Erectile Disorder

Erectile dysfunction manifests itself through various signs and symptoms.² The symptoms can be physical, psychological, or a combination of both, and they may vary in severity from person to person. 

Physical symptoms of erectile dysfunction

Below are several physical symptoms of erectile dysfunction: 

• Difficulty getting an erection: Not being able to achieve an erection is the most common symptom. Despite sexual arousal, the penis does not become hard or erect. 
• Difficulty maintaining an erection: An erection may be achieved but cannot be sustained long enough for sexual intercourse. 
• Reduced sexual desire: A decreased interest in sexual activity can sometimes accompany erectile dysfunction. 

Psychological symptoms of erectile dysfunction

When it is hard to get or keep an erection that's firm enough for sex, it can be distressing. Erectile disorder may cause several mental health symptoms, including but not limited to the following: 

• Stress or anxiety: The fear of being unable to perform sexually can create a cycle of anxiety and failure that worsens the condition.
• Depression or low self-esteem: Chronic erectile problems can lead to thoughts of worthlessness or symptoms of depression. 
• Relationship difficulties: Problems maintaining an erection can lead to relationship stress or create a cycle where anxiety about performance causes further sexual dysfunction. 

Related symptoms of erectile dysfunction

Erectile dysfunction can also occur alongside other health conditions, which can also be considered symptoms. Some conditions include:

• Premature or delayed ejaculation: Problems with the timing of ejaculation (usually either too soon or not at all) can coexist with erectile dysfunction.
• Loss of libido: Loss of libido is a decreased desire for or interest in sexual activity.
• Problems with orgasm: Experiencing less intense orgasms or difficulty reaching climax may occur alongside erectile disorder. 

Experiencing one or more of the above symptoms does not necessarily mean one is living with erectile dysfunction. However, if symptoms persist or cause concern, consulting with a healthcare provider is recommended. Early detection and intervention can lead to more effective treatment³ and prevention of potential underlying health issues.

Erectile dysfunction can arise from physical health factors like cardiovascular disease or diabetes, as well as from psychological stressors such as anxiety or depression, each influencing the other and potentially creating a reinforcing cycle of symptoms.

Physical causes

Below are some potential physical causes of erectile disorder: 

• Cardiovascular disease: Conditions like heart disease or atherosclerosis (the thickening or hardening of the arteries) can affect blood flow, which is crucial for erections.
• Diabetes: High blood sugar can damage the nervous system and blood vessels, affecting the penis’ function.
• Hormonal imbalances: Conditions like thyroid or adrenal gland disorders can affect hormone levels that influence erectile function.
• Neurological disorders: Conditions such as Parkinson’s disease, multiple sclerosis, or stroke can disrupt the nerve signals needed for an erection. 
• Spinal cord damage: Damage to the spinal cord can lead to erectile dysfunction due to disruptions in the neural pathways responsible for sexual function.

If you have physical symptoms that concern you, consult your primary care physician for support and diagnosis. 

Psychological causes

Potential psychological causes of erectile disorder may include the following: 

• Mental health disorders: Conditions like anxiety, depression, or chronic stress can affect sexual desire and cause ED.
• Relationship problems: Discontent or stress in relationships can also contribute to ED.
• Sexual performance anxiety

Risk factors

Certain behaviors and conditions can increase the risk of developing ED:

• Age: While ED can affect people of all ages, the risk increases with age.
• Tobacco use: Smoking or using tobacco products can cause damage to blood vessels, increasing the risk of ED.
• Alcohol and drug use: Excessive alcohol and drug use can lead to ED. 
• Obesity: Having a higher weight can cause or worsen ED.
• Medical treatments: Certain medical treatments like prostate surgery or radiation therapy for prostate cancer and other forms of cancer can cause ED.

Treatment for erectile dysfunction is varied and tailored to each individual, addressing the physical and psychological causes. The goal of treatment is often to restore sexual function, improve the quality of sexual relationships, and enhance the individual’s overall quality of life. Seeking early and comprehensive treatment for erectile dysfunction, including medical evaluation, lifestyle adjustments, and psychological counseling, can improve both sexual health and overall well-being.

Medication

Several medications can help with erectile dysfunction, or the persistent inability to achieve or maintain penile erection sufficient for satisfactory for sex. Here are some commonly prescribed medications:

• Phosphodiesterase-5 inhibitors (PDE5): PDE5 medications include sildenafil, tadalafil, and vardenafil. These medications enhance the effects of nitric oxide, a natural chemical the body produces to relax muscles in the penis, increase blood flow, and aid in achieving and maintaining an erection.
• Testosterone replacement therapy: If testosterone levels are low, testosterone replacement therapy may improve erectile dysfunction. Examples include testosterone injections or patches.
• Alprostadil: Available as an injection or a suppository inserted into the urethra, alprostadil is a drug that helps increase blood flow to the penis, facilitating an erection.

These medications should be used under the supervision of a licensed healthcare provider, as they can have serious side effects and interactions with other drugs. Consult a medical doctor before starting, changing, or stopping a medication for any condition. The above information is not a replacement for medical advice or diagnosis. 

Other treatment options

For those who don’t respond to medication or therapy, there are other treatment options available:

• Penis pumps: Penis pump devices create a vacuum that pulls blood into the penis, leading to an erection.
• Penile implants: These devices are surgically placed in the penis. Penis implants can be manually controlled to achieve an erection regardless of erectile dysfunction.
• Vascular surgery: In some cases, surgery to improve blood flow to the penis might be an option. Find a doctor to discuss your medical history and surgical options for potentially damaged blood vessels.

Self-care

Self-care and lifestyle changes can significantly impact the management and prevention of erectile dysfunction. Below are a few self-care practices that may help: 

Healthy lifestyle: Maintaining a healthy diet, exercising regularly, and getting sufficient sleep can improve overall health and sexual function.

Limiting alcohol: Excessive alcohol can cause or worsen erectile dysfunction.

Not smoking: Tobacco use can restrict blood flow to veins and arteries, leading to chronic health conditions that cause erectile dysfunction.

Managing stress and anxiety: Regularly practicing stress management techniques such as mindfulness, meditation, or yoga may manage anxiety and stress levels, improving sexual function.

Treatment options should be discussed with a healthcare provider to identify the most suitable approach for you. The combination of professional treatment and self-care can often lead to improved outcomes and a return to satisfactory sexual health.

Therapy may play a pivotal role in managing erectile dysfunction, especially when psychological factors like stress, anxiety, or relationship problems may contribute to the condition. Online platforms like BetterHelp offer licensed therapists who can provide support and strategies for ED. Clients can choose between phone, video, or live chat sessions, which may be helpful for individuals experiencing embarrassment due to their condition. 

Other resources 

Other resources for information, support, and treatment options include:

• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): The NIDDK provides detailed information on erectile dysfunction, including causes, risk factors, treatment options, and clinical trials.
• American Urological Association (AUA): The AUA offers a variety of patient resources for conditions like erectile dysfunction, including patient guides and support groups.
• Sexual Medicine Society of North America (SMSNA): SMSNA is a professional society focused on promoting, encouraging, and supporting the highest standards of practice, research, education, and ethics in studying human sexual function and dysfunction.

These resources can provide information, professional guidance, and peer support to help individuals dealing with erectile disorder. They can also provide information on research and clinical trials for current and potential treatments. 

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

Stem cells, known for their unique regenerative capabilities, are showing promise in treating erectile dysfunction, with initial studies indicating their potential efficacy. Clinical studies, mainly using stem cells derived from adipose tissue and bone marrow, have shown encouraging results for restoring penile tissue function. Various stem cell delivery methods, such as direct injection into the penis, have been trialed with significant outcomes, even though only a tiny percentage of the injected cells remain in the target tissue. Despite these promising results, further comprehensive trials are required to determine optimal therapeutic approaches and long-term impacts.

Other recent clinical studies suggest that low-intensity extracorporeal shock wave therapy (Li-ESWT), a non-invasive treatment, might improve erectile function in people with ED. A comprehensive review examined seven studies involving 522 participants to see the treatment’s effectiveness. Different machines and treatment frequencies were used across these studies, but the focus was improving IIEF-EF (International Index of Erectile Function erectile function domain) scores, a measure of erectile function. Some studies showed promising results, while others were less conclusive. The research suggests that treatment duration, frequency, and intensity can influence outcomes. While the exact way Li-ESWT works remains unclear, it might improve blood flow and tissue health in the penis.

PDE-5 inhibitors have an overall success rate of up to 76%

PDE-5 inhibitors are highly effective in sustaining erections, especially beneficial for younger men or those in early stages of ED.¹

¹Translational Andrology and Urology

Below are more statistics on erectile disorder:

• According to research published by Stat Pearls, “PDE-5 inhibitors, such as sildenafil and tadalafil, are usually the first-line treatment of erectile dysfunction. PDE-5 inhibitors are highly effective and have an overall success rate of up to 76%.”
• A randomized controlled single-blind trial performed at the Institute of Psychiatry of the Medical School at Universidade de São Paulo examined PDE-5 inhibitors and group psychotherapy (GPT), finding that “Satisfaction with the treatment, confidence, and “naturalness” increased in the GPT plus sildenafil and GPT exclusively groups from baseline to endpoint.“