Erectile dysfunction (ED) can be an early warning sign for other potentially serious health problems, which is one of the reasons why it’s recommended that you talk with your doctor if you’re experiencing erection problems. The good news is that ED is one of the few sexual issues doctors likely have some training on. The bad news is that even if they are more comfortable talking about erectile dysfunction, you may not be.
Below are some tips on preparing for, and talking to your doctor about erectile dysfunction.
Take Notes Beforehand
The more information you can provide your doctor the better they’ll be able to ask questions and help figure out what might be going on. Once you notice a problem, start keeping track of how often you’re having problems. Describe the kinds of erections you have (e.g. non-existent, semi-hard, inconsistently firm), what’s your general stress level, are there specific events like conflict at work or with partners or family members that happen prior to you having difficulty getting an erection. Your erections happen in the context of your life, and the more detailed a picture you can paint for your doctor the better.
They’ve Heard It Before
Because erectile dysfunction is common, and because there are many treatments available, most doctors who have been practicing for at least a few years will have treated patients with ED. Starting the conversation, telling your doctor why you’re there, can feel scary. But if it helps, remember that they’ve heard it before, and just as with any other health concern, it’s their job to address it.
Consider Practicing
For some people it helps to practice the first conversation. Even saying to yourself out loud “I want to talk to you about problems with my erections” – or whatever words you want to use – may make it easier for you to start the conversation in the office. Think about what you want to say, and also what information you want to know. If you have a friend you trust, you can also talk with them as a way of practicing. If that feels too risky, you may want to ask a question on an erectile dysfunction forum where you can be anonymous.
The Discomfort (May Not Be) All Yours
Medical doctors receive very little training about human sexuality. And they get even less training on how to talk about sex with patients. It is entirely possible that your doctor will be uncomfortable talking about sex. If they are professional they’ll try to cover up their discomfort, and that’s appropriate. But if you’re feeling bad because you think you “shouldn’t” be uncomfortable or embarrassed, give yourself a break. None of us are encouraged to talk about sexual difficulties, doing so is tough, but it’s also a sign of you taking care of yourself, and something you can feel proud about.
Write Your Questions Down
Depending on the health care you have access to, you probably won’t have a lot of time with your doctor. If ED is a subject that makes you nervous or uncomfortable, it’s possible that once you get it out you’ll be so relieved that you’ll forget questions you have, and/or you won’t remember what your doctor tells you in response to your questions. It’s a good idea to come with some questions written down. That way if you lose track, you can refer to your list of questions. And consider making notes as your doctor is talking to you, so you’ll remember what they have told you.
Tips:
If you’re not sure what to say, or what to ask, here are some areas you may want to cover.
What’s the difference between a problem with an erection and erectile dysfunction?
What defines erectile dysfunction?
Erectile dysfunction (ED) is a common sexual complaint which by some estimates affects as many as one in five men. Erectile dysfunction is a clinical term, which is actually called male erectile disorder, and refers to a specific diagnosable experience, which may have several different causes. As such clinicians don’t talk about symptoms of erectile dysfunction as much as factors associated with it, or experiences that would qualify as erectile dysfunction.
According to the DSM, the manual used to diagnose sexual dysfunctions, in order to be considered erectile dysfunction (as opposed to the expected erection problems that all men encounter at some point in their lives) a person must have a “persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate erection” and the difficulty must cause “marked distress or interpersonal difficulty“.
Thus the two main symptoms of erectile dysfunction could be said to be:
- A problem that happens frequently and has been going on for a while (many clinicians suggest a minimum of six months)
- That the problem is causing you and/or your partner distress
If you are experiencing difficulty with erections more than occasionally it is recommended that you talk with a doctor about it. ED is a known early warning sign for other potentially serious health problems. It may be your body’s way of telling you that something else is going on. Whether what you are experiencing would be classified as erectile dysfunction or not, there are healthcare professionals trained to help you through whatever difficulty you are experiencing, and while talking about it can feel embarrassing or risky, it’s also a good way of moving toward a solution.
Impotence or Erectile Dysfunction?
There are several differences between the words impotence and erectile dysfunction. Erectile dysfunction is a relatively new word, a medical diagnosis that refers to a prolonged and consistent inability to get or maintain an erection that allows for sexual activity. Impotence is a very old word with multiple meanings, including being weak, powerless, and lacking in sexual power or ability.
Neither word is “bad“, but in the context of sexual health, when the goal of using language is to help people struggling with a sexual problem, the word erectile dysfunction is not only preferable to impotence, but in almost all cases it should be used instead of impotence.
What’s wrong with impotence? The two biggest problems, and best reasons to stop using the term, are that it is vague and judgmental. Early use of impotence to describe a sexual problem (which date back to the mid – 1600s) didn’t refer only to erectile difficulties. Impotence referred to a generalized lack of sexual power, which may have been an inability to get or keep an erection, but also may have referred to lack of sexual drive or libido. Being vague or overreaching may be useful in literature, but when it comes to diagnosing and treating complaints, the more specific we can be, the better. These days, impotence (which is still used in some medical spheres) has come to mean essentially the same thing as erectile dysfunction, making it vague and now redundant.
Impotence is a judgmental or loaded term because it connects an inability to get an erection with both a lack of general power and an inability to give or receive pleasure. If a man can’t get an erection, he’s of no use. These implications are false.
A man’s sexual power does not rest solely in his ability to get an erection, and men regularly have enjoyable sex that doesn’t involve their penis.
Erectile dysfunction, while obviously a more clinical term, is useful precisely because what is called for in this context is a clinical term. Erectile dysfunction describes what is happening; a man isn’t getting erections when he wants or how he used to. An inability to get an erection may or may not be related to issues of power in a relationship or pleasure in a sexual encounter. When discussing sexual health for the purpose of helping people who are struggling with a problem, it is preferred to use language that does not impose an individual or universal meaning, unless we are using the word to describe ourselves or our own experience.
Impotence is a powerful word, but as a medical or therapeutic term, it has become dated and more problematic than useful, particularly as sex therapists and researchers develop more precise language to address sexual dysfunction. In any sexual health context, the term erectile dysfunction would be preferable to impotence.
What might be creating the problem, what will your doctor look for in your body?
Erectile Dysfunction Causes
While it’s appropriate to talk about the factors that might cause erectile dysfunction (ED), it’s important to know almost all men will experience ED at some point, particularly older men. Aging is the most common and most unavoidable cause of erectile dysfunction. One in five men experience ED, and multiple research studies with men around the world have demonstrated a clear relationship between age and erectile dysfunction.
So if you live long enough, chances are you’re going to experience erectile dysfunction. This doesn’t mean there aren’t things you can do to reduce your risk of ED, and learning about the other causes of ED is a good place to start.
As research into sexual response and erections improves, and as researchers develop better tools with which to understand exactly how erections work, new erectile dysfunction causes are being discovered. Getting an erection involves multiple parts of your body, including your brain, nerves, hormones, muscles, and heart. Anything that interrupts any of these systems may result in erectile dysfunction. And as you might imagine, because erections involve multiple systems, there are often multiple causes of erectile dysfunction. But it can help to think about the causes by first breaking them down generally into causes that are primarily physical and causes that are primarily psychological.
Physical Causes of Erectile Dysfunction
Physical conditions that reduce blood flow, or cause interruptions in nerve messages getting from the brain or spinal cord to the penis can result in erectile dysfunction. The most common ones include:
- diabetes
- high blood pressure
- multiple sclerosis
- Parkinson’s disease
- heart disease
- conditions that affect thyroid function and/or interrupt hormones in the body
Some injuries are known to be associated with and thought to be a cause of erectile dysfunction. Surgeries and other treatments, particularly if they risk the cutting of nerve endings in and around the penis, may also be a primary cause of erectile dysfunction. More common ones include:
- spinal cord injuries
- injuries to the groin (recent research also points to consistent but mild trauma related to cycling)
- colon surgery
- hemodialysis
- prostatectomy
- other treatments for prostate, penile, and rectal cancers including some chemotherapy and hormone treatments
Both prescription medications and recreational drugs can impact the ability to get an erection – either immediately or slowly over time. Some of the more common ones include:
- medications for high blood pressure, heart disease, and some antidepressants
- alcohol
- marijuana
- cocaine
- tobacco
Psychological Causes of Erectile Dysfunction
Psychological factors can also have an impact on erectile function, and may be a primary cause of erectile dysfunction. These include:
- depression
- stress
- sexual performance anxiety
- relationship problems (which may or may not be related to sex)
Can the problem be fixed? What are the options?
Erectile Dysfunction Treatments
Erectile dysfunction (ED) is a common sexual complaint among men. Some studies indicate that as many as one in five men experience ED. There are several known erectile dysfunction causes, and ED may be something that has always been a problem, or a relatively new experience in your life. What treatment you choose will likely relate to what, if any, causes have been discovered. For many men there won’t be a cure for erectile dysfunction, but for most there are several effective erectile dysfunction treatments available.
Erectile dysfunction can also be an opportunity to rethink and recreate a sex life that doesn’t focus solely on erections.
Before Using Treatment for Erectile Dysfunction
As your spam filter will tell you, companies are all too keen to market drugs for treatment of erectile dysfunction whether they are safe or legal or effective. Erectile dysfunction is a known early warning sign for other potentially serious health problems. It may be your body’s way of telling you that something else is going on. Which is why before considering any treatment for ED you should consult with a doctor. To understand the options that are available to you, read on for the various treatments already available for ED.
Erectile Dysfunction Drugs
Prescription drugs are by far the best known treatment for erectile dysfunction, thanks mostly to the financial success of oral medications that can be taken prior to wanting an erection. While the mechanisms of the drugs work differently, they all function by facilitating greater blood flow to the penis, which in some men will produce an erection that can be maintained.
Erectile Dysfunction Products
There is only one type of external device that has been clinically tested to treat erectile dysfunction. Known as a vacuum pump, vacuum device, and sometimes vacuum constriction device, it works by drawing blood into the penis, creating an erection. Another line of products – which have never been clinically tested, and shouldn’t be considered an actual treatment for erectile dysfunction, but which may be useful for some men – are sex toys, also called “marital aids” or “sexual pleasure devices“.
Penile Rehabilitation
The term penile rehabilitation may include any of the treatments listed on this page. But in addition to these treatments, there have been case studies that have indicated that when erectile dysfunction is the result of prostatectomy, pelvic floor rehabilitation may be a treatment for erectile dysfunction.
Erectile Dysfunction Surgery
Erectile dysfunction surgery involves inserting implants into the penis which can provide rigidity to allow for intercourse. The surgery is by far the most invasive treatment for erectile dysfunction, and is often considered an option after other treatments have been tried and ruled out.
Erectile Dysfunction Therapy
Sex therapy may be an effective treatment for erectile dysfunction, depending on the cause, but regardless of the cause, it is often recommended as part of erectile dysfunction treatment. Even when there is a physical cause, usually once a man experiences erectile dysfunction, there are some emotional and psychological issues that can exacerbate the ED, and working through them with a sex therapist can be helpful.
Natural Remedies for Erectile Dysfunction
While few of them have been extensively tested as treatments for erectile dysfunction, there are many natural remedies that have been recommended for hundreds of years as being beneficial to erectile functioning. Even though, like sex toys, these remedies aren’t acknowledged by western medicine as treatment, they may be helpful and worth exploring with a knowledgeable health care practitioner.
Erectile Dysfunction Cure
But is there a cure for erectile dysfunction?
The answer is this: in rare cases, yes, most of the time, no, but regardless, there are plenty of erectile dysfunction treatments to be tried.
Having a cure for ED would suggest that you experience ED, get treated, and then it goes away. There are some ED treatments, like penile implant surgery, which may for a period of time mean that you can get erections when you want. There are some causes of erectile dysfunction, like relationship problems, which may be treated with ED therapy and may result in resumption of erectile functioning. But in both of these cases, there is no guarantee that the ED won’t return. In fact, if you take into account what we know about erectile dysfunction and aging you’ll realize that if you live long enough, it’s very likely you’ll experience erectile dysfunction again.
For this reason, talking about a cure for erectile dysfunction doesn’t seem quite right. Of course there are many companies, both legitimate and shady, who would like you to think they have an ED cure, which they’re happy to share with you for $19.99. And many treatments work. But erectile dysfunction isn’t a disease. It’s a predictable part of aging, just as erection problems are a predictable part of having a penis.
There’s nothing wrong with going looking for treatments, and there isn’t any benefit to worrying about what’s around the corner. It can be helpful to think about erectile difficulties in general, and erectile dysfunction in particular, as something that is simply part of having a rich and fulfilling sex life. That may help reduce some of the anxiety before, during, and after any period in your life when you may be experiencing ED.
How common is erectile dysfunction? What puts me at risk for ED?
Erectile Dysfunction Prevalence and Risk Factors
Erectile dysfunction (ED) affects approximately one in five American men, appears to be associated with cardiovascular and other chronic diseases and may predict severity and a poor prognosis among those with heart disease.
In large part the result of new medications to treat erectile dysfunction, there has been a 50 percent increase in doctor visits related to erectile dysfunction from 1996 to 2000.
Despite this, previous estimates of erectile dysfunction (ED), have not included a diverse population.
In response to this situation, researchers at The David Geffen School of Medicine at UCLA, and the Urologic Diseases in America Project analyzed data from over 3500 male participants of the 2001-2002 National Health and Nutrition Examination Survey (NHANES). The goal was to arrive at a better understanding of U.S. national estimates of prevalence and risk factors for ED.
Recent Study on the Prevalence and Risk Factors Association with Erectile Dysfunction
Following recommendations from the National Institutes of Health Consensus Development Panel on Impotence, erectile dysfunction was self-defined by subjects based on their answer to the question:
How would you describe your ability to get and keep an erection adequate for satisfactory intercourse?
Responses included “always or almost always able“, “usually able“, “sometimes able“, “never able“, and “don’t know“.
Men who responded that they were “always, almost always able” or “usually able” to maintain an erection sufficient for sexual intercourse were considered to not have ED.
Men who responded that they were “sometimes able” or “never able” to have an erection sufficient for sexual intercourse were considered to have ED. Those who refused to answer the question or responded “don’t know” were excluded from the study.
While the press release for the study begins by pointing out that the study found almost 1 in 5 men had ED, the facts, particularly in regards to aging, show a more predictable, and possibly less dire, picture of things. Here are some of the statistics from the study (figures may not add to 100% because of rounding):
- Men 20-29: 93.5% did not have ED, 6.5% had ED
- Men 30-39: 96.2% did not have ED, 3.8% had ED
- Men 40-49: 91.7% did not have ED, 8.2% had ED
- The figures continue to increase until the age of 75. 77% of men 75 and older were living with ED.
In terms of other factors that might contribute to ED, including age and other medical conditions, findings included:
- Hispanic men had almost twice the risk of ED as white men.
- Obesity, hypertension, smoking and diabetes also were associated with risk of ED.
- There are many interesting things to consider about these numbers. Let’s start with the 77% figure for men over 75.
What does it mean to say that 77% of a population lives with something that is not life threatening? If that many people have an experience at a particular age, does it make sense to think of this experience as a medical condition? Is it just a predictable reality of aging?
Given this number one would hope researchers are asking themselves whether it makes sense to define norms of sexual functioning without taking age into account. In other words, should a 20-year-old erection be like an 80-year-old erection? Who is served by defining something as a dysfunction as opposed to defining it as a “normal” part of aging? How do these labels impact both our experience of something and the ways we think about changing it?
Another interesting data point is the fact that ED seems to be more prevalent in men in their 20’s than it is for men in their 30’s. This may be in part a function of younger men needing to learn ejaculatory control, and getting the hang of it in their 30’s. It might be something else. Either way, it points to the fact that erectile functioning actually fluctuates across the lifespan, and again raises the issue of how we are defining erectile dysfunction versus how we are describing erectile functioning.
