Need Erectile Dysfunction Treatment? A Comprehensive Guide to Relieving Impotence

Erectile Dysfunction
(Shutterstock Images)

erectile dysfunction article

 

 

 

 

Dysfunction can be debilitating. Not being able to intimately in bed can cause shame and embarrassment, as well as decreased satisfaction inn a relationship. But, the good news is–

Erectile dysfunction is treatable.

Scroll down to learn more about erectile dysfunction. What is erectile dysfunction? What causes it? What are the treatments for erectile dysfunction? And, how can you go beyond ED to male enhancement, to improve your sex life?

Written by Rob Michaels
Updated 01/23/2019

THE ESSENTIALS

      • It Happens to Most Men – The inability to get or keep an erection happens to most guys, at some point in their lives. However, this does NOT always mean it could be erectile dysfunction.
      • Two Factor Categories – Factors leading to erectile dysfunction are either physically and/or psychologically based.
      • Treatment Options – Treatment options for ED vary depending on the underlying factors. Prescription medication, penis pumps, injections, and even therapy are all common treatments that can lead you back to a healthy sex life.

WHAT IS ERECTILE DYSFUNCTION (ED)?

Erectile dysfunction, commonly referred to as ED, is defined by the Mayo Clinic as the condition when a man is unable to get or maintain an erection firm enough for sex.[1] In fact, according to the Urology Care Foundation, it is the most common sex problem that men report to their doctors, affecting as many as 30 million men.[2]

erectile dysfunction chart
Erectile Dysfunction Chart 2010 – Data from Adweek.com

Also known as impotence, erectile dysfunction can cause stress in your relationship and damage your self confidence. Although most men, at some point, have trouble getting or maintaining their erection, this is not the same thing as true ED. With erectile dysfunction, erection difficulties are the norm. Erectile dysfunction becomes more common as men age. As noted above, the good news is ED is usually treatable.

      • If erectile difficulties only happen rarely — Chances are, the problem isn’t too serious. Remember, most men have trouble with erections at some point in their life.
      • If your erectile difficulties get gradually worse and more persistent —There is likely a physiological cause to your erectile dysfunction. You should seek the advice of a medical professional.
      • If your erectile difficulties begin abruptly, but you still get early morning erections and can become erect when masturbating  Chances are, there is a psychological factor affecting your ED. Speak to a medical or psychological professional.

You can read other information about erectile dysfunction on TrueLibido, by clicking here.

WHAT CAUSES ERECTILE DYSFUNCTION?

Psychological Factors Causing Erectile Dysfunction

Psychological factors include:

erectile dysfunction self-fulfilling prophecy

      • Stress and Anxiety –  Being stressed and anxious about work, money, and other problems can lead to erectile dysfunction. A study in the International Journal of Impotence Research shows how anxiety plays a major role in problems associated with ED, and how it can be treated with counseling and medication.[3]
      • Performance anxiety Once you’ve experienced erectile dysfunction, worry about it happening again can increase your anxiety and actually cause the problem to happen again.
      • Depression – Depression affects you both physically and emotionally, which can lead to ED. Research published in the American Family Physician shows 70% of adults, going through depression without treatment, had problems with libido.[4] Moreover, many antidepressants, including Valium and Prozac, have ED as a side effect.[5]
      • Guilt – Guilt ties in with performance anxiety, when the guilt is about not being able to satisfy your partner, or may lead to anxiety if the guilt is about other issues in your relationship.

Each of these factors  cause the body to go into “flight or fight” mode. Stress hormones are triggered, including epinephrine and norepinephrine. According to psychologist Dr. Andre Goliszek: “During stress, blood vessels don’t dilate fully and the sphincter fails to constrict, both contributing to erectile dysfunction. Negative events create a spontaneous stress response that intensifies the more ingrained it becomes.”[6]

In short, stress hormones constrict the blood vessels in the penis, making it more difficult to get or maintain an erection. This sets up a vicious cycle — you’re worried about your sexual performance, which leads to more stress and anxiety, releasing more stress hormones, which becomes a self-fulfilling prophecy.

Physiological Factors Causing Erectile Dysfunction

Since the erection is a hydraulic function, if ED is due to a physical issue, it’s usually centered on either circulation or nerve sensitivity. Physiological factors are varied and fall into three basic sub-categories.

erectile dysfunction causes
Data from Medscape.com [7]

Vascular Causes of Erectile Dysfunction

Vascular causes of erectile dysfunction center on issues with the blood flow to the penis. Your erection is dependent on blood flowing and being maintained in the cavernous tissues of the penis. According to the Cleveland Clinic Foundation, vascular diseases accounts for approximately 70% of erectile dysfunction with physical-related causes.[8] These include:

      • Heart/Vascular Disease – Vascular disease, often associated with obesity and other unhealthy lifestyle choices, blocks the blood vessels, restricting blood flow, making getting and maintaining an erection difficult. Atherosclerosis (hardening of the arteries), high blood pressure, and high cholesterol are among the most common causes of ED.
      • Venous leak Blood flowing into your penis, and the veins constricting to trap the blood, leads to an erection. However, if penile veins can’t maintain the blood during erection, and flows out too fast, you may have a venous leak.[9] The venous leak is linked to diabetes, nerve conditions, and anxiety. It can also occur due to penile injury.
      • Kidney Disease – A study published in the World Journal of Nehprology shows ED is a common disorder in chronic kidney disease patients.[10] It can affect several areas needed for a healthy erection, including: vascular function, hormone levels, and the nervous system. This disease can also negatively affect your physical stamina, causing a drop in your libido. To compound matters, some medications used in the treatment of kidney disease have been known to cause erectile dysfunction.

Operative Causes of Erectile Dysfunction

On occasion, some surgical operations may cause erectile dysfunction. Approximately 10% of physiologically-induced erectile dysfunction is actually due to surgery. This often includes:

      • Prostate and Bladder Cancer Surgery – Studies show erectile dysfunction is common among men after radical prostatectomy or prostate cancer surgery.[11] Sexual dysfunction is also prevalent among men who have cystectomy, also known as bladder cancer surgery.[12] Although prostate and bladder cancer do not cause erectile dysfunction, treatments may lead to temporary or permanent ED. Surgery for either cancer type can damage the nerves and tissues needed for a healthy erection. This damage usually heals within 6 to 18 months; however, in some cases, the damage is permanent.
      • Other Surgeries in the Pelvic Area – Any other surgery in the pelvic region has a chance of leading to erectile dysfunction. This is especially true of penis enlargement surgery. A 2018 study in The Journal of Sexual Medicine notes that substances in penile silicone injections can damage blood vessels and nerves, causing weak sensation and erectile dysfunction.[13] Dermal fillers are currently not approved by the U.S. Food and Drug Administration (FDA).

Pharmacological Causes of Erectile Dysfunction

Drug use, both illicit and prescribed, causes about 10% of erectile dysfunction due to physical factors.[7] Many drugs negatively affect the penis’s ability to maintain blood in the veins. These drugs include:

      • Nicotine, Alcohol or Illicit Drug Use – All three can damage the blood vessels needed for a healthy erection. Smoking and drinking can specifically reduce blood flow to the penis, increasing your chance of getting erectile dysfunction.[14]
      • Prescription Medications – According to WebMD, there are more than 200 prescription medications known to cause erectile dysfunction.[15]
        These include:

        • Diuretics,
        • High blood pressure medication,
        • Antidepressants/Anti-anxiety medications,
        • Anti-epileptic drugs,
        • Antihistamines,
        • NSAIDs
        • Parkinson’s medication,
        • Antiarrythmics,
        • Histamine H2-receptor antagonists,
        • Muscle relaxants,
        • Prostate cancer medications, and
        • Chemotherapy drugs
penis anatomy cross-section
Penile Anatomy (Illustration by William Westwood)

Neurological Causes of Erectile Dysfunction

Neurological causes of erectile dysfunction are issues with the nervous system. This can happen from damage caused by operations or trauma to the penis. However, other nerve damage issues account for 5% of all physiologically-induced erectile dysfunction incidents.[7] These primarily include neurogenic disease.

      • Neurogenic disease (stroke, Alzheimer’s disease, Multiple sclerosis, Parkinson’s, etc.)A study published in Translational Andrology and Urology shows how the nervous system is critical to getting and maintaining an erection.[16] Neurogenic disease can disrupt the signal between your brain and your penis, leading to erectile dysfunction.

Endocrinologic Causes of Erectile Dysfunction

Endocrinologic causes of erectile dysfunction center on issues with the pituitary, thyroid, adrenals, testes, or pancreas organs. These issues include:

      • Poorly controlled diabetes – Diabetes can damage the blood vessels and nerves needed to get and maintain an erection. Poorly controlled diabetes can double your chance of erectile dysfunction.[17]
      • Hormone problems – Low testosterone or an imbalance of other hormones can also negatively affect your libido. While sometimes these issues are related to disease, such as pituitary gland tumors or kidney disease, hormone changes are also normal when you age. When it comes to testosterone therapy, Dr. Abraham Morgentaler, founder and director of Men’s Health Boston says:

“It’s well established that testosterone by itself, for men with sexual dysfunction that includes erectile dysfunction, can improve erections in the majority of men who take it.”[18]

Trauma Causes of Erectile Dysfunction

Trauma to the pelvis, bladder, spinal cord, and penis may also cause erectile dysfunction. This trauma can be from direct injury or even from wearing tight clothing.

erectile dysfunction causes chart

Pornography as an Exacerbating Factor to Erectile Dysfunction

Pornography can have many negative effects on sexual health. Particularly insidious is pornography’s exacerbation of erectile dysfunction. There has been countless anecdotal evidence to exactly how damaging this can be. Moreover, a 2016 research in Behavioral Sciences argues that more men are seeking ED treatment, which could be due to the desensitizing effects of pornography.[19] 

Masturbation habits lead to over-stimulation and overloading the pleasure center of the brain with dopamine. This, like drug addiction, leads to needing more and more stimulation to reach the same level of pleasure. You can read more about the challenges of moderation and pornography in these articles:

DIAGNOSING ERECTILE DYSFUNCTION

Given the seriousness of many of these potential contributing factors, it’s important to seek the advice of your medical professional, for a diagnosis, if you have concerns about erectile dysfunction. Read our article, Diagnosing Erectile Dysfunction, for more details on tests used to diagnose ED.

HOW DO YOU TREAT ERECTILE DYSFUNCTION

Treatment for ED depends on the underlying factors of the erectile dysfunction.

Treatment for Psychologically-Induced ED

Erectile dysfunction caused by psychological issues is usually treated with therapy to address the underlying issues. A mental health professional can help you break the anxiety-ridden cycle that compounds the erectile dysfunction problem.

      • Talk Therapy – Talk therapy is often the first course of treatment if anxiety or stress is expected to be a factor in erectile dysfunction. Discussing your worries (work, relationship, financial, etc.) with a licensed mental health professional can help. Additionally, they can give you strategies to increase your intimacy. Some sessions with your partner may also be of help.

Even when your ED is based on psychological issues, physical treatments can help, by building self-confidence, as well as strengthening muscles and improving blood flow to the penis.

Treatment for Physically-Induced Erectile Dysfunction

Treatment for physiological factors causing ED are varied, depending on the factors attributed to your erectile dysfunction.

Prescription Medications

There are a number of prescription medications on the market today, for those suffering from erectile dysfunction. These are PDE05 inhibitors and work by relaxing the smooth muscle tissue in your penis. This increases blood flowing into the penis. The primary benefit is increased self-confidence in the bedroom, and an improved intimate relationship with your partner. Popular medications include:

      • Viagraviagra erectile dysfunction
      • Levitra
      • Cialis
      • Sildenafil

Despite their effectiveness, there are side effects associated with these medications. These include:

      • Headaches
      • Muscle aches,
      • Flushing,
      • Blue-greenish vision tinge.

For men in poor health, the side effects can be more severe, including heart attach and even death.[20] For this reason, prescription medications are often not recommended for men who are diabetic, obese, are on nitrate medication, or smoke cigarettes.

Penis Pumps

Penis pumps are a common and incredibly effective treatment for erectile dysfunction. In fact, in an article by Dr. Larry Lipschultz published in Prostate.net, he notes that penis pumps are designed to help men achieve and maintain a healthy erection.[21] The pump creates a vacuum around the penis. This expands the tissues within the penis, causing it to fill with blood. The process to use a penis pump is simple.

      • Place the Penis in the Pump -The pump is placed inside
        bathmate
        Sponsored Link

        the cylinder of the device.

      • Create Vacuum – Using either a manual or electronic pump, a vacuum in the cylinder is created, causing the penis to fill with blood and become erect.
      • Use a Cock Ring – A cock ring is then placed around the base of the penis, to prevent the blood from flowing out of the penis, before the pump is removed.

The benefit: There are no ill side effects when pumping is performed correctly. However, a pump does not fix the underlying problem causing the ED.

Some insurance policies cover penis pumps if you’re diagnosed with erectile dysfunction. Before buying an ED pump, make sure to check with your insurance provider first. Take note: You won’t be covered unless you see a doctor and get a diagnosis. It must be prescribed by your doctor. 

Please view our article – Penis Pumping: Techniques & Routines – for more information on penis pumps.

Penis Exercises

Penis exercises can help strengthen the muscles needed for healthy erections, while also improving blood flow to the penis. The benefit to this method of ED treatment is that it’s all natural and the primary side effect is a larger and healthier penis. These exercises include:

      • Kegels Kegels contract the pelvic floor muscles to make them stronger. These are the skeletal muscles needed for a healthy erection.
      • JelqsJelqs use a milking-like motion to force blood into the penis. This nutrient-rich blood results in a healthier penis.
      • Stretching Stretching also encourages blood to flow into the penis, for a healthier penis and healthier erections.

However, penis exercises, like any other exercise routine, takes time and commitment. For this reason, you may wish to pursue other treatments for immediate improvements, while exercising for a healthier penis. Read our page – Penis Exercising 101 – How Penis Exercises Work, and How it Can Work for Youfor more information on penis exercises.

Kegel how to 2

Suppositories and Injections

For those who do not respond to oral medications, or who can’t take medications like Viagra, suppositories and injections are another treatment option for immediate, temporary erectile functioning.

erectile dysfunction alprostadil suppository
Image from infopharmacie.com
      • Suppositories – For the suppositories, an alprostadil pellet is inserted into the tip of the penis. Alprostadil boosts blood flow to your penis. This method is less effective than injections.
      • Injections – The injections inject alprostadil directly into the penis. In addition to the unpleasantness of having an injection into your penis, this method also has a higher incidence of priaprism (dangerously prolonged erections) and can lead to scarring.
erectile dysfunction alprostadil injection
Image from mensexualclinic.com

Surgical Methods

There are two primary surgical methods used for erectile dysfunction.

      • Vascular Surgery – Vascular surgery may be indicated for those with a venous leak. This can permanently repair your erectile dysfunction.
      • Surgical Implants – Surgical implants are also an option, especially for those suffering from permanent erectile dysfunction. These penile prosthesis are either bendable or inflatable.

Both forms of surgery are costly and come with the risks associated with surgery.

CONFRONTING ED: YOUR MALE ENHANCEMENT ROUTINE FOR OVERCOMING ED

Following is your action plan for confronting your erectile dysfunction.

Step 1: Confronting ED – Supplements

      1. Supplements – Take the right supplements to improve the blood flow to your penis. Just like supplements are effective for improving muscles in other parts of your body, penis supplements can positively affect your ED treatment plan. Specifically look for a supplement with L-Arginine. We recommend: VigRX Plus, SinRex, and Male Extra.

Step 2: Confronting ED – Kegels for Men

      1. Kegels – Read our article – Kegel Exercises for Men – to fully understand how to do Kegels and to learn a great beginner’s routine. Don’t go overboard on Kegeling!  Over-Kegeling can actually lead to more ED problems if you overtrain your pelvic floor muscles.

Step 3: Confronting ED – Improve your Lifestyle

      1. Improve Your Lifestyle -Blood flow is the most important factor when it comes to your erection. For this reason, make healthy lifestyle choices that will improve your heart health and improve your blood flow to your penis. Eat a heart healthy diet. Stop smoking. Drink only in moderation. Exercise, with at least 30 minutes a day of cardio to get your heart pumping. There’s also a bonus of reduced stress with working out!

Step 4: Confronting ED – Penis Exercises

Step 5: Confronting ED – Penis Pumps

      1. Penis Pumps -For ED treatment, penis pumps are a tried-and-true method for temporary relief. The Bathmate penis pump is the most versatile pump on the market, allowing you to use it in or out of the bath or shower.

Step 6: Confronting ED – Talk to a Doctor

      1. Talk to a Doctor – Consult your physician. Your doctor can prescribe an appropriate medication, suppository or injection. Also, consider seeking out a mental health professional, if you feel you may have a psychological component to your erectile dysfunction. Because ED may be a symptom of a much more serious problem – like cardiovascular disease or diabetes – always talk to a doctor if you have recurring or persistent erection problems.

TRANSITIONING FROM ED RELIEF TO MALE ENHANCEMENT

Once you’ve successfully overcome erectile dysfunction, male enhancement can help you not only maintain, but also improve your erection quality. Male enhancement will help ensure you have firm erections, further improving your sex life. Please visit our Male Enhancement page to learn how you can reach optimum sexual improvement.

References

[1] “Erectile Dysfunction.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 9 Mar. 2018. Web. 22 Jan. 2019 Retrieved from www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776
[2] “What is Erectile Dysfunction?” Urology Care Foundation. June 2018. Web. 22 Jan. 2019. Retrieved from https://www.urologyhealth.org/urologic-conditions/erectile-dysfunction
[3] Hedon, F. “Anxiety and Erectile Dysfunction: a Global Approach to ED Enhances Results and Quality of Life.” Nature News, Nature Publishing Group, 16 Apr. 2003. Retrieved from https://www.nature.com/articles/3900994
[4] Phillips, Robert L., & James R. Slaughter. “Depression and Sexual Desire.” American Family Physician, American Academy of Family Physicians. 15 Aug. 2000. Retrieved from https://www.aafp.org/afp/2000/0815/p782.html
[5] Blahd, W. “Medications That Can Cause Erectile Dysfunction.” WebMD, 07 Sep. 2017. Web 22 Jan. 2019. Retrieved from https://www.webmd.com/erectile-dysfunction/guide/drugs-linked-erectile-dysfunction
[6] Goliszek, Andrew. “The Stress-Sex Connection.” Psychology Today, Sussex Publishers. 22 Dec. 2014. Web. 22 Jan. 2019. Retrieved from www.psychologytoday.com/us/blog/how-the-mind-heals-the-body/201412/the-stress-sex-connection
[7] Lue T.F. ed. Impotence and Infertility. In: Vaughan E.D. Jr., Perlmutter A.P., Goldstein M. eds. “Atlas of Clinical Urology.” Vol 1. Philadelphia, Pa: Current Medicine, Inc. 1999.
[8] “Erectile Dysfunction & Heart Disease.” The Cleveland Clinic Foundation, Web. 22 Jan. 2019 Retrieved from https://my.clevelandclinic.org/health/diseases/15029-heart-disease–erectile-dysfunction
[9] Blahd, W. “Venous Leak, Vascular Disease, and Erectile Dysfunction.” WebMD, 08 Sep. 2017. Web. 22 Jan. 2019. Retreived from https://www.webmd.com/erectile-dysfunction/guide/vascular-disease-ed
[10] Suzuki, Etsu, et al. “Chronic Kidney Disease and Erectile Dysfunction.” World Journal of Nephrology, Baishideng Publishing Group Inc., 6 Nov. 2014. Retrieved from www.wjgnet.com/2220-6124/full/v3/i4/220.htm
[11] Emanu, Jessica C., et al. “Erectile Dysfunction after Radical Prostatectomy: Prevalence, Medical Treatments, and Psychosocial Interventions.” Clara Barton: Angel of the Battlefield, Clinical Journal of Sport Medicine, 1 Mar. 2016. Retrieved from https://insights.ovid.com/pubmed?pmid=26808052
[12] Modh, Rishi A., Mulhall, John P., & Gilbert, Scott M. “Sexual Dysfunction after Cystectomy and Urinary Diversion.” Nature News, Nature Publishing Group, 1 Jul. 2014. Retrieved from  https://www.nature.com/articles/nrurol.2014.151
[13] Furr, J., Herbert Kristi, Wisenbaugh Eric, & Gelman, Joel. “Complications of Genital Enlargement Surgery.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, Dec. 2018. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30446473
[14] “Erectile Dysfunction: Find out How It’s Linked to Heart Disease.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 11 July 2018. Web. 22 Jan. 2019. Retrieved from www.mayoclinic.org/diseases-conditions/erectile-dysfunction/in-depth/erectile-dysfunction/art-20045141
[15] DerSarkissian, Carol. “Erection Problems (Erectile Dysfunction) Causes: Cancer, Diabetes, and Other Physical Conditions.” WebMD, 29 October 2017. Web. 22 Jan. 2019. Retrieved from https://www.webmd.com/erectile-dysfunction/guide/understanding-ed-causes#1
[16] Shridharani, Anand N. & Brant, William O. “The Treatment of Erectile Dysfunction in Patients with Neurogenic Disease.” Translational Andrology and Urology. Vol 5, No. 1. February 2016. Retrieved from http://tau.amegroups.com/article/view/9075/9706
[17] Cowley, Goretti & Biggers, Alana. “Does diabetes cause erectile dysfunction?” 19 Apr. 2017. Web. 22 Jan. 2019. Retrieved by https://www.medicalnewstoday.com/articles/317012.php
[18] Pendick, Daniel. “A Logical Approach to Treating Erectile Dysfunction.” Harvard Health Publishing, Harvard Medical School. 27 November 2012. Web. 22 Jan. 2019. Retrieved from https://www.health.harvard.edu/blog/a-logical-approach-to-treating-erectile-dysfunction-201211275583
[19] Park, B Y, et al. “Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports.” Behavioral Sciences, Aug. 2016. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27527226
[20] Nordqvist, Christian. “Viagra: Uses, Side Effects, and Risks.” Medical News Today, MediLexicon International, 19 Nov. Web. 22 Jan. 2019. Retrieved from https://www.medicalnewstoday.com/articles/232912.php.
[21] Lipshultz, Larry. “Do Penis Pumps Work?” Prostate.net. 21 Sept. 2011. Web. 22 Jan. 2019 Retrieved from https://prostate.net/articles/do-penis-pumps-work/

About Rob Michaels

Rob Michaels is the founder of PEGym.com and the author of the bestselling book, Penis Exercises: A Healthy Book for Enlargement, Enhancement, Hardness, & Health.

Rob Michaels has been featured in numerous media platforms, including Men’s HealthGQ Magazine, and Salon.com, among others. As a male enhancement expert, he has spent more than a decade researching different male enhancement techniques and reviewing products that men can use safely. He continually strives to develop effective programs that will help men gain confidence and a healthy sexuality by achieving their male enhancement goals.