Main Information about Erectile Dysfunction

Very often in medical articles about male sexual health one can find the term “erectile dysfunction”. What is it? Erectile dysfunction (ED) in men is, simply put, impotence, a condition in which a man’s sexual organ does not achieve an erection sufficient to perform full sexual intercourse. How does erectile dysfunction usually start? A man has a failure in bed, justifies it by bad mood or fatigue. If the situation repeats, and successful sexual contact becomes not the norm, but the exception to the rule, then we can talk about such a serious problem with potency, like erectile dysfunction. Today it is the most common disruption of the functioning of the male reproductive system.

Main Causes of ED

Erectile dysfunction is a rather complicated violation in terms of its origin. It cannot be said here, like, in the case of the flu or an abscess, that it is caused by a virus or bacteria. There are many reasons that lead to this disorder of potency, and often one patient has several of them.

Very often, impotence is caused by psychological reasons. These include an increased level of stress, and not necessarily related to sex or sexual partner. Also a very serious factor is the unpleasant sexual experience, especially if during the process a man lost an erection and could not complete sexual intercourse. As a result, the syndrome of anxious waiting for sexual failure can even develop, when a man is so nervous before sex that he completely loses an erection.

Also among the psychological causes of impotence are depression and other mental disorders, experienced moral trauma related to sex life, and even banal fatigue from a regular partner if sex with her has become a routine activity.

As for the physiological causes of impotence, these include infectious and inflammatory diseases of the urogenital tract, overweight, diabetes, thyroid dysfunction, prostatitis, prostate adenoma (BPH), genital surgery, traumas of the penis and various disorders of the functioning of the cardiovascular system, such as atherosclerosis, blood stasis in the pelvic organs. In addition, bad habits such as alcoholism, tobacco smoking, drug use, abuse of sweets, lack of sleep, a sedentary lifestyle, are very detrimental to the state of male potency. depressed man - ED

More than half of the cases of erectile dysfunction in medical practice have a mixed etiology, including both psychological and physiological factors. For example, a man with blood stasis in the pelvis begins to experience regular problems with potency after sexual experience with a woman in whose appearance something turned out to be so unpleasant for him that he lost an erection during sex. Even more common is the example in which a man against the background of constant stress at work began to suffer from coronary heart disease, which together led to the development of ED.

To find out how erectile dysfunction began in a particular case, a man needs to consult a urologist and honestly answer all the questions which the doctor will ask during the examination. Often, to cure impotence, you need to focus your efforts not on the penis, but on getting rid of bad habits, fighting subconscious fears or normalizing the level of cholesterol in the blood.

To determine the type of ED, you can use the table

Comparison of psychogenic and organic erectile dysfunction (ED)

Symptom Predominantly psychogenic ED Predominantly organic ED
Beginning Acute Gradual
Circumstances Situational Independent of circumstances
Course Variable Permanent
Erection outside sexual intercourse Stable Weak
Morning or night erection Normal Rarer and weaker than normal
Psycho-sexual problems Present for a long time Secondary to ED
Anxiety, fear Primary Secondary to ED

Real-life example of psychological causes of impotence

When George was 15 years old, he heard from a teacher at school that those teenagers who often masturbate become anxious during the first intercourse, that’s why they fail. Since first sexual experience makes a big impression on a teenager, then failure for the first time can cause uncertainty or complex.

George was a very impressionable child, and he was very worried that it would happen to him. Every time he talked with girls, he recalled the words of his teacher. Bob’s first sexual intercourse was at 21, he was worried and as a result received a weak erection, besides sexual intercourse lasted only a couple of minutes, because of which George developed a complex.

By 25 years, Bob’s failures in sex had already become systematic. Being in a serious relationship with a girl, George even lost an erection every time when it came to a sexual intercourse. This caused great suffering for George and his partner, their relationship was on the verge of breaking. George decided to consult an urologist. After a full examination, the doctor said that he hadn’t found any health issues, and the problem was purely psychological.

This is an example from the life of our reader, about how he faced the problem of ED. Read more about psychological causes and Anxiety During Sex.

Dependence of Erectile Dysfunction on Men’s Age

A lot of men wonder, when does erectile dysfunction start. There is no definitive answer to this question, since everything depends on the individual characteristics of the organism of a particular man, his lifestyle and the presence of various chronic diseases. In addition to these factors, even heredity plays a role, although in recent times it is customary to assert that everything that happens to our body depends only on us. However, if your father didn’t have bad habits and diabetes and was sexually active up to 75 years, you are also likely to have sex at 75 if you follow a healthy lifestyle.

ED statistics show that most men begin to experience difficulties in bed after 50 years of age, which is associated with a decrease in the level of the male sex hormone testosterone. Although the extinction of reproductive function in men is not as pronounced as in women, it still takes place and is manifested in a decrease in sexual desire and the number of sexual acts following one another, which is caused by an increase in the refractory period.

Impotence in early age is usually caused by psychological reasons. If a man is overstressed, problems with potency may appear even at the age of 30.

It should be noted that the extinction of potency in old age (over 65) is not erectile dysfunction, but the natural state of the organism due to a decrease in testosterone, and even intake of special medicines will not be able to return the sex life of an elderly man to the level at which it was twenty or thirty years ago.

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Anxiety And Sex

How Is ED Diagnosed?

No man wants the disorder of potency to take him by surprise. Therefore, the question “What are erectile dysfunction symptoms” is more than relevant. Erectile dysfunction is one of the diseases, the first signs of which a man can easily notice himself. If he regularly cannot maintain his erection at the proper level, or it does not occur at all, then we can talk about incipient impotence. Also an alarming symptom is the disappearance of the morning erection.

However, in order to start effective treatment of ED and make sure that you suffer from this particular disease, you must visit a urologist and undergo a medical examination. The doctor will collect an anamnesis of your problems, conduct a visual examination of the genital organs, an ultrasound examination of the prostate, and often the patient is also given a series of tests, in particular, tests for thyroid hormones. As a rule, these manipulations are enough to make a diagnosis and determine the course of treatment.

A good tool for self-diagnosis of erectile dysfunction is the International Index of Erectile Function (IIEF) – a questionnaire that is freely available on the Internet and which every man who is interested in maintaining his potency at a high level can pass. If the results of the survey show a greater likelihood of having signs of ED, it is recommended to consult a doctor.

The International Index of Erectile Function (IIEF-5) Questionnaire
Reprinted from by Macmillan Publishers Ltd: Rosen RC, Cappelleri JC, Smith MD, et al. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999 Dec;11(6):319-26. © 1999
Over the past 6 months:
1. How do you rate your confidence that you could get and keep an erection? Very low 1 Low 2 Moderate 3 High 4 Very high 5
2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration? Almost never/never 1 A few times (much less than half the time) 2 Sometimes (about half the time) 3 Most times (much more than half the time) 4 Almost always/always 5
3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner? Almost never/never 1 A few times (much less than half the time) 2 Sometimes (about half the time) 3 Most times (much more than half the time)4 Almost always/always 5
4. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? Extremely difficult 1 Very difficult 2 Difficult 3 Slightly difficult 4 Not difficult 5
5. When you attempted sexual intercourse, how often was it satisfactory for you? Almost never/never 1 A few times (much less than half the time) 2 Sometimes (about half the time) 3 Most times (much more than half the time) 4 Almost always/always 5

IIEF-5 scoring:

The IIEF-5 score is the sum of the ordinal responses to the 5 items.

22-25: No erectile dysfunction

17-21: Mild erectile dysfunction

12-16: Mild to moderate erectile dysfunction

8-11: Moderate erectile dysfunction

5-7: Severe erectile dysfunction

Common Ways of Erectile Dysfunction Treatment

Methods of treating erectile dysfunction vary depending on the causes of its occurrence, as mentioned above. It should be noted that the most common recommendations of the doctors are changes in lifestyle and diet. It is very important to give up bad habits: smokers, for example, have a much higher chance of developing impotence, because tobacco has a strong negative effect on the blood vessels of the whole organism, in particular, the penis. Nicotine and other harmful substances harm the smallest blood vessels of the penis, which in a quiet state are twisted into spirals, and during erection get straightened and responsible for filling the penis with blood, stick together, atrophy and lose elasticity, and sometimes even necrotize.

doctor's consultation about ED treatment

The second most common way of ED treatment is drug treatment. For combating erectile dysfunction of various origin urologists use PDE-5 inhibitors, the drugs which improve erection due to their ability to dilate blood vessels in genital area and prevent the release of the phosphodiesterase enzyme type 5, which is responsible for stopping an erection. he most common drugs of this group are Viagra, Cialis and Levitra. They can be used as a systematic treatment of disorders of potency and “on demand”. So, Viagra is traditionally used only immediately before sexual intercourse, while Cialis is often prescribed to be taken daily in courses.

All these drugs, although they have the same mechanism of action, are characterized by their own unique features. We will conduct a brief overview.

  • Viagra has the strongest effect, lasting 4-6 hours. This drug has quite a lot of contraindications and side effects and is taken before sexual intercourse.
  • Cialis acts not so strongly, has fewer contraindications and side effects. Its action lasts up to 36 hours, which makes this drug very convenient for taking before a night out or a romantic weekend. In addition to fighting ED, this medicine is also used in the complex treatment of BPH, also known as prostate adenoma. Often Cialis is taken in courses.
  • Levitra is the youngest drug among the most successful PDE-5 inhibitors on the pharmaceutical market. It is active during from 8 to 12 hours, should be taken on demand (before sex) and differs in that it prolongs sexual intercourse very significantly, due to which it is widely used against premature ejaculation.
ED Drugs

Some men use vacuum devices for the treatment of impotence. A typical device of this kind is an outer pump with a compressive ring in which the penis is placed. By creating a vacuum around the penis, the pump causes an increased blood flow to it and an erection. Then the pump is removed, and at the base of the penis remains a compression ring, which helps to maintain an erection.

Despite the fact that with these manipulative erection will definitely appear, for many reasons the use of such devices is not popular. First, when using the pump, on the penis bruises and hematomas are often formed. Secondly, the use of a compressive ring reduces the force of ejaculation and can lead to blurred sensations during orgasm. In addition, a very important factor is that the use of the pump cannot be hidden from your partner, who may not be happy about it at all. A man becomes very embarrassed and may lose all the desire to have sex if the prelude to it resembles a complicated medical procedure.

Even less commonly used is surgical treatment of impotence – falloprosthetics. It is resorted to only if medicines in pills, physiotherapy, injections into the penis, consultations with a psychologist and lifestyle changes didn’t help against this ailment. Usually, falloprosthetics are used in case of improper structure of the penis, specific lesions of the nervous system, and serious injuries of the penis. The essence of the operation of the falloprosthetics is that special semi-rigid or hydraulic prostheses are inserted into the cavernous bodies of the penis, with which a man can control the onset and termination of erection.

Alternative treatments of erectile dysfunction, which do not correspond to standard medical practice, include the use of food additives, the consumption of certain foods, herbal remedies (powders, pills, decoctions, tinctures), and acupuncture. Do dietary supplements and alternative treatments work? This is not a simple question. Many dietary supplements, for example, bioflavonoids, vitamin complexes, zinc preparations, have a positive effect on the general condition of the body, which can lead to an improvement in well-being and erection. However, in serious cases of impotence, they prove to be not very effective or ineffective at all. With regard to special foods such as ginseng, ginger, walnut, celery, they are certainly nutritious and beneficial to the body, but don’t have any significant effect on erection, except for psychological.

Various tinctures, herbal teas and pills can help at the early stage of ED, but not all men, and they should be used with caution, because very often they cause allergic reactions or indigestion.

Acupuncture is the effect of metal needles on the biologically active points of the body. This method of treatment of erectile dysfunction is popular in the East, European medicine calls into question its efficacy.

Insurance Coverage for ED Treatment

Most drugs for the treatment of ED are very expensive. Fortunately, in some cases, health insurance fully or partially covers the cost of treatment for impotence. The politics of health insurance companies differ in this regard. In order to find out how things are going in your particular case, study your insurance plan.

For older men, one of the most profitable options is Medicare, in which patients are fully reimbursed for drug treatment or special devices like vacuum pumps if the diagnosis of erectile dysfunction and treatment recommendations are documented.

This article was reviewed by George Abdelsayed, MD