Primary Care in Rochester and Kasson

Men's health: How to discuss erectile dysfunction

6/13/2022 by David Brennan, M.D.


Erectile dysfunction, commonly known as ED, affects millions of men worldwide. Unfortunately, it's a topic many hesitate to discuss. As a result, sexual health and relationships can suffer, and underlying medical problems can go undiagnosed. 

What is erectile dysfunction?

Erectile dysfunction is the inability to get an erection or keep one long enough to finish having sex. Other related types of sexual dysfunction include low libido and premature ejaculation. Many people wonder if these problems are simply a normal part of aging, and the answer is no. Most healthy men can get and keep erections into their 70s and 80s. 

What causes erectile dysfunction?

Sexual health is complex, and an erection relies on the mind and body to cooperate. The physical component of an erection involves blood vessels opening up and engorging the penis with blood so that it hardens. 

Several conditions can impair this process, including: 

  • Medical problems, including high cholesterol, high blood pressure, diabetes and heart disease, which can reduce blood flow into the penis. 
  • Smoking, heavy alcohol use and regular use of opiates and cannabis. 
  • Neurological problems, such as strokes, multiple sclerosis and peripheral nerve disease. 
  • Some prescriptions, particularly blood pressure medicines. 
  • Psychological problems, including depression and relationship problems with your partner. 

In addition, 40%–50% of men who have had their prostate removed due to prostate cancer may be affected by erectile dysfunction. 

Which treatments are effective?

Medications like Viagra and Cialis are usually the first step in treatment and are effective for many people. However, a discussion and examination with your primary care team is important to ensure these medications are safe. Your team also can ensure that any underlying medical conditions are identified and effectively managed. 

When oral medications fail, don't be discouraged. 

Other options 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 in the scrotum. An implant allows for normal urination and ejaculation. 

How to get help with erectile dysfunction

Although some people are hesitant or embarrassed to discuss these issues, sexual health is an important part of a healthy, happy life. Primary care is the perfect place to bring up concerns related to erectile dysfunction because your team has the expertise to help with next steps. 

If you are unsure how to start the conversation, start with an online questionnaire like this one that can help you and your primary care team learn more about your erectile symptoms: Sexual Health Inventory for Men

David Brennan, M.D., is a primary care physician in Community Internal Medicine, Geriatrics, and Palliative Care. He practices in the Baldwin Building in Rochester, Minnesota.