Almost every man has problems in this
area from time to time, and consistent
erectile dysfunction affects men of all
ages. For straightforward advice you can
trust on what causes erectile dysfunction
and how you can go about treating it,
we enlisted urologist Dr Peter Stahl.
What is erectile dysfunction and
what are the symptoms?
Erectile dysfunction (ED) is the inability
to achieve or maintain an erection
firm enough for satisfactory sex.
Sometimes affected men are able to
achieve a satisfactory erection, but
lose their erection prior to orgasm.
In other cases, affected men struggle
to achieve a satisfactory erection at all.
When should you see a doctor
about ED?
Occasional difficulties with erection
rigidity that self-resolve are normal and
don’t require evaluation. But all men with
consistent or recurrent ED should seek
evaluation and treatment with a doctor.
The evaluation might result in diagnosis
of a medically important condition, and
treatment can certainly have an important
impact on quality of life.
What causes erectile dysfunction?
Erections are complex neurobiological
events mediated by chemical and hormonal
signals that involve the brain, nerves,
blood vessels and of course the structural
components of the penis itself.
Anything that interferes with any of
these physiological components of the
male sexual response can cause ED.
In young men, psychogenic erectile
dysfunction is very common. Generalised
or performance anxiety leads to
production of adrenaline and similar
neurotransmitters that turn on the
sympathetic nervous system. This system
is the “flight or fight” mechanism that is
meant to save your life in a threatening
situation. It works by shunting blood
away from organs, like the penis, that
aren’t helpful in a dangerous situation.
That results in at first minor loss of
rigidity, but awareness of the lost rigidity
usually then results in more worry
and distress, more adrenaline, and
unfortunately a vicious cycle that often
results in complete loss of an erection.
In other variants of psychogenic ED,
arousal is insufficient to initiate the
entire erection response. This can occur
when a man isn’t sufficiently attracted
to his partner, when he is distracted
or tired, or in some cases when a man
is used to unrealistic or alternative
stimulation – ie, pornography or unusual
masturbatory habits.
Physical causes of ED are also common.
In particular, the same processes that
clog up the arteries to the brain and heart
and predispose you to heart attacks and
strokes can affect the penis and limit blood
flow during an erection. The arteries to
the penis are smaller than the coronary
arteries and the penis is typically affected
earlier than the heart. ED can therefore
be an important warning sign of hidden
cardiovascular disease. This type of ED
is referred to as arteriogenic ED.
Other less common physical reasons
for ED include hormonal abnormalities,
nerve dysfunctions and veno-occlusive
dysfunction. Testosterone deficiency is
the most common type of a hormonal
abnormality. Affected men typically
also report low libido, fatigue, difficulty
maintaining their body composition and
poor physical strength and endurance.The first thing to know about
erectile dysfunction is that it’s
way more common than you
probably think.
Nerve problems typically occur in
patients with known neurological
diseases or diabetes. Veno-occlusive
dysfunction is a structural problem with
the penis that results from impaired
ability to trap blood and generate high
pressures inside the corpora cavernosa- the erection chambers of the penis.
How do you treat erectile
dysfunction?There are two goals in treating men with
ED. The first is for a doctor to recognise
and diagnose health-relevant conditions
that may be associated with ED. For
example, a 40-year-old patient who
reports non-variable and consistent ED
who hasn’t seen a doctor in a long time
might have unrecognised cardiovascular
disease. That patient should be notified
of the importance of getting evaluated for
things like high cholesterol, diabetes and
hypertension. In other ED patients who
have suggestive symptoms such as low
libido, laboratory testing for testosterone
deficiency might be advised.
The second goal of ED treatment, of
course, is to restore erection rigidity. This
is typically accomplished by prescription
of oral medications. Phosphodiesterase
inhibitors are pills that promote the
relaxation of smooth muscle in the penis
and thereby facilitate penile blood flow
and better erection rigidity.
When appropriate, these can be
combined with other treatments such
as psychotherapy or testosterone
replacement therapy. In some cases, such
as psychogenic ED related to performance
anxiety, treatment with oral medications
can be temporary and part of a confidence
restoration strategy. In other cases, long-
term use of oral medications is required
to treat unmodifiable physical conditions.
When pills don’t work, other effective
treatments such as penile injection
therapy and penile prosthesis surgery
are available. These more invasive
treatments are typically provided by
a specialised urologist.How common is ED?
One in five men over the age of 20 have suffered
from ED and it is an increasingly common
problem among young men. Studies suggest
that 10-30% of men younger than 40 are
affected. It’s no longer just men in their 60s and
70s who are dealing with it, but men of all ages.74 MEN’S FITNESS SEPTEMBER 2019