If you’ve ever had trouble getting or keeping an erection, you’re not alone. However, there’s a difference between occasionally being unable to get an erection and erectile dysfunction (ED).
It’s normal for men to experience an inability to get an erection occasionally, but if you are unable to get and keep an erection firm enough for sex more than half the time, then it may be time to talk to your doctor about erectile dysfunction.
According to the Urology Care Foundation, it is possible for men to have healthy sexual function into their 80s. However, ED is a complicated problem and many things can influence the condition. For an erection to occur, a combination of factors all needs to be working properly: blood vessels, nerves, emotions and hormone levels.
Some common causes of ED are:
- High Blood Pressure and Heart Disease. High blood pressure and heart disease have a common enemy – narrowing arteries caused by a buildup of plaque. As the arteries become narrower it results in poor blood flow throughout the body, including to the penis when trying to get an erection. In fact, ED is often an early sign of high blood pressure and heart disease.
- Being Overweight or Obese. A healthy Body Mass Index (BMI) is in the 20 to 25 range, overweight is between 26 to 29 and medical obesity is reached at a BMI of 30. Research published in the Annals of Internal Medicine found that men with a BMI of 28 or more had a 30% increased risk of ED. A separate study published in JAMA found that 31% of obese men with ED were able to regain sexual function by losing weight and increasing physical activity.
- Medication. ED is a side effect of many medications. According to the American Academy of Family Practice, medications that can cause or worsen ED include antidepressants, antihistamines and heartburn medication, beta blockers used for high blood pressure, diuretics, pain killers and more. Be sure and discuss any medications you’re taking with your doctor. In some cases, you may be able to switch to a different medication to see if your ED improves.
- Diabetes. Research published in the journal Diabetes Care found that 58% of men with diabetes reported frequent or occasional ED. This can occur if blood sugars are poorly controlled and there has been damage to the blood vessels or nerves. Other underlying health issues like high blood pressure or obesity can also be a factor for those with diabetes.
- Tobacco Use. The observational Massachusetts Male Aging Study that looked at men ages 40 to 69 found that those who smoked cigarettes almost doubled their risk of moderate or complete ED in the next 10 years. Fortunately, quitting smoking now can reduce your risk for ED and potentially reduce the risk for myriad other conditions including many types of cancer.
- Depression. Several studies have linked depression and ED. According to research published in the Journal of Urology, depression increases the risk of ED and having ED increases the risk of depression.A vicious cycle may develop.In addition: stress, anxiety or conflict with a partner can also impact erectile function and desire for sex. Often, couples counseling and sex therapy can be very effective.
- Low Testosterone. Testosterone is the main sex hormone in men. If testosterone levels drop below the normal range, the result can be an inability to get and keep an erection. According to guidelines from the American Urological Association, men who have a history of unexplained anemia, bone density loss, diabetes, exposure to chemotherapy, direct or scatter radiation therapy to the testes, HIV or a history of chronic drug use are at risk for low testosterone. Symptoms of low testosterone include reduced energy, reduced endurance, visual changes, depression, reduced motivation, poor concentration, impaired memory, irritability, reduced sex drive and changes in erectile function. The condition can be diagnosed with a blood test by your doctor, and testosterone replacement can be prescribed if necessary.
- Inactivity. A prospective study published in The American Journal of Medicine found that physical inactivity was an independent risk factor for developing ED. If exercise is not already part of your daily routine, walking is a good place to start.
- Red Meat and Processed Meat. Recent research published in JAMA Network Open examined diets of more than 21,000 men, found those who followed a Mediterranean diet closely had the lowest risk of ED across all age groups. The more red and processed meat men ate, the greater their risk for ED.
- Obstructive Sleep Apnea. Obstructive sleep apnea is a sleep-breathing disorder characterized by the cycle of stopping breathing during sleep, waking up briefly, then falling back asleep only to stop breathing again, up to hundreds of times throughout the night. The disorder prohibits quality sleep and has been linked to several conditions including mood changes, diabetes, high blood pressure and weight gain. It can also contribute to ED. In a study published in the journal Sleep Medicine, 75% of men with ED and obstructive sleep apnea were able to reverse their ED after one month of CPAP treatment for their sleep apnea.
The reasons for erectile dysfunction can be complicated, and many men have more than one contributing factor. A comprehensive look at your lifestyle and overall health can pinpoint problem areas, and testing can help determine if there’s a medical reason for the condition. In many cases, treating ED can improve underlying conditions and your overall health and quality of life.
Find out more about solutions for erectile dysfunction.
Ross Wopat, MD, provides comprehensive urological care, with a focus on minimally invasive surgery, such as laparoscopy and robotic assisted laparoscopy, for diseases affecting the kidneys, ureters, bladder and prostate. He can be reached at Samaritan Urology – Albany, 541-812-5800.