Causes and Treatment Options for Erectile Dysfunction (ED)

What is ED?

Erectile dysfunction (ED) is a condition whereby there is an inability to achieve or maintain an erection sufficient for sexual intercourse. It may occur intermittently or be chronic and can negatively impact a person's self-esteem, relationships and quality of life.

Prevalence of Erectile Dysfunction

Statistics vary between studies however ED is considered to be common.

One study indicated approximately one third of those assigned male at birth will be affected by ED.

Another study from 1995 indicated approximately 152 million people worldwide experienced ED and this number was projected to increase to around 322 million by 2025 due to an aging population and increased risk factors such as diabetes and cardiovascular diseases. Around 30% of people under 40 years of age experience some form of ED, though it is often milder in this age group and about 52% of people between the ages of 40 and 70 experience mild to moderate forms of ED.

In Australia, a self-reported erectile dysfunction study of over 100,000 men aged 45 years or older indicated a 61% prevalence of ED with 25% experiencing mild erectile dysfunction, 19% moderate erectile dysfunction and 17% severe or complete erectile dysfunction.

Severity of Erectile Dysfunction 

Erectile dysfunction severity is commonly categorised into mild, moderate, and severe levels based on the degree of difficulty in achieving or maintaining an erection sufficient for satisfactory sexual performance.

Of those assigned male at birth, it is estimated that approximately;

• 17% experience occasional difficulty achieving or maintaining an erection or mild ED.
• 25% experience moderate ED that is frequently having difficulty achieving or maintaining an erection.
• 10% experience severe ED and are unable to achieve or maintain an erection suitable for sexual intercourse.

Causes of Erectile Dysfunction

ED can be caused by a range of factors, which are typically categorised into physical, psychological, and lifestyle-related causes:

Physical Causes

• Cardiovascular Disease: Conditions like hypertension, atherosclerosis, and heart disease can impair blood flow to the genitals, leading to ED.
• Diabetes: High blood sugar levels associated with diabetes can damage nerves and blood vessels, contributing to ED.
• Hormonal Imbalances: Low levels of testosterone or other hormonal issues can impact erectile function.
• Neurological Disorders: Conditions such as Parkinson’s disease or multiple sclerosis can affect nerve signals necessary for erection.
• Medications: Certain drugs, including those for high blood pressure, depression, and allergies, can have side effects that include ED. 

Psychological Causes

• Stress and Anxiety: High levels of stress or performance anxiety can interfere with sexual arousal.
• Depression: Depression and other mental health issues can reduce libido and affect sexual function.
• Relationship Problems: Issues within a relationship, such as communication difficulties or unresolved conflicts, can contribute to ED.

Lifestyle-Related Causes

• Smoking: Tobacco use can damage blood vessels, impairing blood flow to the genitals.
• Excessive Alcohol Consumption: Heavy drinking can lead to temporary or chronic ED.
• Obesity: Being overweight or obese can contribute to both physical and psychological causes of ED.

When to See a Doctor

If you suspect you have ED, it is essential to consult a healthcare provider who can perform a thorough evaluation to identify the root cause and provide suitable treatment options. Early diagnosis and intervention is recommended to identify the underlying health conditions or causes and prevent further complications.

Getting Diagnosed

The severity of erectile dysfunction is measured using various tools and scales that assess different aspects of erectile function. These tools and methods help healthcare professionals determine the severity and underlying causes of ED and guide the appropriate treatment options. 

Evaluation methods your doctor uses may include various questionnaires and tests, some of which are listed below;

1. International Index of Erectile Function (IIEF):  The IIEF is a widely used, self-administered questionnaire that evaluates erectile and orgasmic function, sexual desire and intercourse and overall satisfaction. It produces an IIEF score with a score of 25 indicating no ED, down to a score of 5, which indicates severe ED.
2. Erection Hardness Score (EHS): The EHS is a scale that measures the hardness of an erection with scores shown below;
   Score of 4: Penis is completely hard and fully rigid
   Score of 3: Penis is hard enough for penetration but not completely hard
   Score of 2: Penis is hard but not hard enough for penetration
   Score of 1: Penis is larger but not hard
   Score of 0: Penis does not enlarge
3. Self-Esteem and Relationship (SEAR) Questionnaire: The SEAR questionnaire assesses the impact of ED on self-esteem and relationships, including emotional and relationship issues caused by ED.
4. Quality of Erection Questionnaire (QEQ): The QEQ measures the quality of erections based on factors like hardness, duration, and satisfaction, providing insights into the overall sexual experience and satisfaction.
5. Nocturnal Penile Tumescence (NPT) Testing: NPT testing evaluates erectile function during sleep. Men typically have multiple erections during REM sleep. Absence or reduction of nocturnal erections can indicate physiological causes of ED.
6. Penile Doppler Ultrasound: This imaging test assesses blood flow to the penis. It can identify vascular issues contributing to ED by measuring blood flow and the response to injected vasodilators.
7. Psychological Assessments: For cases where psychological factors are suspected, assessments by a psychologist or psychiatrist may be conducted to evaluate stress, anxiety, depression and relationships.

Treatment Options for ED

Treatment for ED varies depending on the underlying cause and the severity of the condition. Your physician will discuss treatment options with you however common approaches include:

Lifestyle Modifications

• Diet and Exercise: Improving diet and increasing physical activity can enhance overall health and reduce ED.
• Smoking Cessation and Moderation of Alcohol: Quitting smoking and reducing alcohol intake can improve erectile function.

Medications

• Oral Medications: Phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are commonly prescribed. They work by enhancing blood flow to the genitals.
• Hormonal Treatments: In cases of hormonal imbalance, hormone replacement therapy may be recommended.

Therapy

• Psychological Counseling: Therapy or counselling can help address psychological factors contributing to ED, such as anxiety or depression.
• Couples Therapy: If relationship issues are a factor, couples therapy may be beneficial.

Medical Devices and Procedures

• Vacuum Erection Devices: Vacuum Erection Devices (VED), also referred to as penis pumps or vacuum constriction devices (VCD), create a vacuum around the penis, drawing blood into the organ to facilitate an erection.
• Penile Implants: Surgical options, including penile implants, may be considered when other treatments are ineffective.
• Vascular Surgery: In rare cases, surgery may be performed to improve blood flow to the penis. 

Alternative Treatments

Some individuals explore herbal remedies however, the efficacy and safety of these supplements vary. Taking any herbal supplements should be discussed with a healthcare provider.

Erectile dysfunction is a complex with numerous possible causes and treatment options. Early consultation with a healthcare provider is essential for diagnosis and effective management to address any underlying health concerns. 

Pumps and Erectile Devices

Disclaimer: This blog is for informational purposes only and is not a substitute for professional medical advice. Always consult with a qualified healthcare provider for accurate diagnosis and appropriate treatment.

References

1. National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Erectile Dysfunction
2. Mayo Clinic. (2023). Erectile dysfunction (impotence)
3. Verywell Health: How Common Is Erectile Dysfunction
4. NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases): Definition & Facts for Erectile Dysfunction
5. Weber MF, Smith DP, O’Connell DL, et al. Med J Aust 2013;199(2):107–11. Risk factors for erectile dysfunction in a cohort of 108 477 Australian men
6. American Urological Association. (2021). Erectile Dysfunction: Evaluation and Management.
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8. Mulhall JP, Goldstein I, Bushmakin AG, Cappelleri JC, Hvidsten K, Shen W, Russak S.  J Sex Med. 2007 Nov;4(6):1626-34. Validation of the Erection Hardness Score.
9. Rosen RC, Cappelleri JC, Gendrano N 3rd. Int J Impot Res. 2002 Aug;14(4):226-44. The International Index of Erectile Function (IIEF): a state-of-the-science review
10. Althof SE, Cappelleri JC, Shpilsky A, Stecher V, Diuguid C, Sweeney M. J Sex Med. 2007 Jan;4(1):163-9. Treatment responsiveness of the Quality of Erection Questionnaire
11. Meuleman EJ, van Moorselaar RJ, Hovestad-Bijl E, Doesburg WH.  Urol Int. 1987;42(6):404-9. The value of nocturnal penile tumescence measurement in the diagnosis of vasculogenic impotence.
12. Shamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013 Jan 12;381(9861):153-65. Penile Doppler Ultrasound
13. Shabsigh R, Perelman MA, Lockhart DC, Lue TF, Broderick GA. J Urol. 2005 Jan;174(1):662-7. Psychological Assessments: Health issues of men: prevalence and correlates of erectile dysfunction