Erectile Dysfunction: The Complete Guide

Take-home points:

• Erectile dysfunction is a common condition in men, with its prevalence steadily increasing by 10% per decade after the age of 40.
• Certain conditions are strongly associated with erectile dysfunction, such as CVD and obesity.
• Erectile dysfunction is treatable, and in some cases reversible. Treatment options include lifestyle interventions, medications, and therapy.
• If you suspect you have erectile dysfunction, it’s important to visit your healthcare professional.  

‍What is erectile dysfunction?

Erectile dysfunction, formerly known as impotence, is defined as the inability to achieve or maintain a rigid penile erection suitable for satisfactory sexual intercourse.¹

Do I have erectile dysfunction? Erectile dysfunction symptoms

Failing to obtain an erection can be an unnerving event. If this happens to you occasionally, it’s likely nothing to worry about, with factors such as stress, tiredness, anxiety, or drinking too much alcohol all influencing the ability to obtain an erection. However, if this happens persistently, then erectile dysfunction may be the culprit, and you should visit your healthcare professional to help identify the potential causes of your symptoms (through some questionnaires and erectile dysfunction tests), and receive the appropriate treatment.²  

Read our article on how to tell if you have erectile dysfunction

How common is erectile dysfunction?  

It's estimated that approximately 40% of men in their 40s experience some form of erectile dysfunction, with the prevalence believed to increase by around 10% per decade thereafter.³ A study examining men aged 20 to 75 from eight countries (United States, United Kingdom, Germany, France, Italy, Spain, Mexico, and Brazil) revealed that the percentage of men with erectile dysfunction varied from 22% in the United States to 10% in Spain.⁴ However, current prevalence estimates are likely significant underestimations of the actual figures due to men's tendency to be hesitant in discussing their sexual health with healthcare professionals.⁵

Across all studies, a consistent observation is that the likelihood of erectile dysfunction increases with age.¹ Nevertheless, this does not imply immunity to erectile dysfunction in young people, as evidence from real-world studies show that one in four males presenting with erectile dysfunction to their healthcare professional were under the age of 40.⁶

Find out more about how erectile dysfunction affects all ages

Erectile dysfunction causes and risk factors: Why does erectile dysfunction happen?

Risk factors are variables thought to increase the risk of an outcome, like erectile dysfunction. As discussed earlier, age is strongly associated with the condition. As age goes up, the prevalence of erectile dysfunction does too, making age one of the most established risk factors.³  

Other risk factors include:¹  

• Obesity  
• Smoking  
• Cardiovascular disease  
• Metabolic syndrome

If you have these risk factors, it does not mean erectile dysfunction is inevitable; it simply means your risk is higher. However, some risk factors can also act as a cause, implying the presence of a risk factor (such as cardiovascular disease) could be what causes you to have erectile dysfunction in the first place.⁶ Erectile dysfunction causes are typically categorised as either organic or psychologically induced, also known as psychogenic erectile dysfunction.  

Learn more about the relationship between erectile dysfunction and CVD

Organic causes of erectile dysfunction result from various abnormalities in the neurologic, hormonal, or vasculature structures.⁷ One example of an organic cause includes coronary artery disease (CAD), where it's estimated that nearly 50% of men with proven CAD have severe forms of the condition.⁸

Other organic erectile dysfunction causes include:⁹  

• Diabetes  
• High blood pressure and hyperlipidemia
• Hypogonadism  
• Smoking  
• The use of certain medications  

Some men can present with both organic and psychogenic causes of erectile dysfunction.

Psychogenic erectile dysfunction causes include:¹⁰  

• Performance anxiety  
• Lack of adequate stimulation  
• Relationship conflicts  

Distinguishing between psychogenic and organic causes*

Erectile dysfunction diagnosis (testing)

Although discussing sexual health concerns may be challenging, healthcare professionals specialising in sexual health view erectile dysfunction as any other health condition and can provide appropriate support. When consulting a healthcare professional about erectile dysfunction, they will typically gather a detailed description of your symptoms, including their duration, presence of risk factors, medication use, and relationship issues, among other relevant factors. A physical examination and blood tests to measure lipid levels and fasting blood sugar may also be recommended to identify the underlying causes of erectile dysfunction and determine the most suitable treatment options.¹  

Erectile dysfunction treatment: Can erectile dysfunction be cured?‍

Erectile dysfunction is a reversible condition and you may be wondering which erectile dysfunction drug is best, but if you have been diagnosed with erectile dysfunction, most treatment starts with lifestyle interventions such as nutrition and exercise to help identify any reversible risk factors. This should also accompany any new medication or talking therapy. Medications to help treat erectile dysfunction include, but not limited to:^1–5

• Vasodilators: Medications (normally tablets or pills) taken orally that open (dilate) the blood vessels to increase blood flow to the penis to help obtain an erection.  
• Erectile dysfunction cream: Applied topically on the penis and induces smooth muscle relaxation to help with the initiation of an erection.  

• Injections: Injection near the base of the penis which induces smooth muscle relaxation to help with the initiation of an erection.  
• Vacuum devices: Placed over the penis to create a negative pressure to increase blood flow to the penis.

Importantly, the use of medications and talking therapy to treat erectile dysfunction should not be withheld on the basis that lifestyle changes have not been made. Psychosexual therapy, either alone or in conjunction with the couple’s relationship therapy, is also recommended, particularly when there is a psychological cause or influence.¹  

Which doctor treats erectile dysfunction?

Erectile dysfunction is a urological condition. If you have concerns about erectile dysfunction, your first point of contact is often a general practitioner or nurse. If they suspect an underlying urological cause or are unable to resolve the issue, you may be referred to a urologist who specialises in treating urological conditions.

Find out more about erectile dysfunction treatments

Prognosis, or outcome, for erectile dysfunction treatment is good, and therapy can lead to better overall physical and emotional health, and often improves intimacy for couples too. If you experience erectile dysfunction, it’s essential to visit your healthcare professional so you can receive a professional diagnosis, and if indicated, treatment.

TRTed talking guide for sexual health

Talking about sexual health can be challenging, but it's an important part of regular medical care. TRTed has developed a guide comprising a sample of questions and discussion points for healthcare professionals and patients to support men’s health patient care, located here.

Continue the conversation on the TRTed Community!

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References

1. Hackett G, et al. J Seks Med 2018;15(4)430–457.
2. NHS. Erectile dysfunction (impotence) available at: https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/. Date accessed: September 2022. 
3. Feldman HA, et al.  Journal of Urology 1994;151(1), 54–61. 
4. Rosen RC, et al. Curr Med Res Opin 2004;20(5):607–17.
5. Sooriyamoorthy T, Leslie SW. Erectile Dysfunction. [Updated 2022 May 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562253/?report=classic.   
6. Capogrosso P, E. et al.  Journal of Sexual Medicine 10(7), 1833–1841.   
7. Ludwig W, Phillips M. Urol Int 2013;92(1):1–6.  
8. Montorsi F, et al. Eur Urol 2003;44(3):360–4.  
9. Patel DV, et al. Br J Radiol 2012 ;85(1):S69–S78.  
10. Raymond C, Rosen RC. Urol Clin N Am 2001;28(2)269–278.