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What is erectile dysfunction?
Erectile dysfunction, formerly known as impotence, is defined as the inability to achieve or maintain a rigid penile erection suitable for satisfactory sexual intercourse.1 It's estimated that approximately 40% of men in their 40s experience some form of erectile dysfunction, with the prevalence believed to increase by around 10% per decade thereafter.3
A study examining men aged 20 to 75 from eight countries (United States, United Kingdom, Germany, France, Italy, Spain, Mexico, and Brazil) revealed that the percentage of men with erectile dysfunction varied from 22% in the United States to 10% in Spain.4
However, current prevalence estimates are likely significant underestimations of the actual figures due to men's tendency to be hesitant in discussing their sexual health with healthcare professionals.5
Symptoms of erectile dysfunction
Failing to obtain an erection can be an unnerving event. If this happens to you occasionally, it’s likely nothing to worry about, with factors such as stress, tiredness, anxiety, or drinking too much alcohol all influencing the ability to obtain an erection.
However, if this happens persistently, then erectile dysfunction may be the culprit, and you should visit your healthcare professional to help identify the potential causes of your symptoms (through some questionnaires and erectile dysfunction tests), and receive the appropriate treatment.2
Diagnosis of erectile dysfunction
Although discussing sexual health concerns may be challenging, healthcare professionals specialising in sexual health view erectile dysfunction as any other health condition and can provide appropriate support. When consulting a healthcare professional about erectile dysfunction, they will typically gather a detailed description of your symptoms, including their duration, presence of risk factors, medication use, and relationship issues, among other relevant factors.
A physical examination and blood tests to measure lipid levels and fasting blood sugar may also be recommended to identify the underlying causes of erectile dysfunction and determine the most suitable treatment options.1
Erectile dysfunction causes are typically categorised as either organic or psychologically induced, also known as psychogenic erectile dysfunction. Organic causes of erectile dysfunction result from various abnormalities in the neurologic, hormonal, or vasculature structures.7
One example of an organic cause includes coronary artery disease (CAD), where it's estimated that nearly 50% of men with proven CAD have severe forms of the condition.8 Some men can present with both organic and psychogenic causes of erectile dysfunction.
Causes of erectile dysfunction
Organic: 9
- Heart disease
- Diabetes
- Obesity
- High blood pressure and hyperlipidemia
- Hypogonadism (low testosterone)
- Smoking
- The use of certain medications
Psychogenic: 10
- Performance anxiety
- Lack of adequate stimulation
- Relationship conflicts
Treatment of erectile dysfunction
Erectile dysfunction is a reversible condition and you may be wondering which erectile dysfunction drug is best, but if you have been diagnosed with erectile dysfunction, most treatment starts with lifestyle interventions such as nutrition and exercise to help identify any reversible risk factors. This should also accompany any new medication or talking therapy. Medications to help treat erectile dysfunction include, but not limited to: 1–5
- Vasodilators: Medications (normally tablets or pills) taken orally that open (dilate) the blood vessels to increase blood flow to the penis to help obtain an erection.
- Erectile dysfunction cream: Applied topically on the penis and induces smooth muscle relaxation to help with the initiation of an erection.
- Injections: Injection near the base of the penis which induces smooth muscle relaxation to help with the initiation of an erection.
- Vacuum devices: Placed over the penis to create a negative pressure to increase blood flow to the penis.
Importantly, the use of medications and talking therapy to treat erectile dysfunction should not be withheld on the basis that lifestyle changes have not been made. Psychosexual therapy, either alone or in conjunction with the couple’s relationship therapy, is also recommended, particularly when there is a psychological cause or influence.1
Questions to ask your doctor about erectile dysfunction
What might be causing my erectile dysfunction, and how do you determine the underlying cause?
Are there any lifestyle changes I should make to help improve my symptoms?
What treatment options are available, and which one is best for me?
Will medications like Viagra or Cialis be effective for me?
Can psychosexual therapy help, and should I consider it in addition to medication?
How long will it take to see improvement with the treatment plan we choose?
Could my erectile dysfunction be a sign of an underlying health condition, such as diabetes or heart disease?
Are there any potential side effects or risks associated with the medications you're prescribing?
How will my treatment plan change if lifestyle modifications do not improve my symptoms?
