9 Most Frequently Asked Questions About Erectile Dysfunction

Formerly known as impotence, erectile dysfunction is the inability to get or keep a penile erection firm enough for sexual intercourse. Most men will experience erectile dysfunction at some point but are hesitant to ask their doctors about it, so we gathered the most commonly asked questions about erectile dysfunction. 

1. Is ED normal?
2. What causes ED?
3. Is it permanent?
4. How do I know if I have erectile dysfunction?
5. How is it treated?
6. What are the common ED treatments?
7. Can ED devices help?
8. Are ED exercises helpful?
9. Can ED cause infertility?

Read on to learn more about the answers to each question. 

1. Is erectile dysfunction normal?

Erectile dysfunction (ED) is common; men of various ages can sometimes experience it when they’re stressed. However, progressive and frequent ED can signify potential health issues that require treatment by a medical professional.

2. What causes erectile dysfunction?

The physical cause of ED is either limited blood flow to the penis (which prevents it from hardening), an inability to retain blood, or nerve damage. Stress and emotions can also play a role in ED. However, it can also be a symptom of serious illnesses like heart disease, high blood pressure, high blood sugar, or atherosclerosis, which is the hardening of arteries.

How do erections work? During sexual arousal, nerves signal the release of chemicals that increase blood flow into two spongy muscle chambers in the penis. Upon orgasm, nerves release another set of chemical signals that release the blood back into circulation.

Here are the known risk factors for ED:

• Diabetes
• Cardiovascular disease
  
• Smoking
  
• Drug use
  
• Drinking too much alcohol
  
• Obesity
  
• Sedentary lifestyle
  
• High blood pressure
  
• Being over the age of 50
  
• Emotional concerns (anxiety, depression, severe stress)

3. How can I get tested for erectile dysfunction?

While there is no specific ED test, men can undertake genital-focused (penis and testicles) tests to check for ED. The test may also check your heart and blood pressure, as well as examine your family history. Depending on your age, your doctor may also perform a rectal exam to check your prostate gland. 

Here are some advanced ED tests to guide treatment:

• Blood work to check male hormone levels and blood sugar
• Ultrasonography to check blood flow
• A vascular stimulant shot directly into the penis to cause an erection
• Pelvic X-rays
• Nocturnal penile tumescence (NPT), an overnight test for sleep erection

4. Is erectile dysfunction permanent?

ED is usually treatable with either medication or surgery. Treating the underlying causes and making lifestyle changes can also help reverse symptoms without the need for medication. Psychological and emotional causes of ED are treatable with counseling or psychological therapy.

5. How is erectile dysfunction diagnosed?

You may be dealing with ED when you have the following symptoms:

• Inability to get an erection
• Inability to maintain an erection
  
• A reduced desire for sexual activity

6. What are common treatments for erectile dysfunction?

Doctors may start assessing your risk factors for any lifestyle changes that you can implement. This involves changing food habits, incorporating exercise, limiting/omitting alcohol and drug use, or beginning counseling to treat the psychological or emotional causes of ED. Doctors will often try using non-invasive treatments first, like medications and hormone therapy.

Here are the most common non-invasive ED treatments:

• Testosterone therapy
• Penile injections
• Intraurethral medication
• Oral drugs (PDE5 inhibitors) like Viagra, Cialis, Levitra, or Stendra
   

What are PDE5 inhibitors? Short for phosphodiesterase type 5 inhibitors, these are medications that block PDE5, an enzyme in blood vessel walls, causing them to relax and increase blood flow.

7. Will devices help with erectile dysfunction?

One non-invasive device that can help with ED is a vacuum erection device. It’s a plastic tube worn over the penis. It has a pump that creates a low-pressure vacuum seal around the erectile tissue, causing an erection. It has an elastic ring that slips onto the base of the penis, holding the blood in and maintaining erections for up to 30 minutes.

Other ED devices are penile implants that require surgery. They are usually recommended for aging men for whom oral PDE5 inhibitors or ICI or IU therapy have proven ineffective. Penile implants are placed entirely inside the penis and have the highest rates of success among treatment options for ED.

• Bendable implant: Made with two semi-rigid silicone rods, these can bend downward for urinating or upward for sex.
• Inflatable implant: Cylinders filled with fluid placed lengthwise into the penis, with tubing that leads to a pump inside the scrotum. Pressing the pump results in the cylinders inflating the penis for a natural-looking erection. This type of implant lets men control the firmness and size of their erections.

8. How can exercises improve erectile dysfunction?

Kegels or exercises strengthening pelvic floor muscles greatly benefit those with ED. The pelvic floor muscles are essential in sustaining blood flow to the penis by putting pressure on the penile veins. The pressure keeps blood from leaving the penis, maintaining an erection.

Here are some ED exercises to try at home:

• Pelvic floor muscle activation: Lie down with knees bent, arms to your sides, and feet flat on the floor. Squeeze the pelvic floor muscles for three seconds, inhale, then release. 
  
• Sitting pelvic floor activation: Sit with arms on your sides with your feet flat on the floor. Use the same technique as above, making sure not to contract your buttock, stomach, and leg muscles.
  
• Standing pelvic floor activation: Stand straight with your arms to the side. Use the same technique as above.
   

Treatment for ED also begins with caring for your heart and vascular health. This means aerobic exercises are beneficial for men with ED.  Studies show that 40 minutes of moderate to vigorous aerobic exercise four times a week contributed to decreased ED symptoms.

9. Can erectile dysfunction lead to infertility?

Male infertility comes from low sperm production, sperm abnormalities, or blockages in the sperm delivery system. ED is not a direct cause of male infertility, but they may have similar root causes.

Schedule a virtual clinic visit or in-person appointment with a St. Joseph Health urologist to start your urologic health journey.

Resources: 

Medical News Today | Erectile Dysfunction: Treatments and Causes

Healthline | Erectile Dysfunction (ED): Causes, Treatment,  Symptoms, and More

Urology Care Foundation | Erectile Dysfunction (ED): Symptoms, Diagnosis & Treatment

NCBI | Physical Activity To Improve Erectile Function: A Systematic Review of Intervention Studies