People don’t talk much about impotency, or erectile dysfunction, the preferred term. Even those who need to talk about it, often don’t. That can be a serious problem, considering that several studies report ED becomes more prevalent with age, affecting approximately 52% of men. Some research suggests that 40% of men have some form of ED by age 40. The rate continues to increase with age, with 70% of men age 70 reporting ED.

Thanks to very effective media campaigns by large pharma in the past decade, most people in our society are aware that ED can be a problem – and there are several possible solutions available. Viagra is a household word in the US. The ‘little blue pill’ has assisted many couples in rekindling the flames into old age.

What ED Is and Is Not

ED, or impotence, is the inability to sustain an erection sufficient for intercourse. ED may include any of the following: problems getting an erection, difficulty keeping an erection, decrease sexual desire or drive and only being able to get an erection during masturbation, but not sexual intercourse. Premature ejaculation is not the same as impotency/ED – it is a different sexual disorder.

It is not unusual for men to have brief periods of time when they experience ED. This may be related to stress, alcohol use, medication side effects, performance anxiety or other issues. If the problem continues for longer than a few weeks, it might be a good idea to talk to your doctor. Sometimes simple changes in your lifestyle can help, for example, not drinking before lovemaking or getting more exercise. Erections are primarily about blood flow, so anything that impedes blood flow may affect one’s ability to get and keep an erection.

ED and Related Disorders

Thanks to effective patient education, improved screening techniques and initiative in the medical community, more people are talking about ED with their providers. The risk factors for ED are numerous, including diabetes, high blood pressure, high cholesterol, artery disease, substance use/abuse, mental health issues such as depression, smoking, neurologic conditions, injuries and trauma.

Some of the neurological disorders that can lead to ED are MS, Parkinson’s Disease and spinal cord injuries. Additionally, surgery for several types of cancer can result in ED. In 3-5% of cases hormone deficiencies can result in ED. ED is also a common side effect of medication and recreational drug use.

ED may be the first indicator a person recognizes that one of these other problems exist. Heightened awareness of this fact has resulted in more men talking to their providers about ED. Often treatment of the underlying disorder has been sufficient to correct the ED.

Diagnosis

In order to make a diagnosis, your doctor will usually conduct a screening that may include a questionnaire about the problems, how long it has lasted, when it began, how it began and so on. You can also expect questions about your sex life – different positions, partners, etc. A thorough medical exam is usually done to evaluate any underlying factors that might cause ED. There may be some lab tests ordered, but initially this should be minimal. A complete drug history should also be done to ensure the patient is not taking medication that causes ED, ie. blood pressure medications, antidepressants and others.

Treatment

There are three (or more) drugs on the market that are considered first line treatment for ED. Studies comparing the three primary drugs available indicate that  up to 75% of men who used these during clinical trials were able to successfully complete sexual intercourse.

For those who do not respond to oral therapies and treatment of underlying conditions, a trip to a specialist will likely be involved. There are other types of treatment to be considered, including vacuum constriction devices and surgery. A specialist can work with you to determine the right treatment for you.

Secondary Effects of ED

ED can create many associated problems for men. Performance anxiety, stress, strained relationships, feelings of insecurity, anxiety and others are common. Left unchecked, these problems can impact functioning at work, with friends and family members.

Suggestions for Coping with the Psychological Effects of ED

·         Talk about it. Be open with your medical provider and others who are there to help you. Don’t wait to be asked about your sexual health – reach out for answers and help. Start with a physical to rule out underlying causes and see what the doctor orders.  

·         Manage your stress. Stress is related to a multitude of problems, and could be responsible for some of your problems. Men who are concerned about sexual performance often stress over the issue, creating even more problems. Ask a medical provider or therapist about stress management techniques like deep breathing, exercise and challenging negative thoughts that lead to stress and anxiety.

·         Be honest with your partner/spouse about what is going on with you. Many menfeel ashamed of ED and avoid sexual intimacy instead of being honest with their partner/spouse about the real problem. This can damage a relationship and create other problems. If you need help talking about ED with your partner/spouse, consider seeing a therapist to help you with communication. A good therapist can help you figure out what to say – how and when to say it, or work with you as a couple as you address this issue.

·         Make good choices. If lifestyle choices are creating some of the problems related to ED, educate yourself about ways to make changes that will help. These may include diet, exercise, abstaining from alcohol or recreational drugs before lovemaking and others.

·         Follow the doctor’s orders. Work with your medical team to address any and all issues related to your sexual health. Keep follow up appointments and implement the recommendations of the doctor and/or therapist for best results.

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Lakin, Milton, and Hadley Wood. "Erectile Dysfunction." Cleveland Clinic: Center for Continuing Education. Web. 05 Nov. 2013.

"What Is Erectile Dysfunction." Medical News Today. MediLexicon International. Web. 05 Nov. 2013.