologist, or other health care provider for referrals.

Counseling or therapy can help you cope with emotions, improve communication skills, and enhance intimacy with your partner. It can also help you address underlying issues affecting your sexual function, such as trauma, abuse, guilt, or low self-esteem.

Erectile Dysfunction Prevention

There are several steps you can take to help prevent ED. Many of these steps involve making healthy lifestyle changes. As a result, they are beneficial for preventing ED and improving your overall health. Follow these suggestions to help prevent ED:

  • Maintain a healthy lifestyle by exercising regularly, eating a balanced diet, and avoiding smoking and excess alcohol consumption.
  • Get enough sleep to ensure proper hormone production and reduce stress levels.
  • Manage stress levels by practicing relaxation techniques such as deep breathing, meditation, or yoga.
  • Control underlying medical conditions contributing to erectile dysfunction, such as high blood pressure, diabetes, or heart disease.
  • Avoid using drugs that can cause erectile dysfunction, such as antidepressants or blood pressure medications.
  • Consider therapy or counseling if relationship problems or psychological issues affect your sexual performance.
  • Talk to your healthcare provider about any concerns you have regarding your sexual health and any medications you are taking.
  • Being overweight or obese can increase the risk of ED. Losing weight and maintaining a healthy weight can help reduce the risk.
  • Exposure to toxins like pesticides, heavy metals, and chemicals can affect sexual function. Try to limit your exposure to these toxins as much as possible.
  • Regular checkups can help detect and treat underlying health conditions contributing to ED.

Remember that erectile dysfunction can have many causes, so addressing any underlying health conditions and exploring different treatment options is important. Speaking with a healthcare professional can help you find the best approach for your situation.

 

Sources

[1]ALWAAL A,BREYER BN,LUE TF,et al.Normal male sexual function: emphasis on orgasm and ejaculation.Fertil Steril,2015,104(5):1051-1060.

[2]KIRBY M, CHAPPLE C, JACKSON G, et al.Erectile dysfunction and lower urinary tract symptoms: a consensus on the importance of co-diagnosis.Int J Clin Pract,2013,67(7):606-618.

[3]HATZIMOURATIDIS K, SALONIA A, ADAIKAN G,et al. Pharmacotherapy for Erectile Dysfunction: Recommendations From the Fourth International Consultation for Sexual Medicine(ICSM 2015). J Sex Med,2016,13(4):465-488.