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A healthy diet also helps to maintain a healthy body weight, which is important because men who have a 42-inch waist are 50 percent more likely to have ED than men with a 32-inch waist.

Also, obesity increases the risk for vascular disease and diabetes, two factors that contribute to ED. Learn about our expanded patient care options for your health care needs.

Erectile dysfunction is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance.

The Massachusetts Male Aging Study surveyed 1,709 men aged 40–70 years between 1987 and 1989 and found there was a total prevalence of erectile dysfunction of 52 percent. It was estimated that, in 1995, over 152 million men worldwide experienced ED. For 2025, the prevalence of ED is predicted to be approximately 322 million worldwide. In the past, erectile dysfunction was commonly believed to be caused by psychological problems. It is now known that, for most men, erectile dysfunction is caused by physical problems, usually related to the blood supply of the penis.

Many advances have occurred in both diagnosis and treatment of erectile dysfunction. What are the risk factors for erectile dysfunction? According to the NIH, erectile dysfunction is also a symptom that accompanies many disorders and diseases. Direct risk factors for erectile dysfunction may include the following: Hypogonadism in association with a number of endocrinologic conditions.

Low levels of HDL (high-density lipoprotein) Chronic sleep disorders (obstructive sleep apnea, insomnia) Peyronie's disease (distortion or curvature of the penis) Priapism (inflammation of the penis) Lack of sexual knowledge. Many chronic diseases, especially renal failure and dialysis.

Smoking, which exacerbates the effects of other risk factors, such as vascular disease or hypertension. Age appears to be a strong indirect risk factor in that it is associated with increased likelihood of direct risk factors, some of which are listed above.

Accurate risk factor identification and characterization are essential for prevention or treatment of erectile dysfunction.

The following are some of the different types and possible causes of erectile dysfunction: Organic Erectile Dysfunction.

Organic ED involves abnormalities the penile arteries, veins, or both and is the most common cause of ED, especially in older men.

When the problem is arterial, it is usually caused by arteriosclerosis, or hardening of the arteries, although trauma to the arteries may be the cause. The controllable risk factors for arteriosclerosis--being overweight, lack of exercise, high cholesterol, high blood pressure, and cigarette smoking--can cause erectile failure often before progressing to affect the heart. Many experts believe that atrophy, a partial or complete wasting away of tissue, and fibrosis, the growth of excess tissue, of the smooth muscle tissue in the body of the penis (cavernous smooth muscle) triggers problems with being able to maintain a firm erection. Poor ability to maintain an erection is often an early symptom of erectile dysfunction.

Although the condition is called venous leak, the real problem is not with the veins but malfunction of the smooth muscle that surrounds the veins.

The end result is difficulty with maintain a firm erection (losing an erection too quickly) that is now believe to be an early manifestation of atherosclerosis and vascular disease. Erectile Dysfunction is common in people with diabetes.

have diabetes, and 35 to 50 percent of these men are impotent. The process involves premature and unusually severe hardening of the arteries.

Peripheral neuropathy, with involvement of the nerves

controlling

Depression is another cause of ED and is closely related to erectile dysfunction.

Because there is a triad relationship between depression, ED and cardiovascular disease, men with depression should be fully evaluated for medical illness as well as psychological factors. Some antidepressant medications cause erectile failure. There are many neurological (nerve problems) causes of ED.

Diabetes, chronic alcoholism, multiple sclerosis, heavy metal poisoning, spinal cord and nerve injuries, and nerve damage from pelvic operations can cause erectile dysfunction.

A great variety of prescription drugs, such as blood pressure medications, antianxiety and antidepressant medications, glaucoma eye drops, and cancer chemotherapy agents are just some of the many medications associated with ED.

Hormonal abnormalities, such as increased prolactin (a hormone produced by the anterior pituitary gland), steroid abuse by bodybuilders, too much or too little thyroid hormone, and hormones administered for prostate cancer may cause ED. Low testosterone can contribute to ED but is rarely the sole factor responsible for ED.

Premature Ejaculation (PE) Premature ejaculation is a male sexual dysfunction characterized by: Ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration. Inability to delay ejaculation on all or nearly all vaginal penetrations; and, negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.

Premature ejaculation is divided into lifelong and acquired categories: Lifelong premature ejaculation.

With lifelong premature ejaculation, the patient has experienced premature ejaculation since first beginning coitus.

With acquired premature ejaculation, the patient previously had successful coital relationships and only now has developed premature ejaculation.

Performance anxiety is a form of psychogenic ED, usually caused by stress. Diagnostic procedures for ED may include the following: Patient medical or sexual history. This may reveal conditions or diseases that lead to impotence and help distinguish among problems with erection, ejaculation, orgasm, or sexual desire. To look for evidence of

systemic

Circulatory problems could be indicated by an aneurysm.

Unusual characteristics of the penis itself could suggest the basis of the impotence.

These can include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes.

Measurement of testosterone in the blood is often done in men with ED, especially with a history of decreased libido or diabetes. This is done to help reveal psychological factors that may be affecting performance. The sexual partner may also be interviewed to determine expectations and perceptions encountered during sexual intercourse. Specific treatment for erectile dysfunction will be determined by your doctor based on: Your age, overall health, and medical history. Your tolerance for specific medications, procedures, or therapies.

Some of the treatments available for ED include: Medical treatments: Sildenafil. A prescription medication taken orally for the treatment of ED. This drug works best when taken on an empty stomach and many men can get an erection 30 to 60 minutes after taking the medication.

Sexual stimulation is required for sildenafil citrate to have the best efficacy.

This drug has a similar chemical structure to sildenafil citrate and works in a similar manner.

Studies have indicated that tadalafil citrate stays in the body longer than other medications in its class. Most men who take this medication find that an erection occurs within 4 to 5 hours after taking the pill (slow absorption) and the effects of the medication may last up to 24 to 36 hours. The FDA recommends that men follow general precautions before taking a medication for ED. Men who are taking medications that contain nitrates, such as nitroglycerin, should NOT use these medications.

Taking nitrates with one of these medications can lower blood pressure too much. In addition, men who take tadalafil or vardenfil should use alpha blockers with care and only as instructed by their physician, as they could result in hypotension (abnormally low blood pressure). Experts recommend that men have a complete medical history and physical examination to determine the cause of ED. Men should tell their doctor about all the medications they are taking, including over-the-counter medications.

Men with medical conditions that may cause a sustained erection, such as sickle cell anemia, leukemia, or multiple myeloma, or a man who has an abnormally-shaped penis, may not benefit from these medications.

Also, men with liver diseases or a disease of the retina, such as macular degeneration or retinitis pigmentosa, may not be able to take these medications, or may need to take the lowest dosage. These medical treatments should NOT be used by women or children. Elderly men are especially sensitive to the effects of these medical treatments, which may increase their chance of having side effects. Testosterone replacement therapy may improve energy, mood, and bone density, increase muscle mass and weight, and heighten sexual interest in older men who may have deficient levels of testosterone.

Testosterone supplementation is not recommended for men who have normal testosterone levels for their age group due to the risk of prostate enlargement and other side effects.

Testosterone replacement therapy is available as a cream or gel, topical solution, skin patch, injectable form and pellet form placed under the skin. Two types of implants are used to treat ED, including: Inflatable Penile Prosthesis (3-piece hydraulic pump).

A pump and two cylinders are placed within the erection chambers of the penis, which causes an erection by releasing a saline solution; it can also remove the solution to deflate the penis.

Two semi-rigid but bendable rods are placed within the erection chambers of the penis, which allows manipulation into an erect or non-erect position.

Infection is the most common cause of penile implant failure and occurs less that 2 percent of the time.

Implants are usually not considered until other methods of treatment have been tried but they have a very high patient satisfaction rate and are an excellent treatment choice in the appropriate patient. Many times, men will avoid sexual situations due to the emotional pain associated with ED, causing their partner to feel rejected or inadequate. It is important to communicate openly with your partner. Some couples consider seeking treatment for ED together, while other men prefer to seek treatment without their partner's knowledge. A lack of communication is the primary barrier for seeking treatment and can prolong the suffering. The loss of erectile capacity can have a profound effect on a man.

The good news is that ED can usually be treated safely and effectively. Feeling embarrassed about sexual health problems may prevent many men from seeking the medical attention they need, which can delay diagnosis and treatment of more serious underlying conditions. Erectile Dysfunction itself is often related to an underlying problem, such as heart disease, diabetes, liver disease, or other medical conditions. Since ED can be a forewarning symptom of progressive coronary disease, doctors should be more direct when questioning patients about their health. By asking patients more directly about their sexual function through conversation or a questionnaire during a checkup, doctors may be able to detect more serious health conditions sooner. Summary Start Here Diagnosis and Tests Treatments and Therapies. Erectile dysfunction (ED) is a common type of male sexual dysfunction. It is when a man has trouble getting or keeping an erection. Some people have trouble speaking with their doctors about

sex

If you don't see your doctor, these problems will go untreated. Your doctor can offer several new treatments for ED.

For many men, the answer is as simple as taking a pill.

Getting more exercise, losing weight, or stopping smoking may also help. NIH: National Institute of Diabetes and Digestive and Kidney Diseases.

A man is considered to have erectile dysfunction if he regularly finds it difficult getting or keeping a firm enough erection to be able to have sex, or if it interferes with other sexual activity.

Most men have occasionally experienced some difficulty with their penis becoming hard or staying firm.

However, erectile cialis now generic dysfunction (ED) is only considered a concern if satisfactory sexual performance has been impossible on a number of occasions for some time.

Since the discovery that the drug sildenafil, or Viagra, affected penile erections, most people have become aware that ED is a treatable medical condition.

Men who have a problem with their sexual performance may be reluctant to talk with their doctor, seeing it can be an embarrassing issue. However, ED is now well understood, and there are various treatments available. This MNT Knowledge Center article offers helpful information for people experiencing this problem, or those close to them.

Fast facts on erectile dysfunction: Erectile dysfunction (ED) is defined as persistent difficulty achieving and maintaining an erection sufficient to have sex. Causes are usually medical but can also be psychological.

Organic causes are usually the result of an underlying medical condition affecting the blood vessels or nerves supplying the penis. Numerous prescription drugs, recreational drugs, alcohol, and smoking, can all cause ED.

Normal erectile function can be affected by problems with any of the following systems: blood flow nerve supply hormones.

Share on Pinterest Erectile dysfunction can cause embarrassment.

It is always worth consulting a physician about persistent erection problems, as it could be caused by a serious medical condition.

Whether the cause is simple or serious, a proper diagnosis can help to address any underlying medical issues and help resolve sexual difficulties.

The following list summarizes many of the most common

physical

Atherosclerosis is a common cause of blood flow problems.

Atherosclerosis causes a narrowing or clogging of arteries in the penis, preventing the necessary blood flow to the penis to produce an erection. Numerous prescription medications can also cause ED, including those below.

Anyone taking prescription medications should consult their doctor before stopping or changing their medications: drugs to control high blood pressure heart medications such as digoxin some diuretics drugs that act on the central nervous system, including some sleeping pills and amphetamines anxiety treatments antidepressants, including monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants opioid painkillers some cancer drugs, including chemotherapeutic agents prostate treatment drugs anticholinergics hormone drugs the peptic ulcer medication cimetidine.

Physical causes account for 90 percent of ED cases, with psychological causes much less common. In rare cases, a man may always have had ED and may never have achieved an erection. This is called primary ED, and the cause is almost always psychological if there is no obvious anatomical deformity or physiological issue.

Such psychological factors can include: guilt fear of intimacy depression severe anxiety.

Most cases of ED are ‘secondary.’ This means that erectile function has been normal, but becomes problematic. Causes of a new and persistent problem are usually physical. Less commonly, psychological factors cause or contribute to ED, with factors ranging from treatable mental health illnesses to everyday emotional states that most people experience at some time. It is important to note that there can be overlap between medical and psychosocial causes.

For instance, if a man is obese, blood flow changes can affect his ability to maintain an erection, which is a physical cause. However, he may also have low self-esteem, which can impact erectile function and is a psychosocial cause. Questions remain about the effects on men’s health of riding a bicycle.

Some research has raised concerns that men who regularly cycle for long hours could have a higher risk of ED, in addition to other men’s health issues such as infertility and prostate cancer.

The most recent study to investigate this found that there was no link between riding a bike and ED, but it did find an association between longer hours of cycling and the risk of prostate cancer.

However, prostate surgery to remove the cancer and radiation therapy to treat prostate cancer can cause ED. Treatment of non-cancerous, benign prostate disease can also cause the condition.

ED isn’t

just

The sooner you learn about ED treatment alternatives, the sooner you can go back to sharing and enjoying intimate moments with your significant other.

There are many different body parts that play an essential role for a man to get and maintain an erection during sexual intercourse.

Beyond the physical causes that can lead to ED, it has been reported that 20% of ED is related to psychological causes.

2 With so many possibilities leading to erectile dysfunction, it becomes particularly important to find a specialist who can correctly diagnosis the direct cause of your ED and find a treatment option that is right for you.

Often, a physical exam and a discussion regarding medical history will be enough to diagnosis erectile dysfunction and start you on your treatment pathway.

22 As discussed in the “Causes of ED” page; however, there can be many different underlying reasons that have led to ED, and additional tests may be needed to determine the exact cause.

Physical Exam – an examination of the testicles and penis while also checking nerves for sensation.

Blood Tests – Can help to identify signs of heart disease, diabetes, low testosterone, and other health issues. Urine Tests – Similar to a blood test, a urine test can help identify diabetes or other potential causes.

Ultra Sound – This test is usually conducted by a specialist to determine if there is a lack of blood flow which is preventing you from getting an erection. There are many different treatment options for erectile dysfunction, but your diagnosis will determine which treatment option is right for you.

It is important to realize that not all treatment options will work for everyone. A doctor who has specialized in men’s sexual health (typically a urologist) will be the most qualified to discuss all of your treatment options with you. Many specialists will often encourage you to schedule additional follow up appointments to review how your treatment is working for you or if a different option may be more beneficial.

When you make an appointment to discuss ED with your doctor, he’ll go over your options and help you decide what’s best for your unique situation.

He might suggest making lifestyle changes, trying drug therapy, or getting a penile implant.

The same healthy lifestyle tips your doctor has been recommending for years may also help treat your ED: 21.

Quitting smoking Reducing alcohol consumption Losing weight Exercising regularly Reducing stress. These steps aren’t an instant fix, but they may improve your blood flow and nerve functioning.

If you’re having trouble sticking to these goals, ask your spouse or partner to join you. Getting healthy together and trying new things as a couple can be a great bonding experience and can strengthen your relationship.