Erectile dysfunction is a common medical problem affecting up to 35% of men around the world. Approximately 10% of men aged 40-75 years have complete erectile dysfunction. Severe or complete erectile dysfunction is defined as the total inability to initiate or maintain an erection sufficient for sexual intercourse. Within the same age bracket, an additional 25% of men have moderate or intermittent erectile dysfunction. Erectile dysfunction is highly age-dependent. At 40 years the prevalence of the condition is around 22% but at 70 around 50% of the population is affected. Despite age being a strong risk factor, erectile dysfunction still affects 5-10% of men below 40 years.
Another population greatly affected by erectile dysfunction is the diabetic population. 35%-75% of men with diabetes experience some degree of erectile dysfunction in their lifetime. Moreover, men with diabetes develop erectile dysfunction 10 to 15 years earlier than men without diabetes. At the age of 50 the likelihood of a diabetic man developing erectile dysfunction is 50%. By 70 years the probability rises to 95%. The cause of erectile dysfunction among diabetics stems from the microvascular and neuronal damage caused by hyperglycemia. High blood sugars damage endothelial cells and neurovascular components in nervous system. When the vessels and nerves that control erection are involved, erectile dysfunction develops. Aside from the disease, some of the drugs used to manage diabetes can cause erectile dysfunction. Metformin in particular is linked to low testosterone-induced erectile dysfunction.
Erectile dysfunction is also a common complication among hypertensives. The Journal of the American Geriatrics Society found that among hypertensive men between 40 to 79 years, 68% of them had some degree of erectile dysfunction. Hypertension causes multi-organ damage and the penile gland is not spared. Persistently elevated blood pressures prevent the dilatation of arteries supplying the penis. Moreover, the high pressures impede the relaxation of smooth muscles in the penis. Some of the drugs used to manage hypertension also cause erectile dysfunction. Diuretics in particular may cause erectile dysfunction by reducing blood flow to the penis and reducing serum zinc levels, an important element in the synthesis of testosterone. Beta-blockers dampen the response to nerve impulses that lead to an erection. Moreover, the drugs inhibit the dilatation of arteries in the penis.
10-20% of all cases of erectile dysfunction are attributed to psychological factors. The process of sexual arousal involves both physical and psychological components. Individuals with psychological problems are likely to develop erectile dysfunction. Some of the psychological causes of ED include:
Stress: Stress from work, financial problems or marital issues can significantly reduce sexual performance and lead to erectile dysfunction.
Depression: This is a major cause of erectile dysfunction among men. Men suffering from depression are withdrawn and may not find sex pleasurable. As result their sexual performance is greatly affected and erectile dysfunction is a common sequel. Moreover, selective serotonin reuptake inhibitors (SSRI's) are known to cause erectile dysfunction but remain the most commonly prescribed antidepressants.
Anxiety: Performance anxiety is common among men. The fear of sexual failure can easily lead to erectile dysfunction. It's a vicious cycle where a man has performance anxiety which lead to sexual failure causing more anxiety.
Smoking and alcohol are culprits in many medical conditions and it's not any different for erectile dysfunction. Smoking tobacco damages blood vessels leading to numerous health problems including heart disease, stroke and erectile dysfunction. Smoking has been shown to cause erectile dysfunction to men as young as 20 years. In addition to the dysfunction, smoking also causes infertility. Heavy drinking is also another cause of erectile dysfunction. Excessive use of alcohol can cause temporary erectile dysfunction by decreasing blood flow to the penis and dampening sexual arousal. Chronic heavy use of alcohol leads to more permanent side effects on erectile function. When it comes to alcohol consumption, less is more. Alcohol taken in moderation is actually good for your general health including your sexual health.
Although erectile dysfunction is common among men, not many people seek treatment. Many opt to ignore the problem entirely and circumvent its effects. However, it's impossible to overlook the impact of erectile dysfunction on men and their relationships. Treatment and management of erectile dysfunction requires a multi-disciplinary approach. Both psychological and medical therapies exist for men suffering from erectile dysfunction. Psychological therapy is effective for men whose dysfunction stems from psychological stressors. However, the therapy is also a good adjunct to medical therapy.
Medical therapy for erectile dysfunction is a multi-billion industry. Numerous drugs are used to treat erectile dysfunction. Sildenafil, tadalafil, vardenafil and avanafil enhance the effects of nitric oxide, an endogenous compound in the body that relaxes penile smooth muscles. As a result, blood flow to the penis increases leading to an erection. For the drugs to work, sexual stimulation must occur to cause the release of nitric oxide. Just like other medications, these drugs have side effects that include nasal congestion, flashing and headaches. Alprostadil is another drug that can be injected at the base of the penis or inserted as a urethral suppository to initiate an erection. Testosterone therapy is available for men suffering from low testosterone-induced erectile dysfunction.
Other therapeutic alternatives include penile pumps and implants. These are used when medical therapy is ineffective or not appropriate for an individual case. Penile implants involve surgical placement of inflatable or malleable rods into both sides of the penis to facilitate an erection. Many men who have tried medical therapies unsuccessfully have found great success with surgical implants. The burden of erectile dysfunction on the general population cannot be overlooked. Numerous campaigns have been made to educate people and a lot of research is still ongoing to find solutions to the numerous problems erectile dysfunction causes. Although it's a bedroom affair, light needs to be shed on the issue and shame should not accompany erectile dysfunction. For those with erectile dysfunction take solace in knowing you are not alone. One in every 10 men will suffer erectile dysfunction at some point in their lives. There is no shame in that.