Erectile dysfunction, a condition in which a man has repeated difficulty achieving or maintaining an erection for sexual activity, is very common and affects men of all ages. It’s estimated that half of men older than age 40 experience some degree of erectile dysfunction.
The first sign of erectile dysfunction is often a consistent inability to maintain an erection until orgasm. You may also notice that erections are less frequent, do not remain rigid, or do not last long enough to begin sexual intercourse.
There are several possible causes of erectile dysfunction, including hormonal problems, such as having low testosterone levels. Certain medications can also lead to erectile dysfunction. These include antihistamines, antidepressants, and some medications used to treat people with high blood pressure and ulcers.
Erectile dysfunction is associated with other health conditions, such as urinary dysfunction, and certain neurological disorders, such as Parkinson’s disease, stroke, and multiple sclerosis. It may also be the result of psychological issues, such as anxiety, depression, and stress, although this is more rare.
Erectile dysfunction has been linked with diabetes, hardening of the arteries, high blood pressure, and high cholesterol levels. In fact, it’s considered a possible “warning sign” of these chronic health conditions. Because of this, your doctor may wish to investigate whether an underlying heart concern may be the cause of your symptoms.
NYU Langone doctors understand that erectile dysfunction can negatively affect your relationships, self-esteem, and quality of life. Because most causes of erectile dysfunction are physical, rather than psychological, your doctor conducts a thorough initial evaluation, taking a medical history and performing a physical exam. He or she may then order one or more of the following tests:
Blood tests allow your doctor to check for some of the conditions that can lead to erectile dysfunction. For instance, your doctor may measure the amount of sugar in your blood, which can signify if you have diabetes. He or she may check to see if you have too few red blood cells, which can lead to anemia and fatigue. High cholesterol levels have been linked to poor erectile function and may also be checked. Levels of certain hormones may be tested—too low levels of testosterone and too high levels of thyroid hormones can cause erectile dysfunction.
Your doctor may ask you to provide a urine sample, so that he or she can obtain information about sugar and protein levels in the urine. This can help your doctor to determine if diabetes or kidney disease may be contributing to erectile dysfunction.
An imbalance of penile blood flow is a main cause of erectile dysfunction. To achieve an erection, rapid inflow of blood through the penile arteries is necessary. To maintain an erection, the outflow of blood from the penis must also be temporarily minimized.
A penile Doppler ultrasound enables your doctor to see how blood flows in the penis during and after an erection. The results help your doctor to diagnose and evaluate the extent of erectile dysfunction. This test also allows your doctor to determine whether erectile dysfunction medications, which dilate blood vessels, may be an effective treatment for you, because similar medications are used during the test.
Prior to the ultrasound scan, your doctor injects the base of the penis with a medication that causes an erection. An ultrasound device is then used to measure blood flow in the penis prior to and during the erection.
This procedure is performed in the doctor’s office and takes about 30 minutes to complete. Afterward, some men may feel temporary discomfort at the injection site.
Psychological factors are the cause of erectile dysfunction in about 10 percent of men. If no physical or medical causes explain your symptoms, your doctor may refer you to a psychologist for evaluation. Psychotherapy can help to address the causes of your symptoms, and your partner may also be included in therapy to address any intimacy issues that erectile dysfunction has caused.
The most common psychological causes of erectile dysfunction include stress, fear of sexual failure, and depression. Men in their late teens and twenties are most likely to experience erectile dysfunction due to purely psychological reasons.
Some medications for depression can cause erectile dysfunction. If your doctor suspects that one of these medications is causing your symptoms, he or she may work with your mental health care provider to discuss other medications or treatment plans that may be less likely to cause erectile dysfunction.