WHAT IS ERECTILE DYSFUNCTION

Your sexual health is an important part of your overall well-being. Erectile dysfunction (ED) becomes more common with age, but it can affect adults at many stages of life. Many people feel uncomfortable talking about changes in sexual function, yet discussing these concerns with a health-care professional is an important step toward understanding what might be causing the problem.

Erectile dysfunction means having ongoing difficulty getting or keeping an erection that is firm enough for sexual activity. Sometimes ED can be related to underlying medical conditions, including heart and blood vessel disease. Because of this, it is important to speak with a doctor or nurse practitioner so that any contributing health issues can be identified and addressed. If ED is affecting your quality of life or relationships, you do not need to manage it alone. A health-care professional can review your medical history, explore possible causes, and discuss options that may be appropriate for you.
Erectile Dysfunction

Physical Causes of ED

  • There is not enough blood flow into the penis. Many health issues can reduce blood flow, such as hardened arteries, heart disease, high blood sugar (Diabetes), and smoking.

  • The penis cannot trap blood during an erection. If blood does not stay in the penis, a man cannot keep an erection. This issue can happen at any age.

  • Nerve signals from the brain or spinal cord do not reach the penis. Certain diseases, injuries, or surgery in the pelvic area can harm nerves in the penis.

  • Diabetes can cause small vessel disease or nerve damage to the penis.

  • Cancer treatments near the pelvis can affect the penis' function. Surgery and radiation for lower abdomen or pelvis cancers can cause ED. Treating prostate, colon-rectal, or bladder cancer often leaves men with ED. Cancer survivors should see a Urologist for sexual health concerns.

  • Drugs used to treat other health problems can negatively impact erections.

  • Patients should talk about drug side effects with their primary care doctors.

Emotional Causes of ED

Regular sex needs the mind and body to work harmoniously. Emotional or relationship problems can cause or worsen a person's ED. Some emotional issues that can cause ED are:

  • Depression

  • Anxiety

  • Relationship issues

  • Stress at home or work

  • Stress from social, cultural, or religious beliefs

  • Worrying about sexual performance

ED medication works by enhancing the effects of nitric oxide, a natural chemical the body produces that relaxes muscles in the penis. Increasing blood flow allows a man to get and maintain an erection. Sexual stimulation is first required before taking the medication, which releases nitric oxide from the penile nerves. These medications boost the signal, allowing normal penile function to take effect.

The medications vary in dosage, how long they work, and their side effects. If side effects occur, they typically include flushing, nasal congestion, headache, visual changes, backache, and stomach upset. If you do not obtain an erection, contacting your physician is essential. Do not take more or increase your dosage without first speaking to your doctor. Your doctor will assess your situation to determine which medication will work best for you. These medications might not treat your erectile dysfunction immediately.

Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal therapies, get your doctor's approval. Medications for ED do not work for everyone and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:

  • Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Isordil, Bidil)

  • Have heart disease or heart failure

  • Have shallow blood pressure (hypotension)

Other Possible Approaches

In some cases, a specialist may discuss other options for ED management, such as certain medical procedures, devices, or hormone-based therapies. These approaches can have specific benefits, risks, and side effects and are generally considered when more conservative measures are not successful or appropriate. Decisions about these treatments should always be made in consultation with a qualified health-care professional who understands your full medical history.

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The International Index of Erectile Function (IIEF-5) questionnaire below will provide you with a quick result in the form of a score from 5 to 25.

Men with concerns about their erectile function can take this quick test and get some information on whether it might be good to seek help for ED.

What Qualifies as an Erectile Dysfunction Problem?

Most men have experienced some difficulty in getting or keeping an erection. Having trouble when you’re nervous or have had too much to drink may not be something to be concerned about.

It isn’t erectile dysfunction unless you are experiencing ongoing difficulty.

The Canadian Study of Erectile Dysfunction identified 49.4% of men over 40 with ED (Canadian Urological Association erectile dysfunction guideline 2015). Though all men may experience an occasional lapse of sexual function, ED is the persistent inability to achieve an erection, despite being sexually aroused.

IIEF-5 Erectile Dysfunction Questionnaire Scoring

Each of the questions has five possible responses, with score values from one to five.

Your total score is simply the sum of the values of all five answers to the ED test questions.

Possible ED Test Score Ranges

22-25: No erectile dysfunction
17-21: Mild erectile dysfunction
12-16: Mild to moderate erectile dysfunction
8-11: Moderate erectile dysfunction
5-7: Severe erectile dysfunction

The results of this brief self-evaluation should be used as a guide for whether you might want to consult with a doctor, and not as a replacement for a medical consultation.

Take the International Index of Erectile Function (IIEF-5) Questionnaire

Answer the five questions and the results will be automatically emailed to you in minutes.

The information you choose to share will be treated as confidential and will not be disclosed to any third parties.

1. How do you rate your confidence that you could get and keep an erection?**
2.When you had erections with sexual stimulation, how often were your erections hard enough for penetration?*
3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?*
4. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?*
5. When you attempted sexual intercourse, how often was it satisfactory for you?*