Erectile dysfunction (ED) is something no man wants to experience, much less talk about. Yet, it is one of the leading health conditions plaguing men as they age.
Many factors can contribute to ED, including hormonal imbalance, age, medical problems, stress, lack of sleep, smoking, and others. The problem has no direct cause for some men, yet it still exists. Finding a solution is crucial for a healthy sex life.
As many as 30 million men in the US may suffer from some form of erectile dysfunction.
What Is Normal Erectile Function?
Penile functions are crucial to a man’s well-being. “Normal” erectile functions stem from a chemical reaction between the brain and body. Various physical responses need to occur for an erection. Sexual stimulation is not always necessary, as many males experience erections for no apparent reason.
One of the most critical factors in getting and maintaining an erection is strong blood flow. The stages of achieving an erection are:
- Flaccid (soft): The normal resting state of the unaroused penis or following ejaculation. Blood flow into and out of the penis is equal.
- Tumescent (swollen): As sexual arousal begins, penile blood vessels begin to dilate as the penis fills with blood. More blood flows in than out of the penis.
- Rigid (erect): The blood that enters the penis in the tumescent stage cannot drain from the penis, causing it to harden sufficiently for sex.
Another aspect of normal erections is morning erections. Many males awake with an erect penis and a full bladder.
Normal erections vary significantly in duration, lasting from less than a minute to close to an hour. Nocturnal erections often last an average of 25 to 35 minutes.
The next stage in normal erections is the refractory period or recovery. Some men are ready to achieve another erection in minutes, while others, especially older men, require a few days.
Causes of ED
Erectile dysfunction can look many ways and stem from many issues. Loss of morning erections is often one of the first things men notice. They can become less frequent or shorter-lasting. Anticipated erections, such as those associated with sexual arousal, can become more challenging to achieve, lose their rigidity quickly, or suffer from premature ejaculation. These are some of the issues associated with ED.
The erectile dysfunction causes are varied and include vascular, neural, psychological, as well as hormonal (endocrine) problems. Some causes of ED are due to lifestyle habits or daily actions that can interfere with arousal and sexual functions.
Here are some of the most common causes of erectile dysfunction:
- Aging: Men over 40 are most likely to experience a decline in erectile functions, with as many as 50 percent of those over 40 struggling with ED. Aging also increases the risk of other health issues that can interfere with erectile functions, including diabetes, cardiovascular disease, and problems with the central and peripheral nervous systems.
- Testosterone deficiency: Testosterone is the leading male sex hormone, and men with low testosterone may find it difficult to achieve and maintain an erection. Men with Low T often have high cholesterol, which can inhibit blood flow. Testosterone also supports red blood cell production for healthy circulation.
- HGH deficiency: Human growth hormone influences erectile functions in numerous ways. It directly influences sexual desire via its actions on the brain and GH receptors in the testes. HGH also stimulates healthy nitric oxide production to support healthy blood flow, which is crucial for erections.
- Underactive thyroid and increased prolactin: Hypothyroidism, a condition causing reduced thyroid hormones, can increase prolactin production, which can decrease testosterone levels.
- Increased estrogen: Estrogen dominance occurs when the body converts too much free testosterone into estradiol (the leading form of estrogen). Estradiol causes the body to increase fat retention, a problem that worsens this situation because belly fat produces aromatase, the enzyme that converts testosterone into estradiol. Many men with ED have high estrogen and low testosterone levels.
- High cortisol levels: The stress hormone cortisol inhibits testosterone production. Cortisol also interferes with HGH levels. That combination, along with feeling increased stress, can hinder erections.
- Obesity: Carrying too much weight can lower hormone levels and cause many of the issues associated with medical conditions that contribute to ED. As mentioned, excess belly fat increases testosterone conversion into estradiol, which further lowers testosterone levels.
- Unhealthy habits: Smoking and excessive alcohol consumption can interfere with erections and contribute to other issues associated with ED.
- Diabetes: Men who have diabetes may suffer from hardening of the arteries that can interfere with blood flow to the penis. Reduced nerve sensations can inhibit erections.
- Other medical causes: High cholesterol, which can cause clogged arteries, atherosclerosis (hardening of the arteries), heart disease, kidney disease, liver problems, and other health issues can interfere with erectile functions. Problems with the nervous system, including multiple sclerosis, nerve and spinal cord injuries, and nerve damage, can interfere with erections. Metabolic syndrome, which consists of numerous health issues, including high blood pressure, diabetes, obesity, and high cholesterol, can lead to ED. Testicular injuries, mumps, and cancer treatments are some of the conditions that can interfere with testosterone production and hinder erections.
- Emotional or psychological issues: Depression, stress, anxiety, and other emotional issues can stand in the way of your sexual desire and ability to achieve erections. Problems with your relationship can also influence sexual desire, arousal, and erectile functions.
- Medications: Certain prescription drugs, including those for blood pressure, depression, chemotherapy, anxiety, and eye drops for glaucoma, can cause ED.
- Steroid abuse: Using anabolic steroids can interfere with natural testosterone production and lead to ED.
Potential Complications of ED
Erectile dysfunction can cause many problems, both for the man and the relationship. Erections can disappear during foreplay, putting on a condom, during penetration, or intercourse. A man can lose his erection before ejaculation and orgasm.
The following issues can result from erectile dysfunction:
- Unfulfilled sex life: Wanting sexual intimacy is natural, and ED can leave a man feeling unfulfilled. Sexual desire is a normal part of a relationship. The loss of intimacy with a partner can lead to a strained relationship.
- Performance anxiety: Worrying about whether or not you can achieve and sustain an erection can further your problems. Instead of being in the moment, you may find you are in your head. The more you worry about ED, the more you may avoid intimacy.
- Emotional problems, including depression and low self-esteem: Erectile dysfunction can lead to numerous emotional issues for men. Depression is common, as an unfulfilling relationship can lead to emotional upheaval. Lack of intimacy can leave one feeling alone. Orgasms help to release crucial endorphins, and when ED gets in the way, these vital neurotransmitters decline. Self-esteem and self-confidence can plummet.
- Conception difficulty: Pregnancy is often a desired outcome of sexual intimacy. A man who has trouble achieving and maintaining a healthy erection may not be able to ejaculate. That can cause added financial expense in a relationship due to fertility treatments.
Conclusion
Many issues can lead to erectile problems, with hormonal imbalance often playing a role, especially as men age. A hormone specialist can diagnose ED problems associated with hormonal imbalance or deficiency. Physical examination, a consultation, a health history review, and, most importantly – blood analysis can determine if hormone replacement therapy might help.
Erectile dysfunction is a treatable condition. Your healthcare provider can offer options depending on the cause of the problem.
