Erectile dysfunction (ED), also known as impotence, is the inability to get and maintain an erection. 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.
It’s important to see a doctor if you have erectile dysfunction for more than a few weeks. They will assess your general state of health because the condition can be the first sign of more serious health conditions, such as heart disease (when the heart’s blood supply is blocked or interrupted).
Why does erectile dysfunction happen?
Erectile dysfunction can have a range of causes, both physical and psychological.
Physical causes include:
- narrowing of the blood vessels going to the penis – commonly associated with high blood pressure (hypertension), high cholesterol, or diabetes;
- hormonal problems;
- surgery or injury.
Psychological causes of ED include:
- relationship problems.
Sometimes erectile dysfunction only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection but you are unable to get an erection with your sexual partner.
If this is the case, it is likely the underlying cause of erectile dysfunction is psychological (stress-related). If you are unable to get an erection under any circumstances, it is likely that the underlying cause is physical.
Erectile dysfunction can also be a side-effect of using certain medicines.
Although you may be embarrassed, it’s important to get a diagnosis so that the cause can be identified.
A doctor can usually diagnose erectile dysfunction. This will involve answering questions about your symptoms, as well as a physical examination and some simple tests.
Tests to determine the cause of ED include:
- Physical Exam – an examination of the testicles and penis while also checking nerves for sensation.
- Blood Tests – Can help to identify signs of heart disease, diabetes, low testosterone, and other health issues.
- Urine Tests – Similar to a blood test, a urine test can help identify diabetes or other potential causes.
- UltraSound – This test is usually conducted by a specialist to determine if there is a lack of blood flow that is preventing you from getting an erection.
How is erectile dysfunction treated?
Erectile dysfunction is primarily treated by tackling the cause of the problem, whether this is physical or psychological.
The narrowing of the arteries (called atherosclerosis) is one of the most common causes of ED. In these cases, a doctor may suggest lifestyle changes, such as losing weight, to try to reduce your risk of cardiovascular disease. This may help to relieve your symptoms as well as improving your general health.
Overall, treatments for erectile dysfunction have improved significantly in recent years. Most men are eventually able to have sex again.
The same healthy lifestyle tips a doctor has been recommending for years may also help treat your ED:
- quitting smoking;
- reducing alcohol consumption;
- losing weight;
- exercising regularly;
- reducing stress.
These steps aren’t an instant fix, but they may improve your blood flow and nerve functioning. If you’re having trouble sticking to these goals, ask your spouse or partner to join you. Getting healthy together and trying new things as a couple can be a great bonding experience and can strengthen your relationship.
Drug Therapy and Injections
When lifestyle changes alone don’t work, drug therapy is normally the next step. Most of these medications work similarly to enhance a natural chemical in your body that relaxes the muscles in your penis. The goal of this medication is to increase your response to sexual stimulation by increasing the blood flow in your penis allowing you to get an erection.
In addition to pills, injections can be used to treat ED. Erections usually occur within 5-20 minutes, but there is the risk of an erection lasting longer than 4 hours and often has poor long-term tolerability.
Shock Waves for ED
Shockwave therapy is administered with a wand-like device placed near different areas of the penis. A healthcare provider moves the device along parts of your penis for about 15 minutes while it emits gentle pulses. No anesthesia is needed.
The pulses trigger improved blood flow and tissue remodeling in the penis. Both of these changes can lead to erections sufficient for sex.
A 2019 review and meta-analysis of clinical trials found that the most common treatment plan was twice weekly for 3 weeks, followed by 3 weeks without treatments, and another 3-weeks of twice-weekly treatments.
The analysis found that the effects of shockwave therapy lasted about a year.
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