Erectile dysfunction, or ED, is a man’s inability to achieve and erection or to maintain an erection for sexual activity. It is not the same as other sexual difficulties like lack of desire, or problems with ejaculation. Though accurate statistics are difficult to obtain, the Massachusetts Male Aging Study, one of the largest American studies of ED, estimated that 50 million men in the United States have some degree of ED. Erectile dysfunction can occur in men of any age, but it is more common as men get older. By age 45, most men have experienced ED at least once. Medical experts disagree on what causes ED, but six of the most commonly cited causes are (in no particular order):
- Cardiovascular Disease
- Low Testosterone Levels
- Psychological Issues
- Environmental Toxins
This article discusses each of these six cited causes of ED.
Dr. Terry Mason, Chief Medical Officer at Cook County Hospitals in Illinois and a trained urologist, attributes many cases of ED to cardiovascular disease. In 2011, Dr. Mason told CNN.com, “When men begin to have erectile dysfunction, it’s a sign that there’s more widespread disease, and not just for the heart, but throughout all blood vessels in the body.
Sub-optimal heart health can also cause ED in another way. When a man’s diet contains a lot of fatty foods and he does not exercise regularly, narrowing and hardening of the arteries result, causing poor circulation throughout the body, including sexual organs.
Another medical expert who believes that cardiovascular disease is behind many cases of ED is Dr. Robert Stein, a New York University School of Medicine professor of cardiology and spokesman for the American Heart Association. Says Stein to CNN.com, “If I suffered from ED, I would start changing my lifestyle. Eat better, watch my cholesterol, stop smoking, exercise and see my doctor. This is important for all men, not just those with cardiovascular problems.”
A condition known as endothelial dysfunction happens when there is a chemical breakdown of the thin layer of endothelial cells that lines blood vessels, and it is common in people with diabetes. Erection occurs when blood vessels leading to the penis dilate, causing them to fill with blood. The process begins when the endothelial cells release nitric oxide, which signals for the smooth muscles in the penis to relax, allowing more blood to circulate.
Drugs like Viagra work by increasing nitric oxide in the endothelium. But while drug treatments for ED treat the problem of sexual dysfunction, they do not address underlying health problem like diabetes.
Doctors fear that when men treat their ED without considering underlying causes, they could be jeopardizing their overall health. Dr. Michael Bohm, lead author of a study published in 2011 in Circulation: Journal of the American Heart Association, says that ED can be a real wake-up call.
“The medication works, and the patient doesn’t show up anymore,” says Bohm, who concluded, “A whole segment of men is being placed at risk.”
A recent Australian study published in the Journal of Sexual Medicine found a strong link between excess weight and decreased sexual function in the form of ED. The good news is that losing 5% to 10% of body weight helped men regain erectile function. The study found that excess weight, particularly when it’s carried in the abdominal area, can affect sexual function in two ways, causing testosterone levels to drop, and interfering with the body’s ability to direct blood flow to the penis.
Though doctors aren’t certain of the exact physiology behind the phenomenon, obesity apparently causes damage to the endothelial cells lining blood vessels, resulting in insufficient blood flow to the sexual organs. Many doctors hope that the link between obesity and ED will prompt more men to seek medical attention to address their weight problem.
Kevin Billups, associate professor of urology at the University of Minnesota, Minneapolis, says, “You talk all the prevention you want. When I talk about restoring penile health, I have their attention.”
Low Testosterone Levels
Adequate levels of testosterone are necessary for achieving and maintaining erections, and many doctors believe that low testosterone is under-diagnosed. Excess weight carried in the abdomen not only diminishes endothelial cell function, but also causes testosterone levels to plunge. Losing excess weight will often restore erectile function.
There are cases, however, where low testosterone levels are not caused by excess weight. Dr. Ronald Tamler, co-director of the men’s health program at Mount Sinai Medical Center in New York says that treating low testosterone levels can restore sexual function.
“Men who have persistently low testosterone levels and ED despite losing weight may need to consider testosterone gels, shots, or patches.”
A testosterone study at Northwestern University Feinberg School of Medicine found that testosterone supplementation in the form of testosterone gel restores sexual function in older men.
“With men, testosterone loss sneaks up. One day they realize they’re not getting results in the gym, or they can’t get an erection in the morning when testosterone levels are highest,” according to Northwestern urologist Dr. Keven McVary.
Some men with ED suffer from psychological problems such as anxiety and depression. Erectile dysfunction can start a downward cycle of shame and doubt, making the problem worse. Joel Block, PhD, a psychologist and clinical professor at Albert Einstein College of Medicine in New York, says, “Once ED happens, it becomes self-perpetuating. The more he fails, the more difficulty he has.”
Psychological problems can eventually cause a man with ED to avoid sex, and can lead to serious conditions like clinical depression. If a man tries to cope with psychological problems by self-medicating with excess alcohol or drug use, the problem is compounded.
A study in China lead by Dr. De-Kun Li, reproductive epidemiologist at Kaiser Permanente has shown that bisphenol-A, or BPA, a chemical found in hard, clear plastic, may increase risk of ED in factory workers who are exposed to large amounts of the chemical. The risk of ED was more than four times greater in men who worked with BPA compared to men who worked in factories where they were not exposed to it.
The hypothesis is that when BPA enters the body, it can mimic the effects of the hormone estrogen and block male sex hormones, including testosterone.
The good news is that the rate of ED among those who worked with BPA was still only 15%. Furthermore, there is no conclusive evidence that everyday exposure to BPA from food packaging and other platics is enough to cause ED.
Though many men who suffer from ED simply want to treat the problem with popular ED drugs and move on with their lives, the fact that so many medical conditions are associated with ED should prompt men who experience the problem to visit their physician and find out if they have a medical problem that, with treatment, could address the root causes of ED.