Men with Erectile Disorder (ED) have trouble getting or keeping an erection that is stiff enough for sex during most of their intimate encounters. Trouble with erections often cause a major blow to men’s egos, leading many to struggle with depression and low self-esteem. Men put a lot of value in their sexual prowess and frequently see ED as a personal failure. They feel embarrassed about it, which prevents many from discussing it with their partners or even their doctors. Additionally, partners blame themselves, thinking they are not attractive or sufficiently sexually enticing. As the problem continues, sex becomes a point of contention and stress for couples instead of an enjoyable experience.
Most men who encounter ED deal with it because of various physical health issues, such as heart disease and high blood pressure. As a result, people usually associate ED with just getting older. However, ED is not a natural part of aging and often serves as an early warning sign of other, underlying medical issues.
On the other hand, the other main group of men dealing with ED are both young and generally physically healthy. These are the men whose emotions, like anxiety and depression, cause erectile problems. Close to one in ten men have trouble getting an erection during their first time having sex from the sheer amount of anxiety around such a major step in life. Having a new, relatively unknown partner as well as drinking and drug use can also cause erection issues. After ED happens once, some men develop anxiety about it happening again, “performance” anxiety, which causes even more erection problems.
Causes and Risk Factors
Age and rates
As men get older, the likelihood of them developing ED increases, gradually during the younger years and then much more so after middle age. Before middle age (40 to 50 years old), about 2% of men have problems with erections, but after middle age, that number jumps to 20%. Beyond age 75, half of all men will struggle with ED.
For a good number of people, the difficulty of ED is partially self-inflicted – though of course unintentionally. Smoking is a major risk factor for erectile issues because it damages blood vessels throughout the body, especially smaller ones like those in the penis. Other unhealthy vices like excessive drinking and other drug use can also cause erectile problems. Obesity, high salt diets, and lack of physical fitness put people at risk for high blood pressure and diabetes, which also contribute to ED.
Even if a man is in perfect physical health, numerous emotional issues can still lead to erectile problems. In fact, up to 1 in 5 cases of ED have psychological causes rather than physical ones. Emotional issues include any types of life stressors, such as a difficult job or financial problems. Relationship issues are another frequent cause as trouble in the bedroom can be a sign of lack of sexual interest in a partner or underlying emotional distance. Additionally, anxiety and depression are two of most common emotional issues that have complicated relationships with ED.
Anxiety and “performance”
Anxiety from any source can impair erections, but for people who are prone to anxiety, this can lead to a vicious cycle. After this first happens, it then leads to “performance anxiety”, where the man is anxious that he may not be able to get an erection next time. Like a cruel joke, this performance anxiety can then actually lead to more episodes of erectile problems, creating a cycle that is hard to break.
Depression is a force so powerful that it can crush the libido of any healthy, young man. ED may often be the most prominent or even the only sign of depression in some men because they often try so hard to hide the other symptoms. Erectile problems can also turn around and compound the depression symptoms. Unfortunately, depressed men who start taking antidepressant medications can continue to struggle with ED because erectile issues are a common side effect of those drugs.
Diagnosing Erectile Disorder
Men with ED have trouble getting or keeping an erection during most of their sexual encounters. ED can also mean that when these men do have erections, they are less stiff than they should be. Symptoms may start when people first become sexually active or later, even after years of normal erectile function. Doctors make the diagnosis of ED when symptoms last for at least six months.
Ruling out other problems
Although ED can occur on its own, many medical conditions can cause erectile problems as well. Doctors need to make this important distinction before deciding which treatment to use. They will perform a physical exam and look for signs of nervous system problems and hormone imbalances. Additionally, an ultrasound of the penis can identify if poor circulation is an issue. The most important test, however, is the nocturnal (nighttime) erection test. The man wears a small device on his penis during the night that detects the frequency, firmness, and duration of any erections that occur at night. A physically healthy male normally has a few erections every night, and if the device detects these, the cause of the ED is more likely psychological than physical.
Treating Erectile Disorder
“Little Blue Pills”
Medications like Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil) have offered the most common and efficient option for treating ED. These medications all work by relaxing muscles around vessels leading to the penis and increasing the flow of blood. Most people who use these medications have problems with erections due to medical issues, like diabetes, high blood pressure, heart disease, or old age. Unfortunately, people who take medications like Minipress (prazosin) for prostate enlargement or nitroglycerin for heart failure cannot take Viagra or others like it.
Because Viagra and similar medications so well, many people request them from their doctors even when the cause of their ED is emotional, rather than physical. If the problem is truly just emotional, people who want less invasive treatment with lower potential for side effects may prefer therapy. This treatment involves people learning about how anxiety, one of the most common emotional culprits of ED, works to derail intimate encounters. Through Cognitive Behavioral Therapy, they practice using relaxation techniques in these situations to help slow racing, nervous thoughts and instead enjoy the moment. Couples therapy offers a good option when problems in the relationship are contributing to the issue. Additionally, individual psychotherapy can help address depression symptoms and low self-esteem.
A few older medications are available, but they need to be applied right to the penis via either a pill inserted into the urethra or an injection. Many people consider these unpleasant, so they are no longer the most popular treatment alternatives. For a small number of men who do not respond to medications, surgery is a final option. For men who have ED caused by blood vessel damage in the penis, surgeons can repair this to restore blood flow. However, this option usually works best only in young men. The other surgical option is an implant placed inside the penis that enables an erection.
Managing Erectile Disorder
Embrace a healthier lifestyle
For older men, ED is often an early warning sign of heart disease and damage to the body’s blood vessels. In fact, a third of men who see their doctor about ED end up discovering an underlying heart issue that they had not known about. To avoid a nasty surprise like this, studies recommend several healthy lifestyle interventions.
One of the most accessible remedies is exercise: Just half an hour a day of moderate exercise will reduce the risk of ED by over 40%. The other main chance to intervene is by focusing on food. Avoid red meat and processed sugars while eating more fruits, vegetables, whole grains, and fish. Other good goals include losing weight if one is overweight or obese and ensuring that blood pressure and cholesterol are within the healthy ranges. Yearly check-ups with a primary care physician will help keep track of all these health measures.
Working through performance anxiety
Although anxiety of any source can cause ED, anxiety about the ability to “perform” in the bedroom can be especially bad because it comes from pressure men put on themselves. One of the keys to overcoming this is to realize that sex is not one person “performing” for another; instead, it is a couple enjoying a shared experience. One of the best ways to diffuse the anxiety is to focus on the present physical and emotional sensations of intimacy, rather than on past erection issues or possible future problems.
Talk to your partner
Trying to go it alone, without input or support from a partner, makes ED especially demoralizing. Talking with your partner about your feelings during sex and throughout the process of dealing with ED reduces the pressure men put upon themselves. Communication also keeps the partners from blaming themselves, which happens rather frequently with ED. By keeping an open dialogue, couples can prevent ED from causing a rift in their relationship.