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What Causes Erectile Dysfunction and How to Prevent and Treat It

Erectile dysfunction is more common than you might think. Here’s what to know about the causes, risk factors, and treatment options.

About one-fifth of American men older than age 20 will experience erectile dysfunction (ED)—the persistent inability to maintain or achieve an erection for intercourse—within their lifetime. And 50% of those over the age of 40 have some level of ED. It’s also a dysfunction experienced by some people assigned male at birth who are nonbinary or trans.

“Because it’s a private matter, ED can feel kind of isolating. But, in reality, it’s very common,” says Jefferson Health urologist Joceline Fuchs, MD, who specializes in male reconstructive urology and prosthetics.

To know how you can prevent and treat ED, it’s important to first understand what causes it. Here are some of the major risk factors.

High Blood Pressure

One of the most frequent causes of erectile dysfunction is high blood pressure. “Think about how an erection happens: blood rushes to the penis, creating pressure and making it expand. You need healthy blood vessels to get an erection,” says Paul Chung, MD, a Jefferson Health specialist in reconstructive urology, trauma and prosthetics. “If you have narrow, ruptured or leaky blood vessels, this can be a cause of erectile dysfunction.”

Blood vessels in the penis are small, which means if you are experiencing ED because of hypertension, it could be a predictor of more serious health problems later in life. “If the small blood vessels in the penis are becoming damaged, think about what could happen to the larger blood vessels that lead to the heart or brain—if they become clogged, it can lead to a heart attack or stroke,” says Dr. Chung. Therefore, it’s important to not delay care, even if ED feels like a very personal issue.

Prostate Cancer

While prostate cancer is often associated with ED, it does not directly cause it. “It’s not the prostate cancer, but the cancer treatments, that can result in ED on a temporary or permanent basis,” says Dr. Fuchs. A bundle of nerves that lay on the outside of the prostate can be damaged, whether the prostate is being removed or treated by radiation. Colorectal cancer treatment can also result in ED in some people.

Other Risk Factors

In general, anything that affects the vascular system can cause ED. This includes coronary artery disease, stroke and being a smoker. Other causes of ED include diabetes, taking anti-anxiety or anti-depression medication, low testosterone and penile curvature. “Every person is different. My job, as a urologist, is to help patients understand why they’re experiencing ED, and educate them on the right treatment options for their wants and needs,” says Dr. Chung.

Prevention

Preventing erectile dysfunction starts with your overall health. “Anything that is good for heart health is good for an erection as well,” says Dr. Fuchs. “This includes a low-fat diet, weight loss, smoking cessation and stress reduction.”

Treatment Options

While the most common first defense against ED is oral medication, there are different treatment options available. “We first want to assess the severity of the problem by asking questions like: ‘Is it difficult getting an erection or maintaining one? Is rigidity an issue? How long has it been going on?’” says Dr. Fuchs. “Once we assess the severity, we can talk about goals and review medications, lab work and your physical exam to determine the right treatment plan.”

Oral treatment options include phosphodiesterase inhibitors, which promote blood vessel dilation to achieve and maintain a rigid erection. “You may need to try taking the medication five or six times before you see results, because it requires you to take it correctly—about an hour before sexual activity and on an empty stomach,” says Dr. Chung.

If medication doesn’t work, or if you would rather not take it, there are other treatments available, including a vacuum erection device, penile injections and penile implants. “Implants, while they may sound scary, are reliable and predictable. Those who get a penile implant have an 87-98% satisfaction rate,” says Dr. Fuchs.

Extracorporeal wave therapy is an alternative treatment technology believed to improve erectile dysfunction through several mechanisms, explains Dr. Perry Weiner, director of the Men’s Health Program. First, the sound wave causes microdisruption of tissue which induces the release of natural healing substances. “These in turn allow for new blood vessels to be generated which results in improved blood flow to the affected organ,” says Dr. Weiner. “Increased blood flow is essential for erections to occur.” Secondly, erections are under nerve control. “These nerves send signals to the blood vessels to open and close at appropriate times,” explains Dr. Weiner. “Research has shown that the sound-based energy waves improve nerve regeneration, which is particularly important in men who have had prostate cancer surgery. Research has also suggested that certain muscle tissue may be stimulated to respond better following application of sound wave energy which contributes to improved erections.”

It’s important to talk to a urologist about your treatment options, says Dr. Chung. “There are many companies now providing prescriptions online through telehealth appointments, as well as companies offering treatment options that are not FDA-approved or proven effective. Seeing a provider in person means we can help you navigate misconceptions and use diagnostic tools to figure out the best solution for your ED.”

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