Understanding Erectile Dysfunction: Causes, Treatments, and Lifestyle Changes

A Comprehensive Guide to Understanding and Managing Erectile Dysfunction

Erectile dysfunction (ED), also referred to as impotence, affects as many as 20 million people in the US—and it can be a frustrating experience. It happens when a man has trouble getting or maintaining an erection firm enough for sexual intercourse. While it’s a common issue, many men feel uncomfortable discussing it. But it’s important to remember that ED is often treatable, and you don’t have to go through it alone. This guide explores the common causes of ED, discusses available treatment options, and offers practical lifestyle changes that can help improve sexual function.

Understanding Erectile Dysfunction

When a man is not sexually aroused the penis is soft and limp. When he becomes sexually aroused, nerves release chemicals which increase blood flow to the penis. Blood flows into the corpus cavernosum, spongy muscle tissue which traps the blood and makes the penis firm, causing an erection. When a man has an orgasm, another set of nerve signals cause the tissue to contract, releasing blood back into circulation, and the erection comes down. ED happens most often when blood flow to the penis is restricted or nerves are harmed. Erectile dysfunction can be a warning sign of diseases like atherosclerosis, heart disease, high blood pressure, or diabetes. Obesity, smoking, using drugs, or drinking too much alcohol are other factors. Stress, relationship issues, or emotional problems can also cause ED.

Causes of Erectile Dysfunction

Most often, ED is caused by physical problems. Some of the most common causes are heart disease and cardiovascular disease, atherosclerosis, high blood pressure, high cholesterol, and metabolic syndrome. Narrowing and clogging of the arteries in the penis limit blood flow and cause ED. Diabetes can reduce blood flow or cause small vessel disease and nerve damage to the penis. Neurological conditions like multiple sclerosis, Parkinson’s disease, and injuries to the spinal cord or pelvis can affect the nerves’ ability to signal for increased blood flow to the penis. Hormonal disorders like thyroid problems and low testosterone levels are another cause. ED may even be a side effect of some medications, such as some antidepressants, blood pressure medications, anxiety treatments, digoxin, opioids, some cancer drugs, anticholinergics, and hormone drugs. Psychological causes of erectile dysfunction are much less common than physical ones, causing about 10% of cases—with the remaining 90% attributed to physical causes. Depression, anxiety, relationship issues, stress from social, cultural, or religious conflicts, stress at home or at work, and anxiety about sexual performance can cause or worsen ED.

Treatments for Erectile Dysfunction

If you have normal nerve function to the penis and are not taking nitrates for your heart, your doctor may prescribe a PDE5 inhibitor like Viagra®, Cialis®, Levitra®, or Stendra®. Men with ED take these pills about an hour or two before having sex. These increase penile blood flow and improve erections for about 7 out of 10 men. Response rates are lower for men with diabetes and cancer patients. Side effects usually are mild and include headaches, stuffy nose, a flushed face, muscle aches, and indigestion, which last a short time. In cases where a man has a low sex drive and low testosterone levels, testosterone replacement therapy (TRT) may restore normal erections or help when used with PDE5 inhibitors. If oral medications don’t work, you may be prescribed Alprostadil, a drug you inject yourself into the side of the penis (intracavernosal injection or ICI) or insert as a tiny pill in the urethra (IU). The first shot should be at your healthcare provider’s office, where they will teach you how to give the shot and change the dosage if necessary. ICI Alprostadil has a success rate as high as 85% and often works for men who don’t respond to oral medications. An erection lasts 20 to 30 minutes or until climax. The major side effect is a prolonged erection of more than 2 to 4 hours, which is an emergency and must be treated in the emergency room to avoid permanent damage to the penis. Medical devices can also help men have erections. A vacuum erection device is a plastic tube which slips over the penis and uses a low-pressure vacuum to pull blood into the penis. The user then slips a ring over the base of the penis, which holds the blood in and maintains the erection for up to 30 minutes. Penile implants involve surgery to insert either semi rigid or inflatable implants in the penis. Semi-rigid implants are bendable silicone rods that give the firmness needed for an erection. An inflatable implant is connected to a pump which is placed in the scrotum between the testicles. A man can engage the pump to inflate the penis and make it stiff. Implants can make sex more spontaneous since they don’t need preparation to work. Psychological factors cause ED in 10-20% of cases. Depression is the most common psychological cause of ED, but in some cases, challenges stem from childhood abuse or trauma. It’s also not uncommon for a man to experience performance anxiety: when he experiences ED, fears it will happen again, which creates anxiety around sexual intercourse and impedes the ability to get or maintain an erection. Stress in a relationship can cause sexual desire to ebb. Seeing a therapist or a couples counselor to address relationship issues can help resolve psychological issues that affect your sex life.

Lifestyle Changes for Managing Erectile Dysfunction

A healthy diet, exercise, and other lifestyle changes often can improve erectile dysfunction. Eating a varied and nutritious diet low in processed and fast foods is better for your heart health and helps maintain a healthy weight. A review of research studies found that ED was lessened in men who followed the Mediterranean diet. The Mediterranean diet is rich in fruits, vegetables, whole grains, healthy fats, and protein from seafood, beans, and nuts. It’s low in red meat and processed foods. Some foods may help improve blood circulation, like fatty fish, walnuts, and berries and watermelon, which are rich in antioxidants. Physical exercise can also help improve testosterone levels naturally and improve ED. Obesity is one of the major causes of ED, and regular exercise can help you lose weight. Regular aerobic exercise also improves heart health and circulation. Research suggests that pelvic floor exercises may help with ED by strengthening pelvic floor muscles, but more research is needed. Stress reduction techniques like yoga, meditation, and mindfulness can help you manage stress at work or at home, which contribute to ED. Take a walk in nature, pet your dog, exercise, do something you enjoy, even if it’s just for 10 or 15 minutes. Stress may contribute to not sleeping well or getting enough sleep. Recent research has found that disrupted sleep and sleep disorders like obstructive sleep apnea are associated with ED. Practicing good sleep habits can help you get a good night’s sleep, which is important to overall health as well as testosterone levels. Smoking, drinking too much alcohol, and obesity are associated with sleep apnea as well as ED and other health problems. Men who smoke are twice as likely to develop ED as nonsmokers. Once you quit smoking, your circulation starts improving within 2 to 12 weeks. Research has found that men with obesity and overweight who lost weight seemed to have improvement in their erectile function and testosterone levels.

Consulting Healthcare Providers

Don’t let shame or embarrassment keep you from getting help and enjoying your sex life. If you’ve had ED for 6 months or more, talk to your healthcare provider about your symptoms. Most of the causes of ED are physical, and persistent ED is often a sign of other significant health problems. Find a healthcare provider you feel comfortable with and tell them what’s going on. Providers are there to help you find a solution best suited to your circumstances. Start by requesting a consult with your WIN Nurse Care Advocate for support and to find a provider who can help.

Understanding Erectile Dysfunction: Causes, Treatments, and Lifestyle Changes

A Comprehensive Guide to Understanding and Managing Erectile Dysfunction