Erectile dysfunction (ED) is the most common sexual dysfunction in men. It is defined as the inability to achieve or maintain an adequate erection. It becomes increasingly more common as men age. Interestingly enough, it is demonstrated to correspond with each decade of life. For example, 50% of men in their 50’s, 60% of men in their 60’s, and 70% of men in their 70’s will experience erectile dysfunction.
It is my goal in this post to not only define ED, but give you reasons one might be experiencing ED, how to discern or discover which may be the reason you may be experiencing ED, and common solutions to help get your A-game back in the sack. Interested? Then let’s go!
Why is this happening?
There are a number of reasons one may be experiencing erectile dysfunction. One of the biggest and most concerning reason to consider would be endovascular disease. If you are having a problem with your erections AND you have a history of cardiovascular disease, hypertension, diabetes, high cholesterol, or you smoke, you should first rule out endovascular disease.
As mentioned in a previous post, the first sign and/or symptom of cardiovascular disease in up to 50% of people is death. However, erectile dysfunction could also be a symptom that most people miss. You know that you are going to the right provider if prior to receiving treatment for ED a comprehensive blood panel, including an A1c and a lipid profile is performed prior to treatment.
Another reason you may be experiencing erectile dysfunction are the medications you might be taking. Yes! The quality of your erection can be affected by medications! If you are taking medications such as SSRI’s, some BP meds, Spironolactone, cimetidine, ketoconazole, clonidine, or methyldopa, you may have difficulty in achieving an adequate erection. Do any of these medications look familiar to you? If you are experiencing ED, you may want to talk to your prescribing provider and let them know what is going on. It is very possible they can change the medication to something else that will not impact your erection quality.
Low testosterone has been shown to be a contributor of erectile dysfunction. This is because the male sex hormone, testosterone, contributes to your libido (sex drive). If your testosterone levels are not optimized, this could not only make it difficult to achieve an erection, but may make it difficult to be interested in sex at all! This can be extremely troublesome in a relationship where the partner has a great libido. Testosterone, free and total, and SHBG, levels should and will be checked when visiting a progressive and thorough men’s health provider.
Psychogenic ED is erectile dysfunction as a result of things going on in the other head. This could be a result of, but not limited to, performance anxiety, depression, poor self-image, relationship problems, childhood sexual abuse, fear of disease transmission, just to name a few.
These issues go way deeper than just taking a pill. Some of the treatments include anxiety reduction and desensitization procedures, psychotherapy, couples counseling, and even guided sexual stimulation techniques. This will take some self-reflection. I would recommend one who identifies themselves with having psychogenic ED to seek help from a therapist. There is absolutely nothing wrong with talking to someone about these issues. They may go deeper than you think. It has been shown that men have a difficult time speaking to therapists or counselors about mental health problems, in general. We will go into much more depth on that in a later post.
Tumescense is a word that is defined by the complex process of achieving an erection with the aid of prostaglandins, nitric oxide, and the interplay of the sympathetic and parasympathetic nervous systems. Nocturnal tumescense is the occurrence of erections throughout the night when one is sleeping or in the morning upon awakening.
If one is achieving adequate erections throughout the night and upon awakening, but they cannot achieve an adequate erection prior to sexual performance, psychogenic ED is most likely the cause. It is possible to be tested for nocturnal tumescence. NPT testing uses a device to monitor your erections throughout the night. This can be very helpful in identifying the cause and can provide clues as to which course you should take.
Let’s talk treatments
There are a variety of treatments used in the diagnosis of erectile dysfunction. Each treatment will depend on the cause of the erectile dysfunction. For instance, you may have a poor libido and once your labs are obtained, you discover you have low testosterone. Once you are placed on testosterone replacement therapy, both your libido and your erection quality will most likely improve.
Perhaps you have a great libido, but when it comes time to perform, it just ain’t happening. In these cases you have some great options.
Phosphodiesterase type 5 inhibitors are a class of medications discovered in 1998 as a class of medications that work to treat erectile dysfunction. The first medication introduced was Viagra (sildenafil). In the first 6 years over 20million men were treated with this medication! Other medications in this class are:
These medications are extremely effective for men suffering from ED. They, however, do not help with libido. If a low libido is the issue, as mentioned above, other options should also be explored.
You should know that if you take nitrates for blood pressure or heart disease, you should absolutely not take PDE5 inhibitors. This could cause your blood pressure to drop extremely low and could result in death. Not the worst way to go, but I would strongly advise against it.
If you want my opinion, Cialis (Tadalafil) is a great option if you are not exactly sure when things are going to heat up. The reason is because it can work up to 72 hours after it has been taken.
Other Treatment Options
Tri-Mix is a triple threat medication that combines Alprostadil, Papaverine, and Phentolamine, which all cause vasodilation by different pathways, causing erection. It comes as a transdermal gel or a penile injection. In my opinion, this is a last ditch medication option for those who have failed treatment with PDE5 inhibitors.
Other non-medicinal treatment options include GAINSWave, which uses small low intensity shock waves to reverse erectile dysfunction. If you are interested in trying GAINSWave, here is a link to find a provider in your area that can hook you up.
Lastly, penis pumps. Yes, they have been shown to be effective and can be an option for those who are not yet willing to opt for medication therapies. Here is a link to some more information on penis pumps that you may find helpful.
Erectile dysfunction is a very common men’s health issue. One experiencing ED need not be embarrassed to discuss it with their healthcare provider. ED may not only affect the individual experiencing ED, but may also affect the partner and result in relationship strain.
If you are a man experiencing ED, there are things that can be done. You do not have to live with it. At Next Level TRT, we get to the root of the problem (no pun intended). We perform a comprehensive lab analysis and afterward, we review those results with you in the comfort of your own home. After a comprehensive assessment, we will discuss treatment options and then when we together make the decision on the right treatments for you, your treatments will be mailed to your address.
We hope you aren’t dealing with ED, but if you are, we hope you will give us the opportunity to get you on the up and up (pun intended).
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Thanks again for reading!
Michael Ward, APRN, AGACNP-BC
Co-founder and Chief Clinical Officer at Next Level TRT