What is Erectile Dysfunction?

Erectile dysfunction (ED) is the consistent inability to maintain or achieve an erection enough for satisfactory sexual activity. It is one of the most common yet under-discussed health conditions affecting Australian men. ED is not just a bedroom problem: it can be an early symptom of a hidden health condition such as diabetes and cardiovascular disease.

Regardless of how common ED is, many men delay seeking help, often out of embarrassment or the mistaken belief that it's simply "part of getting older," but the truth is that ED is treatable and in several cases it is preventable. In this blog, we will provide you with everything you need to know about erectile dysfunction, what it exactly is, its main causes, symptoms and treatment options available.

What Exactly is Erectile Dysfunction?

ED or impotence are the other names of Erectile dysfunction: it is basically the continuous or recurrent inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance. The main focus here is “continuous” because it is normal if you have difficulty getting or maintaining an erection occasionally and it is not a cause for concern. However, when it happens regularly, it becomes erectile dysfunction.

An erection is a complicated physiological function that involves the coordination between the nervous system, hormones, blood vessels and psychological state. When you become sexually excited, the brain sends signals that relax the smooth muscle in the penis, which allows blood to rush in and fill two cylindrical chambers. The pressure is created due to this increased blood flow, which results in an erection. Any disruption in the process, such as nerve damage, reduced blood flow, hormonal imbalance or psychological stress, can result in ED.

ED By the Numbers: Key Statistics

What Is Included in ED And What Is Not?

It is crucial to understand what is included in erectile dysfunction and what is not:

How Common is Erectile Dysfunction in Australia?

Erectile dysfunction is far more common than people think and Australia is no different from the rest of the world.

• According to a landmark cohort study of 108,477 Australian men, around 1 in 5 Australian men over 40 years of age experience erectile dysfunction.
• More than 50% of Australian men aged over 50 have some form of ED.
• According to a Western Australian population study, around 25.1% of adult males had any form of ED and severe ED is experienced by around 8.5% of them.
• Globally, erectile dysfunction is estimated to affect over 322 million men by 2025 which is up from an estimated 152 million in 1995, as per BJU International.
• Erectile dysfunction affects 40% of men in their 40s and approx50% of men in their 50s, this percentage is increasing by roughly 10% per decade of life.
• Even though its prevalence is increasing, ED is still underdiagnosed and undertreated because many men delay seeking help for years or never seek it at all.

Is Erectile Dysfunction Common in Young Men?

ED is often associated with older men, but it is increasingly common in men under 40 years of age. Approximately 26% of newly diagnosed ED cases are found in men under 40 and around 8% of men aged 20 to 29 years experience some degree of ED. Main causes of ED in younger men include the following:

• Psychological factors: ED in men under 40 can be caused by factors including depression, stress and performance anxiety.
• Lifestyle factors: Factors like poor sleep, excessive alcohol, smoking and lack of exercise can result in erectile dysfunction.
• Pornography induced ED: Excess exposure to pornography can reduce the sensitivity of the brain's arousal response, which can contribute to ED with real partners.
• Underlying health conditions: Due to modern lifestyle trends conditions like type 2 diabetes, hypertension, and hormonal imbalances are occurring earlier in life.

Many young men feel embarrassed to raise it with a doctor or assume that erectile dysfunction would not affect them. This can result in unnecessary distress and delayed treatment. However, ED in younger men often responds well to treatments when lifestyle or psychological factors are addressed early.

What Are the Signs & Symptoms of Erectile Dysfunction?

Some of the main symptoms of erectile dysfunction that are related specifically to difficulties with erection include the following:

• Difficulty achieving an erection when sexually aroused
• Trouble maintaining an erection long enough to complete sexual intercourse
• Erections that are not firm enough for penetrative sex
• Reduced frequency of erections
• Needing more stimulation than previously required to achieve an erection

These symptoms may occur occasionally or consistently. When symptoms occur consistently in all situations including with different partners, during masturbation or upon waking, physical causes may be the reason. But when symptoms are situational, then psychological causes are more likely to be involved.

When Should You See a Doctor?

You should seek help from a doctor if:

• Having difficulty getting or maintaining an erection for 3 months or more
• Cause distress or affect your relationship
• Having other symptoms like reduced libido, fatigue or changes in mood
• known cardiovascular disease or diabetes risk factors
• ED started after a pelvic or spinal injury or after starting a new medication

“ED is known as the early sign of serious diseases. If you have erectile dysfunction, you are at high risk of heart disease, stroke and death from cardiovascular causes.”

What is the Major Cause of Erectile Dysfunction?

ED is caused by a combination of physical, psychological and lifestyle factors. Approximately 80% of ED cases have a physical or organic cause and the remaining 20% account for psychological ED. Some of the main causes of erectile dysfunction are:

Physical Causes of Erectile Dysfunction

Some of the most common physical causes that interfere with the blood flow, nerve signals or hormonal balance required for an erection include the following:

Psychological Causes of Erectile Dysfunction

Although physical factors can function normally, your mind or attitude can affect your ability to get an erection. The following is a list of psychological causes of erectile dysfunction:

• Performance anxiety
• Depression, anxiety, or stress
• Stress due to job, relationship, or financial reasons
• Problems with partner
• Past sexual abuse or trauma
• Pornography-induced erectile dysfunction
• Low self-image and body image issues

Lifestyle Risk Factors

There is a strong link between your lifestyle and erectile dysfunction, and the following lifestyle factors can worsen erectile dysfunction:

• Smoking restricts blood supply to the penis
• Drinking excessive amounts of alcohol causes your central nervous system to slow down, making it hard for you to get an erection
• Drug use (including illegal drugs)
• Lack of exercise that prevents you from achieving regular muscle conditioning leads to poor body function
• Poor diet (too many processed and fatty foods consumed)
• Sleep problems, especially obstructive sleep apnoea, can lead to poor sleep quality

Lifestyle and ED have a powerful relationship and the good news is that you can modify lifestyle to get some of the best opportunities for improvement.

How is Erectile Dysfunction Diagnosed?

Your doctor will assess ED through a combination of medical history, physical examination and targeted tests:

• Step 1: Full Medical & Sexual History: Generally, the frequency, duration and nature of the erection problem, relationship factors, medication use and general health are discussed.
• Step 2: Order Blood Tests: Tests including testosterone levels, blood glucose (HbA1c), cholesterol panel, thyroid function and more.
• Step 3: Perform a Physical Examination: Doctor will perform Physical examinations like genital examination, blood pressure and body mass index to check for hormonal, vascular or neurological abnormalities.
• Step 4: Urine Tests: It is performed to check for any signs of diabetes or kidney disease.
• Step 5: Specialised Tests (If Required): The doctor may perform tests such as nocturnal penile tumescence, penile Doppler ultrasound or psychological assessment.

It is recommended that men with ED should also be screened for cardiovascular risk factors because ED is considered a predictor of major cardiovascular diseases.

What is the Best Way to Treat Erectile Dysfunction?

The treatment of ED should be tailored to its cause. Here are some of the available treatment options:

Comparing Erectile Dysfunction Treatment Options

Oral Medications: PDE5 Inhibitors (First-Line Medical Treatment)

The most widely prescribed and well researched class of medications for ED is PDE5 (Phosphodiesterase type 5), which works by enhancing the effect of nitric oxide that relaxes the smooth muscle of the penis and increases blood flow during sexual stimulation.

PDE5 inhibitors are found to be effective in approx. 60% to 70% of men with ED. In clinical trials, rates of successful intercourse for sildenafil, tadalafil and vardenafil were 65%, 62% and 59% as compared to 23% to 28% for placebo.

Can Erectile Dysfunction Be Prevented?

While genetics, aging, medical problems and compromised blood flow due to a lack of exercise do not allow all instances of erectile dysfunction (ED) to be prevented, a considerable amount of ED can be prevented from developing by making lifestyle modifications. Here are some of the best ways to help prevent the onset of ED:

• Keep Your Weight Under Control: Obesity is a leading risk factor for ED that is modifiable.
• Exercise: An exercise regimen that includes a significant amount of cardiovascular exercise will offer the greatest benefits to the health of the vascular system, which in turn will help maintain the health of the penis and the ability to achieve and/or maintain an erection.
• Quit Smoking: Smoking causes injury to the endothelial cells that line the arteries, which over time can lead to a decrease in the healthy function of the arteries and can interfere with the process of achieving and/or sustaining an erection.
• Control Vascular Diseases: Keeping diabetes, hypertension and hyperlipidemia under control through the provision of proper medical therapy is another important step to prevent the development of ED.
• Drink Alcohol in Moderation: An occasional drink is okay, but excessive alcohol consumption harms both the vascular system and the nervous system and will adversely affect the ability to achieve and/or sustain an erection.
• Protect Your Mental Health: Managing stress, securing treatment for any underlying anxiety or depression and recognizing the psychological components of sexual health are also necessary strategies to help prevent ED from occurring.
• Get Routine Medical Examinations: Obtaining routine medical examinations will help identify cardiovascular risk factors like diabetes and low testosterone early so that medical intervention can occur before ED is diagnosed or when it can be accelerated.

How DirectMeds Can Help?

Are you experiencing erectile dysfunction? You do not need to visit a GP waiting room or feel embarrassed at a pharmacy counter. DirectMeds connects you with AHPRA registered doctors online for confidential, expert ED assessment and treatment with comfort and privacy.

• Complete a 2 minute free online ED assessment
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• Receive a personalised treatment plan based on your specific health profile
• Have your prescribed medication delivered discreetly to your door
• Ongoing doctor support and treatment review included

FAQs About Erectile Dysfunction

1. What is the best treatment for erectile dysfunction?

Best treatment for erectile dysfunction – depends on the cause. Lifestyle changes (exercise and weight loss) and quitting smoking may improve symptoms in some men. Others may get relief from medication (Viagra, Cialis), counseling, and/or hormone therapy or extraordinary treatment (such as shock wave therapy).

2. Can erectile dysfunction be cured completely?

Sometimes, erectile dysfunction can be cured permanently. When the cause of erectile dysfunction (such as stress, obesity, smoking, etc.) is addressed, many men experience increased function. Improving health and lifestyle may create lasting changes in erectile function.

3. Which medicine works best for erectile dysfunction?

Some of the common prescribed ED medications include Vardenafil, Sildenafil (Viagra) and more. Each of these works in a somewhat different manner to create the desired effect. Consulting a physician about your medical history and overall health is important for finding the drug that is best for you.

4. Do younger men often experience erectile dysfunction?

Yes, younger men can also experience ED. The most common reasons ED occurs in men younger than 40 years old are stress, anxiety, depression, poor lifestyle choices, high levels of alcohol consumption, smoking and lack of sleep.

5. Can stress and anxiety cause erectile dysfunction?

Yes, stress, anxiety, feeling pressured to perform sexually or having problems in a relationship all contribute to decreased arousal leading to erectile dysfunction. Seeing a therapist or developing healthy stress management strategies may help improve symptoms.

6. Are erectile dysfunction medications safe to use?

Most ED medications are considered safe when prescribed by your doctor. However, men taking nitroglycerin for chest pain as well as men who have some heart conditions, should avoid using ED medications. Patients should always consult with their doctor before beginning any type of ED medication.

7. How effective are ED pills like Viagra and Cialis?

Many men have seen success using ED medications (Viagra & Cialis) because they help to increase the flow of blood to the penis. Some studies indicate that PDE5 inhibitors (Viagra/Cialis) will work in approximately 60-70% of ED cases.

8. Can exercise and diet improve erectile dysfunction?

Yes, you can greatly improve the quality of your erections by maintaining a routine of regular exercise as well as following a healthy diet. Some examples of exercise and diet that have been shown to help include aerobic exercise, controlling weight, getting better sleep on a regular basis and eating a Mediterranean diet. Doing these things will improve blood flow, balance hormones and improve sexual function in general.