What are the causes of ED?
While people used to believe that erectile dysfunction was entirely a psychological issue—often dismissed as performance anxiety or insecurity— we now know otherwise. In fact, it’s more common for ED to be caused by organic factors (like cardiovascular issues, diabetes or medication) than psychogenic factors (like anxiety or depression). Often the answer involves complex health issues working together; sometimes organic-caused ED can lead to anxiety around sex, which certainly does not help when it comes to getting and staying hard. As Dr. Patel put it, “The most common cause we see is vasculogenic erectile dysfunction, or issues with blood flow to the penis.” Because that’s so common, he stressed that it is important for men experiencing ED to come in and get it checked out, “primarily because we can also identify the factors that will put them at higher risk of developing other cardiovascular disease, even if they’re younger, things like heart attack, stroke, high blood pressure, things of that nature.”
There are lots of medical factors that make people more likely to suffer from erectile dysfunction, things like medication side effects, stroke, thyroid disease. For people with diabetes, for example, the rate of ED is much higher than the general population. That said, in younger men, studies seem to show that psychological factors such as work stress seem to play a larger role than they do for older men.
What are the most common or first treatment options?
Firstly, your doctor is likely going to look into your medical history and lifestyle. Certain medications such as antidepressants, anti-seizure medications and medications for high blood pressure can contribute to or cause ED, according to Dr. Patel. Additionally, he says that he always talks to patients about alcohol and tobacco use, both of which can contribute to the problem, and other lifestyle factors like weight and stress. The first treatment option beyond lifestyle changes is generally going to be prescribing a pde5 inhibitor—common brands are Viagra or Cialis—in pill form.
*What should you know before taking the pill?
Dr. Synder helped to lay out some misconceptions about taking pde5 inhibitors like Viagra or Cialis. He first explained that these pills can actually be helpful for psychological ED as well as physical ED since they don’t strictly give you an automatic erection. According to him, pde5 inhibitors “amplify the positive signals from the brain to the penis. This can be helpful if you’re trying to contend with negative signals, such as from performance anxiety.” But he reminds patients that you can’t just expect to take the pills and get hard. He compares it to an amplifier on a stereo— “You can turn the amp up as high as you want, but you won’t hear anything unless there’s a record playing.”
The disclaimers on TV are scary. Are there risks with the pill?
Dr. Synder: “As far as we know, Viagra and Cialis don’t produce physical dependence. But they can absolutely produce psychological dependence, where you start to feel naked without a pill. I usually advise men with psychological ED to consider these medications like training wheels: use them to get yourself going, then take them off as soon as you’re feeling confident again.” As for side effects, the most common according to the National Library of Medicine are headache, flushing, nasal congestion, nasopharyngitis, and dyspepsia. And of course, if you get an erection lasting more than 4-6 hours, you need to contact a doctor.
Are there other treatment options?
There are actually quite a few—some have more science behind them than others. There are vacuum devices, which can actually be purchased online and do not require a prescription. (These have been around since at least 1874 and were patented in 1917 in the US). Another option is to inject the same kind of medication that is in the pde5 inhibitor into the base of the penis before sex. Dr. Patel says that this method “works very well in a large percentage of guys, and there’s a lot of wiggle room in terms of upping that dose safely, because you don’t see any of those other bad side effects.” And then there’s also a pellet that you can put in your urethra that dissolves, although Dr. Patel says that that method is less common and can cause a burning sensation for some patients.