Everything You Need to Know About Erectile Dysfunction
Suffering from Penile Problems? Know You’re Not Alone
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Men spend an inordinate amount of time worrying about their penises. Whether it’s the size, the shape, or the presence or lack thereof of a foreskin, there hardly seems to be a single aspect of the penis that isn’t fretted over.
But for many people, whether that penis can get erect or not might be the most important one.
In a world where men associate their manhood with their ability to achieve erection — to the point where the word “manhood” can literally be used as slang for an erect penis — there’s the idea that there’s something wrong with a man who can’t get erect or has trouble staying there.
In many men’s minds, erections are supposed to be simple, lengthy and plentiful — and any deviation from that can feel like a massive failure. But that conception of erections skips out on some important facts — namely, that more than half of men will experience some form of erectile dysfunction (E.D.) at some point in their lives.
Considering those statistics, it’s a good idea for the people behind those penises to get educated about what E.D. is, where it comes from, and how to deal with it. AskMen spoke with doctors, psychologists and sexperts to help simplify the science behind getting hard.
What Is Erectile Dysfunction? Symptoms and Types of E.D.
Erectile dysfunction, or E.D., is a problem with many causes and many solutions, but it manifests itself in one way: difficulty achieving an erect penis.
“Erectile dysfunction is when there is an erection that is insufficient for penetration or sexual activity,” says Dr. Koushik Shaw, MD of the Austin Urology Institute.
However, it’s important to note that just because the issue manifests itself in a physical way, it doesn’t mean that the root of the problem is a medical one. While there are many different physiological causes for it, it’s common for E.D. to occur as a result of psychological factors, too.
“It’s often thought of as a physical issue, while many people (including doctors) overlook emotional factors that may be contributing (such as relationship concerns),” says relationship therapist and co-creator of Viva Wellness Jor-El Caraballo.
More broadly, it’s worth considering whether E.D. is necessarily an issue at all. Outside of health concerns, sex educator Kenneth Play argues, it might be a good idea to shift the baseline and instead change our expectations — that it’s quite normal for penises to remain flaccid on occasion, even when we want to achieve an erection.
“It’s important to look at this holistically,” Play says. “It may not always be a disorder. Media and society think that men should just always be ready to have sex and be easily aroused, but it isn’t like just waving a steak in front of a dog.”
“Sexual arousal, sexual pleasure and sexuality in general is more complicated than that, and for men, too,” he notes. “So sometimes, what’s perceived as a disorder like E.D. may actually be heavily influenced by a stereotype that men have to battle.”
Who Experiences Erectile Dysfunction?
There’s a stereotype that erectile dysfunction overwhelmingly or exclusively impacts older men. That’s far from the truth, however.
“Potentially anyone with a penis” can be impacted by E.D., says Kayla Lords, sexpert for JackAndJillAdult.com. “Stress, anxiety, depression and other mental health issues can cause E.D. — which impact men of all ages. Physical disability, which knows no age limit, can also cause E.D. So if you have a penis, you could, at some point, have to deal with E.D.”
Beyond it just being possible at any age, it’s also, as Caraballo notes, common at many different ages.
“At some point in their lives, most men have experienced E.D.,” he says. “This can be due to a number of factors — including increasing age, pre-existing health issues, psychological concerns and the influence of substances. Research suggests that as many as 40% of men are affected at age 40, with those percentages increasing with age.”
As well, it’s important to remember that men aren’t the only ones impacted by E.D. — non-binary people and trans people with penises can also struggle to achieve erections.
In short, if you’ve been having trouble getting or staying erect, you’re far from alone in the matter.
Physiological Causes of Erectile Dysfunction
In order to properly understand what’s going on when you’re struggling to achieve an erection, you first need to understand what’s happening in your body when you succeed at achieving one.
Hormonal Environment: Testosterone, Estrogen and Erectile Dysfunction
For starters, if you’ve heard that testosterone and erections are related, there’s definitely truth to that — but that’s not the only hormone you need.
In order to have an erection, says Shaw, “from a physiological standpoint, you need to have the appropriate hormonal environment — so you have to have enough testosterone, and you need to have some estrogen, but not too much.”
Vascular System: Blood Pressure, Diabetes and Erectile Dysfunction
As well as the right hormonal balance, since erections are the result of blood filling up the spongy corpus callosum tissue in the penis until it’s hard, you also need to be able to pump blood without any significant issues.
In order to get erect, “You need to have a [healthy] vascular system — so blood flow, as well as intact nerves,” Shaw says. “That means you need to have appropriate cholesterol levels. High cholesterol can impact erectile function. Blood pressure has to be normal. If blood pressure is high, that can attack nerves and blood vessels. You need to have good blood-sugar levels, because diabetes can affect erectile function negatively.”
“So hypertension, diabetes and cholesterol all negatively impact erectile function,” Shaw concludes — meaning your eating habits can have a massive impact on your sex life, if you’re eating foods that are high in sugar, salt or fat to the point of impacting your health.
Lifestyle Choices: Alcohol, Marijuana, Smoking and Erectile Dysfunction
Poor sleep habits or difficulty sleeping such as sleep apnea, cigarette smoking and excessive consumption of drugs and alcohol can also have noticeable effects on your erections. If that sounds like your lifestyle — either currently or in the recent past — that might be what’s affecting your erection struggles, at least in part.
“What happens is it’ll accelerate aging of the body, including the nerves and blood vessels to the penis,” he says of living an unhealthy lifestyle. Often, he says, “You can party in your 20s and 30s, but beginning in your 40s, these things will tend to catch up with you, and the birds will come home to roost.”
So in the short term, according to Shaw, you might get away with it — “but later, you’re going to pay for it.”
Other Causes: Diseases, Injuries and Medications That Cause E.D.
There are lots of other medical issues that could impact your erectile function, too. Things like Parkinson’s disease, multiple sclerosis, sleep disorders, prostate issues, penile fractures or other scarring, pelvic or spinal injuries, and even the use of Adderall or other prescription medications can cause erectile dysfunction.
Because there are so many different potential physiological causes — and because many of them are quite serious — if you’re experiencing E.D., you should consult a doctor as soon as possible.
It might be embarrassing — or it might not seem serious — but E.D. could be an early warning signal for other health concerns, so getting checked out fast is crucial.
Psychological Causes of Erectile Dysfunction
That being said, E.D. is often completely unrelated to physical health.
While the smart thing to do if you’re experiencing it is to speak to a licensed medical professional as soon as you notice the issue, it’s possible that the issue is completely psychological one — so it’s a good idea to examine your mental and emotional state, as well.
Long-Term Stress and Erectile Dysfunction
“Psychological and relational problems are often completely overlooked as it relates to E.D.,” says Caraballo. People “fail to realize that a penis is not simply a dildo to be used for pleasure. It’s a body part attached to a greater whole, a living person, with feelings, anxieties and day-to-day concerns to contend with.”
“Along with purely physical concerns,” he notes, “relationship problems, problems at work or school, low self-esteem and other mental health issues can be at the root of this problem.”
Situational Anxiety and Erectile Dysfunction
As well as more long-term issues like the above, in-the-moment nervousness can also produce erectile difficulties.
If you’re nervous about hooking up with a new partner, feeling more pressure to perform than usual, or simply beginning to doubt your sexual prowess, these feelings can have a serious impact on your erection. How? By triggering your sympathetic nervous system, rather than your parasympathetic one.
“The parasympathetic system, which is the hormonal system for relaxation, good times and things like that — you need that for the erection,” Shaw says. “However, if it’s a stressful environment, where you release the sympathetic system — which is the fight-or-flight component — you’re not going to have erectile function.”
You might never have heard of the sympathetic and parasympathetic nervous systems before, but you’ve definitely experienced them. These two states help humans govern vastly different responses to different stimuli in their environments.
And it makes sense — your body needs to be able to react differently to, for instance, a tiger attacking you than it does when your lover starts to kiss you while sitting on the edge of the bed. The sympathetic and parasympathetic nervous systems ensure that the person being chased by a tiger is ready to run for their life, while the person getting kissed is able to relax and enjoy themselves.
However, if you’re feeling unexpectedly anxious in a sexual situation, your brain can read these signals as an indication to release the sympathetic nervous system — even if there aren’t any tigers present.
The Snowball Effect and Erectile Dysfunction
People can “get caught up in this negative cycle of anxiety and stress with erectile function, which feeds on itself,” says Shaw.
As a result, if the stress of not performing in one situation carries over to a future situation, even a relatively small amount of pressure can quickly snowball into what feels like a lasting and chronic problem as you become less and less confident and more and more anxious.
“There are guys whose wives are going through fertility issues, and the guy is basically a sperm donor, there to have sex on a regular basis, and the wife is agitated, up in arms, trying to have kids. I have guys who come to me, like, ‘I’ve never had erectile dysfunction, and now my wife wants me to have sex with her all the time, and I can’t get it up!’”
How Can Erectile Dysfunction Impact You?
Erectile dysfunction is a peculiar medical condition in that, in and of itself, it doesn’t impact any aspect of your life — except sexual function.
But because sex and libido are such important parts of so many people’s lives, and the ability to be a good lover is an important part of so many men’s self-conceptions and self-esteems, E.D. can have serious impact on your emotional well-being. It won’t in every case, of course — particularly if it’s a rare or one-time thing. But different people will react differently to the experience.
“It really depends on what a guy makes of it, and how his partner(s) responds,” says Dr. Jason Winters, founder and director of the West Coast Centre for Sex Therapy. “Most guys will occasionally struggle to get or maintain their erections — it’s pretty common.”
“If a guy recognizes this and can brush off the experience, then he won’t likely be affected that much,” Winters notes. “On the other hand, if he experiences it as a devastating, humiliating blow to his ego, he’s likely to become anxious about his future performance. This can have a snowball effect, because his anxiety will create a self-fulfilling prophecy, in that it will lead to difficulties in functioning during subsequent experiences.”
“Repeated experiences will just make things worse, and his confidence will erode,” he explains. “A partner who responds poorly, such as being critical or making it about them (i.e., perceiving it as being due to their lack of attractiveness), can also negatively impact a guy and leave him anxious about future experiences.”
There’s a reason guys can get so worked up about this: they’re often taught from a young age that being a powerful, masculine lover is an important trait of being a man.
“Culturally, we view men with E.D. as less virile, and less worthy, which only adds stigma to a very normal experience,” says Caraballo. “Sexologist Dr. Chris Donaghue coined the term erectile disappointment, which is far less stigmatizing, yet accurate in addressing the issue.”
Whether it’s schoolyard jokes, portrayals of virile or effete men in pop culture, or explicit instructions about pleasing a partner, there’s often little room in our cultural consciousness for men who are simultaneously impressive and impotent.
“E.D. can lead to embarrassment, sexual shame and future performance anxiety,” Caraballo adds. “Men should realize that erectile disappointment is normal and doesn’t mean that they are broken. There a number of factors as to why it could be happening, but most importantly, men should not panic when this occurs. Consulting with a therapist and a doctor can very quickly help you get to the cause and potential resolutions.”
How to Prevent, Address and Treat Erectile Dysfunction
If you’re looking up E.D., chances are you’re already being impacted it — or you’re worried about the possibility. You probably want to know how best to prevent it from happening — whether it’s for the first time, the second time, or for the dozenth or hundredth time.
As Caraballo noted, it’s important not to panic. While struggling to achieve erection could indicate underlying health concerns, it might be a random occurrence more due to over-indulgence in drugs or alcohol, or a moment of situational anxiety, as opposed to a chronic issue.
“If it’s an occasional experience, then let it slide,” Winters advises. “It happens; erections will flat-line when conditions aren’t conducive to arousal. If you find yourself struggling and getting anxious, focus on what feels good, rather than performance — sexual pleasure leads to arousal, and arousal leads to erections.”
To do that, Winters suggests you try to “create and tune into the sensory experiences that are going to turn you on (i.e., touch, and what you see, hear, smell, and/or taste).”
“Getting stuck in your head is going to distract you from what would otherwise arouse you,” he notes.
And while you might find the experience (or experiences) deeply embarrassing, you should talk to your partner about them rather than trying to hide the issue or pretend nothing’s wrong, he says.
“Addressing the elephant in the room will help you both feel better about what’s happening, and will prevent your partner from taking blame,” Winters notes. If you continue to struggle with psychological issues that are causing E.D., he suggests visiting a professional, potentially a sex therapist.
“But make sure that it’s someone who has the credentials and expertise to be able to help you out,” he cautions. Doing a bit of background research first can go a long way towards solving the problem.
Erectile Dysfunction and Doctors
Before you start looking up psychologists and sex therapists, you should first consult a medical doctor.
If the erection issues you’re experiencing are symptoms of a health issue, figuring out what that is exactly should be your first concern, since some causes of E.D. are linked with much more serious conditions than a flaccid penis.
So however important your sex life is to you, talking to your doctor about your E.D. could be an issue impacting your actual life. In other words, power through any concerns you have about making a doctor’s appointment and set some time aside in your schedule.
“Guys don’t go to the doctor on a regular basis, but when they have erectile issues, they come in,” Shaw says. “A lot of guys are embarrassed to come in and get checked out.”
“There is scientific research and data that suggests that guys in their 30s and 40s who have early-onset erectile dysfunction have a higher risk of heart attack or stroke in the upcoming decade, because there are lurking factors,” he adds. “Way before you block a major coronary artery or your aorta or your carotid artery, the tiny blood vessels to the penis are going to get affected first. So the penis is like the canary in the coal mine.”
So yes, that E.D.-inspired doctor visit could mean the difference between catching a potential health crisis with enough time to prevent it and falling victim to it.
“The right answer is to go visit the doctor and get evaluated,” Shaw says. “I always suggest going to a urologist or a primary care or internal medicine doctor for evaluation, because then you’re going to get the thorough, deep-dive check. Being checked by a medical professional is probably the best way to make sure that nothing is missed.”
Erectile Dysfunction and Pills
Shaws says that the prevailing culture might be to try to fix the problem with an easy pill-based solution, but a full check-up is necessary to make sure the doctor can figure out the root causes of your erection issues.
“All that stuff is, ‘go get a Viagra, go get a Cialis,’ which may work for a lot of people,” Shaw says. “But I will tell you, a guy may have an underlying factor, like low testosterone. They may have diabetes and don’t know it. They may have high cholesterol and don’t know it.”
That being said, if your E.D. isn’t linked to more serious health concerns, modern medicine can help fix it — but you don’t need to break the bank to do so. Why? Paying top dollar for brand names just isn’t necessary now that there are generic versions on the market. You can get the same effect for a much lower price, and through a pharmacy, meaning you aren’t dealing with shady black-market ingredients.
“I would say to go with a mainline medication like sildenafil or tadalafil, which is the generic Viagra and Cialis,” Shaw says. “Don’t try to buy things off the Internet, because they may be laced with other agents. Go through a licensed reputable physician and pharmacy for your medical treatment.”
Erectile Dysfunction and Sex
If the issue isn’t immediately or easily resolvable, so long as you’re seeking treatment for it, you might wonder what to do in the interim. Can you have good sex if you have E.D.?
The answer is a resounding yes — provided you’re willing to change your expectations somewhat. For starters, you’ll need to say goodbye to how you used to have sex — at least for a little bit.
“Rethink what sex means,” Lords advises. “If you only view ‘sex’ as penetration, you’re going to be disappointed in your post-E.D. sex life. But if you look at it as anything that feels good sexually — to you or to your partner — then you’ve opened up a range of options.”
Can Porn or Masturbation Cause Erectile Dysfunction?
If you’re a big consumer of internet porn, you don’t necessarily have to quit watching it.
While it’s true that studies have shown that porn consumption can impact sexual desire and function in some people — by watching porn to the point where they struggle to remain aroused without it — most E.D. issues are related to other factors.
If you’re able to achieve an erection while watching porn but struggle to without it, it might be a good idea to try to wean yourself off porn for a while in order to reset your relationship to it.
RELATED: How to Quit Watching Porn (At Least Temporarily)
How to Stimulate a Man with Erectile Dysfunction
Regardless of your gender or sexual orientation, if it’s your partner who’s struggling with erection issues, you might be wondering how to touch them now, or whether it’s your fault.
Because E.D. is so often a physiological issue, there’s a good chance that it’s not you — particularly if you’ve been together a long time and there’s no first-time jitters.
That being said, changes in the relationship can impact what the sex is like, so it’s worth talking to your partner honestly to find out if there’s something making them stressed out in a way that might impact their arousal levels.
As for what you can do, well, the only limit is your imagination.
“We reduce men’s sexuality to equipment, function, and performance, and we think performance is literally only penetrative sex with a penis into a vagina,” says Play. “We should think more about the full picture here. Men have more erogenous zones than just their penis, which are often overlooked.”
And if a guy is worried about not being able to pleasure a female partner without a throbbing erection, there’s lots to learn.
“Pleasure for women is often actually much more about touch and external stimulation of the clitoris,” Play says. “Pleasure and performance can have a much broader category. If you want some examples, think erotic massages, sexual touch, kink, prostates and nipples, and so much more.”
Lords agrees, adding that couples can try oral sex performed on your partner, fingering or handjobs, and using sex toys. “For people with E.D., now might be a time to try anal play — prostate massage, butt plugs, rimming, pegging.”
Products to Help People Impacted by Erectile Dysfunction
Apart from exploring all your many kinks and new sensations to the fullest, unhooking sex from pure penile penetration can also mean you explore using sex toys for the first time — or more than you’re used to.
“Depending on the cause and symptoms of a person’s E.D., some sex toys might help,” says Lords. “Cock rings can help you maintain an erection by squeezing the base of the shaft (or testicles) to restrict the blood flow once you’re hard. Penis pumps can help draw the blood into your shaft so that you get an erection. Prostate issues (such as an enlarged prostate) can lead to E.D., so prostate massagers that help you stimulate that area might also be something to try.”
Looking to improve your sexual performance and satisfaction in bed? While you should definitely prioritize seeking medical attention and having a candid conversation with your doctor instead of attempting home remedies that might not work (or might not be safe!), there are some sex toys and supplements that might make a slight difference if your ED is mild.
Here, a few options to attempt – just keep in mind that your health is far more important than attempting to solve the issue on your own. Consult a trusted physician before trying anything below your belly button:
Bigbanana 6-Speed Vibrating Penis Ring
Don’t let the color shade fool you – this awesomely-rated and highly-recommended waterproof, rechargeable cock ring means business. It features six vibration speeds, allowing you to determine which pulsing motion works best for your specific sexual needs and preferences. Its design aims to enhance your performance, while also working double-duty to delay the grand finale, giving your partner time to enjoy the ride.
VitaFLUX Daily Supplement
This supplement not only brings a wellness boost to your every day, with benefits including increased energy, improved circulatory help, and faster recovery from workouts, but it can also help you out in the bedroom. The ingredient blend of L-arginine (2000 mg), L-citrulline (1000 mg), L-Carnitine tartrate (1000 mg, Zinc, and Magnesium, gives the libido a boost, increases testosterone production, and improves blood flow, resulting in erections that are stronger and easier to gain and maintain.
Silicone Male Erection Enhancement Set
Want to try out a cock ring but not ready to talk to your partner about it? Order this set of six to give you a crash course into using these enhancement toys, all delivered in discreet packaging. Made for various sizes, waterproof, and totally safe-silicone, give yourself permission to take an afternoon off to play, practice, and pleasure yourself.
Extra Strength L-Arginine Supplement
Made with extra-strength L-Arginine, this natural supplement combines with Arginine HCI and Arginine Alpha Ketoglutrate with Citrulline, to rev up your body and prepare it for the long haul of love-making. What is L-Arginine? Talk to your doctor before popping a pill, but this amino acid converts into Nitric Oxide, so it helps your blood vessels relax while amping up your blood circulation. This recommended brand contains no artificial ingredients, sugars, chemicals, or preservatives, so it’s about as all-natural as you can get.
Extra Strength Horny Goat Weed Extract
The name says it all for this bad-boy supplement: it’s designed to get you in the mood. What’s it made of? An impressive mixture of eco-friendly all-stars, including ginseng, maca root complex, saw palmetto, L-Arginine, and tribulus that helps you zen out, while pumping your blood harder. It’s also recommended for working out, and promises not to give you jitters with its chemical, preservative, artificial ingredients-free formula.
Hims Sildenafil
hims has changed the way men are taking care of themselves from head to… well, penis. Using telemedicine practices that link patients to doctors through the internet, hims launched with affordable hair loss options both OTC and prescription in early 2017, and soon made their way into prescription remedies for erectile dysfunction. To obtain Viagra in the past, guys had to get a script from the doctor with a hefty price tag. hims now offers the option to obtain Sildenafil, the active ingredient in Viagra, for a fraction of the price. Arriving in nondescript packaging, you can rest assured no one is going to be any wiser to your new found erectile freedom.
Try hims for only $5 at forhims.com
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