Dr. Nesochi discusses erectile dysfunction on Insider.

10 common questions about erectile dysfunction, answered

by Sophia Mitrokostas

• Erectile dysfunction (ED) is the inability to get or keep an erection.
• There are varying degrees of ED and it’s possible to experience mild or moderate symptoms.
• ED can be caused by many things, including diabetes, anti-depressant medications, heart disease, and stress.
• ED can be treated with medication, vacuum devices, and penile implants. Diet and lifestyle changes may also improve symptoms of ED.

Despite being the most commonly treated sexual disorder, many people find talking about erectile dysfunction (ED) to be difficult. Some people also might think it only affects older people and its treatment is as simple as popping a pill. 

In an effort to dispel some of the myths around ED, INSIDER consulted with doctors to answer some of the most common questions about the condition and what a person can do about it. 

What exactly is erectile dysfunction?

Erectile dysfunction, or ED, is the inability to get or keep an erection. Not being able to sustain an erection can interfere with sexual intercourse or make sex less satisfying. It can also lead to self-confidence problems and may even impact romantic relationships. 

“An erection is simply a physiological process resulting in increased arterial blood flow to the penis. Erectile dysfunction may arise when that blood flow is compromised, making it difficult to achieve or maintain an erection for sex,” Nesochi Okeke-Igbokwe, internal medicine physician and health expert, told INSIDER.

There is a difference between occasional performance problems and erectile dysfunction. Generally, you need to be experiencing erectile dysfunction the majority of the time to be diagnosed with ED. 

“The clinical term ‘erectile dysfunction’ is reserved for men who have a problem getting or keeping an erection more often than not. And while it can certainly put a damper on sexual intimacy, ED can also serve as a warning sign of other serious health issues,” S. Adam Ramin, urologist and medical director of Urology Cancer Specialists in Los Angeles, told INSIDER. 

Is it possible to have ‘a little’ ED?

It is possible to have varying degrees of erectile dysfunction and not all individuals present with the same symptoms. 

“Though some men experience severe ED and are unable to obtain erections that are adequate for intercourse, many men experience mild to moderate symptoms of ED. Some men may have intermittent difficulty obtaining erections, and others men might have slightly decreased erection hardness or difficulty maintaining erections as long as they are used to,” Dr. Alex Shteynshlyuger, board-certified urologist and director of urology at New York Urology Specialists, told INSIDER. 

How do you know if you have ED?

Though many people are able to recognize erectile problems based on knowledge of their normal sexual performance, doctors can also use something called a Sexual Health Inventory for Men (SHIM) score to quantify ED. A SHIM score of fewer than seven means a patient has severe ED, while a score between 17 and 21 suggests mild ED. 

“ED is one of the few diagnoses that is self-diagnosed by a patient. If a man feels that his erections are not as good as they used to be, or not as good as he wishes them to be, he may self-diagnose ED,” explained Dr. Shteynshlyuger. 

It’s worth talking to your healthcare provider to determine if you could benefit from possible treatments of ED. 

What are the most common causes of ED?

When aroused, the brain sends signals to nerve receptors in the body that increase blood flow to the penis. This results in the pressure necessary to make it firm, or erect. The penis will remain hard until either ejaculation occurs or arousal stops. In many cases, circulation or blood flow problems are at fault for erectile problems. 

“Even though by the name alone it sounds like it should help, not hurt an erection, high blood pressure prevents the arteries that carry blood to the penis from expanding the way that they’re intended to. This causes a lack of blood flow to the penis and stops it from becoming erect,” said Dr. Ramin. 

Erectile problems can also be a sign of heart disease, as a narrowing of the arteries can make it difficult for the penis to receive enough blood flow to become erect.

Diabetes is another potential culprit, as it can lead to damage to the nerves and blood vessels that facilitate erections. 

“One of the signs that diabetes may be to blame for a man’s ED experience is the age of onset. ED tends to occur earlier in men with diabetes than in those who do not have the disease. In fact, sometimes a visit to the doctor for ED can lead to a diagnosis of diabetes the man previously didn’t know he had,” Dr. Ramin told INSIDER. 

Sometimes, medications taken to treat conditions other than ED can cause erectile problems. 

“Certain classes of antidepressant medications such as SSRIs may sometimes induce the side effect of erectile dysfunction in patients,” Dr. Okeke-Igbokwe added. 

Can stress or nerves cause ED?

People with no circulatory problems or chronic medical conditions can still experience erectile dysfunction. Sometimes, difficulty achieving an erection can actually be linked to stress, fatigue, or nervousness about sexual performance. 

“In younger men, situational erectile dysfunction caused by stress and anxiety related to sexual activity as well as work stress is the most common cause of ED,” said Dr. Shteynshlyuger. 

Unfortunately, worrying about not being able to get an erection can actually prevent you from achieving one. If you’re finding that sexual performance fears are turning into a self-fulfilling prophecy, it could be smart to talk to a therapist or your healthcare provider about possible treatment options. 

Is ED common?

“Erectile dysfunction is very common,” said Dr. Shteynshlyuger. 

According to The Massachusetts Male Aging Study, ED is increasingly prevalent with age. Approximately 40% of men are affected at age 40 and nearly 70% of men are affected at age 70. 

These numbers vary, however, depending on the definition of ED and the varying degrees of the condition. 

Doctors know that most people with penises will experience some sort of erectile problem at some point in their life. Though erectile dysfunction can be frustrating at any age, it’s a condition that urologists and healthcare providers are well-equipped to diagnose and treat. 

Is ED permanent or can it be cured?

It is possible to treat this condition in almost everyone. 

“Fortunately, ED can be effectively treated in almost all men. In many men, healthy lifestyle and diet can help prevent and sometimes reverse ED,” Dr. Shteynshlyuger said. 

In some cases, treating ED might involve working to heal the underlying medical conditions contributing to erectile problems. In other cases, working with a mental health professional can help to alleviate situational erectile dysfunction caused by stress and anxiety.

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