Erectile Dysfunction (ED)

What is Erectile Dysfunction (ED)? 

Erectile dysfunction (ED) is also known as impotence that interferes with male sexual intercourse. ED is quite different from other conditions such as decreased libido and other dysfunctions of the male reproductive system. This article will outline the assessment and treatment for ED.

  • Statistics
  • Risk Factors of ED
  • Causes of ED
  • Examination and Tests
  • Treatments for ED
  • What will the future bring for ED?
  • Conclusion




ED or impotence is not the same in all men and varies with severity. ED will be very severe in some and in some others it might not be so. These variations make it hard to estimate the rate of incidence or the frequency ED. ED is said to be under diagnosed due the reluctance of some men not wanting to discuss ED with doctors as they don’t feel comfortable or due to embarrassment. However, authorities have reported that 30 million men in the United States are affected.

ED has the tendency to occur at any age but it is more common in elderly men and uncommon among the young. The Massachusetts Male Ageing Study has stated that, impotence or ED increases from  5% among men aged 40 to a staggering 15% among the 70 year olds. Population studies carried out in the Netherlands discovered that some degree of ED took place in 20% of men aged 40-54 and 50% of men aged 70-78. The National Ambulatory Medical Care Survey in 1999 found out that 1,520,000 men visited a health care professional concerning ED.

Risk Factors of ED

  • Old age
  • Diabetes mellitus
  • Cardiovascular disease
  • High cholesterol
  • Smoking Cigarettes
  • Drug use (recreational)
  • Depression
  • Other psychiatric disorders

Causes of ED

Normal male reproductive system functions depend on a healthy nervous system to carry nervous impulses or messages, healthy arteries in and near copora cavernosa and healthy smooth muscles and fibrous tissues as well as appropriate levels of nitric oxide. The following outlines the causes of ED:

  • Ageing- two reasons are link ED and ageing. Firstly, the elderly are likely to develop heart attacks, cardiovascular diseases, strokes, diabetes mellitus, high blood pressure, etc which are risk factors associated with ED. Secondly, old age can bring about ED due to damaged or decreased compliance of tissues in the corpora cavernosa. 
  • Diabetes mellitus- ED is said to arise 10-15 years earlier in men suffering from diabetes than the ones who do not. It may be due to the earlier onset and the severity of developing atherosclerosis due to diabetes mellitus. Atherosclerosis is characterised by the narrowing of the arteries which will result in less delivery of blood to the make genitalia which will concurrently lead to ED. Diabetes mellitus can cause ED due to the damage of the nervous system, both the sensory and autonomic nerves. This is known as diabetes nephropathy. In addition, smoking cigarettes, obesity, diabetes mellitus, etc also lead to increase risk of developing ED.
  • Hypertension (high blood pressure)- It is not clearly known how hypertension contributes to ED. It has been discovered that hypertension is linked to low nitric oxide production by the arteries of the body. Hypertension also leads to atherosclerosis.
  • Cardiovascular diseases- atherosclerosis is the most common cardiovascular disease in the U.S. When the arteries of the pelvic organs are narrowed by atherosclerosis, ED occurs.
  • Smoking cigarettes- this will worsen atherosclerosis which will increase the risk of developing ED.
  • Nerve and spinal cord damage- this can cause ED due to damage sustained to the nerves in the pelvis and the spinal cord. Nerve damage can arise due to disease, trauma, surgery (prostatectomy),etc.
  • Substance abuse- ED can develop due to marijuana, heroin, cocaine, crystal meth, alcohol abuse and methamphetamines. Alcohol abuse can cause nerve damage, atrophy of the testicles and low levels testosterone.
  • Low levels of testosterone- can lead to libido and ED.
  • Medications- certain medications lead to the development of ED as a side effect. These medications include the ones used to treat high blood pressure, antihistamines, antidepressants, tranquilizers and appetite suppressants.
  • Depression and anxiety disorders- It is proved that psychological disorders can lead to ED. Many anti-psychotics are also responsible for developing  ED.


Examination and Tests

Physical Examination

Physical examinations may help in the identification of the causes of ED. Problems in the nervous system may be detected due to the insensitivity of the penis to touching. Hormonal problems can be identified by small testicles, lack of facial hair and enlarged breasts known as gynecosmastia. Hormonal problems include hypothyroidism. Diminished arterial pulses in the legs or by listening to the sound of blood flowing through narrowed arteries with a stethoscopes are some of the techniques used to diagnose reduced blood flow as a result of atherosclerosis. Other unusual and uncommon characteristics of the genitalia can be another cause of ED.

Laboratory Tests

  • CBC (complete blood count)
  • Urinalysis- abnormal results will indicate diabetes mellitus or kidney damage.
  • Lipid profile-  high levels of LDL, bad cholesterol, lead to atherosclerosis
  • Blood glucose levels- high glucose levels indicate diabetes mellitus
  • Blood haemoglobin A1c-  This test will indicate the poor control of blood glucose levels in diabetes mellitus patients. 
  • Serum creatinine- abnormal results will indicate kidney damage as a result of diabetes.
  • Liver function tests and liver enzymes- Cirrhosis, a severe liver disease, lead to hormonal imbalance and gonad dysfunction. This may cause low testosterone levels.
  • Total testosterone levels- Blood samples to test the level of testosterone is obtained early morning, before 8 a.m. due to wide variations in the level of testosterone throughout the day. Hypogonadism will indicate low testosterone levels. Furthermore, measuring the bio available testosterone levels is a better indicator than measuring total testosterone levels specially in men who are obese and men who suffer from liver diseases. However, this measurement is not widely available.
  • Other hormone levels (LH, prolactin, cortisol)- these measurements provide further clues to the causes of poor levels of testosterone and ED problems. The causes can be the result of pituitary disease or abnormal adrenal glands. Thyroid hormone levels are also routinely checked for hypothyroidism and hyperthyroidism conditions. These conditions can lead to ED.
  • PSA levels- PSA or the prostrate specific antigen levels in blood is important to rule out prostrate cancer before the patient undergoes treatment for testosterone as this hormone can worsen prostrate cancer. Prostate examination is important too, prior to this treatment.
  • Other blood tests- other tests may be performed that  will indicate zinc deficiency, hemochromatosis, lupus, scleroderma, cancers, sickle cell anaemia , etc.

Imaging Tests 

X-rays may be utilised to evaluate bone abnormalities due to pelvic trauma. Ultrasound can be used to check for testicular size and abnormalities of the structure. In addition, ultrasound with Doppler imaging can assess the blood flow to this region. Angiograms are sometimes performed (very rare) in cases where vascular surgery may be thought to be advantageous.

Psychosocial Examination

A psychosocial examination will take the form of an interview and questionnaire which may give the medical doctor clues and factors that are contributing to ED.

Treatments for ED

The following are the primary treatments administered and procedures undertaken for patients who suffer from ED:

  • Work with doctors when selecting medications. Medications that do not contribute to ED should be selected.
  • Life style changes
  • Drugs to treat ED
  • Intraurethral suppositories- inserting medication into urethra
  • Intracavernosal injections- inserting medication into corpora cavernosa
  • Use of vacuum constrictive devices
  • Penile prostheses
  • Psychotherapy

Altering Medications

Many medications can contribute to ED. As previously mentioned, medications used to treat hypertension, depression and high lipid levels are some of the common medications that can lead to ED. In the case of medications for hypertension, three different classes of anti-hypertensive medications are available. These medications lower the blood pressure which include beta-blockers, calcium channel blockers, diuretics to increase volume of urine, ACE inhibitors (angiotensin converting enzyme inhibitors and ARBs (angiotensin receptor blockers). Anti-hypertensive medications can be prescribed alone or in combination in order to bring down or control blood pressure. The different classes of anti-hypertensive medications render different effects on erectile function. For example, certain beta blockers and diuretics are known to bring about ED. Other anti-hypertensive medications namely calcium channel blockers and ACE inhibitors are not known to cause ED. ARBs are said  decrease ED and increase libido. Therefore, particular attention should be employed in finding the correct anti-hypertensive medication to avoid ED.

Lifestyle Improvements

Certain lifestyle improvements will not only improve an individual’s general health but also contribute in preventing ED. These lifestyle changes include:

  • Quitting smoking
  • Regular exercise
  • Losing excess weight
  • Cut down on excessive alcohol consumption
  • Control hypertension conditions
  • Blood glucose level optimisation in diabetics

Some studies conducted reported that men who had changed certain lifestyle habits have had much better success with oral medicines.


Medications that are used to treat ED include the following:

  • Testosterone
  • Oral phosphodiesterase type 5 (PDE5) inhibitors
  • Intracavernosal injections
  • Intraurethral suppositories

 How effective is Testosterone in treating ED?

Testosterone treatment can improve both libido and ED in patients who suffer from hypogonadism. However, testosterone treatment alone to treat ED in hypogonadism patients is insufficient. Many men require additional oral treatment apart from testosterone.

Patients who require testosterone treatment,  aged 40 years and above, should first undergo a digital examination of the prostate, breast examination and PSA level detection prior to the treatment to rule out breast and prostate cancers. As previously mentioned, testosterone can worsen these cancers. Thus, patients who are diagnosed with breast or prostate cancers or even the ones suspected of having them should not go ahead with this treatment.

Blood testosterone help in identifying many deficiencies, if present. Despite the fact that there are no exact values of testosterone that define hypogonadism, a value or level lower than 250 nano grams per decilitre are said to be low and levels higher than 350 nano grams per decilitre are said to be normal. In addition, if any result of this test show levels between these figures, can be considered or labelled indeterminate.

It is important to note that there are certain medications that are available that can alter or disrupt gonadal function. Some of these medication include seizure medication, long-acting opiate pain medications, thiazide diuretics, antipsychotic medications as well as oral steroids.

Testosterone replacement therapy, or in short TRT, are available only to some. This therapy is associated with potential adverse effects and complex metabolism. As a result, TRTs are only prescribed to men with symptoms of ED and men who have a testosterone level less than 200 nano grams per decilitre. This therapy is administered, in the United States, as topical, injectable and transbuccal (placing inside the mouth, between the cheek and upper gum) testosterone. In the United Stated oral preparations are not available.

Video of Erectile Dysfunction

However, there are certain side effects that can be experienced in those undergoing this therapy. Common side effects include local irritations, breast tissue enlargement, prostate enlargement, aggravation of certain cancers (prostrate and breast cancer), depression, elevated red blood cell (RBC) count and aggravation of congestive heart failure.

 What will the future bring for ED?

Combination therapy has been analysed and studied many times by researchers for the treatment of ED. Most of these studies that have been conducted have been small trials. Thus, significant data regarding their productiveness and their safety are lacking. Nevertheless, with extensive evaluation, research and counselling, combination therapy may be regarded as one of the prime therapies for certain patients with ED.

A newer medication  which is being developed for ED has taken the form of melanocortin receptor agonists. This medication acts on the nervous system in particular, rather than the vascular system. Another nasal preparation is also available. This preparation happens to be effective on its own or in combination with PDE5 inhibitors. There are certain side effects experienced which include flushing and nausea. However, these drugs are not approved for commercial use.

Moreover, several other medications are being researched and studied that will effectively treat ED. These include a PDE5 inhibitor, sublingual drug and the combination of two drugs. Other advanced methods which are being utilised to treat ED is gene therapy. Scientists are now researching gene therapy for ED.


Erectile dysfunction (ED) is also known as impotence that interferes with male sexual intercourse. ED is quite common where an estimated 30 million males in the United States alone are said to be affected. There are many causes for ED. The common causes that pertain to ED are ageing, high blood pressure, smoking cigarettes  atherosclerosis, diabetes mellitus, side effects of medications, nerve damage, spinal cord damage, excessive consumption of alcohol or other substance abuse (heroine, marijuana,etc) and low levels of the male hormone, testosterone. ED is a treatable condition in all age groups. Treatments of ED include psychotherapy, appropriate lifestyle changes, oral PDE5 inhibitors, intraurethral medications, intracavernosal injections, vacuum devices, surgery, etc. In addition,  patient should consult their medical doctors and work toward avoiding medications that may lead to ED. Currently, new research and developmental methods are undertaken to find more effective and efficient therapies to treat ED.

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE



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The Team Manager Web Diseases



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