Erectile dysfunction (ED) is typically defined as a consistent and recurrent inability to achieve or maintain an erection sufficient for sexual activity. When diagnosing ED, health care practitioners consider several factors including:
- Ability to achieve an erection
- Strength of the erection
- Duration
- Time between erections (latency)
While it is normal to have occasional erectile difficulties – especially as you get older – most men never want to have that problem. If you haven’t experienced ED, accept the fact that at some point in your life it is most likely going to happen. If it doesn’t, you’re either one of the lucky chosen few, you’re not having sex, or you read this info and did everything you could to prevent it from happening.
Causes of Erectile Dysfunction
- Alcoholism. Moderate alcohol consumption and even occasional binge drinking don’t appear to have a negative effect on normal erectile function. Chronic excessive alcohol consumption (i.e., alcoholism), on the other hand, can lead to ED through various mechanisms including reduced testosterone levels and an increased risk of depression.
- Disease. Several chronic diseases are associated with an increased risk of ED including:
- Heart disease
- Hypertension
- Atherosclerosis and Hyperlipidemia
- Diabetes
- Lower Urinary Tract Symptoms (LUTS): urinary frequency, urgency, hesitancy, difficulty, etc.
- Drugs. Both prescription drugs and recreational drugs can lead to ED .
Prescription drugs: Antipsychotics, antihypertensives, anticonvulsants
Recreational drugs: Marijuana, cocaine, MDMA, amphetamines
- Hormone imbalances. An imbalance of sex hormones can lead to problems achieving an erection, specifically the hormones testosterone, serum hormone binding globulin (SHBG), and leutinizing hormone (LH).
- Trauma. This includes trauma or damage to penile blood vessels, arteries, nerves, or to the penis itself. It can be caused by:
- Surgery to treat bladder, rectal, or prostate cancer
- Nerve damage caused by physical trauma from a kick or forceful impact
- Peyronie’s disease (an abnormal and often painful curvature of the penis)
- Nerve disorders. Nervous system dysfunctions can lead to a decrease in sensation and nerve impulse transmission which can inhibit erections. This can result from a spinal cord injury, brain injury, stroke, or other damage to nerves or the nervous system.
- Overweight and obesity. Being overweight or obese can lead to erectile dysfunction by reducing blood flow to the penis, increasing blood pressure, and increasing the risk of cardiovascular disease. Excess abdominal fat also makes your penis look smaller (about one inch for every 30 pounds you’re overweight).
- Physical inactivity. A lack of exercise can lead to erectile dysfunction through both direct and indirect mechanisms including poor circulation, oxidative stress, depression, excess body fat, and a higher risk of chronic disease.
- Psychological issues. Erections can be initiated by both physical stimuli – like touch – or psychological stimuli – like erotic thoughts. Psychological issues like depression and anxiety disorders are strongly associated with ED.
- Smoking. Smoking can cause erectile dysfunction by restricting blood flow.
- Age. Older men are at a greater risk for erectile dysfunction than younger men, but this is because of an age-related increase in chronic diseases, excess body fat, physical inactivity, and hormone deficiencies rather than age itself. The risk of erectile dysfunction increases about two percent per year from age 40 (9%) to age 65 (54%).
Diagnosing Erectile Dysfunction
With so many potential causes of ED, diagnosing the problem can be difficult. Below are some of the most common tests for finding the source of the problem.
- Nutrient status. Blood testing for levels of hormones, vitamins, minerals, amino acids, neurotransmitters, and antioxidants.
- Diagnostic ultrasound. This test can check blood flow to the penis as well as diagnose venous leak, atherosclerosis, and damage to erectile tissue.
- Neurological evaluation. Testing for normal sensation can determine if neurological damage is to blame.
- Blood flow evaluation. This includes Dynamic Infusion Cavernosometry and Cavernosography, Penile Angiogram, Digital Subtraction Angiography, and Magnetic Resonance Angiography. These tests examine penile circulation and blood vessel health.
- Nocturnal Penile Tumescence test. For this test, a special type of perforated tape is wrapped around the penis overnight. Separation of the tape indicates that there was an erection during sleep and that the person is physiologically capable of achieving an erection (so psychological causes are likely to blame).
Erectile Dysfunction Treatments
- Lifestyle changes
- Lose weight
- Exercise
- Eat right
- Quit smoking
- Don’t do drugs
- Limit alcohol intake
- Manage stress
- Supplements. Icariin (horny goat weed extract), ginseng, DHEA and yohimbine HCl (alone or combined with L-arginine) have all shown a benefit for erectile dysfunction.
- Drugs. Viagra, Cialis or Levitra may be effective in somes cases.
- Treat trauma. Conditions like Peyronie’s disease can often be treated with a targeted supplementation protocol. Other more serious conditions may require surgery.
- Balance hormones.
- Correct vitamin, mineral, amino acid, and neurotransmitter abnormalities to optimize hormone levels
- Bio-identical hormone therapy may be useful in lieu of hormone replacement therapy
- Psychological therapy. Everyone (yes, everyone) should see a psychologist regardless of their physical or mental status. Removing psychological barriers to sexual arousal can benefit erectile dysfunction.
- Penis pump. This is an effective tool, but should only be used until the underlying cause is corrected.
