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Facing up to Erectile Dysfunction

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Man in doctor's office receiving compassionate care from doctorIn the past, sexual dysfunction in men was a hidden subject that wouldn’t be discussed with doctors, let alone between friends or partners. It was considered too embarrassing to discuss “out loud”. Luckily, the times have changed, and there has been a big shift over the past twenty years or so that has driven a once shameful conversation about erectile dysfunction (ED) right smack into the light of day.

Today, the internet is brimming with discussion and advice about what causes erectile dysfunction and how to address the problem. 

Understanding the cause and treatment of erectile dysfunction begins with identifying whether the symptoms of ED are in response to an underlying and potentially more serious physical or psychological cause. A peek under the hood, if you will, of the nuts and bolts of erectile dysfunction.

A one-two-three guide to erectile dysfunction

As defined on the website of American Family Physician, erectile dysfunction (ED) is an inability to achieve or maintain an erection all the way through the sexual response cycle, sufficient for satisfactory sexual performance (orgasm or ejaculation).

Erectile dysfunction is when one or more of the following is repeated in a man’s sexual experience.
He is:

  • Inconsistent is his ability to get and sustain an erection through to orgasm
  • Sometimes able to get an erection, but not always able to sustain it up to ejaculation
  • Unable to achieve an erection at any time

The definition of a satisfactory sexual response cycle for a male is typically described as having four major phases, and failure to achieve all four would be the basic definition of erectile dysfunction:

  1. Desire (psychogenic)
  2. Arousal and erection (psychogenic and organic)
  3. Orgasm and ejaculation (organic)
  4. Relaxation (psychogenic).

There are two main contributors to ED, psychological factors (aka psychogenic causes) and physical factors (aka organic causes).

Psychological factors 

Can include relationship concerns, stress and anxiety, depression, low self-esteem, or guilt. Roughly four out of ten cases of erectile dysfunction are considered psychogenic.

Physical factors
Can include: 

    • Cardiovascular disease – leads to blockages in the arteries that reduce blood flow to the penis.
    • Gastrointestinal disturbances – conditions like Gastrointestinal Reflux Disorder (GERD), Crohn’s Disease, Celiac disease, and Inflammatory bowel disease (IBD) can adversely affect sexual activity.
    • Sleep apnea – causes a decrease in testosterone and oxygen levels, making it difficult to get and maintain erections
    • Diabetes – high blood sugar levels can damage the blood vessels and nerves that are essential for achieving and maintaining an erection.
    • Hormonal imbalances – low testosterone levels interfere with the signaling pathways that lead to an erection.
    • Prostate surgery – surgery to remove the prostate gland can cause nerve damage.
    • Medications – such as anti-depressants, blood pressure medications, and drugs used to treat prostate cancer, can cause ED.
    • Age – ED grows more common as men age. Over half of men over 40 have suffered from ED at some time, and the number grows with the advancing years. (
    • And more…

Facing up to ED

Just because our fathers and grandfathers suffered from ED as they aged without knowledge of the causes or available treatment doesn’t mean that we have to. The key thing is to reach out for help from healthcare specialists who are well-versed in treatment and care.

Opening up to an experienced healthcare provider is critical. The diagnosis procedure is relatively straightforward and typically involves a battery of tests to identify the presence of an underlying cause. 

Being open and sharing all aspects of the condition, despite the possible embarrassment, is really the only way to move through ED and start taking responsibility for the areas that are within your control. A thorough examination, including a Doppler ultrasound of the penile area plus blood and urine tests, can establish whether there is a physical issue that needs to be addressed. 

Upon completion of a thorough exam, one can expect to understand if their physical and neurologic conditions are within normal range, if their testosterone levels are within normal range,  if their genitalia is normal, that there is no peripheral vascular disease, or if their intake of drugs is or is not a significant contributor.

In most cases, where at least some of the erectile dysfunction can be attributed to a physical or organic cause, the examining physician must decide if treatment is worth any potential risk. For example, a medication used for the treatment of hypertension can produce ED as a side effect. 

It’s important to realize that any examination that reveals low testosterone can be addressed with relatively simple and straightforward treatment. In an equivalent of the Hormone Replacement Therapy that has become a widely used solution for menopausal women, supplying estrogen, there is a similar solution for men, which supplies testosterone. 

Examples are:

  • AndroForte testosterone cream (sold in 2% and 5%), a bioidentical, pharmaceutical-grade hormone cream explicitly designed to target low testosterone levels in men. 
  • AndroGel is a testosterone replacement therapy for male hypogonadism when clinical features and biochemical tests have confirmed testosterone deficiency. It comes in 30-gram cream sachets, to be applied daily.

Once the organic or physical causes have been ruled out,  psychogenic causes will be more closely considered. Counseling by trained individuals is a common and often effective path. Until recently, there was an assumed preference for male therapists, but some men find it more helpful to engage with female therapists since women are sometimes more sympathetic than men in a subject where they have no personal bias from their own experience (or more to the point, lack of experience of ED).

Treating the symptoms, without addressing the causes.

Treatment of erectile dysfunction has been revolutionized over the past two decades, due largely to the accidental discovery of a drug (and several variations) that can induce a satisfactory erection, provided there are no serious underlying root causes. By and large, the patients benefitting from these new drugs can become aroused normally, but were experiencing problems sustaining an erection through to the end. The following short table summarizes the main courses of treatment available in cases of psychogenic erectile dysfunction:

Oral medications

Based on variations of phosphodiesterase 5 (PDE5) inhibitors, these drugs work by relaxing the blood vessels connected to the penis. This allows more blood to flow into the chambers and helps sustain an erection. All PDE5 drugs only work when there is some degree of arousal.

Cialis (tadalafil) is known as the ‘weekend pill’ because it can give a sustained erection lasting up to 36 hours.

Viagra (sildenafil) works quickly to promote an erection within one hour, but erections only last for a maximum of four hours.

Levitra (vardenafil) yields an erection that lasts slightly longer than Viagra and can be taken at any time since it’s not affected by food intake.

Testosterone replacement

Low testosterone can contribute to issues with forming and maintaining an erection. 

AndroForte and AndroGel provide simple ways of applying testosterone replacement therapy.



How do I know if I need testosterone?

A drop-off in testosterone levels can produce changes in mood, thoughts, muscle strength, body shape, sexual arousal and/or sexual function and energy levels. Changes in these areas provide an indication that perhaps there is a possibility of falling testosterone levels. A doctor can order a blood test to determine if the levels are below the expected range.

What is the main physical cause of erectile dysfunction?

Most often, erectile function can start to happen when blood flow into the penis is limited, or nerves have been harmed. More serious illnesses, such as heart diseases (atherosclerosis, hardening of the arteries, high blood pressure) or high blood sugar levels (diabetes) can also lead to ED. Often these can be ancillary effects of aging.

What happens if erectile dysfunction goes untreated?

By allowing erectile dysfunction to remain untreated, there is an elevated risk that some underlying issues can advance undetected. For example, if a younger man develops erectile dysfunction which is a by-product of heart disease, lack of treatment could be putting his life at risk. As well, untreated ED can have deep psychological and psychosocial effects, leading to serious possible outcomes.

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