What Is ED?

Erectile dysfunction is the inability to obtain or maintain an erection sufficient for satisfying sexual activity. It can also mean personal dissatisfaction with the size, hardness or duration of erections.

“Experiencing this issue every once in a while is common, but if it happens often enough to negatively impact your sex life, it’s time to schedule an appointment with your physician,” says Peter N. Tsambarlis, MD, a Northwestern Medicine urologist. “Erectile dysfunction does not have to be a permanent diagnosis. There are several treatment options available. You don’t just have to live with it.”

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 then increases by about 10% with each passing 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. Tsambarlis. “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 treatments for erectile dysfunction. 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
• Shockwave therapy
• Vacuum devices (commonly known as penis pumps)
• Penile implants
• Testosterone therapy for men with low testosterone

ED Is One Type of Sexual Dysfunction

According to Dr. Tsambarlis, 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. Tsambarlis has treated several young patients with unexplained ED. After understanding the situations in which a patient has difficulty performing, he creates a penile rehabilitation plan. The goal is to help them build confidence and achieve consistent results, based on mutually agreed-upon goals. Once rehabilitation is complete and the patient achieves consistent erectile function, treatment is typically withdrawn and the patient can maintain the benefits they obtained during the rehabilitation process.

“Painful sex can lead to avoiding sex as you may start to associate pain with it,” says Dr. Tsambarlis. “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.