What's to know about erectile dysfunction?
- By: Medically reviewed by Joseph Brito III, MD — Written by Markus MacGill on June 16, 2021
- Source: Medical News Today.
- Website: https://www.medicalnewstoday.com
A person with erectile dysfunction will regularly find it difficult to attain or keep a firm enough erection to have sex. This can interfere not only with sexual activity but also with a person’s quality of life.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms, “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
Some people will occasionally experience some difficulty with their penis becoming hard or staying firm. However, erectile dysfunction (ED) is often only a concern if satisfactory sexual performance is consistently impossible.
The awareness that ED can be a treatable condition has increased since the discovery that the drug sildenafil, or Viagra, affected penile erections. However, people who have a problem with their sexual performance may be reluctant to talk with their doctor, seeing it as an embarrassing issue.
ED is now well understood and there are various treatments available.
Causes
ED may affect up to 20 million people in the U.S. The condition’s prevalence is over 50% in those over 50 years old and increases with a person’s age.
Normal erectile function can be affected by problems with a person’s blood flow, nervous system, and hormone levels. A person may also experience ED due to psychological factors, such as anxiety over sexual performance.
Gay men report ED at a higher rate than heterosexual men, according to a 2019 review. However, the exact reasons for this remain unknown, and researchers recommend more study in the field.
Physical causes
Most cases of ED are secondary. This means that erectile function has been normal but becomes problematic. Causes of a new and persistent problem are usually physical.
In rare cases, a person may have primary ED. This is where a person has never achieved an erection. The cause of primary ED may be psychological or the result of a physical condition.
A person should consult a medical professional if they experience persistent erection problems, as an underlying medical condition could be causing the issue. A proper diagnosis can help address any underlying medical issues and help resolve sexual difficulties.
Some of the most common physical causes of ED include:
heart disease and narrowing of blood vessels
diabetes
high blood pressure
high cholesterol
obesity and metabolic syndrome
Parkinson’s disease
multiple sclerosis
hormonal disorders, including thyroid conditions and testosterone deficiency
structural or anatomical disorders of the penis, such as Peyronie disease
smoking, alcohol use disorder, and substance abuse, including cocaine use
treatments for prostate disease
surgical complications
injuries in the pelvic area or spinal cord
radiation therapy to the pelvic region
Atherosclerosis is a common cause of blood flow problems. Atherosclerosis causes a narrowing or clogging of arteries in the penis, preventing the necessary blood flow to produce an erection.
Numerous prescription medications can also cause ED. A person taking prescription medications should consult their doctor before stopping or changing their medications. Some drugs that may cause ED include:
drugs to control high blood pressure
heart medications such as digoxin
anxiety treatments
antidepressants, including monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants
opioid painkillers
some cancer drugs, including chemotherapeutic agents
anticholinergics
hormone drugs
Physical causes account for 90 percent of ED cases, with psychological causes much less common.
Psychological causes
Psychological factors can cause or contribute to ED, with factors ranging from treatable mental health illnesses to everyday emotional states that most people experience at some time. These are less commonTrusted Source than physical causes, however.
Psychological factors can include:
fear of intimacy
depression
general anxiety
A person may also be unable to attain a full erection due to specific sexual performance anxiety, a common psychological factor in people with ED. Sexual performance anxiety affects 9-25% of males, according to a review.
It is also important to note that there can be an overlap between medical and psychosocial causes. For instance, if a person is obese, blood flow changes can affect that person’s ability to maintain an erection, which is a physical cause. However, the person may also have low self-esteem, impacting erectile function, which is a psychosocial cause.
Does riding a bicycle cause ED?
Questions remain about the effects on men’s health of riding a bicycle.
Some research has raised concerns that men who regularly cycle for long hours could have a higher risk of ED, in addition to other men’s health issues such as infertility and prostate cancer.
A 2014 study found no link between riding a bike and ED, but it found an association between longer hours of cycling and the risk of prostate cancer. However, a further study published in 2020 found no correlation between cycling and ED or prostate cancer.
The association between cycling and prostate cancer remains controversial and requires more research.
Prostate disease and ED
Early-stage prostate cancer does not cause ED, but advanced forms of prostate cancer can.
Prostate surgery to remove tumors and radiation therapy to treat prostate cancer can cause ED.
Some medications for prostate cancer may also result in ED. For example, hormone therapies can lower a person’s libido, and by association lead to ED. Research has shown that the medication finasteride may cause sexual dysfunction in men.
r ED including prescription medication or, in rare cases, surgical intervention