By Barbara Pierce
Erectile dysfunction is one of the most common but least discussed health concerns affecting men particularly as they age, said Christopher Emerson, physician assistant, Upstate Urology at Mohawk Valley Health System.
As many advances have occurred in both diagnosis and treatment of ED, we asked Emerson to update us about this common condition.
1. What is ED?
“ED is defined as the persistent inability to achieve or maintain an erection firm enough for satisfactory sexual intercourse,” Emerson said. “It’s sometimes referred to as impotence, although that term is now less commonly used in medical practice. It can affect not only physical intimacy but also emotional well-being, relationships and overall quality of life. Thankfully, ED is highly treatable once properly understood and addressed.
“ED can occur occasionally, especially during times of stress or fatigue. But if it happens regularly, it may indicate an underlying health issue that requires medical attention.”
2. How common is ED?
ED becomes increasingly common with age. Studies show that approximately 50% to 70% of men over the age of 60 experience some degree of ED; 30% to 40% of men between ages 40 and 59; and about 5% of men younger than 40.
These numbers may be underestimates, as many men are reluctant to bring up the issue with their healthcare provider.
3. What are the main causes?
“ED can have a variety of causes, often categorized into physical, psychological or lifestyle-related,” he explained. For most men, erectile dysfunction is caused by physical problems, usually related to the blood supply of the penis.
First, there are vascular or heart, issues. Poor blood flow to the penis due to clogged arteries (atherosclerosis), high blood pressure or vascular disease is one of the most common causes.
“Neurological conditions can also interfere with nerve signals that are necessary for an erection. These include disorders such as multiple sclerosis, Parkinson’s disease or spinal cord injuries,” he said.
Hormonal imbalances, such as low testosterone levels or thyroid dysfunction may contribute to ED. Elevated estrogen levels or side effects from hormone therapies may also play a role, he added.
Psychological factors, such as anxiety, depression, stress and relationship difficulties can interfere with sexual performance and desire.
Then there are lifestyle factors: smoking, obesity, lack of exercise, excessive alcohol consumption and drug use all can increase the risk of ED, he said.
Age is a strong indirect risk factor in that it is associated with increased likelihood of the health issues, some of which are listed above.
4. How is ED diagnosed?
“Diagnosis starts with a detailed medical history and a physical examination. The healthcare provider may ask about: frequency and severity of ED symptoms, underlying health conditions, medications being taken and lifestyle habits,” said Emerson.
Laboratory tests may include blood sugar levels, to rule out diabetes, cholesterol and lipid panel, testosterone and other hormone levels. In some cases, additional testing such as a penile Doppler ultrasound or nocturnal erection monitoring may be recommended, he added.
5. What treatment options are available?
“Erectile dysfunction is a common issue with a wide range of causes. But it’s also highly treatable,” he said. “Treatment is highly individualized and depends on the underlying cause.”
Effective for many men is medication taken orally, like sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). These medications increase blood flow to the penis.
If low testosterone is found to be the cause, hormone replacement therapy may be considered.
Emerson added that there are mechanical devices that may be recommended, such as Vacuum Erection Devices that create an erection by drawing blood into the penis. Or constrictive rings can be used to maintain the erection once achieved.
There are medications that can be injected directly into the penis or placed into the urethra to stimulate blood flow.
Penile implants or surgically inserted devices may be an option for men who do not respond to other treatments.
“Counseling or therapy can be particularly helpful if psychological issues such as anxiety or depression are contributing to ED,” he said.
And lifestyle changes, such as improving one’s diet, quitting smoking, reducing alcohol intake, managing stress and increasing physical activity can all help restore erectile function.
This is the bottom line, he suggested: Men experiencing symptoms should feel empowered to speak openly with their healthcare provider. Addressing ED not only improves sexual health but can also lead to the diagnosis and treatment of other potentially serious medical conditions, such as heart disease or diabetes.
“Men that bring their sex partners to appointments regarding erectile dysfunction have significantly better outcomes,” he added. “Don’t suffer in silence. Help is available and it often begins with just one conversation.”