It’s not just Erectile Dysfunction

‍ED is more common than you may think

At face value, erectile dysfunction (ED) may seem harmless. For most men, however, this couldn't be further from the truth.

There's an existing perception among men that the inability to produce or maintain an erection, known as ED, warrants shame and embarrassment, even though ED is far more common than most men think. The best estimates suggest that up to 52% of men in the US between 40 and 70 years old struggle with ED.¹ However, ED is relatively common in younger males too. A separate analysis found that 1 in 4 men seeking medical help for ED was under the age of 40.² This may seem surprising, but these values are likely a gross underestimate of the true prevalence of ED, given that men tend not to disclose their sexual issues, and healthcare professionals tend not to discuss sexual health with their male patients.³  

It's not just ED

The burden of ED does not only cause distress to sexual life. There's often an untold cascading impact from ED that can have severe consequences on the mental health and wellbeing of those affected. The embarrassment and shame can lead to anxiety, depression, and loss of self-esteem to further detriment to the man's overall health. In one analysis, the most reported reaction to ED was a sense of emasculation.⁴These feelings are intensified In young men with some describing them as "total humiliation" and a "profound feeling of being less than anyone else". ⁵

Several studies have investigated the relationship between ED and the occurrence of mental health conditions.^6,7 Although estimates vary – there is a relatively consistent relationship between men with ED and a higher occurrence of depression.^6,7 In one large-scale meta-analysis, men with ED were nearly three times more likely to experience depression than men without ED.⁶ In a separate study that took into account variables that could influence depression risk in men with ED, such as diabetes, high blood pressure and high cholesterol – ED patients were still twice as likely to experience depression compared to those without over a 5 year period.⁷

The burden of ED is shared

Many consider a happy and healthy sex life a major contributor to quality of life.⁸ It should therefore be no surprise to discover that ED and its associated impact on wellbeing also affects patient partners. One study exploring the experience of female partners with men affected by ED found partners reported engaging in less sexual activity, accompanied by lower sexual desire, arousal, and orgasms. When men with ED sought treatment, women "almost always" or "most times" reported increased sexual desire, arousal, and orgasms.⁹ Unsurprisingly, in a separate study, the majority of both affected men (75%) and their female partners (82%) reported high levels of sexual dissatisfaction.¹⁰

Could ED be a sign of something more serious?

In clinical practice, the presentation of ED can serve as a valuable predictor for future cardiovascular events. The reason for this is the arteries that carry blood to the penis tend to develop a build-up of a fatty wax-like substance called plaque, leading to obstructed blood flow and an increased ED risk. The build-up of plaque, known as atherosclerosis, tends to occur in the penile arteries long before it appears in the arteries that supply blood to the heart.³ Atherosclerosis can cause heart attacks over time, highlighting the importance for men experiencing ED to visit their healthcare professionals to discuss their condition, look into underlying causes, and explore treatment options.¹¹

There is good news, ED is treatable

There is good news for men suffering from ED – it can be successfully treated and in some cases, cured.¹² As outlined by the British Society for Sexual Medicine Guidelines, a blood test is recommended to measure levels of lipids (such as cholesterol) and fasting blood glucose (levels of sugar in the blood) to assess the risk of cardiovascular disease and diabetes, and to identify what may be contributing to ED. Low levels of testosterone in the blood, known as hypogonadism, is also a treatable cause of ED; a healthcare professional should measure testosterone levels to assess for this condition.¹²  

Lifestyle interventions are recommended to help identify reversible risk factors and should accompany any new medications or therapy; however, the use of medications and talking therapy to treat ED should not be withheld on the basis that lifestyle changes have not been made. Different medications can help treat ED, in addition to therapy. For men with ED, it's crucial to speak to a healthcare professional to identify potential causes and, in return, receive the appropriate treatment.¹²

The importance of open communication

One of the major hurdles stopping men from accessing treatment is talking about their ED. For men, in particular, discussing any sensitive topic can be difficult. Despite societal advances in facilitating conversations around sexual health, many men remain too embarrassed or ashamed to disclose any sexual health issues.¹³ Sexual health issues in men are common and should be perceived no differently than any other health problem. But the emphasis on facilitating these conversations does not solely lie on those affected.  

Generally, both men and women believe the responsibility to discuss sexual health falls on the healthcare professional as part of the clinical interaction.¹⁴ Research indicates that healthcare providers are reluctant to discuss sexual health or offer appropriate advice or clinical tests, partly down to a perceived lack of education to address sexual health-specific issues.¹⁵ Providing healthcare professionals with the tools to feel comfortable and confident discussing sexual health with patients could be an important piece of the puzzle to help curb the underdiagnosis of ED in men.  

The TRTed guide

Talking about sexual health can be challenging, but it's an important part of regular medical care. TRTed has developed a guide comprising a sample of questions and discussion points for healthcare professionals and patients to support men’s health patient care, found here

Take home points:

• The burden of ED extends far beyond sexual health
• ED can lead to depression, anxiety, and significantly impact relationships
• Consistent data points to ED as a strong predictor for future cardiovascular events
• If you suspect you have ED, it's strongly recommended to visit your healthcare professional

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Continue the conversation on the TRTed Community!

References:

1. Feldman HA, et al.  Journal of Urology 1994;151(1), 54–61.  
2. Capogrosso P, E. et al.  Journal of Sexual Medicine 10(7), 1833–1841.
3. Sooriyamoorthy T, Leslie SW. Erectile Dysfunction. [Updated 2022 May 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562253/?report=classic.
4. Tomlinson J, et al. BMJ 2004;328(7447):1037.
5. Kale S. Erectile dysfunction or performance anxiety? The truth behind a modern malaise. Available at: https://www.theguardian.com/lifeandstyle/2018/oct/18/erectile-dysfunction-performance-anxiety-truth-modern-malaise. Date accessed: September 2022).
6. Qian L, et al. J Sex Med 2018;15(8):1073–1082.  
7. Ping-Song C, et al. J Sex Med 2015;12:804–812.  
8. Greenberg JM, et al. The textbook of Clinical Sexual Medicine 2017:539–572.  
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12. Hacket G, et al. J Seks Med 2018;15:430–457.  
13. Sheng Z. Trends in Urology & Men's Health 2021;12(6):19–11.  
14. Althof DE, et al. J Sex Med 2013l 10(1):26–35.
15. Ezhova I, et al. International Journal of Nursing Studies 2020; 107.