When you’re experiencing erectile dysfunction (ED), it can feel like you’re the only one going through it. You may be asking yourself questions like: Does anyone else have this issue? Why do you have this problem? Is it solvable, or is it going to be like this forever?!
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“Erectile dysfunction essentially refers to either the inability to get a sufficient erection or the inability to maintain a sufficient erection for sexual intercourse,” explains urologist Petar Bajic, MD. “It’s quite common, though there are varying degrees.”
Dr. Bajic addresses the most frequently asked questions about erectile dysfunction and debunks some persistent myths and misconceptions.
Most males experience ED at one time or another. Studies suggest that as many as 52% of men between the ages of 40 and 70 may have difficulty with erection, while 1 in 10 men deal with it for the long term.
“This is a condition that affects a lot of men, and it can happen at any age for a variety of reasons,” Dr. Bajic says.
And keep in mind that erectile dysfunction is a spectrum, not an all-or-nothing phenomenon. You may still be able to get erections, but they may be weak or short-lived.
“Basically, if you’re bothered by a lack of sufficient rigidity, then you have erectile dysfunction,” he adds.
It’s common for erections to be more difficult to achieve with aging due to other medical conditions.
“Any health problems that affect normal erectile function can lead to erectile dysfunction,” Dr. Bajic says, “so, as you get older, erectile dysfunction can become more prevalent.”
But that doesn’t mean you should just grin and bear it. Urologists are medical doctors who specialize in conditions that affect the urinary tract and reproductive system, and they can help you get to the bottom of the problem.
Erectile dysfunction is a sign of an underlying issue of some sort, and treating that issue can typically help restore most, if not all, of your sexual function.
Depending on the cause of your ED, treatments may include:
This might’ve been true when you were younger, but as you get older, it’s normal not to be able to get erections as often or as easily. As you age, hormonal changes and other factors (hello, stresses of adulthood) affect your arousal levels.
“It may take longer to achieve an erection and may require more direct stimulation and foreplay,” Dr. Bajic notes.
ED is often a sign of another medical issue. In fact, the vast majority of erectile dysfunction is actually a blood flow problem related to cardiovascular disease.
“Things like high blood pressure, high cholesterol, diabetes and tobacco use can all cause your arteries to harden and narrow,” Dr. Bajic explains. “This can reduce blood flow to the penis, which makes it more difficult for it to fill up with blood.”
And here’s a shocking bit of news: Solid evidence suggests that ED often happens about three to five years before a heart attack. How can it be such a predictor? It all comes down to the size of your arteries.
The blood flow to your penis relies on two arteries that are less than 1 millimeter in diameter, while your coronary arteries (the ones that carry blood to your heart) are about 10 times bigger than that. But cardiovascular disease affects your smallest arteries first, making ED a possible early warning sign.
“By the time the coronaries are affected, ED has likely happened several years prior,” Dr. Bajic states. “So, when someone comes to see me with new onset ED, we always have that discussion and focus on optimizing their overall health.”
Yes. “More than 200 prescription drugs are thought to be associated with difficulty achieving erection,” Dr. Bajic says.
This includes common medications like antidepressants, antihypertensives, diuretics, antiepileptics and anxiolytics.
If you’re taking one of these medications and suddenly experiencing ED, don’t abruptly stop taking your medication. Instead, make an appointment with your primary care provider or a urologist for guidance.
Sometimes, yes; sometimes, no. Psychological factors can be the culprit behind erectile dysfunction, especially in younger men. That includes:
“Sometimes, people will tell me, ‘I’m getting excellent morning erections, but when I’m with a partner, things just don’t seem to function properly,’” Dr. Bajic relays. “In those cases, ED is often situational and anxiety-based, rather than related to a blood flow issue.”
But that doesn’t mean the problem is “all in your head” or that it isn’t real. Mental health issues are a recognized cause of a variety of very real physical health issues, including erectile dysfunction.
It could be — but not necessarily.
Low testosterone (low T or male hypogonadism) is a condition in which your testicles don’t produce enough of the hormone testosterone. As you age, your testosterone levels may start to decline, which can contribute to erectile dysfunction. But it’s not one of those most common causes.
“One of the common misconceptions is that low testosterone is the most common cause of ED, but it really is not,” Dr. Bajic clarifies.
But your testosterone level varies throughout the day. It’s highest in the early morning, which is why you may have more morning and nocturnal (overnight) erections and less during the day and evening.
Recreational drugs, alcohol and cigarettes can all cause serious damage to your blood vessels and restrict blood flow to your penis, which leads to ED. Poor blood flow can also cause scarring of your penile tissue and even a loss of length (read: a shorter penis).
This list includes:
Consuming too much caffeine can have all kinds of effects on your body — but it’s probably not related to ED one way or the other.
In 2015, researchers thought that caffeine, a stimulant, would trigger penile blood flow, finding that men who drank two to three cups of coffee per day had the lowest rates of erectile dysfunction.
Not so fast, though: In 2017, a larger study conducted by the same researchers found no link between coffee and ED.
But coffee has other health benefits. In moderate amounts, it can help lower your risk for chronic conditions like diabetes and depression, which can both contribute to ED in the long run.
No, this one is a total myth.
“Though the causes of erectile dysfunction can be both physical and/or psychological, wearing tight underwear is not among them,” Dr. Bajic confirms. So, go ahead and wear those tighty-whities if you want to!
One word of caution, though: Tight underwear may be associated with a lower sperm count, so if you’re trying to have kids, boxers or boxer briefs may be a better move.
This isn’t anyone’s favorite answer, but … well, it’s not totally clear.
Some studies suggest that frequent riding compresses the pudendal nerve (which sends sensations from your genitals to your brain) and could lead to erection issues. Bike seats are also related to testicular pain and pelvic floor dysfunction, which could contribute to ED.
“There may be some mechanisms that we don’t yet fully understand, where prolonged biking and bike seats can negatively impact erections,” Dr. Bajic states. “In general, though, the vast majority of ED stems from a blood flow issue, which isn’t related to what you’re sitting on.”
In moderation, bicycle riding isn’t thought to affect erectile functioning. But take breaks when you’re cycling long distances, and look for a bike and seat that fit ergonomically with your body to relieve discomfort and pain.
Untreated ED can also lead to emotional issues between you and your partner.
Though the internet is full of far-reaching claims, Dr. Bajic says no particular food has been shown to improve erections.
“Like many things relating to men’s health, and specifically to male sexuality, there’s no robust evidence to support any individual theory,” he cautions.
But keeping your heart healthy can help keep your sexual health at peak functionality, too. Heart-healthy, plant-heavy eating styles like the Mediterranean diet can help fend you off cardiovascular disease and prevent other health concerns.
The best thing you can do for your ED is to see a urologist, who can determine the underlying cause and advise you on any specific lifestyle changes that you can tackle on your own.
But one of the best things that you can do for your sexual health — and your overall health — is to get in the habit of eating well and exercising regularly.
“For early erectile dysfunction, there is some evidence that consistent cardiovascular exercise can help reverse restricted blood flow and improve erections, to some degree,” Dr. Bajic says.
Definitely. Seek medical guidance if ED occurs more than half of the time.
Start by talking to your primary care provider, or make an appointment with a urologist to discuss the issue. They’ll be able to help determine the cause of your ED, which will dictate how it should be treated.
But be wary of digital-only health providers who say they can treat your ED with just an online appointment. While this might work for some medical issues, ED shouldn’t be among them.
“One of the significant limitations of many of these platforms is that they don’t determine the underlying cause of your ED,” Dr. Bajic points out. “You have to give them some background information about yourself, but there are no diagnostics or evaluation to understand why your erectile dysfunction is happening.”
Because ED can have so many underlying causes — including cardiovascular disease — it’s important to go see a medical provider in person.
“These are topics that primary care physicians and urologists deal with on a daily basis,” Dr. Bajic reassures, “so if you’re having an issue or notice something new, bring it to their and let them help you figure it out.”