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Psychological causes of ED include depression, anxiety and relationship issues.

In most cases, erectile dysfunction can be successfully managed, with treatment options depending on the root cause of the disorder.

[1] Treatment may involve forms of sex therapy and counseling, exercises and lifestyle changes, ED drugs, including pills and topical medications, pumps and ‒ in more severe cases ‒ prosthetics. The symptoms of erectile dysfunction may include: An inability to get an erection An inability to maintain an erection during sexual activity.

These symptoms may come and go over time or be situational, for example not present during masturbation but present with a partner. [2] If symptoms occur regularly or semi-regularly, visiting a doctor is advised.

The onset of ED may be different, depending on whether it is caused by physical or psychological factors: If

the

A person’s sex drive is unlikely to be affected, unless the root cause is hormonal in nature.

Psychological causes typically result in the sudden onset of the condition.

If a person is able to get and maintain a healthy erection sometimes, for example when masturbating or on waking, it may be a sign that their erectile dysfunction is psychological in origin. If you are affected by unexplained ED, you can get a free symptom assessment at any time by downloading the Ada app. Finding a treatment approach that can cure erectile dysfunction usually depends on identifying its root cause.

Erectile dysfunction can be caused by a variety of physical and psychological factors: [1] Physical causes of ED. Most cases of erectile dysfunction are caused by physical factors. The most common cause for erectile dysfunction is reduced blood flow to the penis.

This happens as a result of a narrowing of the arteries in the penis. Conditions which can lead to the development of erectile dysfunction include: [3] [4] [5] [6] Diabetes, which can affect the function of the blood vessels and nerves Parkinson’s disease, either as a side-effect of medication or due to the condition itself Multiple sclerosis, a condition associated with progressive damage of the nerves, including those associated with getting and maintaining erections Stroke.

Other factors which are recognised as physical causes of erectile dysfunction include: Excessive intake of alcohol or drugs, which can impair the ability to get or maintain an erection. Medications which cause ED as a side-effect, such as certain kinds of antidepressants, beta blockers and some diuretics A lack of certain hormones, particularly testosterone. (ED caused by hormone deficiencies is uncommon.) Damage to the nerves in the penis as a result of surgery to nearby areas, such as prostate surgery, or from an injury, such as a spinal cord injury. Erectile dysfunction after prostatectomy (prostate surgery) All prostate surgery procedures disrupt the nerves and blood vessels that control the way erections form. For this reason, all prostatectomies will compromise erectile function, at least initially. Up to 50 percent of men who have had a successful nerve-sparing procedure, i.e.

the nerves were left untouched as planned during the procedure, regain their pre-prostatectomy erectile functionality during recovery,

within

In cases where spontaneous erections are no longer possible, there are several possible treatment options which may help with overcoming erectile dysfunction after a prostatectomy.

These include: [7] [8] [9] Oral medications, such as ViagraВ® Topical medications, such as VitarosВ© Vacuum pumps Implants. All of these medications work by increasing blood flow to the penis, causing an erection . (For more information about remedies for ED after having a prostatectomy, see treatment.) Psychological causes of ED. A range of mental health issues can lead to the development of erectile dysfunction, including: Depression Stress/pressure Anxiety Relationship issues. Purely psychological causes for erectile dysfunction are less common, limited to approximately 10 percent of cases.

It is suspected that there is a hereditary component to ED in around one third of cases. [11] A 2018 study has proven the link for the first time, finding that certain variations in some people’s genetic structure increase their risk of developing erectile dysfunction. [11] This discovery paves the way for the development of new treatments to help relieve ED in cases where its cause may be genetic.

Risk factors for erectile dysfunction include: Aging ‒ the older a person is, the greater the risk of developing ED High blood pressure High cholesterol The use of tobacco products Injuries to the groin or surgery, such as prostatectomy, which affects the nerves responsible for erections.

Risk factors for ED after a

prostatectomy

Following a prostatectomy, the risk of erectile dysfunction is influenced by factors including: [12] The skill of the urologist or urological surgeon.

The greater their surgical experience and success rate at preserving sexual function, the more likely a given procedure is to conclude with this outcome. Younger men are more likely than older men to keep or regain their erectile abilities.

The greater a man’s ability to produce erections before the procedure, the more likely he is to keep or regain it after the procedure.

If both bundles of nerves responsible for erections are sufficiently damaged, it may no longer be possible for a man to have spontaneous erections without the aid of devices or medications that assist the bodily process.

(For more information about remedies for ED after having a prostatectomy, see treatment.) Diagnosis of erectile dysfunction. The first step in treating ED is getting a diagnosis of the root cause by visiting a doctor, who will typically begin with questions regarding: [13] The symptoms experienced The length of time symptoms have been present General physical and mental health Levels of alcohol and drug intake Whether any other medication is also being taken. It may also be necessary for a person to answer questions about their sex life. These may include: Details of current and past sexual relationships Information about sexual orientation Whether the dysfunction occurs

all

As narrowed blood vessels are the most common cause of erectile dysfunction, a doctor will usually examine a person’s cardiovascular condition as part of the diagnosis. This may involve testing for high blood pressure, checking for heart irregularities, as well as evaluating their weight or overall level of health. Blood tests may also be ordered to check for underlying medical conditions that may be causing the condition. In most cases, doctors will be able to suggest and prescribe treatment options.

Treatment methods will depend on the underlying cause of the problem, meaning the chosen method will differ from case to case.

Common treatment options for erectile dysfunction include: Treatment of underlying conditions.

If an underlying condition is causing erectile dysfunction, treating it will generally be the first step towards resolving erectile

dysfunction

If medications used to treat other conditions are thought to be causing erectile dysfunction, a doctor may be able to prescribe alternatives. [14] Good to

know

A range of lifestyle changes can help treat erectile dysfunction, including: Losing weight

Reducing

There are a number of exercises that may help to treat ED.

These include: Pelvic floor exercises: Exercises designed to strengthen the pelvic floor muscles, such as Kegel exercises, can be effective in treating or preventing erectile dysfunction.

Yoga: Can be effective in reducing stress and anxiety, psychological problems that can cause erectile dysfunction.

Swimming: A good exercise for improving overall health, which can in turn help treat erectile dysfunction.

Counseling, sex therapy and relationship counseling.

If stress, anxiety or depression are causing erectile dysfunction, counseling may be an effective treatment. If relationship issues are the cause, some form of sex therapy or relationship counseling may prove successful. Sensate focus, a type of sex therapy, focuses on building intimacy between partners. It involves totally abstaining from sex and intimate touching for a set period of time, then gradually reintroducing it. The method can be effective in overcoming the psychological issues behind erectile dysfunction.

[15] Relationship counseling, in which partners are prompted to explore the physical and psychological issues behind their sexual problems, may also be an effective method of overcoming erectile dysfunction. Partners are encouraged to become more aware of each other’s needs, allowing them to reach a solution which works for them both. Oral medications which are used to

treat

The drugs most commonly used to treat ED are called phosphodiesterase-5 (PDE-5) inhibitors. These medications work by counteracting phosphodiesterase-5 (PDE-5), a chemical naturally occurring in the body, thereby increasing blood flow to the penis during sexual stimulation. PDE-5 inhibitors are the most commonly prescribed medication for treating erectile dysfunction.

The most common types are: Sildenafil: Brand name, ViagraВ® Tadalafil: Brand name, Cialis Vardenafil: Brand name, Levitra Avanafil: Brand name, Spedra.

These medications work by artificially dilating the blood vessels in the penis, enabling improved blood flow. The effects of tadalafil last for up to 36 hours, while the other three varieties generally last for around 10 hours.

Each should be taken 30 to 60 minutes before engaging in sexual activity and will only take effect when one is sexually aroused. [14] A doctor will be able to advise about which type of PDE-5 is most suitable for each person and the health risks and side effects that come with them. Good to know: Following a prostatectomy, if one, rather than both, sets of the nerve bundles responsible for erections has been damaged (a unilateral nerve-sparing prostatectomy), it is possible to use PDE-5 inhibitors to stimulate an erection.

[16] PDE-5 inhibitors are associated with several side-effects including headaches, a runny nose, hot flushes, an upset stomach and light sensitivity.

In some cases, they can cause more severe vision problems: a temporary or permanent blindness which may be a sign of non–arteritic anterior ischemic optic neuropathy (NAION). This eye condition has been linked to all brands of PDE-5 inhibitors. Recent research indicates that there is an approximate two-fold increase in the risk of NAION in men over 50 who have recently used PDE-5 inhibitors, compared to those who have not.

[16] However, the overall risk of PDE-5 inhibitors causing NAION is low, with a risk estimate of 2.27 percent in a 30 day period and 3.52 percent in a 12 month period. [17] PDE-5 inhibitors are not recommended for people who have already been affected by NAION, or who have a family history of retinal degenerative disorders. These medications are also known to react with nitrate-containing drugs used to treat heart disease, so it is important to discuss possible interactions with the doctor in cases where PDE-5 inhibitors may be taken in combination with other medications, especially heart medications.

An efficient medication for assisting erectile function is thought to be alprostadil, a man-made version of prostaglandin E1, a substance naturally made in the body to help produce erections. Generally, due to the fact that it is a relatively new treatment with limited safety data, alprostadil will only be prescribed if other treatments, including counseling, lifestyle changes and PDE-5 inhibitors, have been ineffective or are unsuitable. It is administered in three main forms: [18] As an injection, directly into the base of the penis As a small pellet, which is placed into the urethra, i.e. the opening on the tip of the penis As a topical cream, applied to the urethra. Doctors will advise on which form of alprostadil should be used and give instructions on how to properly administer it at home.

After application, an erection can usually be achieved in around 15 minutes. Alprostadil has significantly fewer and less severe side effects than most oral medications which can be used to treat erectile dysfunction.

It works by widening the blood vessels and increasing the blood flow to the penis, causing an erection.

If side effects occur, these are usually non-serious and are limited to prolonged erections, pain and dizziness.

[19] Another advantage of Alprostadil is that the dosage can be adjusted to determine the duration of an erection.

A commonly prescribed topical medication for ED is VitarosВ©, a prescription medicine in the form of a cream, containing the active ingredient alprostadil. [7] Vitaros comes in a single-use container with a plunger, barrel and protective cap, containing either 200 or 300 micrograms of alprostadil in 100 mg of cream.