What You Need to Know about Erectile Dysfunction

Ever wondered whether struggling to achieve an erection is a one-off or a sign of something more serious?

While it isn’t unusual for men to have issues ‘performing’ now and then, frequent problems obtaining and maintaining an erection can signify erectile dysfunction (ED).

ED, unfortunately, remains a taboo subject and the associated feelings of shame, embarrassment and fear have serious implications for physical and mental wellbeing.

However, ED is not an inevitable part of ageing, and there is a clear case for the role of lifestyle and behaviour in improving sexual health.

Read on for the full low-down on ED, including key takeaways you can apply today to reduce your risk.

 

What is Erectile Dysfunction?

In clinical settings, erectile dysfunction (ED), also known as impotence, is the consistent inability to achieve or sustain an erection of sufficient rigidity for sexual intercourse. While it’s common for men to fail to achieve an erection under 20% of the time, if it’s more than 50%, it could be a sign that you require treatment[1]. Other symptoms that may accompany ED include:

  • Impaired sexual function, e.g., difficulty ejaculating, reduced volumes of ejaculate, low sex drive
  • Pain, swelling or lumps on the testicles
  • Recurrent respiratory infections
  • Loss of/reduced sense of smell
  • Growth of breast tissue (gynecomastia)
  • Reduced/difficulty growing facial hair or other indicators of hormonal imbalances
  • Reduced sperm count (fewer than 15 million sperm per millilitre of semen or a total sperm count of less than 39 million per ejaculate)[2].

Effective treatment for ED can only start following a medical diagnosis, which may include a lifestyle interview, physical examination and blood tests to determine hormone levels[3],[4]. However, while the stats show that ED prevalence is on the rise, only 25% of men with ED seek treatment[5],[6].

The Stats

  • One in 10 men will suffer from ED at some point in their lifetime[7].
  • ED prevalence increases by around 10% with each decade of life, and around 50% of men in their fifties report experiencing ED[8].
  • One in six cases of male infertility involves ED[9]. Infertility is also one of the most frequently cited grounds for divorce[10].
  • Men with ED are nearly three times more likely to experience depression than those without ED[11].

 

What Causes Erectile Dysfunction?

To explain how ED works, it’s important to understand the anatomy ‘down there’ and what causes erections. The penis is composed of:

  • Two chambers known as the corpora cavernosa. Running along the organ’s length, they contain a series of blood vessels shaped like a sponge.
  • The urethra. It runs under the corpora cavernosa and carries urine and sperm.
  • Erectile tissue, which surrounds the urethra, two main arteries and several veins and nerves.
  • The shaft, the longest part of the penis.
  • The head (glans) sits at the end of the shaft.
  • The meatus, or opening at the tip of the head, where urine and semen are discharged.

The process of producing an erection starts in the brain when you see, feel, hear, smell or think something that triggers sexual arousal. The brain then sends nerve signals that stimulate the penis, causing the muscles of the corpora cavernosa to relax. An influx of blood flow fills and expands the sponge-like tissue to create an erection. As this occurs, the membrane surrounding the corpora cavernosa, known as the tunica albuginea, traps the blood to help sustain the erection. When the muscles of the penis relax, the outflow channels open and blood flow into the penis slows down.

It’s no surprise then that most ED issues stem from problems with blood supply to the penis, which can arise from:

  • Narrowing of the blood vessels
  • An inability for the blood vessels to expand (known as vasodilation)
  • Interference with signals sent between the brain and vascular system
  • Structural issues (including congenital curvature of the penis that impedes blood flow) [12].

 

The chain of processes that lead to an erection is complex and can be affected by various factors, including:

    • Vascular diseases (like atherosclerosis)
    • Psychological conditions (like depression and anxiety)
    • Trauma or injuries (to the nerves or arteries that supply the penis)
    • Medical conditions (including Parkinson’s disease and multiple sclerosis)
    • Hormonal imbalances (most commonly low testosterone)
    • Recreational drug use (including anabolic steroid abuse)
    • Ageing (the prevalence of ED increases with age)
    • Medications.

Certain medications can interfere with the supply of blood to the penis, including those used to treat:

  • High blood pressure
  • Depression and other mental health conditions, notably SSRIs
  • Irregular heart actions
  • Prostate cancer
  • Seizures[13]

 

Ageing is just one of the factors that can influencer erectile dysfunction.

 

ED is often a symptom of another underlying health problem that has secondary effects on sexual health[14]. It is estimated that around one in four adults in the UK has metabolic syndrome, a cluster of conditions that includes type 2 diabetes, high blood pressure and abnormal cholesterol levels. These conditions all increase the risk of ED significantly, and up to 75% of men with type 2 diabetes have experienced ED at some point[15],[16].

Metabolic syndrome increases the risk of ED because it has several negative consequences for the vascular system, such as damaging blood vessels’ lining, preventing nitric oxide turnover, and narrowing the diameter of blood vessels. As a result, the vascular system cannot pump enough blood to the penis, making it challenging to attain and maintain an erection[17]. The relationship between the two is so strong that medical practitioners often see ED as an early warning sign for more serious health conditions[18].

Lifestyle And Erectile Dysfunction

While ED becomes more common with age, lifestyle habits play an important role in maintaining healthy sexual function throughout life. Around 60% of obese men are thought to experience low testosterone (hypogonadism), the most common hormonal cause of ED[19]. Poor sleep also increases your risk for high blood pressure by 50%, which doubles the risk of developing ED[20],[21]. With today’s culture of decreased sleep, high stress and poor nutritional choices, it’s no wonder that ED prevalence is increasing.

Trends have also shown a worrying swing in recent years, with up to 25% of younger men experiencing ED. A key contributing factor is increased use of anabolic-androgenic steroids (AAS), which is most common in their 20s and 30s[22]. AAS often improves erectile function due to increased testosterone levels in the short term, but over time it can result in elevated blood pressure and cholesterol levels, restricting blood flow[23],[24]. Another problem related to steroid misuse is users going ‘cold turkey’ when they end a cycle, temporarily or permanently shutting down testosterone production. As a result, as many as one in four men who have previously used AAS report having ED[25].

Likewise, younger men are statistically most likely to take part in excessive alcohol consumption or recreational drug use, both of which increase the risk of erectile problems. Despite often being seen as aphrodisiacs, recreational drugs such as amphetamines and MDMA can increase the risk of ED by over 36%[26]. Unfortunately, the growing use of over-the-counter medications such as Viagra may inadvertently also result in ED. While research shows that Viagra is safe at all ages in responsible doses, it can indirectly cause ED when men stop using it due to perceptions of stress regarding sexual function, a significant cause of ED[27],[28].

Reducing Your Risk of ED

While there are several non-modifiable risk factors for ED, lifestyle plays a key role in managing ED risk.

1. Improve Your Body Composition

Obesity is responsible for as many as eight million cases of ED in the US[29]. However, research shows that even modest weight loss of 5% to 10% of total body weight improves ED outcomes significantly[30].

 

2. Get Moving

Physical activity is probably the most influential lifestyle factor in ED. As little as two to three hours of exercise per week appears to help reverse ED in around 70% of sedentary men. What’s more, exercise that involves bouts of intense effort followed by rest, such as resistance training, appear to be most effective at improving ED[31].

 

3. Eat A Nutrient-Rich Diet

There is a consistent relationship between diet and ED. The Mediterranean diet (high in fruit and vegetable intake, nuts, legumes, fish and other sources of omega-3 fatty acids, with reduced intake of red and processed meats) has been consistently associated with decreased risk of ED[32].

 

4. Quit smoking

Smokers are over two times more likely to experience ED than non-smokers[33]. This effect also appears to be dose-dependent, so the more you smoke, the more severe and longer-lasting the effects[34]. However, quitting helps reverse this trend, with one study showing that over 25% of men with ED improved erectile function after one year[35].

 

5. Minimise Stress

Statistics show that people with depression are almost 40% more likely to experience ED[36]. Cognitive-behavioural therapy (CBT), a form of psychotherapy, has been shown to help reverse ED in men with poor mental health[37]. Prevention is nearly always better than the cure, so techniques such as meditation and journaling are effective means to stay on top of stress management before it becomes too much.

 

6. Prioritise your sleep.

There are not many health problems that sleep doesn’t improve, and ED is no exception. Men who sleep for under seven hours are at significantly increased risk for ED[38]. Irregular sleep patterns such as working night shifts also appear to lower measures of erectile function compared to men with consistent sleep patterns[39]. Various factors may mean you’re not able to improve your sleep quantity or pattern. However, focusing on improving your sleep quality through improved sleep hygiene is one important way to boost sexual function.

Focusing on improving your health, your body composition, your diet and lifestyle is a great way to minimise the risks of ED. 

The Key Message

ED remains a taboo subject, and as such, men are unfortunately often all too scared or embarrassed to speak up. But while ED becomes more common with age, if you find yourself frequently struggling with sexual performance, it’s important to speak to your healthcare provider to discuss treatment and rule out more serious health conditions. Lifestyle is a key risk factor for ED, so if you haven’t already, it could be a sign to start making some big changes today.

Key Takeaways

  • Erectile dysfunction (ED) is the consistent inability to achieve or sustain an erection.
  • There has been a worrying increasing rise of ED in younger men in recent decades.
  • Multiple non-modifiable factors can cause ED, such as medical conditions, hormonal imbalances, or trauma to the reproductive organs.
  • ED is becoming an increasingly common by-product of lifestyle choices, such as obesity, smoking, diet, and alcohol and recreational drug use.
  • ED is often a source of shame and embarrassment, but effective treatment can only follow a full medical assessment and diagnosis.
  • Lifestyle and behaviour change are two factors you can change today to decrease your risk of ED.

 

Erectile dysfunction is a common symptom of low testosterone levels in a man. Here are 4 tips to help men naturally increase testosterone levels.

 

References

[1] Cleveland Clinic. (2021). Erectile Dysfunction (ED): Causes, Diagnosis & Treatment. https://my.clevelandclinic.org/health/diseases/10035-erectile-dysfunction. [Last accessed 15.09.21].

[2] Mayo Clinic (2021). Male Infertility, https://www.mayoclinic.org/diseases-conditions/male-infertility/symptoms-causes/ [Last accessed 15.09.21].

[3] Cleveland Clinic. (2021). Erectile Dysfunction (ED): Causes, Diagnosis & Treatment.

[4] Cleveland Clinic. (2021). Erectile Dysfunction (ED): Causes, Diagnosis & Treatment.

[5] Frederick, L.R., et al. (2014). Undertreatment of erectile dysfunction: claims analysis of 6.2 million patients. The journal of sexual medicine, 11(10).

[6] Frederick, L.R., et al. (2014). Undertreatment of erectile dysfunction: claims analysis of 6.2 million patients. The Journal Of Sexual Medicine, 11(10).

[7] Cleveland Clinic. (2021). Erectile Dysfunction (ED): Causes, Diagnosis & Treatment.

[8] Van Hemelrijck, M., et al. (2019). The global prevalence of erectile dysfunction: a review. BJU international, 124(4).

[9] Lotti, F., Maggi, M. (2018). Sexual dysfunction and male infertility. Nature Reviews Urology, 15(5).

[10] NICE. (2021). Causes of infertility. https://cks.nice.org.uk/topics/infertility/background-information/causes-of-infertility. [Last accessed 17.09.21].

[11] Liu, Q., et al. (2018). Erectile dysfunction and depression: a systematic review and meta-analysis. The journal of sexual medicine, 15(8).

[12] NICE. (2021). Erectile dysfunction. https://cks.nice.org.uk/topics/erectile-dysfunction. [last accessed 15.09.21].

[13] Mayo Clinic. (2021). Erectile dysfunction – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction. [Last accessed 15.09.21].

[14] Cleveland Clinic. (2021). Erectile Dysfunction (ED): Causes, Diagnosis & Treatment.

[15] NICE. (2021). Erectile dysfunction.

[16] Boston University School Of Medicine. (2021). Epidemiology of ED. https://www.bumc.bu.edu/sexualmedicine/physicianinformation/epidemiology-of-ed/ [Last accessed 15.09.21].

[17] NICE. (2021). Erectile dysfunction.

[18] Widmaier, E., et al. (2019). Vander’s human physiology. 4th ed. New York: McGraw-Hill Education.

[19] Rajfer J. (2000). Relationship between testosterone and erectile dysfunction. Reviews in urology, 2(2).

[20] European Society Of Cardiology. (2021). How to treat high blood pressure without ruining your sex life. https://www.escardio.org/The-ESC/Press-Office/Press-releases. [Last accessed 15.09.21].

[21] Grandner, M., et al. (2018). Sleep Duration and Hypertension: Analysis of > 700,000 Adults by Age and Sex. Journal of Clinical Sleep Medicine, 14(6).

[22] Kanayama, G., Pope, H.G. (2017). History and epidemiology of anabolic androgens in athletes and non-athletes. Molecular & Cellular Endocrinology, 39.

[23] Armstrong, J. M., et al. (2018). Impact of anabolic androgenic steroids on sexual function. Translational andrology and urology, 7(3).

[24] Liu, J. D., Wu, Y. Q. (2019). Anabolic-androgenic steroids and cardiovascular risk. Chinese medical journal, 132(18).

[25] Rasmussen JJ, et al. (2016). Former Abusers of Anabolic Androgenic Steroids Exhibit Decreased Testosterone Levels and Hypogonadal Symptoms Years after Cessation: A Case-Control Study. PLoS One, 11.

[26] Bang-Ping J. (2009). Sexual dysfunction in men who abuse illicit drugs: a preliminary report. Journal of Sexual Medicine. 6 (4), pp. 1072-1080.

[27] Rastrelli, G., Maggi, M. (2017). Erectile dysfunction in fit and healthy young men: psychological or pathological?

[29] Skrypnik, D., et al. (2014). Obesity is a significant risk factor for erectile dysfunction in men. Polski Merkuriusz Lekarski, 36(212).

[30] Esposito, K., et al. (2009). Effects of intensive lifestyle changes on erectile dysfunction in men. The journal of sexual medicine, 6(1).

[31] Gerbild, H., et al. (2018). Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies. Sexual medicine, 6(2).

[32] Bauer, S. R., et al. (2020). Association of Diet With Erectile Dysfunction Among Men in the Health Professionals Follow-up Study. JAMA, 3(11).

[33] Shiri, R., et al. (2005). Relationship between smoking and erectile dysfunction. International journal of impotence research, 17(2).

[34] Kovac, J. R., et al. (2015). Effects of cigarette smoking on erectile dysfunction. Andrologia, 47(10).

[35] Pourmand, G., et al. (2004). Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study. BJU international, 94(9).

[36] Liu, Q., et al. (2018). Erectile dysfunction and depression: a systematic review and meta-analysis.

[37] Khan, S., et al. (2019). Potential for long-term benefit of cognitive behavioural therapy as an adjunct treatment for men with erectile dysfunction. The journal of sexual medicine, 16(2).

[38] Rodriguez, K. M., et al. (2020). Shift Work Sleep Disorder and Night Shift Work Significantly Impair Erectile Function. The journal of sexual medicine, 17(9).

[39] Rodriguez, K. M., et al. (2020). Shift Work Sleep Disorder and Night Shift Work Significantly Impair Erectile Function.

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