Erectile Dysfunction - more than a bedroom problem

By Dr Mick Watts GP

Almost every man worries about erectile dysfunction (ED) at some point in his life.

For some it is simply an occasional bad night, perhaps after too much alcohol, a stressful week at work or poor sleep. For others it develops gradually and begins to affect confidence, relationships and self-esteem. Many men say nothing for months or even years, hoping the problem will simply disappear.

That is understandable.

Sex remains one of the hardest subjects for many men to discuss, even with their partner or doctor. In previous blogs I have written about why so many of us delay asking for help. Erectile dysfunction is a good example. Many men hope it will simply get better on its own, when a simple conversation may provide reassurance, effective treatment or even uncover an underlying health problem.

Yet erectile dysfunction deserves the same calm and sensible approach as any other health problem. Not simply because it affects intimacy and quality of life, but because it can sometimes tell us something important about our overall health.

An erection depends on good health

If you are younger, it is easy to think erectile dysfunction is someone else's problem. I would encourage you to think differently. The lifestyle choices you make in your twenties, thirties and forties can influence whether erectile dysfunction becomes part of your future.

An erection is a remarkable physiological event.

It relies on healthy blood vessels, healthy nerves, the right balance of hormones, a functioning brain, a relaxed state of mind and good communication between all of them. When everything works together, blood flows into the penis and an erection develops naturally.

Because so many body systems are involved, erectile dysfunction rarely has a single simple cause. It is often the result of several small factors acting together.

Understanding those factors is far more valuable than simply treating the symptom.

Sometimes it is the body's first warning light

One important message I give patients is that erectile dysfunction can occasionally be an early sign of developing cardiovascular disease.

The arteries supplying the penis are much smaller than those supplying the heart. If blood vessels begin to narrow through a build-up of cholesterol or damage caused by smoking, diabetes or high blood pressure, changes in erectile function may appear before someone develops chest pain or other symptoms.

That does not mean every man with erectile dysfunction has heart disease. Most do not.

However, it does mean erectile dysfunction offers an opportunity to look more closely at blood pressure, cholesterol, blood sugar, weight, smoking, alcohol intake and overall cardiovascular risk.

In many ways, it can be one of the earliest warning lights that our metabolism and circulation deserve attention.

It is rarely just one thing

Many men wonder whether erectile dysfunction is "physical" or "psychological".

The answer is often both.

Stress at work, anxiety, relationship difficulties, depression and poor sleep can all reduce sexual confidence and make erections less reliable. Once a man has experienced erectile dysfunction a few times, anxiety about future performance can itself become part of the problem, creating a cycle that becomes increasingly difficult to break.

Alongside these psychological factors are a wide range of physical causes.

Increasing age, excess weight, lack of exercise, smoking, diabetes, high blood pressure, raised cholesterol and some medications can all contribute. Hormonal conditions such as testosterone deficiency occasionally play a role.

This is why a proper medical assessment matters. It allows us to look at the whole picture rather than assuming there is one simple explanation.

The encouraging news

The reassuring news is that many of the factors which contribute to erectile dysfunction can be improved.

Looking after our mental wellbeing.

Keeping physically active.

Maintaining a healthy weight.

Eating a balanced diet.

Sleeping well.

Avoiding smoking.

Keeping alcohol within sensible limits.

These lifestyle measures improve blood vessel function, reduce inflammation, improve insulin sensitivity and support cardiovascular health. They also improve mood, confidence and energy levels.

Perhaps unsurprisingly, they often improve erections too.

Studies have shown that regular exercise, weight loss where appropriate, smoking cessation and good management of diabetes and blood pressure can all improve erectile function. In some men these changes make a dramatic difference. In others they reduce the amount of treatment needed.

The lifestyle that protects your heart is often the same lifestyle that protects your erections.

Treatment should fit the individual

Not every man will recover through lifestyle measures alone.

Fortunately, there are now several effective treatments available. Tablets are often very successful and have transformed the lives of millions of men. Other options include vacuum devices, injectable treatments and specialist therapies offered through urology services.

Occasionally testosterone replacement therapy may be appropriate, but only when careful assessment confirms genuine testosterone deficiency and other causes have been considered.

The important point is not which treatment is best.

It is choosing the right treatment for the right individual after understanding why the problem has developed.

Why buying tablets online is not always the best answer

The internet has made treatment easier to obtain than ever before.

While this has undoubtedly helped many men, it also means opportunities to identify underlying health problems are missed.

A consultation provides the chance to discuss symptoms in confidence, review medications, assess mental wellbeing, explore relationship factors and identify cardiovascular risk. It may also include checking blood pressure and, where appropriate, arranging blood tests such as cholesterol, blood sugar or hormone levels.

Sometimes the most valuable outcome of the consultation is not the prescription.

It is discovering a treatable health condition early enough to prevent more serious illness in the future.

Looking after your future health

Erectile dysfunction becomes more common as we get older. It is extremely common and nothing to feel embarrassed about. It affects around 5% of men in their thirties, around 30% in their fifties and well over half of men in their seventies.

For many men it is highly treatable.

For some it is also an opportunity to learn more about themselves and make simple changes to their lifestyle.

In that sense, erectile dysfunction is about much more than sex.

It is another reminder that our bodies are remarkably good at telling us when something needs attention.

The best approach is to reduce the chance of erectile dysfunction developing in the first place through healthy lifestyle choices. But if it does occur, don't ignore it. Listening to those early messages and acting on them may improve not only your erections, but your long-term health as well.

Dr Mick is a GP at Windsor Wellness Clinic.