No man wants to talk about it and there is a stigma associated with impotence which can make anyone shy. Although understandable, having that talk is quite necessary and can actually be a matter of life and death. Speaking to one’s doctor about the common causes of ED (Erectile Dysfunction) is important because it could be the harbinger of chronic diseases that turn fatal, such as a stroke or heart attack.

“By the year 2025, it’s estimated there will be over 322 million ED cases worldwide.”

The tragedy here is that of these projected ED cases, many of these men could circumvent erectile dysfunction altogether.

What Is Erectile Dysfunction and How Does It Impact Men’s Health?

According to doctors, ED is defined as the inability to have and maintain an erection firm enough for a sufficient sexual encounter, at least 50 percent of the time. While possibly embarrassing,  “[Erectile dysfunction] is the canary in the coal mine; it’s a barometer of health that not only men, but their partners can notice too,” said Dr. Kevin Billups, director of the Integrative Men’s Health Program at the Brady Urological Institute at Johns Hopkins.

Any number of factors can cause ED, whether they are vascular, nerve-based or  neurological. These causes can be cardiovascular disease, low testosterone, diabetes, or psychological issues such as depression, anxiety or PTSD. Prostate surgery can also cause damage to the nerve that controls erections. This may be temporary or permanent. To assess whether ED is a personal concern, go here and scroll to find our ED Quiz.

Erectile Dysfunction by the Numbers

ED is not a normal part of aging, although it can get worse as a man gets older, rising in prevalence with each passing decade. These stats and info may shed more light on the progression of ED instances with age.

Approximately 40 percent of 40 year olds will develop ED, with the majority having mild or moderate symptoms. However, instances of severe ED will increase by 10 percent, every 10 years: 70 percent of 70 year olds, 80 percent of 80 year olds, etc.

In today’s society, unhealthy lifestyles in younger people further supports ED development, making it more common for men in their 30’s and 40’s. When a man shows signs of ED at the prime of his life, it is most likely an indicator of cardiovascular issues. The inability to hold an erection for as long as desired can be a telltale sign that it’s better to see the doctor sooner rather than later.

Cause 1 – Cardiovascular Disease

Many cardiovascular issues can manifest themselves in ED, including hypertension and high cholesterol. Clogged arteries exhibit many symptoms, but one of them is erectile dysfunction caused by compromised blood flow in all parts of the body. Heart disease is another common problem associated with ED and is the number one leading cause of death in men.

Cause 2 – Obesity

Being overweight or gaining a lot of weight due to inactivity is another cause of ED. Behavioral modifications in the last few decades such as video gaming, binge-watching television series and other “couch-potato” activities have contributed to the acceptance of unhealthy lifestyles, causing obesity and diabetes to dramatically increase. Obesity causes ED by lowering the availability and activity of nitric oxide in the body, essential to help create erections through blood flow.

Cause 3 – Diabetes

Nerve damage from diabetes can be a cause, however, any metabolic disorder, Type 2 Diabetes Mellitus being the most crucial, can be the cause, more so, by way of  hypothalamic-pituitary-gonadal axis regulation issues. Any hormonal imbalances within this triad of glands can cause ED.

Cause 4 – Low Testosterone and Hormonal Imbalance in Men

Testosterone directly influences penile erections, regulating every part of the sexual experience, from erection to final outcome, including duration. Lowered testosterone creates a seemingly unforgiving hormonal imbalance in men which can lead to fatigue, depression, decreased interest in sexual intercourse, changes in muscle mass and changes in body hair.

Learn more and Testosterone Replacement Therapy

Cause 5 – Psychological Issues

Depression and anxiety can also cause ED. Societal stressors can directly affect erectile function, enhancing the problem, especially when a man is already suffering from a mild form of ED. Depression, anxiety, and guilt can make it worse.

PTSD is a definitive contributor to ED. A 2002 VA study showed that 85 percent of combat veterans who were being treated for PTSD had ED as well. Given the emotional turmoil that PTSD throws a person into, especially from the fight-or-flight response that is part of PTSD, a man will have less interest in sexual intercourse and will have psychological-attributed ED.

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Talk To Your Doctor About ED

What to Do About ED

The first thing to do is talk to your doctor. If you feel you might have any ED symptoms, such as an occasional inability to get or keep an erection, run – don’t walk – to your doctor. The possibility of also having a chronic or fatal disease should not be ignored. Request that your healthcare practitioner run some tests that can rule out specific medical conditions or show you what the underlying issue is. Chances of being able to stop the problem from getting worse and actually improving your overall health are better the earlier you see your doctor.

Fixing ED – LifeStyle Changes

Changing your lifestyle is equally important. Eating right, exercising, and losing weight (if needed) are the key ingredients to a healthy heart and a healthy penis, as well as a healthy sex life. The earlier you start living a heart-healthy lifestyle, the longer you will have to live happier. The old saying of “Mens Sana in Corpore Sano” is true. A healthy mind in a healthy body.

Fix 1 – Clean Living

Quitting smoking can improve ED symptoms after one year. Moderation in alcohol consumption and not using controlled substances are other ways to change your lifestyle for the positive to reduce or alleviate ED symptoms. Unfortunately, some prescription medications can also cause ED. In cases like high blood pressure, for example, it may be necessary to take a pill to treat it, but talk to your doctor about alternatives.

Fix 2 – Exercise

Starting and maintaining an exercise regimen can mitigate symptoms and improve sexual function. Some men may not benefit from exercise, especially those with established heart disease or other medical issues. However, losing that extra weight and keeping the weight off not only gives you endorphins, but can lengthen your lifespan. Even engaging in less strenuous but regular exercise can reduce the risk of ED.

Fix 3 – Eat Right

A Mediterranean diet that focuses on vegetables, fruits, nuts, whole grains and olive oil intake improves vascular health and thereby also penile health. Eat to live, not live to eat.  With daily consumption of vegetables, fruits and whole grains, and weekly consumption of fish, poultry, beans and eggs, this diet is recognized by the World Health Organization as a healthy and sustainable dietary pattern. It pays to eat right. Your partner will love you for it! Especially if both of you are doing it.

Fix 4 – Therapy

Psychological counseling can help with ED, if the problem arises from depression, anxiety or PTSD. There are two types of therapies that work best for PTSD and they are cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) therapy. Time and patience are the main factors to overcome psychological ED.

Fix 5 – Other Treatment Options

Although a lifestyle change is a great option regardless, it may not always improve erectile function. Especially if you have nerve damage, your doctor has many other options for you, including “little blue” pills and others, that do work for most men.

Hormone Replacement Therapy

Hormonal treatment is another option for those whose testosterone levels are low. This can be done by itself or to enhance other treatments. If the pills do not work well enough, testosterone replacement therapy may be recommended.

Alprostadil Treatment

Injection therapy, using a tiny needle to inject alprostadil medication into the penis, is a third option. This allows for an hour long erection, with minimal side effects and usually takes no more than 30 minutes to start. Muse therapy is a tiny suppository of alprostadil placed inside the penile urethra that provides an erection within 10 minutes and can last between 30 and 60 minutes.

Pumps and Implants

Penis pumps and penile implants are other options. Penis pumps pull blood into the penis by creating a vacuum. Once the blood has gathered, a tension ring is placed at the base of the penis and is removed after intercourse. Penile implants are a surgical procedure to implant either inflatable or malleable rods on either side of the penis. This is usually not recommended until all other possibilities have been exhausted.

You Can Take Control of ED Risk

To prevent erectile dysfunction in the first place, exercise, eat right and maintain a healthy weight. Cardio, Mediterranean diet and no smoking! If you believe you are experiencing signs of ED, see your doctor and talk about what you can do. Having that discussion with your doctor is nothing to be ashamed of and will actually empower you to take control of your health. ED is nothing to be embarrassed about and there are treatment options.

If you or someone you care about is considering the use of prescriptions to help with the symptoms of ED, we offer premium compounding services as a more affordable and more effective alternative to the expensive name-brand pharmaceuticals on the market.

Matt Poteet, Pharm.D.

Chief Operating Officer, The Compounding Pharmacy of America

Matthew Poteet, Pharm.D. graduated with Honors from Lee University with a Bachelors of Science in Biological Science. After his undergraduate training, he completed the Doctor of Pharmacy program at Mercer University Southern School of Pharmacy, graduating in 2004. Dr. Poteet has spent much of his pharmacy career on staff at two of the most prestigious academic teaching hospitals in the Southeast; Emory University in Atlanta and Vanderbilt University Medical Center in Nashville. At these institutions he received extensive experience and training in sterile products compounding.

He returned home to East Tennessee in 2010, where he has held the position of Pharmacy Director at two sterile products pharmacies in Knoxville. Matthew lives in Knoxville with his wife, Chris. Dr. Poteet is Tennessee’s first Board Certified Anti-Aging Pharmacist by the American Academy of Anti-Aging Medicine.

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