Employee & Community Health

Men's Health: Getting an ED EDucation

7/5/2016 by Dr. Elliot Bruhl

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Anyone who watches TV probably has seen ads for erectile dysfunction (ED) medications. While these messages have raised awareness about ED, they provide little education about the problem.

What is ED?

ED is when a man can't get an erection or keep one long enough to finish having sex. Several large studies in the United States have shown that ED affects approximately 50% of men at age 50; this percentage increases as men grow older. 

The condition is even more common among men with diabetes, high blood pressure and coronary artery disease. Many people wonder if this problem is simply a "normal" aspect of growing older. The answer is "no." Most healthy men are able to get and keep erections into their 70s and 80s, although they often require more stimulation of the penis to finish having sex and ejaculate as they age. 

What causes ED?

ED is actually a complex problem and has many causes. The most common is inadequate blood flow into the penis. In a normal erection, blood vessels "open up," engorging the penis with blood so that it becomes hard. Many things may lead to ED for a man: 

  • Medical problems, including high cholesterol, high blood pressure, diabetes and heart disease, can reduce blood flow into the penis. Medications like Sildenafil (Viagra) and Tadalafil (Cialis) increase blood flow to the penis and allow men with this type of ED to have an erection. About 60-70% of all men with ED have a good/positive response to these medications. 
  • Smoking, heavy alcohol use and regular use of opiates and cannabis also cause ED. 
  • Neurological problems such as strokes, multiple sclerosis and peripheral nerve disease may affect erectile function. 
  • Many men (40-50%) who have had their prostate removed due to prostate cancer may suffer from ED. 
  • Some types of prescription medications, particularly blood pressure medicines, can cause ED. 
  • Psychological problems, including depression and relationship problems with your partner, also are common causes.

What treatments are effective? 

It's important to realize that drugs like Viagra and Cialis may have no effect on many cases of ED, since they only work in situations requiring increased blood flow. 

But there are many other types of erection treatments, which may be effective when oral medications don't work. These include: 

  • Vacuum pump. The pump inflates the penis with blood, which then is retained using a constricting band around the base of the penis. This generally allows for 20-30 minutes of erection time. Many men can successfully complete sexual relations with this method, including ejaculation. 
  • Medications. Medicine can be injected into the side of the penis or placed directly into the urethra. 
  • Penile implant. An implant requires surgery that places inflatable tubes in both sides of the penis. For an erection, these tubes can be inflated using a small pump located in the scrotum. An implant allows for normal urination and ejaculation. 

Talking with your care team. 

ED is very common and affects nearly half of all men over 50 in our country. Although you may feel embarrassed discussing these problems, it's important that you bring this concern to your care team's attention, since it may be an early symptom of a more serious threat to your health, such as hypertension or diabetes. 

Your care team can work with you to identify possible causes of ED and reverse those that are treatable. By discussing your sexual health openly and honestly with your health care provider, you can work together to find solutions that are right for you. 

Dr. Elliot Bruhl is a family physician in Employee and Community Health's (ECH) Department of Family Medicine and practices at Mayo Family Clinic Northwest.