Erectile dysfunction

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What is erectile dysfunction?

The majority of Australian men aged over 45 have some form of erectile dysfunction, but it’s much less common if you’re healthy than if you have a chronic disease, are overweight, smoke cigarettes or don’t exercise.

Erectile dysfunction becomes more likely as you age. If you’re under 40 and have erectile dysfunction, you’re among up to 10% of men in your age group who are affected. If you’re 85 or older and have erectile dysfunction, you’re like nearly all men your age.

Symptoms of erectile dysfunction

If you have erectile dysfunction, you might:

  • Have difficulty getting or keeping an erection
  • Experience problems engaging in sexual intercourse due to your penis not being hard enough.

Causes of erectile dysfunction

Health problems increase your risk of erectile dysfunction. For example, you’re more than twice as likely to have erectile dysfunction if you have diabetes than if you don’t. Other health problems that increase your risk of erectile dysfunction are:

  • Parkinson’s disease
  • Heart disease
  • Diabetes
  • Stroke
  • Cancer
  • Depression and/or anxiety
  • Blood clotting problems
  • Osteoporosis
  • High blood pressure
  • Arthritis
  • Thyroid problems
  • Asthma
  • High cholesterol
  • Lower urinary tract symptoms (LUTS)
  • Obesity
  • Lack of exercise
  • Sleep apnoea
  • Long-term alcohol use
  • Smoking

Prostate cancer treatment increases your likelihood of erectile dysfunction considerably, with 85% of men with previous prostate cancer having erectile dysfunction1.

Getting and maintaining an erection involves changes in blood flow within your penis in response to nerve stimulation. If something interferes with the function of the blood vessels or nerve transmission, this can cause erectile dysfunction.

The same mechanisms that control blood flow in your penis also control blood flow throughout your body. This is why erectile dysfunction is often a sign of cardiovascular disease. In fact, if you have erectile dysfunction, you are at higher risk than normal of coronary heart disease, stroke and death2.

Other factors that can contribute to erectile dysfunction include:

  • Low testosterone levels
  • Some medications (e.g. antidepressants, blood pressure-lowering drugs)
  • Some recreational drugs (e.g. nicotine, heroin)
  • Psychological factors like depression or anxiety, or relationship problems.

Diagnosis of erectile dysfunction

Erectile dysfunction is diagnosed based on your satisfaction with your ability to get and maintain an erection.

Your doctor will work out the cause of your erectile dysfunction, so they can find a treatment that suits you.

Treatment of erectile dysfunction

You might be able to get back to normal erectile function simply by taking better care of yourself. A healthy diet, regular exercise and excessive drinking, smoking, and drug use may not only improve your erectile dysfunction but will also benefit your overall health and wellbeing. A healthy lifestyle will help you avoid the conditions that cause erectile dysfunction, as well as many other health problems.

If there’s a psychological cause of your erectile dysfunction, speaking to a psychologist or sexual health therapist may help.

Medical treatment for erectile dysfunction is usually a type of drug known as a phosphodiesterase type-5 (PDE5) inhibitor, like sildenafil (Viagra) or tadalafil (Cialis). If you’re using nitrates to manage heart pain, you shouldn’t use PDE5 inhibitors.

If your erectile dysfunction is caused by a hormonal problem like low testosterone, your doctor will usually suggest treating that first.

If medications are unsuccessful in treating your erectile dysfunction, your doctor may suggest using alprostadil, which is injected directly into the penis using a small needle, or a vacuum device.

Surgical insertion of a penis implant is possible if nothing else improves your erectile dysfunction.

Some treatments marketed for erectile dysfunction, such as platelet-rich plasma (PRP) injections and acoustic shock wave therapy, are unproven. More research is needed to identify if these treatments are effective and safe.

Health effects of erectile dysfunction

Erectile dysfunction can have a significant effect on how you and your partner feel, so it’s important for that reason alone to seek help. However, an erection is not an absolute requirement for a satisfying sex life. You can have an orgasm and ejaculate without an erection.

Erectile dysfunction is often a sign of an underlying health problem. If you ignore your erectile dysfunction, you might be missing an opportunity to prevent the development of more severe disease.

What to do about erectile dysfunction

If your erectile function is causing you any concerns, make an appointment to see your doctor about it.

Questions I should ask my doctor about erectile dysfunction

  • What tests do I need to work out what’s causing my erectile dysfunction?
  • What other health conditions could be contributing to my erectile dysfunction?
  • Are there any tests I should have to see if there are other health conditions that might be associated with my erectile dysfunction?
  • What treatments do you think will be best for me?
  • Do I need to see a psychologist?
References

[1] Weber et al., 2013. Risk factors for erectile dysfunction in a cohort of 108 477 Australian men. The Medical Journal of Australia

[2] Shamloul & Ghanem, 2013. Erectile dysfunction. The Lancet

[3] Mobley et al., 2017. Recent advances in the treatment of erectile dysfunction. Postgraduate Medical Journal

Resources

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