Erectile Dysfunction

Erectile Dysfunction: What you need to know

Male sexual dysfunction (e.g., erectile dysfunction, diminished libido, abnormal ejaculation) is a common problem. While typically thought of as only affecting the elderly, studies have shown that sexual dysfunction can be found in as much as 1/3 of men below age 59(1). Erectile dysfunction (ED) itself can be seen in 16% of all men, with as many as 7-8% of men below age 30 being affected (2)!

Normal male sexual function requires the interaction of the cardiovascular (penile blood flow), neurologic (nerve impulse), psychological (libido, or “sex drive”), and hormonal (testosterone) systems. Blood flow and pooling in the penis is the primary mechanism for achieving erection, while nerve impulses from the penis travel to the lower spinal cord and signal the body to redirect of blood flow to the penis. As such, a disruption in any of these systems or use of substances/medications that affect these systems can cause ED.

Potential Cause of ED Problem
Cardiovascular Atherosclerosis, Hypertension Disrupted blood flow to penis
Neurologic Stroke, Spinal Cord Injury Disrupted nerve impulse from penis
Psychological Depression, Stress Loss of libido
Hormonal Low Testosterone Impaired penile mechanisms for erection


Alcohol, Smoking

Antihypertensives, Antidepressives



It is important to mention that while cardiovascular disease can cause ED, it can also be a sign of undiagnosed heart disease. A study of men aged 55+ (3) found that having ED is as important as being a “current smoker” or having a “family history of heart disease” in predicting the presence of cardiovascular disease(4). Consequently, when a man sees his physician for ED and the doctor is more interested in asking about chest pain, the doctor is merely trying to ensure that the patient’s potentially life-threatening issues are addressed before dealing with the sexual dysfunction. Other important causes of ED include:

  • Emotional stress
  • Smoking
  • Excessive TV watching
  • Obesity
  • Diabetes
  • High cholesterol
  • High blood pressure
  • Poor general health

Treatments for ED are most effective when targeted at the specific cause of ED. With the discovery of “the pill” (e.g., Viagra, Cialis), many have turned to these oral medications as a one stop cure for ED. In those individuals who have not found these medications to be effective, the treatment may not be addressing all the causes of their ED. Other potential treatments that you could discuss with your physician include:

  • Lifestyle changes
  • Psychotherapy
  • Testosterone replacement
  • Injectable medications
  • Vacuum devices
  • Surgery

While ED is more common in older men, this doesn’t mean all men are fated to get ED. Preventing “risk factors” and living a “healthy lifestyle” are things that all men can do to prevent ED. And, as always, form a partnership with your primary care doctor so that if there are ever any questions about ED or any other medical problems, you have a place to get all your concerns addressed.


1. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281(6): 537-544.

2. Rosen RC, Fisher WA, Eardley I, Niederberger C, Nadel A, Sand M, The multinational Men’s Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Curr Med Res Opin. 2004;20(5):607.

3. Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med. 2003;139(3):161.

4. Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005; 294(23): 2996-3002.