Erectile dysfunction: experts answer your questions

Some real talk about ED from a urologist and a sex therapist

Did you know Leonardo da Vinci was apparently the one to discover that blood flow in the penis is what creates erections? Before then, it seems that a lot of people thought that boners filled up with air, like a balloon animal. Now, of course, we know a lot more about the dick than just simply, ‘it fills up with blood’. One thing we know for sure? Sometimes it doesn’t, even when you really want it to.

If you have a penis, it’s pretty likely that at some point or another you’ll not be able to get hard when you want to. Not being able to get it up once or twice out of the blue isn’t a cause for alarm by any means, but if you’re having repeated trouble getting or sustaining an erection it might be time to consider more drastic action. There aren’t specific criteria, since there isn’t a specific amount of times per day or week or year that you’re supposed to get hard, but, ultimately, you know yourself best. If you’re frustrated with your dick or your dick’s performance, it might be time to go to the doctor. To find out your most pressing questions, I spoke to two specialists: urologist at the University of Utah, Dr Darshan Patel and sex therapist Dr Stephen Snyder, author of Love Worth Making: How to Have Ridiculously Great Sex in a Long-lasting Relationship. Here’s what I found out.

HOW COMMON IS ED?

The commonly cited stat is that the percentage of people in any age group with penises experiencing erectile dysfunction is close to the age itself, so 40% of 40-year-olds and around 70% of 70-year-olds and so on. These are estimates, of course, and most of the data is selfreported, but the upshot is that no matter what age you are, if you’re having issues getting or staying hard, you’re not alone.

WHEN SHOULD YOU GO TO THE DOCTOR?

Whenever you start to feel like something might be wrong, check in with a doctor. Dr Snyder put it this way: ‘Most men will keep trying to have sex despite the fact that their penis is telling them something’s wrong. It’s best not to do that.’ This is especially true because some causes of erectile dysfunction can be cardiovascular or otherwise serious. If you start experiencing trouble, see a doctor.

WHAT KIND OF DOCTOR SHOULD YOU GO TO?

If you’re already seeing a primary care doctor, you can bring up ED with them. They will probably prescribe pills. However, if you’re finding pills aren’t helping, if you’re experiencing side effects, or if ED is your only concern, you may want to go to a urologist. Urologists often have a broader array of treatment options available to them. A sex therapist like Synder can also be helpful, depending on the source of the dysfunction. Dr Synder explains, ‘If the problem seems psychological – for example, you get great erections by yourself, but you sometimes can’t stay hard with a partner – then your best bet may be first to see a sex therapist.’ Current evidence suggests that only in about 20% of cases is erectile dysfunction completely psychological.

WHAT ARE THE CAUSES OF ED?

While people used to believe that erectile dysfunction was entirely a psychological issue – often dismissed as performance anxiety or insecurity – we now know otherwise. In fact, it’s more common for ED to be caused by organic factors (such as cardiovascular issues, diabetes or medication) than psychogenic factors (such as anxiety or depression). Often, the answer involves complex health issues working together; sometimes organic-caused ED can lead to anxiety around sex, which certainly doesn’t help when it comes to getting and staying hard. As Dr Patel put it, ‘The most common cause we see is vasculogenic erectile dysfunction or issues with blood flow to the penis.’ Because that’s so common, it’s important for men experiencing ED to come in and get it checked out, ‘primarily because we can also identify the factors that will put them at a higher risk of developing other cardiovascular diseases, even if they’re younger, things such as a heart attack, stroke, or high blood pressure.’

There are lots of medical factors that make people more likely to suffer from erectile dysfunction, things such as medication side effects, stroke or thyroid disease. For people with diabetes, for example, the rate of ED is much higher than the general population. That said, in younger men, studies seem to show that psychological factors such as work stress seem to play a larger role than they do for older men.

WHAT ARE THE MOST COMMON OR FIRST TREATMENT OPTIONS?

Firstly, your doctor is probably going to look into your medical history and lifestyle. Certain medications such as antidepressants, anti-seizure medications and medications for high blood pressure can contribute to or cause ED, according to Dr Patel. Additionally, he says that he always talks to patients about alcohol and tobacco use, both of which can contribute to the problem, and other lifestyle factors such as weight and stress. The first treatment option beyond lifestyle changes is generally going to be prescribing a PDE5 inhibitor – common brands are Viagra or Cialis – in pill form.

WHAT SHOULD YOU KNOW BEFORE TAKING THE PILL?

Dr Synder explained that PDE5 inhibitors such as Viagra or Cialis can be helpful for psychological ED as well as physical ED since they don’t strictly give you an automatic erection. According to him,

PDE5 inhibitors ‘amplify the positive signals from the brain to the penis. This can be helpful if you’re trying to contend with negative signals, such as from performance anxiety.’ But you can’t just expect to take the pills and get hard.

HOW LONG DOES IT USUALLY TAKE TO TREAT ED?

Dr Synder says that depends on a few factors, such as ‘whether your ED is mostly medical or mostly psychological, whether your relationship with your partner is a happy one or not, whether you have any other emotional problems that might complicate things, and so on’. As he explained, ‘Medical ED often requires long-term medical treatment, since most medical causes of ED are not completely reversible, but most psychologically-caused ED shouldn’t require long-term treatment.’ Regardless of the cause, most ED is treatable or at least addressable. The first step, of course, is seeing a doctor.

‘No matter what age you are, if you’re having trouble getting hard, you’re not alone’