Erectile Dysfunction

Erectile dysfunction means not being able to achieve an erection that is good enough to have sexual intercourse. It’s very common, about 40% of all men report some erectile dysfunction and 20% report significant erectile dysfunction. That is one in five men with significant problems. Of those men with significant erectile dysfunction only about one-third actually seek help and of those who do seek help less than half actually receive any treatment. Health for men is all about changing that and improving the state of men’s health in Australia.

What causes erectile dysfunction?

Before understanding what causes erectile dysfunction there needs to be some understanding of what causes an erection because its not as simple as it might look.

An erection is essentially an event where the penis fills with blood to the point where it becomes firm and rigid. This pushes nerve endings of the penis closer to the skin and makes the penis more sensitive while at the same allowing the penis to become stiff enough to perform sexual penetration. This all happens through a process that involves thoughts and feelings (psychological), nerves travelling through the body (neurological), blood vessels (vascular) and hormones (endocrinological).

After becoming aroused, the process starts with signalling of nerves in the spinal cord which are overseen by input from centres higher up in the brain. A part of the sympathetic nervous system (the part of the nervous system that helps you fight or run away) needs to be turned down because it would otherwise direct blood away from the penis and toward muscles needing for running or fighting. The parasympathetic nervous system (the one that helps you rest and digest) is activated by physical touch of the penis and it helps blood vessels in the penis release chemicals that allow them to relax and fill with blood. So part of achieving an erection requires a man to be relaxed and comfortable while not being scared or angry.

Anything that damages the nerves (like surgery, a spinal cord injury or diabetes) can therefore cause erectile dysfunction. The centres higher up that control these spinal cord signals can also affect erections (dementia, antidepressants, anxiety or even depression itself).

Once the nervous system is on board the penis will be able to fill with blood. The only way this can happen is if the blood vessels that supply the penis are working properly and aren’t blocked by plaque. That’s is why smoking, diabetes, heart disease, high cholesterol and some medications that work on blood vessels can cause erectile dysfunction.

Hormonal conditions like low testosterone have an impact on erections and erections in the morning are primarily mediated by changes in testosterone that occur throughout the day. Testosterone influences the nerve signalling related to erections, the blood vessels supplying the penis and levels of arousal in the brain. The way it works is much like a dial that turns volume up or down, testosterone also dials responsiveness up or down. The effect is to turn these factors in favour of achieving and erection which is why men are often more interested in sex in the morning (when testosterone is higher). A lack of testosterone caused partly by ageing or certain medical conditions (like sleep apnoea, obesity or diabetes) can contribute to erectile dysfunction as can medications that block testosterone.

Erectile dysfunction is rarely caused by just one of these problems because a lot of them can occur at the same time. The development of one problem can also be associated with stress and anxiety which then leads to another cause for erectile dysfunction and this makes things worse.

What does it mean if I can’t achieve an erection?

There are lots of possible reasons why a man might not be able to achieve an erection and, as described above, there is often more than one and sometimes multiple reasons why a man can’t achieve an erection. Sometimes the reasons are psychological and these are probably the ones that respond best to treatment. Sometimes the reasons are related to your heart and circulation and this might mean you could be at risk of heart disease. Sometimes they are related to your hormones and level of testosterone which might be causing other problems too. It’s an important symptom that is worth discussing with a doctor who is interested in this problem.

What treatments are available?

There are lots of treatments available but there is rarely one size fits all. Treatment starts with identifying the cause or the multiple causes that are contributing to the problem. Sometimes treatment may be as simple as stopping a medication that leads to erectile dysfunction.

Part of treating erectile dysfunction involves the recognition that this could be an early marker of heart disease or diabetes and a lot of the treatments that help with these conditions will also lead to improvement in erectile function. Investigation erectile dysfunction could save men from having a heart attack.

Low testosterone may or may not be relevant to erectile dysfunction but in many cases of low testosterone replacement of this hormone can be an effective treatment.

Exercise and weight loss can improve erectile function and is a very useful treatment if the dysfunction isn’t very severe. If it is severe this is probably not going to be a very effective option.

Erectile dysfunction that is primarily related to thoughts and feelings (sometimes called psychogenic) actually responds very well to medications just like the organic version (although often the two causes go together). Psychogenic erectile dysfunction can usually be cured to the point where medications aren’t needed but a lot of doctors and psychologists aren’t all that interested in this area. This is another reason why it’s a good idea to seek out a doctor who is specialises in men’s health.

First line medical treatments (tablets) which can be taken daily or when required are very effective and these days some of them are much cheaper than they used to be. There are some situations where taking these medications could be dangerous (i.e with certain other medications or medical conditions) but there are very few men where this will be a problem. This is something men are often worried about but most of them don’t need to be.

Most of the time medications or tablets will work but when they don’t there are a variety of options available to men which are also very effective. Sometimes men are reluctant to try things like penile injections but they are often much easier and less painful to deliver then expected. They can be a very useful treatment if supervised by a doctor trained in this area.

Finally, there are quite a number of new and emerging treatments in this area. Even therapies that haven’t been successful in the past might work with some tweaking especially if supervised by a doctor with a specialised interest in this area.