Erectile Dysfunction: Causes, Symptoms and Treatment Options Explained
A urologist explains the causes of erectile dysfunction, the link between ED and overall health, and the treatment options available to help regain sexual function.
Erectile dysfunction, or the inability to attain or maintain an erection sufficient for sexual activity, is estimated to affect between 30 and 50 million men in the U.S.
“Many men are hesitant to bring erectile dysfunction up with their healthcare provider, but these conversations are important, as ED may be a sign of an underlying condition,” says Dr. James A. Kashanian, the Director of Male Sexual Health at Weil Cornell Medicine and a urologist at NewYork-Presbyterian/Weil Cornell Medical Center. “Although it is a sensitive topic, remember that ED is a very common issue and that there are plenty of treatment options to help achieve your goals.”
As men get older, the risk of developing erectile dysfunction increases. It affects about 40% of men ages 40 or older, about 50% of men 50 years or older, and so on. But ED can occur at any age.
Health Matters spoke with Dr. Kashanian to better understand what causes erectile dysfunction, lifestyle changes that may help, and the different treatment options available.
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What are the symptoms of erectile dysfunction (ED)?
Dr. Kashanian: It’s normal to have trouble getting an erection from time to time. However, a persistent inability to achieve or maintain an erection that is firm enough for sexual intercourse is considered erectile dysfunction.
ED solely refers to difficulty with erections. Sexual dysfunction is a broader umbrella term that encompasses other conditions such ejaculatory dysfunction, abnormalities with sensation or orgasm, and curvature of the penis.
What are the most common causes of ED?
Dr. Kashanian: While age itself is not a risk factor, ED can be a function of certain health conditions that become more common with age, such as:
- Vascular disease
- High cholesterol
- High blood pressure
- Coronary artery disease
- Stroke
- Diabetes
- Overweight
- Low testosterone (hypogonadism)
- Surgeries, treatments (such as radiation), or injuries that affect the groin area
Erectile dysfunction can act like a “check engine” light for the body; it may be a warning sign of an underlying condition.
What is the relationship between mental health and ED?
Dr. Kashanian: The mind-body connection plays an important role in sexual arousal and the ability to achieve an erection. Mental health-related causes of ED include:
- Depression
- Anxiety
- Stress
- Performance anxiety or fear of intimacy
- Relationship issues
Not only can mental health issues contribute to ED, but struggling with erections can in turn create feelings of anxiety, depression, low self-esteem, and an aversion to want to be sexually active with your partner; it can be a vicious cycle.
Although it is a sensitive topic, remember that ED is a very common issue and that there are plenty of treatment options to help achieve your goals.
When should somebody see a doctor about erectile difficulties?
Dr. Kashanian: You should see your primary care physician or a urologist if you are having frequent erection issues or are worried about your sexual function. It’s always better to address things head on as soon as you notice them.
It’s important for you and your doctor to have an open and honest conversation about what you are experiencing. A thorough evaluation helps us understand whether erectile dysfunction is being driven by physical, psychological, or relationship-related factors. Because every patient and every relationship is different, treatment needs to be personalized. Some people benefit from working with a therapist individually, while others may involve their partner in the process.
What are the most common treatment options for ED?
Dr. Kashanian: The first step is identifying what may be the underlying cause of ED. Beyond a physical exam, that might require a blood test, hormone test, or mental health evaluation.
If lifestyle modifications – eating a healthy diet, refraining from tobacco use and illicit drugs, limiting alcohol intake, exercising regularly, and making sure are getting the proper amount of sleep – do not help, your doctor may recommend a form of treatment.
Depending on the cause and severity of your ED, treatment options include:
- Oral medications, such as sildenafil, tadalafil, avanafil and vardenafil, help increase blood flow to the penis and begin to work within an hour.
- Intraurethral suppositories are placed inside the urethra and increase blood flow within about ten minutes.
- Self-injection therapy is medicine injected into the base of the penis before sex; it increases blood flow in about five to 10 minutes.
If your ED is not improved by medicine, your doctor may recommend:
- Vacuum erection device (penis pump), a cylindrical device that uses negative pressure to bring immediate blood flow in the penis.
- Penile implant surgery places an inflatable or noninflatable device into the penis that can be manually pumped to achieve erection. Surgery is generally a last resort if non-invasive treatments fail.
- Low-dose shockwave therapy delivers low dose ultrasound shocks to the penis that stimulate blood flow to the penis over time. This therapy is most often used to treat mild to moderate cases of ED and is not FDA-approved.
What are the side effects of these ED treatments?
Dr. Kashanian: Sildenafil has been on the market for decades, so the side effects for oral medications are well known — the most common are headaches, redness in the face, stuffy nose, changes in color of vision, muscle aches and pains, dyspepsia, and acid reflux.
In rare cases, the self-injection therapy can lead to a prolonged erection; if the erection lasts four or more hours, you should seek immediate care — this condition (known as priapism) means the blood in the penis may be trapped which can lead to tissue damage and erectile dysfunction.
And as with any surgery, penile implant surgery does come with a risk of infection, so it’s important to let your doctor know if you experience any redness, pain, swelling, or heat at the site.
What else is important to understand about ED?
Dr. Kashanian: If you’re experiencing ED, there’s no need to suffer in silence. There are healthcare professionals who are ready to support you, answer your questions, and guide you through the right treatment.
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