Erectile dysfunction is far more common than many realize. Here's how to treat it.

Few topics are more taboo than erectile dysfunction. Though countless men have experienced the frustration or embarrassment of failing to perform as expected during intercourse, it's not something you're likely to hear many of them publicly own. 

But multiple sexual health experts say erectile dysfunction is nothing to be ashamed of and that acknowledging that it sometimes occurs can be healthy. "One can consider erectile dysfunction to be part of a complex, normal, and stressful life," says Dr. Paul Turek, a men’s fertility physician and the director of the Turek Clinic in San Francisco. "But believe you me, medical care and lifestyle modifications can lead to impressive improvements in not only erections but lifespan in general."

What is ED? 

Erectile dysfunction, often called ED, "is the inability to initiate or maintain an erection firm enough for penetration," says Dr. Stanton Honig, a urologist and chief of the reproductive and sexual medicine department of urology at Yale University School of Medicine. 

It essentially has two components: getting blood into the penis to initially obtain an erection and keeping blood within the penis to maintain it. "Some men may have problems with one, some men may have problems with the other, and some men have a problem with both," explains Dr. Matt Armstrong, a physician and urologist at Revere Health in Utah.

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There are also different types of ED. Chronic erectile dysfunction, for instance, typically means a person has a blood flow problem or a nerve injury, resulting in ongoing issues, Honig explains. "But a patient who only occasionally has problems with erectile dysfunction, most likely has it on a situation basis, meaning that this is not necessarily a permanent condition but may be driven by stress or anxiety which releases adrenaline that will take an erection away or will not allow appropriate blood flow into the penis." 

In other words, for some men, stress or anxiety is the real - and temporary - cause of the issue, and when the stress is dealt away with, the ED usually goes with it. 

How common is ED?

In fact, when it comes to how common ED is, Turek says that stress-related ED is by far the most frequent contributing factor in young men, "especially young healthy men." In this younger population, ED is even more common than some may realize. One study shows that nearly 1 in 5 men ages 18-24 experience some trouble getting or maintaining erections. 

Generally, though, ED is known to worsen with age, "but it really is variable on the patient and their overall health as causes of ED relate to cardiovascular disease, atherosclerosis and diabetes," says Armstrong. 

Exactly how common it is in older age groups varies, but, after factoring in the average results of multiple studies, Turek says the most reliable formula to follow when determining how many men of different ages actually deal with the issue is to take one's age and subtract 10%. "So, about 60% of 70-year-olds will have some form of ED, and 40% of 50-year-olds will and so on," he explains. 

How to treat ED

For any such individuals and their partners, the question becomes how to treat the condition. Fortunately, it's a question that has many worthwhile answers. Before one starts looking into any medical interventions, however, it's important to get to the root of what's causing the problem in the first place and dealing with it there. 

"First-line therapies include lifestyle modifications such as regular exercise, a heart-healthy diet, adequate sleep, avoidance of behaviors such as smoking and alcohol, stress reduction and weight loss," says Dr. Nahid Punjani, a physician and urologist at Mayo Clinic in Arizona. "We also always encourage patients to speak to their partners and have an open dialogue - something sex therapy can help with, if needed." 

After seeking to understand and dealing with the root cause, numerous medical intervention options remain. The most popular choice for most men is taking oral tablets such as sildenafil (Viagra) and tadalafil (Cialis), "which can effectively treat about 65% of cases," says Turek. 

If these fail, other alternatives may be worth considering. Some of these include topical gels, intraurethral suppositories and shockwave therapy, says Armstrong. Vacuum erection devices, or "penis pumps," as they are often called, are another proven option. "Although these are somewhat clunky to use, they do work quite well," says Honig. 

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Another alternative "involves injecting a medication directly into the side of the penis with a tiny needle that barely hurts," says Honig. "This will work in about 70% men that do not respond to oral medication." 

However, any ED-related medical intervention comes with often minor but sometimes significant side effects one ought to be aware of. This starts with meeting with one's primary care provider, "and being honest, open, and frank in discussing your concerns and questions," offers Armstrong. "Your physician will be more than happy to help you find a solution or a specialist who can help you find an option you are comfortable with."