Erectile dysfunction is the inability to achieve or maintain an erection firm enough for satisfactory sexual intercourse. Treatments range from prescribed medications to surgery, but only a doctor can recommend the best approach. Below, clear up your main doubts about the condition.
Over the years, complaints about erectile dysfunction increase, and this is not by chance or mere coincidence.
On the other hand, besides age, other factors can cause or contribute to the scenario of impotence.
Knowing the main treatments and risk factors is the first step to dealing with the condition. Keep reading and learn everything about erectile dysfunction!
What is erectile dysfunction?
Erectile dysfunction (ED) is a condition that affects a man’s ability to obtain and maintain an erection for sufficient time for satisfactory sexual activity.
It is one of the most common sexual dysfunctions among men, especially as they age.
Studies show that approximately 50% of men over the age of 40 experience some degree of ED at some point in their lives.
Types of erectile dysfunctions
Some degrees of erectile dysfunction can result in sexual impotence, so it is important to understand it in detail.
Many think they have no erection problem because they can achieve it initially.
However, when it cannot be sustained and is lost during the act of sex, or is not enough to ensure safe penetration, this means that erectile dysfunction may be at a mild or moderate degree.
On the other hand, the total absence of erection in a man means there is little blood running through his penis, and thus, erectile dysfunction is at a severe degree.
Knowing how your body works is essential to be able to identify dysfunction in these cases.
An erection is an involuntary response to a sexual stimulus, causing the brain, nerves, heart, blood vessels, and hormones to work together to rapidly increase the amount of blood flowing into the penis.
So many parts of the body working together make discovering the cause of erectile dysfunction depend on medical assessments and specific tests to reach the most appropriate treatment.
However, when something is not going well with the penis’s functioning, the patient is the first to notice.
If you cannot maintain a sexual relationship until the end, or the act occurs very briefly and without the satisfaction of the couple, seek medical help.
Although it may seem harmless, problems resulting from poor-quality erection can bring many headaches.
What are the symptoms of erectile dysfunction?
Erectile dysfunction can manifest through a series of symptoms, which may vary in intensity depending on the individual. Below, check out the main ones:
- Inability to obtain an erection firm enough for sexual activity;
- difficulty maintaining the erection during the desired time for sexual intercourse;
- erections that are less rigid than normal;
- decreased sexual interest or libido;
- anxiety, stress, or excessive worry about sexual performance;
- difficulty achieving orgasm or ejaculation;
- involuntary erections that are less frequent or less rigid.
It is important to note that ED can be occasional in some men and chronic in others.
It may also occur in specific situations, such as during sex with a particular partner, in moments of stress or fatigue.
Is there a difference between impotence and erectile dysfunction?
Yes, there is a difference between the terms “impotence” and “erectile dysfunction”, although they are often used interchangeably.
The medical community prefers the use of the term “erectile dysfunction” due to its accuracy and neutrality. Below, check out the main characteristics between the two terms.
Impotence
The term “impotence” has historically been used to describe a man’s inability to perform satisfactory sexual relations.
However, this term is considered broader and less precise than “erectile dysfunction”. “Impotence” can encompass not only difficulties with erection but also issues related to sexual desire, orgasm, and ejaculation.
Erectile dysfunction
This term specifically refers to the inability to achieve erection or maintain it for satisfactory sexual activity.
ED is a more specific and clinically precise term, focusing exclusively on the issue of erectile function.
Causes of dysfunction
The causes of dysfunction can be specific or combined. Therefore, it is essential to obtain an accurate diagnosis alongside a specialist. Below, see the most common factors that often lead to the condition.
Vascular problems
Vascular problems are common causes of erectile dysfunction (ED), and involve a variety of conditions that affect blood flow to the penis.
When there is impairment of blood circulation to the penis, difficulty in obtaining or maintaining a sufficiently firm erection for satisfactory sexual activity can occur.
Below, check out some of the most recurrent vascular problems that lead to erectile dysfunction.
- Atherosclerosis: a condition in which plaques of fat, cholesterol, and other substances accumulate on the walls of arteries, leading to narrowing and hardening of the same;
- Hypertension: high blood pressure can damage the walls of arteries, making them less elastic and reducing blood flow to the penis.
- Peyronie’s disease: characterized by the development of fibrous scar tissue inside the penis, the Peyronie’s disease causes curvature and pain during erection, which interferes with the ability to maintain it firm long enough for sex.
- Penile fractures: the penile fractures occur when the fibrous tissue of the penis is damaged due to sudden trauma during sexual activity. These injuries cause rupture in the tunica albuginea and, consequently, affect the blood circulation to the penis
In all these cases, the interruption of blood flow to the penis is a key factor in erectile dysfunction.
Endocrine problems
Endocrine problems can also contribute significantly to the development of erectile dysfunction (ED), affecting the hormonal systems that regulate male sexual function.
- Diabetes: in diabetes, high blood glucose can damage the blood vessels and nerves of the body, impairing blood flow and sensitivity.
- Metabolic syndrome: is a combination of risk factors (such as high blood pressure, high blood sugar levels, excess abdominal fat, and abnormal cholesterol) that increase the risk of heart diseases, strokes, and type 2 diabetes and, consequently, impair erectile function.
- Changes in sexual hormones: imbalances in sexual hormones, such as testosterone, can play a significant role in erectile function.
Low production of testosterone, also known as hypogonadism, can result in decreased sexual desire, difficulty in obtaining or maintaining an erection, and even atrophy of penile tissues.
On the other hand, excessively high levels of prolactin, a hormone secreted by the pituitary gland, can interfere with male sexual function.
It is worth noting that the treatment of erectile dysfunction related to endocrine problems generally involves a multidisciplinary approach.
Neurological problems
Neurological problems can have a significant impact on erectile function, as the nervous system plays a key role in regulating the erection process.
- Parkinson’s disease: this neurodegenerative disorder that affects the central nervous system, leading to motor symptoms such as tremors, muscle stiffness, and movement difficulties, can cause autonomic dysfunction, which affects the control of involuntary body processes, including erectile function.
- Dementias: can negatively affect cognitive function and sensory processing, including the signals sent by the brain to trigger an erection;
- Demyelinating diseases: are conditions that affect the myelin, the substance that envelops and protects the nerves in the central and peripheral nervous system, such as multiple sclerosis (MS) and optic neuritis. Both infer on the transmission of the necessary signals for an adequate erection.
- Lesions spinal: resulting from traumas, strokes, or medical conditions, can directly affect the nerves responsible for erection.
In the above-mentioned cases, the treatment of erectile dysfunction can be complex and vary depending on the underlying cause and the extent of neurological damage.
Urological problems
Urological problems, such as prostate cancer and benign prostatic hyperplasia (BPH), can also play a significant role in erectile dysfunction (ED) due to their proximity to the structures responsible for erectile function and ejaculation.
- Benign prostatic hyperplasia (BPH): also known as an enlarged prostate, although not directly related to erectile function, the urinary symptoms associated with BPH, such as difficulty urinating and frequent urination during the night, can affect the quality of erections and interfere with sexual activity.
- Prostate cancer: the prostate cancer is one of the most common forms of cancer among men and can adversely affect erectile function, especially when treatments involve surgery, radiotherapy, or hormonal therapy.
- Prostate removal: surgery to remove the prostate (radical prostatectomy) can damage the nerves close to the organ, essential for erection. Radiotherapy can also cause damage to the nerves and blood vessels in the area.
In addition, hormonal therapy, which is often used to treat prostate cancer, can reduce testosterone levels, adversely affecting erectile function.
Psychological problems
Psychological problems play a significant role in erectile dysfunction (ED), often exacerbating or even triggering the condition. Below, see some common psychological problems that may be associated with ED.
- Performance anxiety: is the persistent fear of not being able to perform sexually during the act of sex. This fear can become a self-fulfilling prophecy, leading to difficulties in obtaining or maintaining an erection due to stress and excessive worry.
- Anxiety: general anxiety, including social anxiety, generalized anxiety disorder, or anxiety disorder, can contribute to ED. Chronic stress and excessive worry can negatively affect sexual desire, arousal, and erectile function.
- Depression: the condition can cause a range of physical and emotional symptoms, including fatigue, lack of interest in sexual activities, low self-esteem, and concentration difficulties. These symptoms can significantly impact erectile function.
- Relationship conflicts: relationship problems, such as inadequate communication, lack of emotional intimacy, resentment, or unresolved conflicts, also contribute to ED.
It is important to recognize that ED can be caused by a combination of physical and psychological factors, and often there is a complex interaction between the two.
Problems with addictions
Finally, problems with addictions, such as smoking and alcoholism, can have a significant impact on erectile function, contributing to the development or aggravation of erectile dysfunction (ED). Below is information on how these addictions can affect erectile function.
- Smoking: cigarette smoke contains chemicals that damage blood vessels and can cause atherosclerosis, a condition in which the arteries narrow due to the accumulation of plaques of fat, cholesterol, and other substances. This can reduce blood flow to the penis, impairing the ability to obtain or maintain an erection.
- Alcoholism: alcohol is a depressant of the central nervous system, which can reduce sensitivity and sexual response. In addition, chronic alcoholism can lead to health problems, such as liver diseases, diabetes, and peripheral neuropathy, which are associated with ED.
Risk factors
Risk factors are characteristics, medical conditions, behaviors, or circumstances that increase the likelihood of a person developing a particular disease or condition.
In the context of erectile dysfunction (ED), various risk factors can influence its development, as follows below.
Age
The risk of ED increases with age. This occurs because as men age, they are more likely to develop medical conditions, such as heart diseases, diabetes, and hypertension, which can contribute to ED.
This thesis is also seen in various studies, such as a clinical research carried out jointly with specialists in the field.
According to the survey, it is estimated that the frequency of ED (moderate and complete) increases with age, especially from the age of 40.
Sedentary lifestyle
The lack of regular physical exercise is associated with a higher risk of developing ED. Regular exercise helps improve blood circulation, reduce stress, maintain a healthy weight, and improve cardiovascular health, important factors for erectile function.
Medications
Some medications, including antidepressants, blood pressure medications, tranquilizers, antipsychotics, medications for prostate problems, and some medications for the treatment of baldness, can cause or contribute to ED as a side effect.
It is important to note that there is often a complex interaction between these risk factors and that not all men who have one or more of these factors will develop ED.
However, recognizing and addressing these risk factors can help prevent or reduce the risk of the onset of the condition.
Obesity
Obesity is associated with a series of medical conditions, such as diabetes, high blood pressure, and cardiovascular diseases, which can increase the risk of ED.
Additionally, obesity can lead to hormonal changes and psychological problems that can also contribute to ED.
In addition to these, other problems such as cardiovascular diseases and diabetes, mentioned previously, are associated with dysfunction in men.
Is it possible to reverse erectile dysfunction?
Most cases of impotence are reversible, but it is necessary to seek medical help and follow the treatment suggested by the specialist strictly.
How is the diagnosis made
The diagnosis of erectile dysfunction (ED) begins with an initial clinical approach, in which the doctor investigates the sexual history of the patient and his partner.
Subsequently, comorbidities and risk factors associated with ED are evaluated to better understand its possible underlying cause and guide appropriate treatment.
In addition, standardized evaluation methods are used, such as the International Index of Erectile Function (IIEF) and the Male Sexual Quotient (QSM), for a more objective assessment.
The IIEF is a questionnaire consisting of 15 questions grouped into five domains, including erectile function, orgasm, sexual desire, sexual satisfaction, and overall satisfaction. It allows classifying the severity of ED into five groups based on the score obtained.
The QSM, composed of 10 questions, covers different aspects of male sexual function, such as desire, sexual self-confidence, erection quality, ability to reach orgasm, and overall satisfaction with sexual relations.
From the answers, an index ranging from 0 to 100 is generated, indicating different levels of performance/satisfaction.
These questionnaires help direct the clinical interview, providing a more accurate assessment of the patient’s problems and assisting in choosing the best therapeutic approach.
Available treatments
Erectile dysfunction can be treated with medications that increase blood circulation in the penis, whether they are tablets, gels, or injections, or with penile prosthesis.
Everything will depend on the degree of dysfunction, its cause, and how long it has been occurring.
However, it is worth noting that the most effective treatment with the highest number of satisfied patients is the implant of a penile prosthesis.
Although feared by many, the implant will bring back the rigidity necessary for penetration.
In addition, other treatments may be indicated complementarily to ensure the effectiveness of erectile recovery, among them:
Change of habits
The change of habits plays a fundamental role in the treatment of erectile dysfunction (ED), as the condition is often closely linked to the lifestyle and habits of the patient.
By adopting healthy habits, such as following a balanced diet, exercising regularly, quitting smoking, and moderating alcohol consumption, it is possible to improve cardiovascular health, which in turn can benefit erectile function.
It is important to emphasize that the change of habits is not just a part of the treatment of ED, but can also be an effective preventive strategy.
Maintaining a healthy lifestyle from an early age can help prevent the development of erection problems in the future.
Sexual therapy
Sexual therapy is an important and effective approach in the treatment of erectile dysfunction (ED), especially when the underlying cause involves psychological, emotional, or relational factors.
This is because, often, ED has a significant psychological component, such as performance anxiety, stress, depression, or relational issues.
In this sense, sexual therapy can help identify and address these underlying factors, providing a safe space for the patient to explore his concerns and feelings regarding his sexual function.
In addition, sexual therapy can include practical techniques and exercises designed to help the patient develop more effective sexual skills.
This can include:
- breathing techniques;
- relaxation exercises;
- effective communication with the partner;
- masturbation techniques;
- sensate focus techniques, which aim to increase the connection and intimacy between the couple.
Alongside general psychotherapeutic approaches, sexual therapy can include specific interventions for ED, such as the progressive desensitization technique, which aims to reduce performance anxiety through gradual exposure to sexual stimuli, and the use of vacuum pumps or penile rings to aid in obtaining and maintaining an erection.
It is important to note that sexual therapy is often combined with other treatment modalities, such as medication, lifestyle changes, and medical treatments, for a holistic and comprehensive approach.
How to help a partner with erectile dysfunction?
Dealing with erectile dysfunction (ED) can be challenging for a couple, but the key to overcoming this situation is open and empathetic communication between the partners.
For this, it is important that both feel comfortable expressing their feelings, concerns, and needs regarding ED, without fear of judgment or embarrassment.
This means creating a safe environment in which the boyfriend or husband with ED can share his emotions and the other partner can offer emotional support, understanding, and empathy.
In addition to offering emotional support, it is important that the partner with ED feels encouraged to seek appropriate treatment. This may involve consulting a doctor, sexual therapist, or other qualified health professionals to explore treatment options.
Exploring alternatives beyond conventional medical treatment can also be beneficial. This may include lifestyle changes, sexual therapy, relaxation techniques, and sensate focus exercises.
Finally, avoid putting additional pressure on the partner regarding his sexual function. Pressuring him will only increase performance anxiety and can worsen ED.
Phosphodiesterase-5 inhibitors
The sexual stimulants are a class of medications widely used in the treatment of erectile dysfunction (ED).
They work by blocking the action of the enzyme phosphodiesterase-5, which normally degrades cyclic guanosine monophosphate (cGMP), a substance that promotes the relaxation of smooth muscles and increases blood flow to the penis during sexual stimulation.
By blocking the action of PDE5, PDE5 inhibitors help maintain higher levels of cGMP in the penis, facilitating the achievement and maintenance of an erection.
These medications do not cause an erection directly; instead, they amplify the body’s natural response to sexual stimulation.
PDE5 inhibitors are available in different pharmaceutical forms, including:
- sildenafil (Viagra);
- tadalafil (Cialis);
- vardenafil (Levitra, Staxyn);
- avanafil (Stendra);
- intraurethral and intracavernous administration.
These medications are generally taken as needed, about 30 minutes to an hour before planned sexual activity.
The duration of the effect varies among the different PDE5 inhibitors, with some remaining active for up to 36 hours after ingestion.
It is important to note that PDE5 inhibitors are not indicated for all men with ED and may not be safe in certain medical conditions, such as severe cardiovascular disease.
Therefore, it is essential to consult a doctor before starting any treatment with PDE5 inhibitors.
Intracavernous injection
The penile intracavernous injection is a treatment option for erectile dysfunction (ED) that involves injecting medications directly into the erectile tissue of the penis.
This technique is generally reserved for men who do not respond to conventional treatments, such as phosphodiesterase-5 (PDE5) inhibitors, or who cannot use them due to medical contraindications.
The most commonly used medication for intracavernous injection is alprostadil, a substance that dilates blood vessels and increases blood flow to the penis, facilitating an erection.
Generally, the injection is done on the side of the penis, at the base of the organ, using a fine needle and a specific syringe for this purpose.
The effects of intracavernous injection generally occur within 5 to 20 minutes after administration and can last from 30 minutes to several hours, depending on the dose and the individual response of the patient.
The resulting erection is not dependent on sexual stimulus and can be more prolonged than a natural erection, requiring care to avoid prolonged erections, known as priapism, which can cause damage to the penile tissue.
Although intracavernous injection can be effective in treating ED, it also presents some risks and possible side effects, including pain at the injection site, bruising, fibrosis of penile tissue, and priapism.
Therefore, just as in the case of phosphodiesterase-5 (PDE5) inhibitors, it is crucial that patients follow the doctor’s guidelines,
Hormone replacement therapy
Hormone replacement therapy (HRT) is a treatment that involves the administration of hormones to compensate for hormonal deficiency in men with erectile dysfunction (ED) caused by low levels of testosterone.
The testosterone is the main male sexual hormone and plays a key role in erectile function, libido, and overall sexual health.
HRT is usually prescribed for men with low levels of testosterone, a condition known as hypogonadism.
The objectives of HRT in ED include increasing testosterone levels to a range considered normal for the age and improving symptoms related to testosterone deficiency, such as decreased libido, fatigue, depression, and erectile dysfunction.
However, it is important to note that not all cases of ED are caused by low levels of testosterone, and HRT may not be effective for all men with ED.
Penile prosthesis
The penile prosthesis is a treatment option for men with severe erectile dysfunction (ED) who do not respond to other forms of therapy, such as oral medications, intracavernous injections, or vacuum devices.
It is also considered when ED is caused by anatomical conditions, such as Peyronie’s disease, or by treatments for prostate cancer that result in irreversible damage to the nerves responsible for erection.
How to treat dysfunction naturally?
There are several natural approaches that can help treat erectile dysfunction (ED) or improve overall sexual health. Below, check out the main ones.
Healthy eating
A balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can improve cardiovascular health, which is fundamental for erectile function.
Foods high in antioxidants, such as red fruits and green leafy vegetables, can help improve blood circulation.
See: Discover the 15 best foods that improve male sexual performance
Regular physical exercise
Regular physical activity can help improve cardiovascular health, increase energy levels, and reduce stress, which can benefit erectile function.
Aerobic exercises, such as walking, running, swimming, and cycling, are especially beneficial.
Stress management
Chronic stress can contribute to erectile dysfunction. Relaxation practices, such as meditation, yoga, tai chi, and deep breathing techniques, can help reduce stress and improve emotional health.
Maintaining a healthy weight
Excess weight and obesity are associated with a higher risk of ED. Losing weight through a combination of a healthy diet and regular physical exercise can help improve erectile function and sexual health.
Natural supplements
Some natural supplements, such as L-arginine, ginseng, ginkgo biloba, and tribulus terrestris, have been studied for their potential benefits in erectile function.
However, it is important to talk to a doctor before starting any supplement, as some can interact with prescribed medications or have undesirable side effects.
Remember: these natural approaches can complement conventional medical treatment, but should not replace it.
Which doctor to consult upon noticing the first signs of sexual impotence?
Upon noticing the first signs of sexual impotence, it is recommended to seek a doctor specialized in sexual health, known as a urologist or andrologist.
These professionals possess the knowledge and experience necessary to diagnose and treat problems related to erectile dysfunction and other issues of male sexual health.
Erectile dysfunction can be a challenging condition, but, as you can see, there are many effective treatments and approaches to minimize or even reverse the problem.
From medications and penile prosthesis surgery to lifestyle changes, sexual therapy, and partner support, the resources are varied.
In addition, it is important to keep in mind that the condition is quite common, after all, it is estimated that more than 100 million men worldwide suffer from some degree of dysfunction, as disclosed by the University of São Paulo (USP).
If you are also going through this, schedule an appointment today with Dr. Paulo Egydio, a specialist in erectile dysfunction, and discover how to regain sexual health!
