Urologist and Medical Director at Kranus Health
What is erectile dysfunction (ED)?
Erectile dysfunction, or ED for short, is the consistent or recurrent absence of an erection of the penis during sexual arousal and/or the absence of an erection of the penis sufficient for sexual intercourse. According to the medical definition, erection problems are classed as erectile dysfunction only when symptoms last at least 6 months and prevent satisfactory sexual intercourse in more than 70% of cases.
There are different levels of severity in erectile dysfunction that range from mild to complete erectile dysfunction. How severe your problems are is determined by a simple questionnaire. The score is used, among other things, as a comparative value to measure the improvement in your erection after having completed successful treatment. This value is called the IIEF score.
How does erectile dysfunction manifest itself?
Some men have erection problems only in situations of sexual intercourse with a partner, others can not obtain a spontaneous erection in the morning. Some men will obtain an erection, but struggle to maintain it long enough. In other words, erectile dysfunction is a multifaceted condition. The diversity in erection problems is best explained with the equally diverse underlying root causes of erectile dysfunction.
How many men are affected by erectile dysfunction?
In Germany alone, probably 6-8 million men are affected by erectile dysfunction (1). However, the actual number remains uncertain as erection problems are widely considered a taboo topic and men have difficulties talking about them. In consequence only slightly more than half of the affected men consult a health care professional (2). What we do know for sure: The frequency (prevalence) of men suffering from erectile dysfunction increases with age. Nearly one in two men over the age of 50 is affected (3), nonetheless as many as 8% of 20-29 year old men (2) are also dealing with erection problems.
Why do erection problems occur?
During sexual stimulation the brain sends signals to the penis through the spinal cord and nerves. This causes arteries to dilate and blood to flow into the penis. The increased pressure makes the penis hard. Blood outflow is simultaneously slowed down by compressing the veins in the penis. As long as the inflow of blood is greater than the outflow, the erection is maintained. Every part of this system, that is, thoughts, nerves and blood vessels, must play its part to enable a healthy lasting erection. There are different reasons why the system can be disturbed and erection problems occur. Often it is not one reason alone that leads to erectile dysfunction but a combination of different causes.
Possible causes of erectile dysfunction are (4) :
- psychological causes, such as stress, insecurity and fear of failure
- Arterial or venous problems that cause blood flow to and from the penis to malfunction
- hormonal disorders, such as the lack of testosterone
- anatomical reasons that may be induced by a pre-existing condition
- side effects that can result from taking drugs and other substances
- nerve damage caused by surgery, accidents or other conditions
The medical guidelines on erectile dysfunction are aimed at medical professionals but can be accessed online by anyone interested:
- Braun, M., et al. (2000). "Epidemiology of erectile dysfunction: results of the 'Cologne Male Survey'." Int J Impot Res 12(6): 305-311.
- Rosen, R. C., et al. (2004). "The multinational Men's Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population." Curr Med Res Opin 20(5): 607-617.
- Feldman, H. A., et al. (1994). " Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study." J Urol 151(1): 54-61.
- EAU Guidelines. Edn. presented at the EAU Annual Congress Amsterdam 2020. ISBN 978-94-92671-07-3.
- Baumhakel, M. and M. Bohm (2007). "Erectile dysfunction correlates with left ventricular function and precedes cardiovascular events in cardiovascular high-risk patients." Int J Clin Pract 61(3): 361-366.
- Silva, A. B., et al. (2017). "Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis." Br J Sports Med 51(19): 1419-1424.
- Myers, C. and M. Smith (2019). "Pelvic floor muscle training improves erectile dysfunction and premature ejaculation: a systematic review." Physiotherapy 105(2): 235-243.
- Bossio, J. A., et al. (2018). "Mindfulness-Based Group Therapy for Men With Situational Erectile Dysfunction: A Mixed-Methods Feasibility Analysis and Pilot Study." J Sex Med 15(10): 1478-1490.
- Sommers, F. G. (2013). "Mindfulness in love and love making: a way of life." Sexual and Relationship Therapy 28(1-2): 84-91.
- Kedia, G. T., et al. (2020). "The Use of Vasoactive Drugs in the Treatment of Male Erectile Dysfunction: Current Concepts." J Clin Med 9(9).
- Rhoden, E. L., et al. (2002). "The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction." Int J Impot Res 14(4): 245-250.
- Kalsi, J.S.; Kell, P.D. Update on the OralTreatments for Male Erectile Dysfunction. Eur. Acad. Dermatol.Venereol. 2004, 18, 267–274.