Table of ContentsView AllTable of ContentsHow Erections OccurPhysical Causes of Erectile DysfunctionPsychological Causes of Erectile DysfunctionTreating Erectile DysfunctionCoping
Table of ContentsView All
View All
Table of Contents
How Erections Occur
Physical Causes of Erectile Dysfunction
Psychological Causes of Erectile Dysfunction
Treating Erectile Dysfunction
Coping
Erectile dysfunction(ED) becomes more common as people get older because testosterone levels drop over time. In fact, age is the variable most strongly associated with ED.
In this article, we’ll discuss why ED becomes more common with age as well as prevention and treatment options.
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During sexual arousal, nerves release chemicals that increase blood flow into the penis. Blood flows into two erection chambers in the penis, which are made of spongy muscle tissue called thecorpus cavernosum(CC). During an erection, the CC fills up with blood, making the penis firm.
After orgasm, the muscles of the penis relax, releasing blood back into the circulation system. As a result, the erection comes down, the penis is soft and limp, and the person’s urogenital system returns to its pre-arousal state.
Occasional ED is common and not usually indicative of a problem, but more frequent bouts may disrupt your life. ED that occurs due to a physical cause usually happens for one of the following reasons:
Other common causes of ED include:
The following risk factors put some people with penises at a higher risk of developing ED in their lifetime:
The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:
Effectively treating ED is highly dependent on finding the root cause of the disorder. Some providers use a questionnaire to supplement their medical history and physical exam. Questionnaires may rate your ability to initiate and keep erections, gauge your satisfaction with sex, and help identify any problems with orgasm.
Your healthcare provider may also order blood tests and collect a urine sample to look for health problems that may cause ED. Gathering this information will help your provider determine the best and mostspecific treatmentsfor your erectile dysfunction.
If the root of your ED is physical, your doctor or another healthcare provider may point out certain lifestyle-related risk factors like smoking or an unhealthy diet that you can change. They may also change medications that you are taking for another health condition that may be causing your ED, such as some antidepressants and high blood pressure drugs.
The most common treatment for ED is a prescription oral pill that can help you get and maintain an erection, such as:
These medications differ in how quickly they work. For example, Viagra, the most popular of these supplements, generally starts to work 30 to 60 minutes after you take it, but Cialis works in 16 to 45 minutes after consumption.
No matter which of these medications you take, seek immediate medical attention if you develop vision or hearing loss or an erection that lasts for more than four hours, a condition calledpriapism.
ED Meds and NitratesED medications like Viagra should never be taken with nitrates or alpha-blockers, as the combination can lead to a sudden drop in blood pressure. Never stop taking medication for another health condition or start taking ED medications without first speaking with a healthcare provider.
ED Meds and Nitrates
ED medications like Viagra should never be taken with nitrates or alpha-blockers, as the combination can lead to a sudden drop in blood pressure. Never stop taking medication for another health condition or start taking ED medications without first speaking with a healthcare provider.
Other Treatment Options
Testosterone therapy: This is helpful in those with chronically low testosterone levels, but it is rarely helpful in those with low testosterone due to age or circulatory or nerve dysfunction. However, while testosterone replacement may not be the only management for age-related ED, there is a synergy between testosterone and ED medication that may be helpful.
Penile injections: People who want more immediate erections may opt to inject a prescription medicine called alprostadil (or a mixture of papaverine, phentolamine, and alprostadil called Trimix) into the penis, causing it to become filled with blood. If you do not like the idea of injecting yourself, you may prefer to insert a suppository of alprostadil—a solid piece of medicine that dissolves—into the urethra.
Penile pumps: People who experience side effects from oral ED pills may find avacuum pumpbeneficial. A vacuum device is used during intercourse to prevent blood from flowing back into the body. It cannot be used for long, however, as the ring portion of the device must be removed after 30 minutes to avoid skin irritation and numbness.
Surgery: This procedure consists of a urologist implanting a device (two- or three-piece inflatable penile prosthesis) to make the penis erect.
Therapy: If the root cause of your ED is psychological, cognitive behavioral therapy, couples therapy, or counseling to talk through your issues or trauma and treat your anxiety and depression may be helpful.
ED can be especially disheartening because it can make you feel unable to meet your sexual needs and desires or those of your partner. Talking to your partner is a good place to start. They can help you cope with the condition and rethink sex. Next, you may want to talk to a doctor to figure out the root cause and identify potential treatment options.
People with ED would probably agree that there is a profound emotional component to the condition. They may feel insecure about their sexual performance, and may begin to experience anxiety and depression. Talk therapy is a useful tool to unpack those thoughts and feelings, and sometimes it’s all that is needed to jumpstart one’s sex life.
It’s also important to note that anxiety and depression can be both a cause and a symptom of ED. In other words, anxiety or depression can affect your sexual arousal and therefore cause ED, but not being able to perform in bed may also make you anxious and nervous or lead to sexual avoidance, which can further exacerbate your ED.
Talking to your partner about ED can be understandably difficult, but a part of any healthy relationship and sex life is communication. Talking about your difficulties takes the pressure off you and informs your partner of what’s going on. It can also serve as an opportunity to engage in more pro-healthy behaviors together, such as quitting smoking, exercising more, and eating a heart-healthy diet.
Joining a support group and reimagining your sex life are also worthwhile coping mechanisms. Remember that intimacy is not dependent on penile penetration. Foreplay and intimate touching are also important components of a healthy sex life.
A Word From Verywell
As you get older, your chances of experiencing erectile dysfunction increase, but it’s far from a definite eventuality. ED is a complex condition, with physical, emotional, social, and practical components. Despite its complexity, it does not have to define you or your relationships.
A supportive environment is important whether the cause of your ED is physical or psychological. Remember that communication is key when dealing with erectile dysfunction and that you can enjoy a great sex life despite it.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB.Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study.J Urol. 1994;151(1):54-61. doi:10.1016/s0022-5347(17)34871-1Echeverri Tirado LC, Ferrer JE, Herrera AM.Aging and erectile dysfunction.Sex Med Rev. 2016;4(1):63-73. doi:10.1016/j.sxmr.2015.10.011Yafi FA, Jenkins L, Albersen M, et al.Erectile dysfunction.Nat Rev Dis Primers. 2016;2:16003. Published 2016 Feb 4. doi:10.1038/nrdp.2016.3Johns Hopkins Medicine.Erectile Dysfunction.Foy CG, Newman JC, Berlowitz DR, et al.Blood pressure, sexual activity, and erectile function in hypertensive men: baseline findings from the systolic blood pressure intervention trial (SPRINT).J Sex Med.2019;16(2):235-247. doi:10.1016/j.jsxm.2018.12.007Nehra A, Jackson G, Miner M, et al.The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease.Mayo Clin Proc. 2012;87(8):766-778. doi:10.1016/j.mayocp.2012.06.015Moon KH, Park SY, Kim YW.Obesity and erectile dysfunction: from bench to clinical implication.World J Mens Health. 2019;37(2):138-147. doi:10.5534/wjmh.180026NIH.Treatment of erectile dysfunction.Khan S, Amjad A, Rowland D.Potential for long-term benefit of cognitive behavioral therapy as an adjunct treatment for men with erectile dysfunction.J Sex Med.2019;16(2):300-306. doi:10.1016/j.jsxm.2018.12.014
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB.Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study.J Urol. 1994;151(1):54-61. doi:10.1016/s0022-5347(17)34871-1Echeverri Tirado LC, Ferrer JE, Herrera AM.Aging and erectile dysfunction.Sex Med Rev. 2016;4(1):63-73. doi:10.1016/j.sxmr.2015.10.011Yafi FA, Jenkins L, Albersen M, et al.Erectile dysfunction.Nat Rev Dis Primers. 2016;2:16003. Published 2016 Feb 4. doi:10.1038/nrdp.2016.3Johns Hopkins Medicine.Erectile Dysfunction.Foy CG, Newman JC, Berlowitz DR, et al.Blood pressure, sexual activity, and erectile function in hypertensive men: baseline findings from the systolic blood pressure intervention trial (SPRINT).J Sex Med.2019;16(2):235-247. doi:10.1016/j.jsxm.2018.12.007Nehra A, Jackson G, Miner M, et al.The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease.Mayo Clin Proc. 2012;87(8):766-778. doi:10.1016/j.mayocp.2012.06.015Moon KH, Park SY, Kim YW.Obesity and erectile dysfunction: from bench to clinical implication.World J Mens Health. 2019;37(2):138-147. doi:10.5534/wjmh.180026NIH.Treatment of erectile dysfunction.Khan S, Amjad A, Rowland D.Potential for long-term benefit of cognitive behavioral therapy as an adjunct treatment for men with erectile dysfunction.J Sex Med.2019;16(2):300-306. doi:10.1016/j.jsxm.2018.12.014
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB.Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study.J Urol. 1994;151(1):54-61. doi:10.1016/s0022-5347(17)34871-1Echeverri Tirado LC, Ferrer JE, Herrera AM.Aging and erectile dysfunction.Sex Med Rev. 2016;4(1):63-73. doi:10.1016/j.sxmr.2015.10.011Yafi FA, Jenkins L, Albersen M, et al.Erectile dysfunction.Nat Rev Dis Primers. 2016;2:16003. Published 2016 Feb 4. doi:10.1038/nrdp.2016.3Johns Hopkins Medicine.Erectile Dysfunction.Foy CG, Newman JC, Berlowitz DR, et al.Blood pressure, sexual activity, and erectile function in hypertensive men: baseline findings from the systolic blood pressure intervention trial (SPRINT).J Sex Med.2019;16(2):235-247. doi:10.1016/j.jsxm.2018.12.007Nehra A, Jackson G, Miner M, et al.The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease.Mayo Clin Proc. 2012;87(8):766-778. doi:10.1016/j.mayocp.2012.06.015Moon KH, Park SY, Kim YW.Obesity and erectile dysfunction: from bench to clinical implication.World J Mens Health. 2019;37(2):138-147. doi:10.5534/wjmh.180026NIH.Treatment of erectile dysfunction.Khan S, Amjad A, Rowland D.Potential for long-term benefit of cognitive behavioral therapy as an adjunct treatment for men with erectile dysfunction.J Sex Med.2019;16(2):300-306. doi:10.1016/j.jsxm.2018.12.014
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB.Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study.J Urol. 1994;151(1):54-61. doi:10.1016/s0022-5347(17)34871-1
Echeverri Tirado LC, Ferrer JE, Herrera AM.Aging and erectile dysfunction.Sex Med Rev. 2016;4(1):63-73. doi:10.1016/j.sxmr.2015.10.011
Yafi FA, Jenkins L, Albersen M, et al.Erectile dysfunction.Nat Rev Dis Primers. 2016;2:16003. Published 2016 Feb 4. doi:10.1038/nrdp.2016.3
Johns Hopkins Medicine.Erectile Dysfunction.
Foy CG, Newman JC, Berlowitz DR, et al.Blood pressure, sexual activity, and erectile function in hypertensive men: baseline findings from the systolic blood pressure intervention trial (SPRINT).J Sex Med.2019;16(2):235-247. doi:10.1016/j.jsxm.2018.12.007
Nehra A, Jackson G, Miner M, et al.The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease.Mayo Clin Proc. 2012;87(8):766-778. doi:10.1016/j.mayocp.2012.06.015
Moon KH, Park SY, Kim YW.Obesity and erectile dysfunction: from bench to clinical implication.World J Mens Health. 2019;37(2):138-147. doi:10.5534/wjmh.180026
NIH.Treatment of erectile dysfunction.
Khan S, Amjad A, Rowland D.Potential for long-term benefit of cognitive behavioral therapy as an adjunct treatment for men with erectile dysfunction.J Sex Med.2019;16(2):300-306. doi:10.1016/j.jsxm.2018.12.014
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