Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

What is erectile dysfunction?

ED (ED) is when a man can't get and keep an erection long enough to have sex on at least 50% of tries. The medical term used to be impotence. If ED occurs often or becomes a pattern, it can damage a man's self-image and the sex life that he and his partner share.

Most men have ED every once in a while or for short periods of time. About 34% of men in Canada have ED regularly. ED is most common in men over the age of 65, though it can occur in middle-aged or younger men. But ED isn't just part of aging. It often has a cause that can be treated. Most men feel awkward talking about ED. But the truth is that many men with ED can be helped. Talk to your doctor to find out what treatment may help you.

What causes ED?

ED can occur when something gets in the way of the process your body goes through to get an erection. This process involves the brain, which controls what you see, hear, feel, smell and think; the nerves, which pass signals from your brain to your body, and the blood vessels in your penis, which open to allow blood to flow in. Many things can get in the way of this process and lead to ED.

ED that happens every now and then may be caused by drinking too much alcohol or by being tired. ED that happens more often may have a physical cause. Physical causes are at the root of the problem in about half of the men who have ED. Other causes include some medicines you may be taking, and things you're doing or going through in your life.

Physical causes of ED include diseases that damage the blood vessels. This damage can block the flow of blood into the penis. Diseases that damage the nerves that carry signals of arousal from your brain to your blood vessels can also lead to ED. Other diseases can lower your level of testosterone or your levels of other male hormones. See below for a list of physical causes of ED.

Physical causes of ED

	Alcohol
	Smoking
	Atherosclerosis or "hardening of the arteries" (which may be related to diabetes, high cholesterol levels, high blood pressure and smoking)
	Diabetes (high blood sugar)
	Brain or spinal-cord injuries
	Hypogonadism (which leads to lower testosterone levels)
	Liver or kidney failure
	Multiple sclerosis (MS)
	Parkinson's disease
	Radiation therapy to the testicles
	Stroke

Feelings that can lead to ED

	Feeling nervous about sex, perhaps because of a past event of this happening before
	Feeling stressed, including stress from work or family
	Being troubled by problems with your partner
	Feeling depressed or sad
	Feeling so self-conscious that you can't enjoy sex
	Thinking that your partner is not responding to you

How you're feeling about your life and about your partner can also add to ED. Many men begin having ED regularly after they have had it happen once. After it has happened to them once, they feel nervous about having sex. This can cause ED to happen again. Over time, this can lead to a pattern. The more you worry about having an erection, the more trouble you may have getting one.

What you're doing during sex may also be adding to problems getting and keeping erection. People's needs often change over time or because of your state of health. This can cause a man to need more touching of his penis during sex to get and keep an erection.

Certain drugs may affect the flow of blood to your penis or the hormone levels in your blood. Drugs that may lead to ED include some antidepressants, some high blood pressure medicines and most nerve pills. If you think your ED is related to a drug you're taking, talk to your doctor about wheter this could be a side effect of the drug. If so, there may be another drug you can take instead.

How is ED diagnosed?

Your doctor will often start trying to find out what's causing your symptoms by asking you some questions. He or she may also give you a physical exam. Samples of your blood and urine may be tested for signs of physical causes.

Other tests may also be needed. For example, your doctor may want to find out if you have erections during sleep. Some tests that can be done at home measure if you have erections while you're asleep. Normally, a man will have about five erections during sleep. If you do, your ED may not have a physical cause.

How is ED treated?

How ED is treated depends on what things are causing it. ED with a physical cause may improve when the cause is treated or brought under control. ED caused by a drug you're taking may improve when your doctor changes the drug or changes how much of the drug you're taking. Counselling can be very helpful no matter what's causing your ED, because ED can affect how you feel about yourself and how you and your sex partner relate.

What about drug treatment?

Drugs used to treat a physical problem that has caused the ED can help. Hormone shots can be given to raise the low levels of testosterone that result from hypogonadism but may not help ED. Other drugs can be taken to treat the ED itself. Sildenafil (Viagra) is often used for ED. Do not use Viagra if you are using nitrates in any form (mostly for heart disease). Check with your doctor to see if this is an option for you. Yohimbine may help some. Some treatments are given directly to the penis (muse/injections).

What about devices that help a man get an erection?

Constriction rings or vacuum devices help a man get and keep an erection can be very helpful. These devices are mostly used when there is a physical cause of ED. Many types of devices exist.

One is a suction device that draws blood into the penis and keeps it there with a band at the base of the penis. This device can be hard to use, can cause some discomfort and can get in the way. But if you can get used to it, it can be very effective and doesn't seem to have any serious side effects. Other devices include implants that are placed inside the penis. This requires surgery. Implants have improved over the years. Some devices stay partly erect all the time. Others are inflatable for use when you want to have intercourse. With these implants, the device inside the penis is hooked to a small pump that you squeeze to cause an erection.

What about surgery?

Surgery can sometimes be done to open up blood vessels to the penis, but this surgery isn't widely used. You can consult with a specialist to learn about other options as needed.

What does counselling involve?

Counselling is often best if your partner comes too. Your counselor may suggest you "start over" with sex to break the cycle you and your partner have.
You may be asked not to have sex for a while, then to begin with touching that isn't sexual. Next, you and your partner can begin sexual touching. Finally, you can begin having intercourse again. This can help change your sexual relations back to ones you both can enjoy. Sometimes, couples have ways to please one another and to show caring that don't include sex. This can reduce the anxiety about having erections.

How do I deal with my partner's reaction to my ED?

One of the toughest things about ED may be dealing with how it makes your partner feel.

Your partner may feel at fault for your ED or may think that it means that the two of you are in trouble or that you're seeing someone else. Your partner may feel unattractive, disappointed, hurt, angry, frustrated and concerned. These aren't easy feelings to deal with. Counselling for both is often the best way to deal with these issues. It can give a way to reassure your partner about your feelings and the causes of your ED.

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Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.