Erectile Dysfunction

Erectile dysfunction (ED) is often also called impotence, and is when a man cannot get or keep an erection. And while it’s quite normal to have the occasional problem with achieving or maintaining an erection, consistent or recurrent erectile dysfunction may be more common than you might think. According to the NHS, an estimated half of all men between the ages of 40 and 70 will have ED to some degree (i). The Men’s Health Forum also suggests 10 percent of men are thought to be affected by persistent ED (ii).

However, while erectile dysfunction may be more common in older men, it’s also true that men of any age can be affected by it. And while it may not be harmful to your health in itself, erectile dysfunction can be an early warning sign of a more serious health condition such as diabetes, high blood pressure, raised cholesterol and heart disease.

The problem is that many experts believe erectile dysfunction is a major cause of lack of sexual satisfaction as well as relationship difficulties. Indeed, erections are important to men because they are closely related to their sense of masculinity as well as their identity.
 

What happens during an erection?

When a man becomes sexually excited, part of the brain called the paraventricular nucleus sends signals via nerves the spinal cord to the corpora cavernosa two columns of tissue on either side of the penis - as well as the arteries that supply the corpora cavernosa with blood. At the same time, muscle fibres in the corpora cavernosa relax, which allows more blood to flow into the area. The muscles in the arteries that supply the penis with blood also relax, allowing for eight times more blood flow. Meanwhile, veins that allow blood to flow out of the corpora cavernosa are blocked, trapping blood within the penis and causing an erection.

After orgasm, the muscles in the corpora cavernosa contract, which allows blood to flow out of the penis again, reducing the blood pressure in the penis.
 

What causes erectile dysfunction?

Many people may believe erectile dysfunction is something that happens when a man doesn’t find his partner attractive. But the truth is there are many things that may cause it, most of which are more likely than lack of sexual attraction. In fact, sexual desire is a hormonal process and as such doesn’t usually have a direct impact on erectile dysfunction though some men may avoid having sex because they fear they may not be able to achieve an erection.

Some experts believe that up to 25 per cent cases of erectile dysfunction – especially in younger men – have psychological causes (iii). Some of these include anxiety, stress, depression and relationship problems. Indeed, according to the Men’s Health Forum, 90 per cent of men affected by depression also have complete or moderate erectile dysfunction (ii) ). Certain physical health problems are also strongly linked with it, including the following:

• Diabetes
  If you have diabetes, your risk for erectile dysfunction can increase dramatically. It’s thought that 75 percent of men aged 60-64 with diabetes are affected by erectile dysfunction, as are up to 25 per cent of men with diabetes aged 30-34 (ii).

• Atherosclerosis
  This condition is caused when the arteries become hardened and clogged up with fat, cholesterol and other substances. When this happens, it also affects the blood flow to the penis, causing erectile dysfunction in around 40 per cent of men aged 50 and over (ii). High blood pressure is also linked with erectile dysfunction.

• Stroke
  Men who have had a stroke may also have a higher risk of experiencing erectile dysfunction. Other neurogenic conditions that may cause it include multiple sclerosis and Parkinson’s disease as well as spinal injuries or disorders. (erectile dysfunction is thought to happen in around 25 per cent of men who’ve had a spinal cord injury) (ii).

• Prostate cancer
  Around 30 percent of men who have had a cancerous prostate gland removed via a radical prostatectomy, where the prostate gland is removed, experience erectile dysfunction (ii).

• Hormones
  Certain hormonal conditions, such as an overactive or underactive thyroid gland, Cushing’s syndrome (a condition that affects the production of the hormone cortisol) and hypogonadism (which causes very low testosterone levels) are associated with ED in some men.

• Peyronie’s disease
  This condition affects the tissue of the penis and is thought to cause erectile dysfunction in some cases.

Certain medicines can cause erectile dysfunction, including those that affect the brain or the blood vessels in the penis, those that affect your hormone levels particularly the hormone testosterone and those that affect the transmission of nerve messages (according to the Men’s Health Forum, up to 25 per cent of men with erectile dysfunction are taking medicines for other conditions that are causing erection problems) (ii).

 Some of these medicines include the following:

• Allergy medicines called antihistamines

• Medicines called diuretics (these are often used to treat high blood pressure, heart failure and kidney disease)

• Antihypertensive medicines (which are also used to treat high blood pressure) such as beta-blockers

• Antidepressants

• Medicines used to lower cholesterol levels called fibrates

• Medicines used to treat certain mental health problems called antipsychotics

• Medicines containing steroids called corticosteroids

• Medicines used to treat stomach ulcers called H2-antagonists

• Epilepsy medicines called anticonvulsants

• Medicines that suppress male sex hormones called anti-androgens

• Chemotherapy medication called cytoxics

If you suspect one of your medicines could be causing erection problems, don’t just stop taking it. Instead, speak to your GP about whether or not there may be an alternative drug you could try.

Another thing that can cause erection problems is regular heavy drinking. That’s because alcohol can damage the nerves leading to the penis as well as reduce testosterone levels and increase levels of the female hormone oestrogen.

Using illegal recreational drugs such as cannabis or cocaine is also linked to erectile dysfunction, as is smoking. In fact, smoking cigarettes is implicated in up to 80 per cent of cases of erectile dysfunction, possibly because of the way nicotine affects the blood supply to the penis (ii).
 

Treatments for erectile dysfunction

If you suspect you have erectile dysfunction, it’s important not to be too embarrassed to talk to your GP about it. You won’t be the first person they’ve seen with this problem, and there could well be a simple way to treat it.

It’s also important to see your doctor because erectile dysfunction is linked with a higher risk of heart disease. So as well as discussing your erection problems, you may have your cardiovascular health assessed. In some cases, if there’s an underlying health condition that’s causing erectile dysfunction, treating that condition often resolves the erection problems. If your GP thinks a treatment for erectile dysfunction is necessary, there are several that are available. If you’re having erection problems because of psychological issues, they may recommend that you see a psychosexual therapist or counsellor.

Meanwhile, some of the medical treatments for erectile dysfunction with physical causes include prescription medicines and hormonal supplements (surgery such as penile implants is only used as a last resort).

These treatments include the following:

PDE-5 inhibitors

These drugs work by helping the blood vessels in the penis to relax, which improves blood flow. However they should be used with caution in men who have cardiovascular disease, such as coronary heart disease, and should not be used by men who are taking nitrate medicines, such as those prescribed for angina. You may know some of these drugs by their brand names, including Viagra, Cialis and Levitra. In some men these drugs may also cause side effects, which your GP should make you aware of.

Vacuum pumps

This consists of a plastic tube connected to a pump that’s used to stimulate the blood flow in the penis. According to the NHS, nine out of 10 men using a vacuum pump are able to have sex successfully (iv). If you qualify for an NHS prescription for erectile dysfunction, you may be able to get a vacuum pump for free. However they’re not always available on the NHS.

Alprostadil

A synthetic hormone that helps to stimulate blood flow, alprostadil is available as an injection into the penis or as a small pellet that’s placed inside the urethra (the tube in the penis that carries urine from your bladder). It is usually only given to men who cannot use PDE-5 inhibitors or vacuum pumps, and like PDE-5 inhibitors it is linked with several possible side effects.

 

Erectile dysfunction: how to help yourself

Making changes to your lifestyle can, in many cases, help improve the symptoms or reduce your risk of erectile dysfunction as well as give your general and heart health a boost. Here are some of the things you could do to help yourself:

Give up smoking

Since smoking affects your circulation, many experts believe it’s directly associated with erectile problems in men too (v). Thinking about kicking the habit?? There are several stop smoking products that you could try, including lozenges, gum and patches that help relieve nicotine withdrawal symptoms.

Lose weight if you need to

If you’re heavier than you should be, it could be causing erection problems. Indeed, experts claim the connection between obesity and sexual dysfunction is a strong one (vi), with obese men far more likely to experience erection problems than men whose weight is normal. Obesity also increases your risk of developing conditions linked with erectile dysfunction, such as atherosclerosis.

Drink in moderation

Many people believe a drink or two can put you in the mood for sex. But too much alcohol may have the opposite effect thanks to the fact that alcohol can decrease the blood flow to the penis. In fact there’s evidence that more than 70 per cent of men who are dependent on alcohol are more likely to have a sexual problem such as erectile dysfunction (vii). Current guidelines state a moderate alcohol intake is no more than 14 units of alcohol a week for both men and women.

Avoid illegal recreational drugs

Drugs such as cocaine, marijuana, heroin, amphetamines and barbiturates are linked with erectile dysfunction.

Take regular exercise

Physical activity is thought to help reduce the risk of erection problems by improving the function of the endothelium, the inner lining of blood vessels that helps blood to flow smoothly. Men between the ages of 19 and 64 should aim for 150 minutes of moderate-intensity activity such as cycling or brisk walking every week (though cycling in this instance may not be ideal as it may damage key blood vessels, which may lead to erection problems (ii) ). Adult males should also do two sessions of muscle-strengthening activities a week – for instance, you could work out with weights, do push-ups, sit-ups and other similar exercises, or you could do a spot of hard work in the garden, such as digging and shovelling.

Lower your stress levels

Stress is the opposite of an aphrodisiac because the hormones involved in the sexual response are affected by stress hormones such as cortisol and adrenaline. If you’re feeling stressed out, learning relaxation techniques will not just be good for your sexual health but your overall health too. Talking to someone about your problems may also help. Read more about stress and how to manage it.

 

Natural remedies for erectile dysfunction

As well as making important lifestyle changes, there are certain natural remedies that may help to keep erection problems at bay, including the following:

Ginkgo biloba

This Chinese herbal medicine is often recommended for memory problems because of the way it’s thought to boost blood flow to the brain. However some herbal practitioners also use it to treat erectile dysfunction. There is also some evidence to suggest ginkgo biloba enhances the effects of nitric oxide (viii), a substance that plays a part in the development of an erection by helping the muscles in the penis to relax, thereby increasing the blood flow. A few studies also claim that ginkgo biloba may be useful for people with sexual difficulties caused by taking antidepressants (ix).
 

Korean ginseng

Also sometimes known as Asian ginseng (or Panax ginseng), this widely used herb has been used in traditional Chinese herbal medicine for centuries. Today, it’s popular in all parts of the world with people of all ages. And there’s evidence to suggest it may help to improve sexual function in men (x).

L’Arginine

This amino acid is thought to boost the body’s levels of nitric oxide. In fact, one study suggests men who take l’arginine in supplement form may experience an improvement in their sexual performance (xi). L’arginine749 is also found in a range of foods such as dairy products, meat, poultry and fish.

Zinc and magnesium

Low testosterone levels can cause erectile dysfunction problems. But there is some evidence to suggest the minerals zinc and magnesium could help to boost testosterone levels (xii). Zinc deficiency is also known to lower sexual function, which implies that taking a supplement may be helpful in some cases.

L-Theanine

If stress is a contributory factor then this amino acid may be just the thing. One of the reasons most people find a cup of tea relaxes them more than a cup of coffee despite the fact that both beverages contain caffeine is that tea also contains a substance called theanine. This non-protein amino acid is found almost exclusively in green, black, oolong and pekoe tea, and is thought to stimulate the production of calming alpha brain waves. And while it will not make you feel drowsy, taking a theanine supplement could help make you feel more relaxed.

Find out more about a variety of other men’s health issues by visiting the men’s health section of our health library has a number of helpful articles.
 

 

References:

1. Available online: https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/erectile-dysfunction-impotence

2. Available online: https://www.menshealthforum.org.uk/erectile-dysfunction-faqs

3. Available online: https://www.foxnews.com/story/psychological-problems-often-the-cause-of-erectile-dysfunction-in-younger-men

4. Available online: https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/erectile-dysfunction-impotence#treating-erectile-dysfunction

5. Available online: https://cks.nice.org.uk/erectile-dysfunction#!backgroundSub:1

6. Skrypnik D. et al., Obesity – significant Risk Factor for Erectile Dysfunction in Men. Pol Merkur Lekarski.26(212):137-41. Available online: https://pubmed.ncbi.nlm.nih.gov/24720114-obesity-significant-risk-factor-for-erectile-dysfunction-in-men/

7. Arackal. BS., Benegal V., Prevalence of sexual dysfunction in male subjects with alcohol dependence. Indian J Psychiatry. 2007 Apr-Jun;49(2):109-112. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917074/

8. Choi. HK, et al. Clinical efficacy of Korean red ginseng for erectile dysfunction. Int. J Impotence Res. 1995.;7:181-186. Available online: https://pubmed.ncbi.nlm.nih.gov/8750052-clinical-efficacy-of-korean-red-ginseng-for-erectile-dysfunction/

9. de Andrade E. et al., Study of the Efficacy of Korean Red Ginseng in the Treatment of ERectile Dysfunction. Asian J Androl.9(2):241-4. Available online: https://pubmed.ncbi.nlm.nih.gov/16855773-study-of-the-efficacy-of-korean-red-ginseng-in-the-treatment-of-erectile-dysfunction/

10. Chen. J, Wollman. Y, Chernichovsky. T.  Effect of oral administration of high-dose nitric oxide donor L-arginine in men with organic erectile dysfunction: results of a double-blind, randomized placebo-controlled study. BJU Int. 1999;83:269-273. Available online: https://pubmed.ncbi.nlm.nih.gov/10233492-effect-of-oral-administration-of-high-dose-nitric-oxide-donor-l-arginine-in-men-with-organic-erectile-dysfunction-results-of-a-double-blind-randomized-placebo-controlled-study/
11. Koltermann. A,, Hartkorn. A. A Ginkgo biloba extract EGb 761 increases endothelial nitric oxide production in vitro and in vivo. Cell Mol Slife Sci. 2007 Jul;64(13):1714-22. Available online: https://pubmed.ncbi.nlm.nih.gov/17497242-ginkgo-biloba-extract-egb-761-increases-endothelial-nitric-oxide-production-in-vitro-and-in-vivo/
12. Cohen. A. A Treatment of antidepressant-induced sexual dysfunction with Ginkgo biloba extract [abstract #716]. Presented at: Annual Meeting of the American Psychiatric Association 1997.
13. Cohen. A. Long-term safety and efficacy of Ginkgo biloba extract in the treatment of antidepressant-induced sexual dysfunction. Presented at: Annual Meeting of the Priory Medical Journals website. 1997.

14. Brilla. LR., Conte V., Effects of a Novel Zinc-Magnesium Formulation on Hormones and Strength. J Ex Phys. 2000 Oct;3(4):1. Available online: https://www.researchgate.net/publication/288406212_Effects_of_a_novel_zinc-magnesium_formulation_on_hormones_and_strength

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
 

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