Opinion article
Erectile dysfunction: what it is and when to seek help
Erectile dysfunction is the persistent inability to get or keep an erection firm enough for satisfying sexual activity. It’s considered erectile dysfunction when the problem happens repeatedly over a period of at least three months, not just on one or two isolated occasions.
Common causes
- Vascular: atherosclerosis, high blood pressure and diabetes, which reduce blood flow to the penis.
- Hormonal: low testosterone levels.
- Neurological: spinal cord injury, multiple sclerosis or pelvic surgery.
- Medication-related: some antidepressants, blood pressure medicines and other drugs.
- Psychological: performance anxiety, stress or depression, often layered on top of a physical cause.
- Lifestyle: smoking, heavy alcohol use, a sedentary lifestyle and excess weight.
Why it’s worth investigating
The arteries in the penis are narrower than the coronary arteries, so erectile dysfunction can show up years before a heart attack or stroke. In middle-aged men with no other obvious cause, erectile dysfunction is treated as a cardiovascular warning sign and warrants a cardiac risk assessment.
Treatment
- Addressing modifiable risk factors: exercise, weight, smoking and alcohol.
- Phosphodiesterase type 5 inhibitors (such as sildenafil or tadalafil), first-line treatment in most cases.
- Vacuum erection devices or intracavernosal injections, when pills aren’t enough or are contraindicated.
- Sex therapy or psychological support, especially when anxiety plays a significant role.
Failing to keep an erection once or twice isn’t erectile dysfunction. It’s the persistence of the problem over time, not a single episode, that warrants a medical evaluation.
This article is for information only and does not replace a medical consultation.
Sources
- Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline. The Journal of Urology. 2018.
- American Urological Association