A man is considered to have erectile dysfunction if he regularly finds it difficult getting or keeping a firm enough erection to be able to have sex, or if it interferes with other sexual activity.
Most men have occasionally experienced some difficulty with their penis becoming hard or staying firm. However, erectile dysfunction (ED) is only considered a concern if satisfactory sexual performance has been impossible on a number of occasions for some time.
Since the discovery that the drug sildenafil, or Viagra, affected penile erections, most people have become aware that ED is a treatable medical condition.
Men who have a problem with their sexual performance may be reluctant to talk with their doctor, seeing it can be an embarrassing issue.
However, ED is now well understood, and there are various treatments available.
This MNT Knowledge Center article offers helpful information for people experiencing this problem, or those close to them.
Fast facts on erectile dysfunction:
Erectile dysfunction (ED) is defined as persistent difficulty achieving and maintaining an erection sufficient to have sex.
Causes are usually medical but can also be psychological.
Organic causes are usually the result of an underlying medical condition affecting the blood vessels or nerves supplying the penis.
Numerous prescription drugs, recreational drugs, alcohol, and smoking, can all cause ED.
Normal erectile function can be affected by problems with any of the following systems:
Erectile dysfunction can cause embarrassment.
It is always worth consulting a physician about persistent erection problems, as it could be caused by a serious medical condition.
Whether the cause is simple or serious, a proper diagnosis can help to address any underlying medical issues and help resolve sexual difficulties.
The following list summarizes many of the most common physical or organic causes of ED:
heart disease and narrowing of blood vessels
high blood pressure
obesity and metabolic syndrome
hormonal disorders including thyroid conditions and testosterone deficiency
structural or anatomical disorder of the penis, such as Peyronie disease
smoking, alcoholism, and substance abuse, including cocaine use
treatments for prostate disease
injuries in the pelvic area or spinal cord
radiation therapy to the pelvic region
Atherosclerosis is a common cause of blood flow problems. Atherosclerosis causes a narrowing or clogging of arteries in the penis, preventing the necessary blood flow to the penis to produce an erection.
Numerous prescription medications can also cause ED, including those below. Anyone taking prescription medications should consult their doctor before stopping or changing their medications:
drugs to control high blood pressure
heart medications such as digoxin
drugs that act on the central nervous system, including some sleeping pills and amphetamines
antidepressants, including monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants
some cancer drugs, including chemotherapeutic agents
prostate treatment drugs
the peptic ulcer medication cimetidine
Physical causes account for 90 percent of ED cases, with psychological causes much less common.
In rare cases, a man may always have had ED and may never have achieved an erection. This is called primary ED, and the cause is almost always psychological if there is no obvious anatomical deformity or physiological issue. Such psychological factors can include:
fear of intimacy
Most cases of ED are ‘secondary.’ This means that erectile function has been normal, but becomes problematic. Causes of a new and persistent problem are usually physical.
Less commonly, psychological factors cause or contribute to ED, with factors ranging from treatable mental health illnesses to everyday emotional states that most people experience at some time.
It is important to note that there can be overlap between medical and psychosocial causes. For instance, if a man is obese, blood flow changes can affect his ability to maintain an erection, which is a physical cause. However, he may also have low self-esteem, which can impact erectile function and is a psychosocial cause.
Does riding a bicycle cause ED?
Questions remain about the effects on men’s health of riding a bicycle.
Some research has raised concerns that men who regularly cycle for long hours could have a higher risk of ED, in addition to other men’s health issues such as infertility and prostate cancer.
The most recent study to investigate this found that there was no link between riding a bike and ED, but it did find an association between longer hours of cycling and the risk of prostate cancer.
Prostate disease and ED
Prostate cancer does not cause ED.
However, prostate surgery to remove the cancer and radiation therapy to treat prostate cancer can cause ED.
Treatment of non-cancerous, benign prostate disease can also cause the condition.
The good news is that there are many treatments for ED, and most men will find a solution that works for them. Treatments include:
Men can take a group of drugs called PDE-5 (phosphodiesterase-5) inhibitors.
Most of these pills are taken 30 to 60 minutes before sex – the best known being the blue-colored pill sildenafil (Viagra). Other options are:
tadalafil (taken as a once-daily pill called Cialis)
PDE-5 inhibitors are only available on prescription. A doctor will check for heart conditions and ask about other medications being taken before prescribing.