Best Men's Health and Lifestyle

Erectile dysfunction, or ED as it is also known as is a common and treatable condition among men over 40, and understanding its causes, diagnosis, and treatment options can help men maintain a healthy sex life and overall well-being.

In this article, you’ll discover:

• What is erectile dysfunction?
• Importance of discussing the topic of erectile dysfunction
• Erectile dysfunction and Its Impact on Relationships
• Symptoms of erectile dysfunction
• Causes of erectile dysfunction
• Diagnosis of erectile dysfunction
• Best treatment options for erectile dysfunction

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What is Erectile Dysfunction (ED)?

Erectile dysfunction (ED) is the chronic inability to achieve or sustain a penile erection for sexual activity.

When a man becomes aroused, the smooth muscles surrounding his penis loosen up, facilitating the influx of blood into the area. When this process is disrupted, it can lead to impotence.

Erectile dysfunction is a very common condition, particularly in older men. It is estimated that half of all men between the ages of 40 and 70 will have it to some degree. Erectile dysfunction – Illnesses & conditions | NHS inform

Importance of Discussing the Topic of ED

While the topic of ED can be hard to discuss by those impacted as well as with doctors, it is important to talk about it.

1. ED can be a sign of other underlying health conditions. Having this difficult conversation with your doctor can lead to early detection and treatment.
2. ED can impact a man’s quality of life, including his self-esteem and relationship. Talking about it with your doctor will allow your doctor to diagnose and treat the problem, helping to enhance your quality of life.
3. ED can negatively impact your relationship if there is a lack of communication between you and your partner. Discussing ED with your partner will lead to better communication and understanding. It will reduce stress and even strengthen your relationship.
4. ED should be discussed with your doctor to identify the cause and implement a treatment plan to resolve the issue.

Statistical Insight: About 40% of men with ED will have hypertension while 35% of all hypertensive men will also have ED. Hyperlipidemia (high cholesterol) is found in about 42% of men with ED. Undiagnosed diabetes is up to three times as likely in men with erectile dysfunction (28%) compared to non-diabetic men with normal erections (10%). Among men over 50 years of age, diabetics are roughly twice as likely to have ED (46%) compared to non-diabetics (24%). One-third of diabetic men will have hypogonadism which may partly explain the high correlation between diabetes and ED. Up to 35% of all men with ED will also have hypogonadism and about 6% will have abnormal thyroid function. While testosterone deficiency can negatively impact erectile function, vascular disease and diabetes are far more likely causes of ED.  Obesity is associated with a 50% increase in ED compared to men of normal weight. One-third of the obese men with ED who enrolled in a weight loss program resolved their ED problem in 2 years. In smokers who quit, erectile quality improved 25% after one year. Heavy alcohol users also report an increased risk of ED compared to the general population.  Patients with depression are almost 40% more likely to have ED than normal men without depression. Conversely, the incidence of depression in men with ED is almost three times greater. At least 30% of patients with ED will also have premature ejaculation and possibly as many as 60%. Successful treatment of the ED will often alleviate the premature ejaculation, due to reduced performance anxiety. If not, premature ejaculation can be alleviated much more easily once the erectile dysfunction has been successfully treated.  Erectile Dysfunction – StatPearls – NCBI Bookshelf (nih.gov)

ED and Its Impact on Relationships

ED can have a significant impact on a relationship. ED can lead to frustration, anxiety, and feelings of inadequacy in both partners. Because ED can impact both partners in a relationship, it is important that the couple engages in open and honest communication. Both may agree to see a counselor to help them work through this adjustment.

Here are some ways that ED can impact a relationship.

• Decreased intimacy
• Communication breakdown
• Emotional distress
• Strained relationships
• Infidelity

Symptoms of ED

While ED can be a symptom of other health problems, ED has symptoms of its own that can alert you to its problem. According to the National Institute of Diabetes and Digestive and Kidney Diseases, symptoms of ED include,

• Being able to get an erection sometime but not every time you want to have sex
• Being able to get an erection, but not having it last long enough for sex
• Being unable to get an erection at any time

Causes of ED

It should be emphasized that ED frequently has multiple origins and it is vital to understand the many different causes. Here are some of the different causes of ED.

Physical

• Aging
• Cardiovascular disease
• Diabetes
• Hormonal imbalance (Low levels of testosterone)
• Hypertension
• Obesity
• Prior pelvic surgery
• Spinal cord injuries

Psychological

• Anxiety and stress
• Depression
• Guilt related to sexual activity
• Performance anxiety
• Relationship problems
• Self-esteem issues
• Sexual abuse or PTSD
• Sexual identity issues

Unhealthy Lifestyle

• Chronic stress
• Drug abuse
• Excessive alcohol consumption
• Sedentary lifestyle
• Smoking
• Unhealthy diet

Health Note: While riding a bike is a healthy and fun activity, the National Center for Biotechnology Information states, “A 2020 meta-analysis of 3,330 cyclists compared to 1,524 non-cycling controls indicated a significantly increased risk of ED in the cyclists.”

Prescription Drugs

The Cleveland Clinic list the following medications that may cause ED.

• Diuretics (pills that cause increase urine flow)
• Antihypertensives (high blood pressure drugs)
• Antihistamines
• Antidepressants
• Parkinson’s disease drugs
• Antiarrhythmics (drug for irregular heart action)
• Tranquilizers
• Muscle relaxants
• Nonsteroidal anti-inflammatory drugs
• Histamine H2-receptor antagonists
• Hormones
• Chemotherapy medications
• Prostate cancer drugs
• Anti-seizure medications

Data Insight: “One-quarter of all cases of ED are thought to be due to prescription medications. Of the twelve most commonly prescribed medications in the US, eight list erectile dysfunction as a possible side effect.[35][50] These drugs would include most antidepressants (especially SSRIs), cimetidine, ketoconazole, spironolactone, sympathetic blockers (methyldopa, clonidine, and guanethidine), thiazide diuretics, and other antihypertensives. (Angiotensin Converting Enzyme (ACE) inhibitors and calcium channel blockers are the least likely to cause ED.) Beta-blockers are only a minor contributor to ED, while alpha-blockers actually improve erectile function.[51][52]” Erectile Dysfunction – StatPearls – NCBI Bookshelf (nih.gov)

Other substances

• Amphetamines
• Barbiturates
• Cocaine
• Marijuana
• Methadone
• Opiates

Diagnosis of ED

If you believe you are suffering from ED, there are several tests that your doctor can perform. However, before any tests are performed, your doctor will want to perform a complete physical exam with a medical history review. Chances are your doctor will review the prescription drugs you are currently on and determine if they can be adjusted.

Here are some tests that may be used to determine if you are suffering from ED.

• Blood test
• Thyroid function test
• Urinalysis
• Ultrasound
• Nocturnal penile tumescene (NPT)
• Penile biothesiometry

You will never forgive yourself if you don’t do this to increase your testosterone.

Best Treatment Options for ED

ED may be caused by both physiological and psychological factors, and treatment options include lifestyle modifications, oral medications, and innovative approaches. Among these, making lifestyle changes and managing coexisting medical conditions are likely to be the most beneficial and effective.

Here are several ways to treat and prevent ED

Effective medical options for ED

• Hormone replacement therapy
• Penile implants

Prescription drugs

• Sildenafil
• Vardenafil
• Tadalafil
• Avanafil

Natural treatment options for ED

• Exercise
• Healthy diet
• Maintain a healthy weight
• Stress reduction activities
• Lower high blood pressure
• Stop or don’t start smoking
• Reduce or stop alcohol consumption
• Don’t use illegal drugs

Data Insight: “Data have found that physical activity is associated with a lower risk of ED while simultaneously both preventing and improving ED 9. In a large study of 31,724 men who were free of ED at baseline, a 40% increased risk of ED was noted with the development of obesity 10. Weight loss was also beneficial on quality of sexual life 11 while a healthy diet and reduced caloric intake have been associated with improvements in erectile function 8. Smoking has a negative relationship with erectile function, with cumulative smoking history being correlated to significantly increased ED risk 12.” Recent advances in the understanding and management of erectile dysfunction – PMC (nih.gov)

Novel Emerging Therapies

• Centrally acting treatments: melanocortin receptor activator
• Peripherally acting treatments
• Regeneration therapy: stem cell
• Therapies using physical energies – low-intensity shock wave therapy & low-intensity pulsed ultrasound
• SPONTAN spray (Nasal spray)

Key Takeaways

1. The topic of ED can be hard to discuss with those impacted as well as with doctors, it is important to talk about it to identify early detection and treatment options.
2. ED can be a sign of other underlying health conditions.
3. ED can lead to frustration, anxiety, and feelings of inadequacy in a relationship.
4. ED frequently has multiple origins, and it is vital to understand the many different causes.
5. ED treatment options include lifestyle modifications, oral medications, and innovative approaches.