Erectile Dysfunction (ED) 101: Symptoms, Causes & Treatment

Erectile Dysfunction (ED) is the inability to keep an erection during sexual activities. Find out more about Erectile Dysfunction (ED), its symptoms, causes and treatment options.

by Calvyn Ee

What is Erectile Dysfunction (ED)?

Erectile dysfunction (ED), sometimes known as impotence, is when you or your partner is unable to keep an erection firm enough for sexual activities. ED may either be an inability to maintain an erection to provide satisfactory sexual activity for both persons, or premature ejaculation. While it can happen occasionally, failing to get an erection more than 50 per cent of the time can be a sign of ED. It may be due to a number of factors, such as damage or defects to blood vessels in the penis, alcoholism, or even stress.

ED can either be a short-term or long-term condition. It is estimated that 1 in 10 men have ED on a long-term basis, and generally affects men over the age of 40. In Malaysia, one study found 69.5 per cent of men aged 40 to 79 years had ED. Other studies have found that ED can also be prevalent among men between the age of 18 to 40. 

ED can lead to a loss of intimacy between couples. However, most men do not get it treated due to a fear of embarrassment or because of societal stigmas towards ED. Treating ED should be normalized, as ED can also be a sign of other underlying medical conditions that are not detected.

Symptoms of Erectile Dysfunction (ED)

The main symptoms of ED are the inability to get and keep an erection during sexual activities, as well as reduced libido, or sexual desire.

Some other symptoms may include having an erection outside of sexual activities, but not during; and an inability to maintain an erection during masturbation.

Causes and Risk Factors of Erectile Dysfunction (ED)

There are a number of reasons that ED may occur, and it is not just because of psychological factors like stress or depression. These may include:

  • Atherosclerosis (blocked blood vessels)
  • Diabetes mellitus
  • Hypertension
  • Damage to the spinal cord
  • Physical trauma
  • Multiple sclerosis
  • Alcoholism
  • Frequent smoking
  • Low testosterone
  • Hormone imbalance
  • Side effects from certain medications
  • Effects of surgery
  • Drug abuse
  • Parkinson’s

Having experienced any of these does not mean you will have ED, but they present a higher risk of getting it.

ED may be a sign of an underlying medical complication that may be present. A thorough diagnosis will usually be done to determine if this is true.

Diagnosing Erectile Dysfunction (ED)

Your care professional may ask you a number of questions related to you or your partner’s medical and sexual history. These can include questions of medications you or your partner are currently taking, medical conditions either of you may be having, and the level of satisfaction from sexual activity. It may be rather embarrassing to go into specifics, but this is the first step to helping remedy the situation. The International Index of Erectile Function (IIEF) is a type of questionnaire that may be used in the diagnosis to ask some of these questions.

A physical exam may also be conducted if the doctor feels it is needed. This can help identify the possible cause of the ED and help inform them of what follow up test is needed next, or if discussing a treatment plan might be required.

There are other tests that can be considered as well, such as blood tests and ultrasound imaging. These tests not only look into the cause of ED but may also shed light on underlying medical conditions that require medical attention. Your doctor will inform you if this is indeed the case. These are generally done only if your doctor has reasonable suspicion that there may be an underlying medical issue that warrants further investigation.

A psychological evaluation may be needed if the cause of ED is not due to a medical condition. Your doctor will carefully assess psychological factors that might be influencing performance. It may even be a case of performance anxiety, due to stress, low self-esteem or embarrassment. Your doctor may then decide if you will require counselling for follow up treatment.

Treating Erectile Dysfunction (ED)

Once the doctor has examined your medical and sexual history, they will decide on what the best treatment plan will be for you or your partner, with their associated benefits and risks.

Oral Medication

Medicines such as sildenafil (also known as Viagra), tadalafil (Cialis, Adcirca), and vardenafil (Levitra, Staxyn) are generally used to treat ED. They enhance the effects of nitric oxide, a natural chemical the body produces for relaxing the muscles in the penis, increasing blood flow to it and allowing you or your partner to get an erection. Taking these medications will still require sexual stimulation to produce an erection, and they are not aphrodisiacs that stimulate sexual desire. Ensure that you or your partner follow the prescription instructions at all times to prevent unwanted side effects.

Side effects may include flushing, nasal congestion, headaches, and indigestion. The dosage will be determined by your doctor, but always consult them if you frequently experience side effects, or if the medication has no effect at all. If you or your partner are having an erection that lasts more than 4 hours, immediately seek medical attention.

Oral medications are not to be taken if you are currently taking nitrate drugs used to treat chest pain, or angina, as it may result in hypotension (abnormally low blood pressure) that can be dangerous. You or your partner should also avoid taking these medicines if either of you has a heart-related condition.

Non-oral Medications

In the event that you cannot take oral medications, there are other medications that may be prescribed to treat ED. One such medication is alprostadil, which can be prescribed in either a self-injection, a urethral suppository (a type of medicine that is inserted into the body, where it dissolves), or a topical cream.

The self-injection requires an injection of alprostadil (sometimes mixed with other medications) with a fine needle into the base or side of the penis. Each injection produces an erection that lasts no longer than an hour. As for the suppository, a tiny alprostadil suppository is placed into the penile urethra by means of a special device. The erection usually starts within 8 to 10 minutes and can last between 30 to 60 minutes.

However, the side effects of either method can be painful to you or your partner. Some side effects include minor bleeding from self-injection or in the urethra using the suppository; or even the formation of fibrous tissue inside the penis. Some with brain or blood-related conditions may even experience dizziness and high blood pressure.

Alprostadil topical creams are a less invasive method that simply requires the application of a medical cream to the penis. One study has found that the topical cream is a safer, painless way to treat ED, especially for those who cannot take oral medications.

Testosterone replacement therapy is also another consideration to treat ED. If the ED is caused by low levels of testosterone, then this will be recommended to treat it. It can help improve a man’s energy, mood, bone density, as well as increase muscle mass and weight, and improve sexual desire. This is only recommended for men with low testosterone levels, as those with normal levels may experience side effects such as an enlargement of the prostate gland.

Mechanical Aids

This refers to medical devices that are approved for treating ED. One such device is a penis pump (vacuum constriction/erection device). Essentially, this device is a hollow tube on one end and a manually or battery-powered pump on the other. The device works by placing the penis into the tube, and then operating the pump to suck out the air inside the tube. This creates a vacuum within the tube that draws blood into the penis, causing an erection. Once done, a band (or tension ring) is slipped around the penis from the tube to maintain the erection before the pump is removed. The band can remain in place for up to 30 minutes; after sexual activity, you can remove the band.

While this is an effective way to treat ED, there are still complications that may arise from its use. For one, some complain that the penis pump is cumbersome and uncomfortable to use. Others find that their penis gets bruised when using it, and are put off by the fact that ejaculation is restricted because of the band.

Penile Implants

This type of treatment involves surgery to insert devices into both sides of the penis, which allow you to manipulate them to produce an erection. The two most common types of implants are inflatable prostheses or malleable/semi-rigid prostheses.

The inflatable implant consists of a pump and two inflatable cylinders. The pump is usually located in the scrotum. By manipulating the pump, a saline solution is released into the cylinders (placed within the penis’ erection chambers) and causes an erection. A deflation valve will remove the solution from these cylinders to deflate the penis after sexual activity.

The semi-rigid implant consists of bendable rods inserted into the penis’ erection chambers, which can then be manipulated to produce an erection or reverse it.

Satisfaction ratings of men who received a penile implant are very favourable. Despite this, penile implants are considered a last resort measure where all other forms of treatment do not work. Side effects from the implants can be dangerous, as an infection is the most common cause for the implants to fail. Breakage can also be a major problem as well that will require immediate medical attention.

Psychological Counseling

Therapy is an effective treatment method for ED if it is caused by underlying emotional or psychological distress, and not due to a medical condition. A licensed counsellor can help with relieving the emotional stress you may be experiencing, sometimes together with your partner to communicate how you feel with them.

It is perfectly fine if there is some embarrassment on the subject, but you or your partner should not keep hiding it or avoiding the problem. A lack of communication only serves to break down any measure of trust between couples and prolong the agony of having ED. Work through your anxieties, doubts and fears with the counsellor, and see what can be done to alleviate them. There are a wide array of therapy methods that will help you communicate your needs with your partner or to find new meaning in your relationship.

Preventing Erectile Dysfunction (ED)

While some cases of ED are unavoidable, there are ways that you can prevent ED from ever happening to you. Most of these involve making important lifestyle changes that will improve your well-being. These include:

  • Having a healthy, well-balanced diet
  • Quit smoking
  • Regular exercise
  • Avoid drug abuse
  • Reduce alcohol intake
  • Follow your medicine schedule
  • Communicate your feelings with your partner

Do not immediately take stock in claims of alternative medicine being able to cure ED, as many alternative cures may be based on pure speculation. Without proper clinical trials to prove their efficacy, taking these cures may be hazardous to your health. Always consult a licensed medical professional if you are considering taking any form of supplement.

An open conversation about sexual activity with your partner and your doctor is an important first step to combating ED.

References

Ab Rahman, A. A., Al-Sadat, N., & Yun Low, W. (2011). Prevalence of erectile dysfunction in primary care setting, Malaysia. Journal of Men’s Health, 8(S1), S50–S53. https://doi.org/10.1016/s1875-6867(11)60021-3

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Cleveland Clinic. (2019). Erectile Dysfunction. Retrieved 25 August 2021 from https://my.clevelandclinic.org/health/diseases/10035-erectile-dysfunction DerSarkissian, C. (2020).

What Can Cause Erectile Dysfunction? Retrieved 25 August 2021 from https://www.webmd.com/erectile-dysfunction/guide/understanding-ed-causes 

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Harvard Health Publishing. (2020). 5 natural ways to overcome erectile dysfunction.  Retrieved 26 August 2021 from https://www.health.harvard.edu/mens-health/5-natural-ways-to-overcome-erectile-dysfunction 

Hellstrom, W., & Anaissie, J. (2016). Clinical use of alprostadil topical cream in patients with erectile dysfunction: A review. Research and Reports in Urology, 8, 123–131. https://doi.org/10.2147/rru.s68560

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Mark, R., Huri, H. Z., & Razack, A. H. (2018). Demographic, clinical and LIFESTYLE predictors for severity of erectile dysfunction and BIOMARKERS level in Malaysian patients. Brazilian Journal of Pharmaceutical Sciences, 54(3), 1–17. https://doi.org/10.1590/s2175-97902018000317552 

Mayo Clinic. (2021). Erectile Dysfunction. Retrieved 25 August 2021 from https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776 

Mayo Clinic. (2021). Erectile Dysfunction – Diagnosis and treatment. Retrieved 26 August 2021 from https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/diagnosis-treatment/drc-20355782 

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MyHEALTH Kementerian Kesihatan Malaysia. (n.d.). Erectile dysfunction. Retrieved 25 August 2021 from http://pendidikanpesakit.myhealth.gov.my/en/erectile-dysfunction/ 

National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Definition & Facts for Erectile Dysfunction. Retrieved 25 August 2021 from https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts

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About the Writer
Calvyn Ee
Calvyn is an aspiring author, poet and storyteller. He spends his time reading, gaming and building stories with his action figure photography.
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