You’ve probably seen numerous ads about medications for erectile dysfunction (ED). As frequent as these ads can be, their persistence comes with good reason. An estimated 30 to 50 million men* in the United States experience ED. And while this issue is widespread, nearly 75% of affected men* don’t see their physicians about available solutions. While there are several factors that influence this statistic, arguably the biggest one is the taboo factor — ED is hard to talk about.

What Is ED?

Why Does It Happen?

There are a wide variety of physical and emotional issues that can be linked to an ED diagnosis, which is why it’s vital to talk with your physician or urologist to get to the root of the problem. Some known factors include:

• Age: Erectile dysfunction can happen at a young age, but it is more common in older men. By the time a man* reaches his 40s, he has about a 40% chance of having some form of ED. The risk increases by about 10% with each decade.
• High blood pressure
• Cardiovascular disease
• High cholesterol
• Smoking
• Alcohol use
• Obesity
• Lack of exercise
• Curvature of the penis (Peyronie’s disease)

Some common emotional issues that can lead to ED are:

• Anxiety
• Depression
• Stress
• Relationship problems

“Patients often worry that erectile dysfunction is a sign that maybe they aren’t attracted to their partner, or if they struggle in the bedroom once or a few times, they have ED,” says Dr. Desai. “It is absolutely normal to have occasional trouble maintaining an erection, and it is not a reflection on you or your partner. If you find that it is happening more frequently, consider it a sign to talk with your physician.”

How to Move Forward

Erectile dysfunction can most often be treated safely and effectively through natural remedies or medication, but the first step is talking about it. Communication between partners is key to ensure that both parties understand the diagnosis is not a reflection of their actions (though underlying relationship issues may be considered). It is important to be supportive of loved ones during this time — through mutual understanding and support in seeking help.

Common Treatment Options for ED

There are several treatment options for ED. Based on the cause of the problem, your physician may recommend:

• Lifestyle changes, such as cutting back on alcohol, quitting smoking and increasing physical activity
• Psychotherapy can help relieve stress and anxiety
• Prescription medications that increase penile blood flow
• Review of your current medications, which can cause ED
• Vacuum devices (commonly known as penis pumps)
• Penile implants
• Testosterone therapy

ED Is One Type of Sexual Dysfunction

According to Dr. Desai, ED is one type of sexual dysfunction, which typically falls under the category of arousal disorder. Additional categories of sexual dysfunction include:

• Desire disorder: Lack of interest in sexual relations
• Pain disorders: Pain during sex
• Orgasm disorder: Emotionally ready for sex but unable to climax

These disorders are often interrelated and can happen concurrently. For example, testicular pain from a surgery, radiation or a trauma can lead to ED. Additional treatment options may also be necessary, depending on the root cause of the disorder.

Dr. Desai says he treated a 45-year-old man for pain during sex. The patient was feeling hopeless after seeing four urologists without a diagnosis. After ruling out other causes, Dr. Desai performed a rare cremaster muscle release surgery. The cremaster muscle raises and lowers the testicles to control their temperature. If this muscle becomes hyperactive, one or both testicles can quickly and forcefully retract up to the groin. The retraction can be painful and typically happens during sex, exercise and other physical activities like getting in and out of a car. The minimally invasive surgery releases the cremaster muscle and stops the retraction. Dr. Desai’s patient is now pain-free and able to resume a healthy sex life. The patient is now pain-free and able to resume a healthy sex life.

“Painful sex can lead to avoiding sex as you may start to associate pain with it,” says Dr. Desai. “Overall, know that sexual dysfunction, including erectile dysfunction, is common and nothing to be ashamed of. The best first step is to talk about it with your physician.”

*Scientists do not always collect information from participants about gender identity. To avoid misrepresenting the results of this research, we use the same terminology as the study authors.