Erectile dysfunction: The Complete Guide

Studies have shown that one in two men have some degree of erectile dysfunction. With age, erectile dysfunction becomes more common, but that is not the only case. There was a time when most healthcare providers thought that the main cause of the problem was stress and anxiety. However, there are studies that have been done more recently showing that most of the cases are caused by an underlying illness. Erectile dysfunction can be a warning sign of a more serious problem.

It is important to diagnose and treat conditions causing Erectile Dysfunction (ED) because it will improve health and sex life. Everyone wants to have good health and sexual activity even when they age.

Erectile dysfunction is the most common sexual problem doctors get. ED (Erectile Dysfunction) in simple terms is when a person is having a hard time getting or keeping an erection that is firm enough for sex. While it is normal for a man to have a sexual problem with their erection from time to time, the Erectile Dysfunction or ED may come slowly over a given period of time or regularly. If any of these signs start coming, it is important to have the problem treated.

Erectile dysfunction ED can happen when:

– limited blood flow to the penis or the nerves are harmed

– A person is stressed or emotional reasons

– An early sign of a serious illness such as heart disease, atherosclerosis (the arteries are blocked or harden), high blood sugar because of diabetes, and high blood pressure.

People who have ED (Erectile Dysfunction) can suffer from depression, low self-esteem, and distress because they cannot enjoy their sex life like before. This can affect the relationship between them and their partner.

How do erections work?

When a person is sexually aroused, the brain sends out signals to the nerve so it can release chemicals responsible for increasing blood flow to the penis. Two erection chambers will receive the blood flow, the chambers are known as corpus cavernosum and they are made up of spongy muscle tissues. These chambers aren’t hollow. When the penis becomes erect, the spongy tissue relaxes then traps blood. There is pressure in the chambers when this happens, and this makes the penis firm, which causes an erection.

After an orgasm, there are nerve signals reaching the penis that results in the muscular tissues contracting. Blood that was in the penis is then released back to the body and the erection comes down. When a person is not aroused, their penis is soft and limp. You might notice that the penis will vary with cold, warmth, or worry. Don’t worry about that because it shows the balance of blood that comes and leaves the penis.

Causes of ED (Erectile Dysfunction)

It is important to know the cause of ED because it will determine the best way to treat it. Erectile Dysfunction or ED can be caused by emotional issues, health problems, or both. There are risk factors that have been shown to have a big impact on Erectile Dysfunction (ED). Some of them include;

– Injury to the pelvis

– Heart disease

– Surgery from cancers of the colon, prostate, bladder, or rectum

– Peripheral artery disease (narrowing of the arteries slows down blood flow)

– High blood sugar (diabetes)

– High blood pressure

– Smoking or vaping

– Drug use

– Alcohol use

– Emotional stress from depression, relationship problems, or anxiety

– Some medicines

Erectile Dysfunction is more common with age, but old age doesn’t automatically cause ED. There are men out there who are in their 80s but still sexually functional.

Physical Causes of ED

The penis failing to trap blood during an erection

If the penis is not able to retain blood, then it will be hard for a person to keep their erection. This is an issue that can come up at any age.

Factors affecting nerves or vessels and restricting blood flow or blood vessels to the penis

There are many issues that can have an effect on blood vessels in the penis. Some common ones are heart disease, atherosclerosis or peripheral artery, smoking, and high blood sugar (diabetes)

Nerve signals from the spinal cord or the brain aren’t reaching the penis

There are some diseases, injuries, or surgeries that can harm the nerves to the penis

Cancer treatments close to the pelvis area can affect the functions of the penis

Radiation and/or surgery for colorectal, prostate, or bladder cancer can cause erectile dysfunction. This is why it is a good idea for cancer survivors to visit a urologist if they are having any sexual health concerns.

Drugs used in treating health problems can affect erections

Drugs usually have side effects, which is why you should talk about the side effects of the drugs you are taking with your doctor.

Emotional Causes of Erectile Dysfunction

Sex is one of those things that will require the body and mind to work together. Relationship or emotional problems can have a negative effect on your erections. Some of the emotional issues that can contribute to erectile dysfunction:

– Depression

– Anxiety

– Stress at work or home

– Relationship conflicts

– Worry about sexual performance

– Stress from cultural, social, or religious conflicts

Diagnosing Erectile Dysfunction

The diagnosis of erectile dysfunction is going to start with a conversation. There are a couple of questions you are going to be asked by your provider, and they will touch on your general health and your erection problem. You might have to get a physical exam, get lab tests, or you can be referred to a urologist. Finding the cause of ED is important because it will help in determining the right treatment.

You should be open with the healthcare professional, even though there might be some questions you consider personal. You might feel embarrassed answering some of the questions, but you need to answer them because they will help in diagnosing and treating Erectile Dysfunction.

Health History

Speaking openly with your doctor is important. The doctor will begin by asking about your lifestyle and health history. You should let them know if you are taking any drugs – whether prescriptions or over-the-counter. If you drink, how much. If you smoke, how much. The doctor can also ask you about recent stressors in your life.

Some of the questions the doctor might ask you include;

– Do you use recreational drugs?

– What supplements, over-the-counter drugs, or prescription drugs are you taking?

– Do you vape or smoke? What are you smoking, and how much?

– Have you undergone radiation therapy or surgery in the pelvic area?

– Do you have any urinary problems?

– How much alcohol do you drink?

– Do you have any other health problem (whether untreated or treated)

ED History

The health provider will be able to learn more from your experience and can know whether the ED stems from the desire for erection function, sex, ejaculation, or orgasm. Like said above, the questions will feel very private, but the answers you give will help in finding the cause of your problem. Some of the questions you can expect include;

– How long have you been having those problems? Did they start all at once or was it gradual?

– Do you wake up during the night or in the morning with an erection?

– Are you having problems with arousal or sex drive?

– If you are getting erections, how firm are they? How difficult is penetration?

– Is there any pain when you get erections?

– Do you notice changes in your erections at different times, like during stimulation by mouth, when entering a partner, or with masturbation?

Stress and Emotional Health History

Emotional health can be the cause of your ED, and this is why the healthcare provider asks questions to do with your emotional health. This will help them know whether you have anxiety or depression. This can involve questions about the relationship with your partner. You might be asked to bring along your partner. Some of the questions on emotional health can include;

– Is there something that has recently upset you? are you often under a lot of stress?

– Are you currently taking mental health medication?

– Is there something that makes you feel depressed or anxious? Do you have a mental health issue?

– How is your relationship with your partner? Are there any changes recently?

– How is your sec life? Are you satisfied? Have there been any changes recently?

Physical Exam

A physical exam is used when checking total health. If the doctor suspects ED, they will begin with an exam of your genitals (the penis and testicles). If you are older or have some risk factors, then the exam can also focus on blood and heart system (blood pressure, heart, and peripheral pulses). You should not stress about these tests because they are not painful.

Lab Tests

Blood tests can be ordered by your healthcare provider so that they can look for health problems that cannot be found using a physical exam. Urine can also be tested.

Other tests

Health experts can use questionnaires to rate your ED problem. The questions can include your ability to get and keep erections, problems with having an orgasm and gauging your satisfaction with sex.

Advanced Erectile Function Tests

There are some men who have to go for specialized testing to provide the best treatment option or what to do if treatment fails. The tests can include;

– Blood work to check blood sugar levels (diabetes) (National Institute of Diabetes for digestive and kidney diseases)

– Checking testosterone and other male hormones

– Injecting the penis with vascular stimulants that causes erections

– NPT (Nocturnal penile tumescence) which helps in checking sleep erections overnight

– Pelvic x-rays like MRI, arteriography, or CT scanning is not needed when checking ED unless a person has had a history of cancer or trauma.

Source: (National Institute of Diabetes for digestive and kidney diseases)


If ED is having an impact on your relationships and well-being, then you should have it treated. Treatment is going to help by fixing or improving erectile function, supporting circulatory health, and improving the quality of a man’s life.

Lifestyle Changes

Treating ED will start by taking good care of your vascular and heart health. The doctor will help in pointing out ‘risk factors’ that can be improved or changed. Your doctor can encourage you to;

– Improve your eating habits (eating more plant-based foods, and reducing your intake of processed and high-fat foods)

– Stop smoking

– Maintaining a healthy weight

– Limiting drugs and alcohol

– Increase exercise

– Getting enough sleep (try getting seven to eight hours of sleep every night)

The doctor will have a look at the drugs you are taking and suggest adjustments. You should never stop or change your prescription drugs on your own, make sure you talk to your doctor or healthcare provider. There is no need to put your life at risk by interfering with your prescription drugs.

Emotional Health Care

Emotional problems can cause ED, and this is why your healthcare provider might suggest dealing with it. this could be life’s stressors, relationship conflicts, anxiety, or depression from past problems with erectile dysfunction (performance anxiety). It is a good idea to talk to a sexual health counselor or even a mental health counselor. Look for a highly trained professional to help you with your emotional problems. They will help you with strategies to use in managing life’s challenges.

Medical Treatments

The first treatment option healthcare providers will look at are non-invasive treatments. Most of ED treatments are safe and work well. Still, you need to talk to your healthcare provider so they can let you know the side effects that come with the treatment options.

Oral Drugs

They are also known as PDE type-5 inhibitors, and they work by increasing blood flow to the penis. The pills are taken by mouth.

In the US, there are a number of approved oral agents approved by the FDA, and they are:

– Levitra

– Viagra

– Stendra

– Cialis

Men with ED take them an hour or two before sex. The drugs will help in creating a strong erection by improving blood flow to the penis. These drugs are going to need normal nerve function to work. 7 in 10 minutes get strong erections after using these oral drugs. People with cancer or diabetes will have lower response rates.

If you take nitrates for your heart, then you should not use these drugs on your own. Talk to your healthcare provider before you use them so they can tell you how it is going to affect your health. Always follow the directions given by your healthcare provider.

Just like any other drug, the above drugs have side effects. The side effects are mild and only last a short time. The most common are;

– Headache

– Facial flushing

– Muscle aches

– Indigestion

– Stuffy nose

The drugs are going to increase blood flow to the penis, and this is going to have an effect on other vascular tissues. You should talk to your urologists if you have any concerns.

Some of the most popular Male Enhancement Pills:

Vacuum Erection Device

This is a plastic tube that is slipped over the penis and makes a seal with the skin of your body. There is a low-pressure vacuum on the other end. Pressure from the pump will cause the penis to get an erection. There is an elastic ring that can then be placed at the base of the penis so that the blood can remain in the penis and not go back to the body. This can end up creating an erection lasting up to 30 minutes. Three out of four men can get a good erection from using the penis enlargement device. A popular penis extender is the Phallosan Forte.

Dietary Supplements

These have become common, but may not work or even be safe to use. Before self-treating or taking supplements, talk to your healthcare provider. The FDA has warned people against using supplements that have not been approved. Some supplements have PDE-5 inhibitors and in high doses. They don’t disclose all the ingredients.

Testosterone Therapy

If blood tests are done and turn out a person has low levels of testosterone and low sex drive, testosterone therapy can help in increasing libido. This treatment can be combined with PDE-5 inhibitors.

Intraurethral (IU) and Intracavernosal (ICI) Therapies

If oral drugs haven’t worked, then Alprostadil can be used. It can be given through an injection in the penis or a pellet placed in the urethra.

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Self-Injection Therapy

Alprostadil will be injected using a fine needle into the side of the penis. The rate of success through this method is as high as 85%. ICI is a great treatment option for those who have tried PDE-5 inhibitors with no success. The erection is going to last twenty to thirty minutes or when you climax.

If this doesn’t work, then it can be combined with different medications to make it even stronger. ‘Trimix’ is the most popular injectable. It requires a prescription and it will be mixed by a pharmacist. You are going to be trained on how to inject and raising dosage on your own.

A common side effect is a priapism, which is a prolonged erection that can last longer than four hours. It can damage the penile tissues and it is also painful. If you experience this, make sure you go to the emergency room because reversing it will involve removing trapped blood and also injecting a reversal agent. Surgical help might be needed for reversing this condition.

Intraurethral (IU) Therapy

The drug Alprostadil is going to be placed in the urethra. This means you don’t have to inject yourself. The downside is that it doesn’t work as well as the injection method. It needs to be tested in the urologist’s office before you use it at home.

A common side effect of this treatment method is a burning feeling in the penis. Talk to your doctor if you notice any side effects.

Surgical Treatments

A penile implant is the main surgical treatment for ED. If the other treatments have failed or if their erectile dysfunction is caused by prostatectomy for prostate cancer, then this might be the best treatment option.

Penile Implants

These are placed inside the penis. The penis will be stiff and you will be able to have spontaneous and normal sex. Surgeries come with risks, and this is the same case with penile implant surgery. Patients with ED have seen a high rate of success through penile implants. The two types of penile implants are;

Semi-Rigid Implant (Bendable)

This is made from two easy-to-blend rods made from metal and silicone. You can bend it up for sex and down for urination.

Inflatable Implant

There are cylinders filled with fluid. They can be pumped to inflate and make the penis stiff. The erections will look normal, and you can control the firmness and size of an erection. This will allow you to have a normal reaction with little to no change in orgasm and sensation.

The surgery is done under anesthesia. Just one small surgical cut is made. There is no tissue removed for this surgery. There isn’t a lot of blood loss. You can expect to go home the same day or spend a night in the hospital.

Bruising, discomfort, and swelling will last for a couple of weeks. It is important to minimize physical activity. You will be guided on matters to do with exercising. After eight weeks, many men can start having sex. You will be taught inflating and deflating the implant.

Other Considerations

Treating Erectile Dysfunction will involve dealing with impotence and the problem for sex, then it wears off. Implant surgery is the only exception. The impotent treatments are going to deal with the symptoms, but they do not fix the cause of the problem. It is important to know the underlying cause then try managing the medical or emotional issues that might be causing erectile dysfunction.

If you happen to have ED or any other sexual dysfunction issues, you don’t have to stress yourself. You can prevent or treat it safely. Talk to your doctor and you will be provided with treatment options. You should not try treating it using risky methods because you may end up making things worse or causing other serious sexual problems.

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Disclaimer: Please do not take this content as medical advice. The content on this site is for informational purposes only. The content on this site has not been evaluated by the Food and Drug Administration. Please consult your Doctor for any medical related advice.

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