Formerly known as impotence, erectile dysfunction is the inability to get or keep a penile erection firm enough for sexual intercourse. Most men will experience erectile dysfunction at some point but are hesitant to ask their doctors about it, so we gathered the most commonly asked questions about erectile dysfunction for one of our urologists to answer.
- Is it normal to have erectile dysfunction?
- What causes it?
- Is it permanent?
- How do I know if I have erectile dysfunction?
- How is it treated?
- What are the most common treatments?
- What are ED devices that can help?
- Will ED exercises help?
- Can it cause infertility?
Read on to find out what urologists have to say about erectile dysfunction.
1. Is it normal to have erectile dysfunction?
Erectile dysfunction is a common medical condition that affects over 20% of all adult males, according to Baylor St. Luke’s Medical Group Urologist Dr. Chrisopher Kosarek, with an age correlation of 40% of men aged 60-69 and 50-100% of men aged 70 and over. However, progressive and frequent ED can signify potential health issues that require treatment by a medical professional. “The younger the patient, the more important it is to see a doctor, as this could suggest early-onset cardiovascular disease,” adds Dr. Kosarek.
2. What usually causes erectile dysfunction?
The physical cause of ED is either limited blood flow to the penis (which prevents it from hardening), an inability to retain blood, or nerve damage. Stress and emotions can also play a role in ED. However, it can also be a symptom of serious illnesses like heart disease, high blood pressure, high blood sugar, or atherosclerosis, which is the hardening of arteries.
How do erections work? During sexual arousal, nerves signal the release of chemicals that increase blood flow into two spongy muscle chambers in the penis. Upon orgasm, nerves release another set of chemical signals that release the blood back into circulation.
Dr. Kosarek adds that other common causes of ED include medication-induced treatments, prior radiation treatment, and certain hormone issues. Here are some of the known risk factors for ED:
3. How can I test for erectile dysfunction?
While there is no specific ED test, men can undertake genital-focused (penis and testicles) tests to check for ED. The test may also check your heart and blood pressure, as well as examine your family history. Depending on your age, your doctor may also perform a rectal exam to check your prostate gland.
“Labs are routinely performed to ensure no other major diseases are present to factor into decision making. Additionally, advanced testing such as penile Doppler ultrasound to evaluate blood flow have a role in select cases.”
-Dr. Christopher Kosarek, urologist at Baylor St. Luke’s Medical Group in The Woodlands
Here are other advanced ED tests to guide treatment:Blood work to check male hormone levels and blood sugar
- Ultrasonography to check blood flow
- A stimulant shot directly into the penis to cause an erection
- Pelvic X-rays
- Nocturnal penile tumescence (NPT), an overnight test for sleep erection
4. Is erectile dysfunction permanent?
“ED is mostly thought of as a chronic disease, but thankfully, there are numerous treatment strategies that result in excellent outcomes,” says Dr. Kosarek. Treating the underlying causes and making lifestyle changes can also help reverse symptoms without the need for medication.
5. How do I know if I have erectile dysfunction?
According to Dr. Kosarek, ED patients commonly have erections that are not hard enough for penetration or erections that do not last long enough to complete intercourse. He says, “These symptoms tend to result in declining confidence in intercourse which can further worsen their symptoms.”
6. What are the most common treatments for erectile dysfunction?
Dr. Kosarek recommends talking to your primary care provider or urologist about the best option for you, including oral pills, a vacuum erection device, urethra pellets, penile injection therapy, or penile prosthesis surgery (implant).
Doctors may also start assessing your risk factors for any lifestyle changes that you can implement. This involves changing food habits, incorporating exercise, limiting/omitting alcohol and drug use, or beginning counseling to treat the psychological or emotional causes of ED. Doctors will often try using non-invasive treatments first, like medications and hormone therapy.
Here are the most common non-invasive ED treatments:
- Oral drugs (PDE5 inhibitors) like Viagra, Cialis, Levitra, or Stendra
- Testosterone therapy
- Penile injections
- Intraurethral medication
What are PDE5 inhibitors? Short for phosphodiesterase type 5 inhibitors, these are medications that block PDE5, an enzyme in blood vessel walls, causing them to relax and increase blood flow.
“Patients take either on-demand or daily ED pills. However, there are numerous other options which patients enjoy,” Dr. Kosarek adds.
7. Are there devices that help with erectile dysfunction?
“There are medical-grade vacuum erection devices, or ‘penis pumps,’ that are safe and effective for some patients with erectile dysfunction,” suggests Dr. Kosarek.
These vacuum erection devices are plastic tubes worn over the penis. They have a pump that creates a low-pressure vacuum seal around the erectile tissue, causing an erection. In addition, they have an elastic ring that slips onto the base of the penis, holding the blood in and maintaining erections for up to 30 minutes.
Other ED devices are penile implants that require surgery. They are usually recommended for aging men for whom oral PDE5 inhibitors or ICI or IU therapy have proven ineffective. Penile implants are placed entirely inside the penis and have the highest rates of success among treatment options for ED:
- Bendable implant: Made with two semi-rigid silicone rods, they can bend downward for urinating or upward for sex.
- Inflatable implant: Cylinders filled with fluid placed lengthwise into the penis, with tubing that leads to a pump inside the scrotum. Pressing the pump results in the cylinders inflating the penis for a natural-looking erection. This type of implant lets men control the firmness and size of their erections.
8. Are there exercises to do to help improve erectile dysfunction?
“Unfortunately, there are no dedicated penis exercises that can be performed,” says Dr. Kosarek. “However, the recommended amount of exercise can help maintain a healthy weight, improving whole-body health, including improved heart function and blood flow.”
This means aerobic exercises are beneficial for men with ED. Studies show that 40 minutes of moderate to vigorous aerobic exercise four times a week contributed to decreased ED symptoms.
9. Can erectile dysfunction cause infertility?
Male infertility comes from low sperm production, sperm abnormalities, or blockages in the sperm delivery system. ED is not a direct cause of male infertility, but they may have similar root causes.
“There is no evidence suggesting that a male is unable to produce sperm if they have ED. However, they need to have their ED managed appropriately in order to have efficient intercourse.”
Looking to manage your ED or urologic health issues? Schedule a virtual visit or in-person appointment with a Baylor St. Luke’s Medical Group urologist to get started on your urologic health journey.
Medical News Today | Erectile Dysfunction: Treatments and Causes
Healthline | Erectile Dysfunction (ED): Causes, Treatment, Symptoms, and More
Urology Care Foundation | Erectile Dysfunction (ED): Symptoms, Diagnosis & Treatment
NCBI | Physical Activity To Improve Erectile Function: A Systematic Review of Intervention Studies