Erectile Dysfunction (ED)
Urology Associates provides various treatment options for erectile dysfunction (ED). Our urology team will help treat your ED safely and effectively.
Erectile dysfunction (ED), also known as impotence, is the most common sexual problem amongst men. ED is defined as the inability to achieve or sustain an erection for sexual intercourse. At least 25% of men over the age of 50 are diagnosed with ED. The numbers continue to increase as age increases. Young males can suffer from ED as well. Roughly 8-10% of men between 20-30 years old suffer from ED.
Normal erections are dependent upon complex interactions between the vascular, hormonal, neurologic, and physiological systems. A disruption within any of these systems can compromise a man’s ability to achieve an erection.
Risk Factors of ED:
- Comorbid Conditions: One of the strongest predictors of ED in men revolves around comorbid conditions. These conditions include, but are not limited to: obesity, cardiovascular disease, diabetes, high blood pressure, high cholesterol, and neurological conditions. 70-80% of ED is related to poor arterial blood flow to the penis which all these comorbid conditions above may contribute to in some degree.
- Anatomical variances/Psychosocial factors: Sometimes, variances in anatomy can impair a functional erection. Many younger men presenting with ED may have abnormal venous outflow from the penis, resulting in loss of erection during sexual activity. Psychosocial factors including depression or anxiety can also cause ED and seems especially more prominent in younger men.
- Lifestyle choices: Additionally, there are strong associations between certain lifestyle choices and ED. Smoking and a sedentary life style increases ED prevalence dramatically. Luckily, lifestyle modifications can dramatically decrease a man’s chances of developing ED or progressing their existing symptoms. Sufficient exercise has been shown to decrease ED occurence. In fact, a well-supported study demonstrated that weight loss and increased activity can actually reverse ED in obese men without the help of medications.
- Sexual Activity: The amount of sexual activity also appears to impact ED prevalence rates. In one study, men having decreased sexual intercourse (average of less than once per week) had twice the rates of ED compared to men having more frequent sexual intercourse (at least once a week).
- Sleep Apnea/RLS: Interestingly, sleep apnea appears to be a risk factor for ED. Treatment with CPAP (continuous positive airway pressure) may improve ED symptoms. Although not fully investigated, restless leg syndrome (RLS) appears also to increase the rates of ED in men. It is still unclear how treatment for RLS impacts ED.
- Medications: Certain medications may increase ED rates in men. It is estimated that medications may be at least partially responsible for 25% of ED cases in men. Some of the most common medications that can cause ED include: antidepressants, sympathetic blockers (clonidine, methyldopa), certain diuretics (water pills), ketoconazole, H2 antagonists (cimetidine, ranitidine), anticholinergics. A variety of other medications are also associated with ED. Alcohol, cocaine, marijuana, and other drugs also can exacerbate ED symptoms.
- Biking/Endocrine/Low Testosterone: Excessive bicycling, endocrine disorders, and low testosterone are also risk factors for ED. Bicycling places pressure on the perineal nerves, which in excessive amounts, can cause numbness of the penis and impotence.
- Others: Other potential causes of ED include systemic sclerosis (scleroderma), Peyronie’s disease (excessive curvature of the penis), past trauma to the penis or pelvis, past surgeries, and prostate cancer treatment.
To summarize, there are many different factors that can cause or contribute to ED. Some of the strongest contributors, such as comorbid conditions, can be modified and controlled with lifestyle changes. Most common however, ED causes are multifactorial and complex. Our urology team is here to work with you to resolve your ED and improve your sexual function.
How We Diagnose ED:
As described above, there are many risk factors and causes for ED. Therefore, our team investigates the potential causes for each patient thoroughly and independently to ensure the best possible outcome. Our work up for ED may include:
- Medical and sexual history
- Physical exam
- Psychological assessment
- Basic labs
Treatment options may vary depending on the presumed cause of your ED. Our team will work with and may suggest the following treatments:
- Oral medications, such as Viagra, Cialis, or Levitra
- Vacuum devices
- Penile self-injection therapy
- Lifestyle modifications
- Surgical procedures
Erectile dysfunction affects as many as 30 million men.