Greater Boston Urology Blog

What Exactly Is Erectile Dysfunction?

We asked Dr. Natalya Lopushnyan to sit down for a Q&A on an important topic in men's health: What exactly is erectile dysfunction? It's a subject she's passionate about. (You can see her videos discussing erectile dysfunction here.)

As with all content on our blog, the following information is educational in nature, not medical advice. Always talk to your physician about your specific health care questions and conditions.

OK, so what exactly is erectile dysfunction anyway?

DR. LOPUSHNYAN: Erectile dysfunction (ED) is the inability or difficulty getting or maintaining an erection firm enough for intercourse.

ED, or impotence as it is sometimes referred to, is VERY common. Approximately 40% of men in their forties experience some degree of ED, and the number rises with age. It is thought that by the age of 70, about 70% of men will have ED.

What are the symptoms of erectile dysfunction?

DR. LOPUSHNYAN:  Symptoms of ED are easy to recognize. They include the following:

  • Difficulty getting or keeping an erection (with a partner or during masturbation)
  • Difficulty with orgasm
  • Reduced libido (sexual desire)

What causes erectile dysfunction?

DR. LOPUSHNYAN: An erection is a complex thing! It is much more than just the anatomic action of making the penis harder. It also involves a man’s brain, emotions, nerves, hormones, and blood vessels. All those components must work together to produce a good erection.

During sexual arousal, a man’s brain and nerves signal the blood vessels to deliver more blood to the penis. Blood fills the spongy parts of the penis called corpus cavernosum and that leads to an erection.

There are physical and psychological causes of ED. The most common physical reasons for erectile dysfunction are conditions that damage nerves and blood vessels. These conditions include the following:

  • Diabetes
  • Heart or vascular disease, atherosclerosis
  • High blood pressure or high cholesterol
  • Obesity
  • Neurologic diseases (spinal cord issues, multiple sclerosis, Parkinson’s disease, diabetic neuropathy, etc.)
  • Smoking, alcoholism, or any other substance abuse
  • History of prostate cancer and treatment for prostate cancer.
  • Low testosterone
  • Certain prescription medications
  • Older age
  • Psychological causes, such as . . .
    • Stress, relationship, and partner issues
    • Depression
    • Anxiety and performance anxiety
    • A man may feel guilty that they are not satisfying their partner.
  • Any other major mental health conditions as well as some medications that are used to treat them

How is erectile dysfunction treated?

DR. LOPUSHNYAN: Before trying to treat ED, it is very important to understand the cause because that may change the treatment. What works for one man may not be useful or appropriate for another.

Erectile dysfunction can be treated in many ways, including lifestyle changes, oral medications, penile injections, vacuum devices, and surgery (penile implant).

Let's discuss each option . . .

Lifestyle changes
Erectile function reflects a man’s general health. The healthier you are, the better your erections are. Smoking cessation, weight loss, and improved diet all have positive effects on erections.

Oral medications
Oral medications improve ED in many men. The most common are sildenafil (Viagra), tadalafil (Cialis), vardenafil (Staxyn), and avanfil (Stendra). All those medications work on increasing blood flow to the penis by relaxing the blood vessels that deliver blood. They work better in patients without significant nerve damage. While risks of taking those medicines are rare, you should always check with your doctor before taking it.

Penile injections and suppository
One of the options for patients who do not respond to oral ED medications is to try penile injections or suppository. Both of those options improve blood flow to the penis directly. Injections are usually taught to the patient by the doctor. It is very important to choose the right medicine and dose in order to avoid unwanted side effects.

Vacuum device
A vacuum device (penis pump) creates a vacuum that brings in more blood to the penile tissue and improves erections. While some men find it helpful, penis pumps can be cumbersome to use.

Penile implant surgery
For patients with severe ED who do not respond to other options, there is an option for insertion of an inflatable penile prosthesis (IPP). An IPP is a device that is implanted inside the penis to give the man on-demand erections. Even though this option requires surgery, it is an excellent option for many men.

There are certain steps that can be taken to prevent or delay ED. Whatever makes your overall health better will likely improve your erections. The most common recommendations include maintaining a healthy weight, eating a healthy diet, controlling blood pressure and cholesterol, exercising regularly, and quitting smoking.

When should a man see a doctor for erectile dysfunction?

DR. LOPUSHNYAN: If you have an occasional problem with erections, it is generally not a concern. But if the issue is becoming more frequent and sex is no longer enjoyable for you or your partner, you may benefit from talking to a urologist.

Any final advice for men dealing with ED?

DR. LOPUSHNYAN: Here are some take-home points:

  • ED is treatable and treating it will likely improve your overall quality of life.
  • ED can be a sign of underlying conditions, such as heart disease.
  • ED can be linked to stress, anxiety, and depression, and treating it may improve other conditions.

Are you dealing with ED? Your quality of life matters. Let us help!

Our board-certified urologists can diagnose and treat your erectile dysfunction. Make an appointment at one of our Greater Boston Urology care centers today.

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