Erectile Dysfunction (ED): Causes, Symptoms and Treatment
Most men will experience difficulty getting or maintaining an erection at some stage in their lives. While an occasional problem is usually nothing to worry about, ongoing erectile dysfunction (ED) is common and should be assessed by a doctor. It can affect confidence, relationships and quality of life, but it can also be an early sign of an underlying health condition.
The good news is that there are effective treatments available, and for many men, addressing the underlying cause can improve both erectile function and overall health.
What is erectile dysfunction?
Erectile dysfunction is the persistent inability to achieve or maintain an erection firm enough for satisfactory sexual activity.
ED is one type of male sexual dysfunction. Other sexual health conditions include:
- Low libido (reduced sex drive)
- Premature ejaculation
- Delayed ejaculation
- Difficulty reaching orgasm
- Peyronie's disease (a curved, sometimes painful erection caused by scar tissue)
These are separate conditions, although they often occur alongside erectile dysfunction and sometimes contribute to erection problems.
How common is ED?
Erectile dysfunction is very common and becomes more frequent with age.
Healthdirect Australia estimates that more than one in ten Australian men experience ED, although the number increases significantly in older age groups. Australian research involving more than 100,000 men over the age of 45 found that almost two-thirds experienced some degree of erectile dysfunction.
Although ED is more common as men get older, it is not simply a normal part of ageing. Younger men can also develop erectile dysfunction, particularly if they have diabetes, obesity, cardiovascular risk factors, anxiety or high levels of stress.
What causes erectile dysfunction?
There is rarely a single cause. In many cases, both physical and psychological factors contribute.
Physical causes
- Diabetes
- High blood pressure
- High cholesterol
- Heart and blood vessel disease
- Obesity
- Low testosterone
- Neurological conditions
- Kidney disease
- Side effects of certain medications
- Smoking
- Excess alcohol
- Recreational drug use
Psychological factors
- Stress
- Anxiety
- Depression
- Relationship difficulties
- Performance anxiety
Because there are often several contributing factors, a thorough medical assessment is important before starting treatment.
Why is ED important?
Many people think of erectile dysfunction as simply a sexual problem, but it can also provide an early warning that something else is happening in the body.
The arteries supplying the penis are much smaller than those supplying the heart. As a result, reduced blood flow may first become noticeable as erection problems before symptoms of heart disease develop.
For some men, ED is the first sign of conditions such as diabetes, high blood pressure, high cholesterol or cardiovascular disease.
Seeking medical advice early allows these conditions to be identified and treated before more serious complications develop.
Who is more likely to develop ED?
Your risk increases if you:
- Are over 40 years of age
- Smoke
- Are overweight or obese
- Have diabetes
- Have high blood pressure
- Have high cholesterol
- Have cardiovascular disease
- Have obstructive sleep apnoea
- Exercise very little
- Experience anxiety or depression
When should you see your GP?
It's worth making an appointment if erection problems continue for more than a few weeks, happen regularly or are causing concern.
A GP will ask about your symptoms, medical history, medications, lifestyle and mental health. They may also examine you and arrange blood tests.
Common investigations include:
- Blood glucose or HbA1c
- Cholesterol
- Morning testosterone
- Kidney function
- Liver function
Depending on your symptoms, additional investigations or referral to a urologist may be recommended.
How is ED treated?
Treatment depends on the underlying cause. For many men, improving overall health makes a significant difference.
Lifestyle changes
Lifestyle measures that can improve erectile function include:
- Losing excess weight
- Exercising regularly
- Stopping smoking
- Reducing alcohol intake
- Improving sleep
- Managing stress
- Optimising diabetes and blood pressure
Even small improvements in weight, fitness and cardiovascular health can lead to noticeable improvements in erections.
Erectile dysfunction medications
Several prescription medicines are available in Australia to help treat erectile dysfunction. These include:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
- Avanafil (Spedra)
These medicines work by increasing blood flow to the penis during sexual stimulation. They do not cause an automatic erection, so sexual arousal is still required for them to work.
Not all medicines are suitable for everyone. Men who take nitrate medications for chest pain, or who have certain heart conditions, may not be able to use these medicines safely. Your doctor will discuss the most appropriate option for you.
Other treatment options
If tablets are not suitable or are ineffective, other treatments may include:
- Penile injections
- Vacuum erection devices
- Penile implant surgery
- Counselling or sex therapy
Treatment is tailored to each individual and depends on the underlying cause, personal preference and overall health.
Can stress and anxiety cause ED?
Yes. Stress, anxiety and performance concerns can all affect erections. In some men, psychological factors are the main cause, while in others they make an existing physical problem worse.
Counselling, cognitive behavioural therapy and sex therapy can all be effective, particularly when combined with medical treatment where appropriate.
Final thoughts
Erectile dysfunction is one of the most common conditions managed by Australian GPs. Although it can feel embarrassing to talk about, it is often treatable and sometimes provides an important clue about your overall health.
If you've noticed ongoing problems with erections, don't ignore them. A simple discussion with your GP can help identify the cause and determine the most appropriate treatment.
Disclaimer: The content of this article is intended for general informational and educational purposes only. It does not constitute medical advice, diagnosis, or treatment, and should not be relied upon as a substitute for professional medical advice from a qualified healthcare provider. Prescriptions are at the discretion of the doctor and only issued if clinically appropriate for you. MediLeave's telehealth services facilitate access to registered Australian healthcare professionals; however, a telehealth consultation is not equivalent to an in-person medical examination. Telehealth may not be appropriate for all conditions, symptoms, or circumstances. If you are experiencing a medical emergency, call 000 immediately or attend your nearest emergency department. Always seek the advice of your doctor or another qualified health professional regarding any medical condition.
