Male Erectile Dysfunction

Quick Facts:

  • An erection involves a complex series of reactions including hormones, nerve conduction, and psychological arousal, which enable the penis to fill with eight times its normal volume of blood.
  • Erectile dysfunction is a common condition that can be treated.
  • About 50% of Canadian men (ages 40 to 70) have erection problems, but less than 10% actually seek help.
  • A man may be embarrassed to talk to his doctor or believe that he doesn’t have a problem that can be helped.
  • Nearly all men experience erectile problems at some point in their life, maybe because of stress, tiredness, guilt, or too much alcohol.
  • If it happens only once in a while then it is probably nothing to worry about.
  • But if it affects your sexual activity then getting advice from a health professional is a good idea.

Erectile Dysfunction used to be called impotence. It’s defined as the inability to get an erection – or keep it long enough to have intercourse. The term "impotence" can make people falsely believe that a man is sterile, or too weak for sexual activity.

What Causes Erectile Dysfunction?

Physical causes:

  • Until recently, many people thought that erectile problems were purely psychological.
  • Now, experts agree that about 80% of men with erectile problems have an underlying physical reason for the condition.
  • In some cases, both psychological and physical reasons can be the cause of the condition.
  • Erectile dysfunction that slowly becomes more noticeable over time usually has a physical cause.

Physical causes can include:

  • A blockage in the arteries going to the penis
  • A disease that affects tissue in the penis
  • Injury or surgery in the pelvic area (between the hip bones)
  • A chronic disease, such as kidney or liver failure
  • Health conditions that affect the nervous system
  • Diabetes
  • Unusual changes in hormones
  • Side effects of some medications
  • Alcoholism and/or drug abuse
  • Heavy smoking

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Psychological causes:

  • Men who notice a sudden change in their ability to have an erection often have a psychological reason for their condition.
  • In fact, when erectile dysfunction is caused by psychological reasons only, a man may still have an erection during his sleep or when he wakes in the morning.

Psychological causes can include:

  • Stress or anxiety
  • Worry or fears about ability to "perform"
  • Unresolved  sexual orientation
  • Problems in the relationship or marriage
  • Depression
  • Guilt

Having a problem with erections may cause conflict and emotional pain for couples. It is common for people to ignore or deny the problem and delay getting help. Open communication with your partner and a commitment to learn more about the condition is the first step in dealing with this problem.

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How can I reduce my chances of having erectile problems?

  • Healthy Eating  - research has found a strong relationship between erection problems, heart disease, high blood pressure and low levels of "good cholesterol" (high-density lipoprotein cholesterol or HDL). It’s widely believed that one common cause of impotence is atherosclerotic plaques forming on the walls of the penile arteries, just like what happens in heart disease.
  • Be Physically Active  - it can make you feel and look great and it boosts your levels of HDL or good cholesterol.
  • Stop Smoking  - smoking in itself can cause erectile problems but combined with heart disease, high blood pressure and some medications it can make the problem even worse.

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What treatments are available for erectile dysfunction?

There are several treatment choices for erectile problems. In some cases, the first treatment may not work well and another one may be found. Other times, a combination of treatments may work best.

Treatment choices include:

Changing Habits or Medications

  • As mentioned above, diet, exercise and quitting smoking may help with erectile problems.
  • In some cases, (and only on a doctor's advice) certain prescription medications may be changed to help with the problem.

Hormones

  • Unusual levels of hormones cause about 5% of all erectile dysfunction. For example, some men may have low levels of testosterone, while others may have higher than expected levels of prolactin or estrogen (these hormones are normally found in men, but in low levels).
  • Hormone medications can help return the balance to normal.

Professional Counselling

  • Because erectile dysfunction can have an emotional or psychological effect on a couple (even if the main cause is physical), counselling can help reduce the anxiety or stress that goes along with it.
  • Counselling is often combined with other treatments.

Vacuum Devices

  • This treatment involves a vacuum device and tension rings (like rubber bands) on the outside of the penis.
  • To use this device, the man places his penis into a plastic tube which is then pumped to create a vacuum.
  • The vacuum causes the penis to enlarge, and once an erection occurs, a tension ring is slipped around the bottom of the penis to keep the erection.
  • The vacuum device is then removed. The erection usually lasts long enough for a couple to have intercourse.

Penile Prostheses

  • Penile prostheses require surgery to place a stationary or movable device into the two sides of the penis, allowing erections as often as desired.
  • These implants come in two forms: an inflatable device and semi-rigid rods.
  • This treatment is not recommended until other methods have been considered or tried first.

Injection Therapy

  • This treatment involves injecting medication with a small needle into the base of the penis.
  • The medication increases blood flow to the penis, which causes an erection.
  • This relatively painless injection helps produce an erection in about 70% - 80% of men.

Medications

  • There are medications available by prescription for men with erection problems. 
  • It works effectively in about 80% of men who use it by improving a man’s response to sexual stimulation and thereby causing an improvement in his erections.

Surgical Treatments

  • Surgery may be done when blood flow has been blocked by injury to the penis or the area around it.
  • The goal of the treatment is to increase blood flow to the penis so an erection can occur naturally.

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Where can I go for help?

  • Since erectile problems can be caused by many factors, it is important for you to speak to a health professional. There are many treatments available ranging from learning how to communicate more effectively with your partner to medications and surgery.
  • You and your health professional will be able to determine which treatment will best suit your situation.
  • Family physicians are a great starting point to help you find the resources you need. Remember, counsellors are used to hearing all types of questions and concerns and it’s totally confidential.

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Resources

  • Sex: A Man's Guide. Stefan Bechtel, Laurence Roy Stains, and the editors of Men’s Health books. Rodale Press Inc. 1996

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