It doesn’t happen all at once.
There may be a time or two when you have some trouble getting an erection. After a while you notice that it isn’t as hard as it once was. Then you actually lose your erection while having sex.
The more bad experiences you have, the more you worry. And the more you worry, the worse the problems get. Before you know it, erectile dysfunction has become a part of your life.
For most men, the prospect of erectile dysfunction is very frightening. A survey of 597 men , conducted in 2018, found that ED can cause loss of self-esteem, anxiety, and depression. Moreover, most men are not comfortable talking about their condition, even with their partners. Many withdraw from intimate relationships and avoid sex for fear of “failure.” This can cause the partner to blame themselves for the problem, or feel undesirable and unwanted.
Fear, anxiety, and lack of communication can become part of a downward spiral, that can damage or even destroy relationships.
Avoiding the Downward Spiral
It’s possible to avoid the downward spiral.
The first step is to acknowledge the problem… to admit to yourself that you are experiencing symptoms of erectile dysfunction. If you are in a relationship, talk with your partner. Let them know that you’re having some difficulties maintaining an erection, and you plan on getting help. Reassure them that ED is a medical issue, and it is not their fault (or yours).
Erectile dysfunction can have many causes, both physical and psychological. The most common cause is a vascular or circulatory problem; that’s why ED is more prevalent among older men. In some cases, ED can be a symptom of a serious medical problem, so it’s important to see a doctor if you’re experiencing erectile problems.
Surprisingly, over 40% of men are “Not at All” or “Not Very” comfortable talking to their doctor about ED . There’s really no reason to be embarrassed or uncomfortable. Doctors treat hundreds of men with ED; their job is to diagnose the underlying cause, and recommend appropriate treatment options.
Although circulatory problems are a common cause of ED, there are many other potential issues, including neurological or nerve damage, Diabetes, Parkinson’s Disease, side effects of prescription medications, hormonal or vitamin deficiencies, and injuries. Erectile dysfunction can also be caused by psychogenic (psychological) factors such as anxiety, stress, depression, or relationship issues. Even if the primary cause is physical, these psychological factors can make the symptoms worse.
Treating Erectile Dysfunction
Unless your doctor finds a specific issue, they’ll probably recommend the standard “first line” treatment for ED:
- Pay attention to your overall health. This means quitting smoking, being moderate in your use of alcohol, eating a heart-healthy Mediterranean diet, and starting an aerobic exercise program. These changes will improve your cardiovascular health, and help fight erectile dysfunction.
- Try a prescription drug like Viagra, Cialis, Levitra, or their generic equivalents. These drugs belong to a class called type 5 phosphodiesterase (PDE5) inhibitors. PDE-5 inhibitors don’t cure ED, but they allow most men to achieve normal erections by taking a pill shortly before having sex. PDE-5 inhibitors have been found to be safe for long-term use.
Some men will experience side-effects, such as headaches or flushing, and some men will respond better to one drug than another. Don’t be discouraged if the first drug doesn’t work well for you; just ask your doctor to switch your prescription to another.
- If your doctor suspects there is a psychological cause for your ED, they may prescribe medication to help address the issue, or they may refer you to a therapist to help you get past it.
These standard steps are effective for about 65% of all men with ED. For men with severe ED, there are a number of other treatment options.
Intracavernous penile injections  are a good alternative for men who don’t respond well to PDE-5 inhibitors; they are effective for 80-85% of men. Medication is injected directly into the side of the penis prior to sex, using a very small needle. Just like a PDE-5 inhibitor, it allows a man to achieve a normal erection.
Another option, the penis pump, consists of a tube placed over the penis, and a pump to create a vacuum. This draws blood into the penis, creating an erection; the blood is then trapped in the penis using a ring or constriction band. Most men find penis pumps to be cumbersome and uncomfortable; they are usually not a good choice to achieve an erection prior to sex. However, there is some evidence that regular use of a penis pump can help restore blood flow to the penis, making it a worthwhile option for treatment of erectile dysfunction.
Another treatment that has become popular in recent years is Low-Intensity Extracorporeal Shockwave Therapy (LI-ESWT), commonly called shockwave therapy . It works by breaking up plaque that may block blood vessels, and promoting the growth of new blood vessels; it is used primarily to treat vascular ED. The therapy consists of a series of treatments administered in a clinical setting. There are also shockwave devices available for at-home treatment.
The most far-reaching solution to erectile dysfunction is a surgically inserted, inflatable penile implant. Most men try all other options before getting an implant, because the procedure is permanent and cannot be reversed. This is somewhat ironic, because both patients and their partners give implants the highest satisfaction rating of any treatment: over 90%! Inflatable chambers are surgically implanted in the penis, and a small pump is placed in the scrotum, allowing a man to have an erection any time he wants.
Over 30 million men in the United States have erectile dysfunction. Fortunately, there are now many resources available to help men and their partners, and there are a number of treatment options.
For men who are just coming to terms with ED, it’s important to acknowledge the problem, talk honestly with your partner, and get help from your doctor.
 “Comprehensive Study on the Impact of Erectile Dysfunction.” ED Treatment Information Center. March 30, 2018. https://edtreatment.info/ed-impact-study/
 “Intracavernous Penile Injections for Erectile Dysfunction” October 11, 2020. https://edtreatment.info/intracavernous-penile-injections-for-ed/
 “Shockwave Therapy (LI-ESWT) for Erectile Dysfunction.” November 30, 2020. https://edtreatment.info/shockwave-therapy-li-eswt-for-erectile-dysfunction/