When our bodies don’t work how we want them to, it can be hard to talk about. This can be especially true in cases of erectile dysfunction (ED). Even if you’ve only heard about it or experienced it on rare occasions, the fear that ED could happen can keep you from being present in moments of intimacy.
But the truth is ED is a spectrum and can be caused by a wide variety of factors. And if it does happen to you, the frustration, embarrassment and stress it can cause aren’t things that you have to put up with. ED is highly treatable through lifestyle changes and other means.
Keep reading for an explanation of what erectile dysfunction is, what causes ED or contributes to it, and an overview of ED treatment options.
Erectile dysfunction isn’t all or nothing
ED isn’t always the complete inability to get an erection. Erectile dysfunction can also be:
- Inconsistent ability to get an erection when you want to have sex.
- Erections not lasting long enough for satisfying sex.
What can cause erectile dysfunction
ED has a number of possible causes and contributing factors. It’s generally the result of a combination of things that do one or more of the following:
- Affect blood flow to the penis
- Affect signals between the brain and the penis
- Affect nerves in the penis
- Affect testosterone levels
Health conditions that can cause ED
Because of the different ways that ED can be caused, there are a number of health conditions that are associated with it.
For example, blood flow can be impacted by issues like blood vessel and heart conditions, high cholesterol, high blood pressure and atherosclerosis (clogged blood vessels). And nerve issues can result from conditions like diabetes, Parkinson’s disease and multiple sclerosis. Sleep disorders like sleep apnea can affect hormone levels and energy levels, thereby contributing to ED.
Other health conditions that can contribute to ED include:
- Peyronie’s disease (which causes painful, curved erections)
- Low testosterone
- Injury to the penis, other pelvic organs or spinal cord
Medicines that can cause ED
Erectile dysfunction can be a side effect of certain medicines and medical treatments. Common examples are some blood pressure medicines, specifically diuretics (such as chlorothiazide and furosemide) and beta-blockers (such as metoprolol and atenolol), which may decrease blood flow to the penis.
Some antidepressants increase the likelihood of ED, as they can make it harder both to get erections and to reach orgasm. They’re also associated with decreased sex drive in general. Most antidepressants have a chance of causing ED, but selective serotonin reuptake inhibitors (SSRIs) like Lexapro, Prozac and Zoloft are among the most likely.
Other medicine and treatments that can contribute to ED include:
- Antihistamines and H2 blockers – In addition to allergic reactions and acid reflux, histamine plays a role in erectile function.
- Opioids – Long-term opioid use is associated with low testosterone levels and ED.
- Certain cancer treatments – Having radiation therapy for prostate or testicular cancer may contribute to ED.
- Surgery to the pelvic area – Procedures involving the prostate, bladder or rectum can affect nerves or blood vessels essential for erections.
Psychological causes of ED
Sex requires the cooperation of your body and mind. So if you’re experiencing relationship problems or negative emotions like stress, fear or guilt, it can make it hard to get and maintain an erection, even without any other underlying health issues. The same goes for mental health conditions like anxiety and depression.
Worry about sexual performance is a common example of a negative feeling that can contribute to ED. And if that worry comes from noticing symptoms of ED, it may create additional stress or anxiety. But it’s important to note that negative feelings don’t have to be related to sex to interfere with it. It can be harder to get and stay in the mood if you work a very stressful job, for example.
Lifestyle factors that can contribute to ED
Your overall health plays a role in sexual health. Certain lifestyle factors are associated with ED for similar reasons to some health conditions.
Being overweight or having low activity levels increases the risk of conditions like heart disease and diabetes, which can damage the blood vessels and nerves involved in erections. Low activity levels also contribute to poor circulation and lower testosterone, both of which make ED more likely.
Substance use plays a role as well. Smoking cigarettes negatively affects blood circulation throughout the entire body. And studies show that chronic use of alcohol or illicit drugs has negative effects on sexual function.
Erectile dysfunction treatment has two parts
Part 1 of ED treatment: Treating underlying health factors
The first step a doctor will take in treating ED is to address any underlying factors that may be involved.
- Health conditions – Many of the health conditions that can contribute to ED, such as those related to blood flow and diabetes, can be improved by lifestyle changes like getting regular exercise and losing weight. But treatment depends on the condition. If you have low testosterone, for example, testosterone replacement therapy may be recommended.
- Medicines – If you take a medicine that can contribute to ED, your doctor may recommend changing the dose or switching it for a different medicine. Always talk to your doctor before you make any changes.
- Psychological factors – If an emotional issue or mental health condition seems to be playing a role in ED, your doctor may recommend going to a therapist or taking other steps to support your mental health.
- Lifestyle factors – Your doctor may discuss lifestyle changes that could help with ED, such as adjusting your exercise routine and reducing or stopping smoking, alcohol use or illicit drug use. It’s important to be honest with your doctor about your substance use, as it helps fill in the picture of your overall health.
Part 2 of ED treatment: Making it easier to get and keep erections
In some cases, improving underlying health factors is enough to manage ED. But if you continue to experience symptoms, there are additional treatments that can help, such as:
- Oral medicines – Medicines like Viagra and Cialis increase blood flow to the penis and help it respond to sexual stimulation.
- Alprostadil – Alprostadil and other similar medications can cause automatic erections. Alprostadil is either injected into the base or side of the penis, or is taken as a penile suppository using a special application tool.
- Penis pumps – If medicines aren’t effective, your doctor may recommend a penis pump. Also known as vacuum erection devices, penis pumps pull blood into the penis manually. A tension ring can then be placed around the base of the penis to maintain an erection.
- Penile implants – Surgical implants can be an option for some people if medicines aren’t effective. These implants are rod-shaped devices that are placed on either side of the penis. They can either be inflatable, or firm but flexible.
Take back control
Erectile dysfunction has a lot of possible causes and is frequently the result of a combination of factors. But the right combination of lifestyle changes, medicine and other treatments can help you regain control over your sexual health and reduce the stress that often comes with ED.
If you feel like you might be experiencing erectile dysfunction, talk to your primary care doctor. They can give you an initial assessment and refer you to a sexual health expert or urologist if necessary.