WHAT IS ERECTILE DYSFUNCTION?
Erectile dysfunction is related to the inability to create and maintain penile erection sufficient for sexual satisfaction (1). For many years erectile dysfunction was considered to be solely a psychological problem (2), but modern studies have demonstrated that there is more to the condition than just psychology. It is now understood that healthy erections require the combinatorial interaction of vascular, molecular, neurological, hormonal, and psychological elements (3). Recent publications have even observed correlations between erectile dysfunction and other health conditions, like diabetes and cardiovascular disease (4,5).
Currently, medical doctors categorized erectile dysfunction based on scores from the International Index of Erectile Function questionnaire (IIEF-5) (6):
- Mild erectile dysfunction (IIEF-5 score of 14-21)
- Moderate erectile dysfunction (IIEF-5 score of 8-13)
- Severe erectile dysfunction (IIEF-5 score of 1-7)
TYPES OF ERECTILE DYSFUNCTION
Proper categorization of erectile dysfunction can help a physician to identify the cause of the condition and to prescribe the appropriate treatment. In addition to being categorized by severity level, erectile dysfunction is also categorized into subtypes based on the time of onset:
Lifelong: In which an erection due to sexual desire cannot be achieved throughout one's life (7).
Acquired: In which the patient had regular erectile function and sexual activity in the past before having erectile dysfunction (7).
For more information about erectile dysfunction: 1. Talk to your doctor or andrologist 2. See the Mayo Clinic article on erectile dysfunction 3. Visit the National Institute of Diabetes and Digestive and Kidney Diseases page for erectile dysfunction
RISK FACTORS FOR ERECTILE DYSFUNCTION
Erectile dysfunction can sometimes be caused by medications. 5α-reductase inhibitors which are commonly prescribed for enlarged prostates may, for example, also can cause erectile dysfunction (8). Other risk factors include:
- Vascular and blood sugar problems like hypertension, diabetes, and insulin resistance (9,10,11,12,13)
- Neurological issues like spinal or brain injuries, Parkinson's disease, and Multiple Sclerosis
- Psychological disorders like depression and anxiety (14)
- Unhealthy lifestyle choices including smoking, excessive alcohol use, drug use, and lack of physical activity (15)
ERECTILE DYSFUNCTION FACTS AND STATISTICS
Erectile dysfunction is a common health problem that is currently affecting 10% of males between the ages of 40 to 70 (16). It is believed that approximately 30 million men in the United States are afflicted with the condition (17). The existing data also indicate that the severity of erectile dysfunction is age dependent, with the prevalence of moderate and severe dysfunction increasing from 22% in 40-year-old men to 49% in those older than 70 (16).
Statistical trends show an increase in reported cases of erectile dysfunction from year to year. Based on these trends, scientists estimate that 322 million men worldwide will be suffering from the condition by the year 2025 (18).
MEDICAL TREATMENT OF ERECTILE DYSFUNCTION
Drugs that help facilitate or inhibit the reflex of the cavernous muscle have strong effects on the erection process. It is known that drugs that raise cytosolic calcium cause contraction of the cavernous muscle and thereby prevent erections from taking place. Drugs that lower cytosolic calcium levels, on the other hand, facilitate relaxation of these muscles and tend to trigger penile erections (19). Drugs commonly prescribed for erectile dysfunction include:
- Sildenafil, marketed as Viagra (20). Side effects include headache, insomnia, skin rash, and indigestion (21).
- Vardenafill, marketed as Levitra (22). Side effects include headache, nausea, runny or stuffy nose, and indigestion. Less commonly it has been known to cause chest pain (23).
- Tadalafil, marketed as Cialis (24). Side effects include headache, muscle pain, indigestion, nausea, high blood pressure, low blood pressure, abnormal ejaculations, and blurred vission (25).
- Udenafil, marketed as Zydena (26).
- Avanafil, marketed as Stendra (27). Side effects include headache, flushing, and dizziness (28).
- Mirodenafil, marketed as Mvix (29).
- Lodenafil Carbonate marketed as Helleva (30).
NATURAL WAYS TO SUPPORT HEALTHY PENILE FUNCTION
Practices to Support Healthy Penile Function:
- Lifestyle modification: Reducing the consumption of alcohol and tobacco products (31,32)
- Diet change: Decreasing sugar consumption and including more whole-grain foods (18)
- Increasing exercise: Frequent moderate to high-intensity physical activity and healthy weight loss (33,34)
Natural Supplements that Support Healthy Penile Function:
- Shamloul R and Ghanem H. Erectile dysfunction. Lancet. 2013;381(9861):153-165. doi:10.1016/S0140-6736(12)60520-0
- Rastrelli G and Maggi M. Erectile dysfunction in fit and healthy young men: psychological or pathological? Transl Androl Urol. 2017;6(1):79-90. doi:10.21037/tau.2016.09.06
- Alwaal A, Breyer BN, Lue TF. Normal male sexual function: emphasis on orgasm and ejaculation. Fertil Steril. 2015;104(5):1051-1060. doi: 10.1016/j.fertnstert.2015.08.033
- Pop-Busui R, Hotaling J, Braffett BH, et al. Cardiovascular autonomic neuropathy, erectile dysfunction and lower urinary tract symptoms in men with type 1 diabetes: findings from the DCCT/EDIC. J Urol. 2015;193(6):2045-2051. doi:10.1016/j.juro.2014.12.097
- Moon KH, Ko YH, Kim SW, et al. Efficacy of once-daily administration of Udenafil for 24 weeks on erectile dysfunction: results from a randomized multicenter placebo-controlled clinical trial. J Sex Med. 2015;12(5):1194-1201. doi:10.1111/jsm.12862
- Yafi FA, Jenkins L, Albersen M, et al. Erectile dysfunction. Nat Rev Dis Prim. 2016:16003. doi:10.1038/nrdp.2016.3
- Pastuszak AW. Current diagnosis and management of erectile dysfunction. Curr Sex Heal Reports. 2014;6(3):164-176. doi:10.1007/s11930-014-0023-9
- Kiguradze T, Temps WH, Yarnold PR, et al. Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride. PeerJ. 2017;5:e3020. doi:10.7717/peerj.3020
- Gazzaruso C, Giordanetti S, De Amici E, et al. Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients. Circulation. 2004;110:22-26. doi:10.1161/01.CIR.0000133278.81226.C9
- Chu NV and Edelman SV. Erectile dysfunction and diabetes. Curr Diab Rep. 2002;2(1):60-66. doi:10.1007/s11892-002-0059-56.
- Ponholzer A, Temml C, Obermayr R, Wehrberger C, Madersbacher S. Is erectile dysfunction an indicator for increased risk of coronary heart disease and stroke? Eur Urol. 2005;48(3):512-517. doi:10.1016/j.eururo.2005.05.014
- Puchalski B, Szymański FM, Kowalik R, Filipiak KJ, Opolski G. The prevalence of sexual dysfunction before myocardial infarction in population of Polish men: A retrospective pilot study. Kardiol Pol. 2013;71(11):1168-1173. doi:10.5603/KP.2013.0297
- Hodges LD, Kirby M, Solanki J, O’Donnell J, Brodie DA. The temporal relationship between erectile dysfunction and cardiovascular disease. Int J Clin Pract. 2007;61(12):2019-2025. doi:10.1111/j.1742-1241.2007.01629.x
- Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinklay JB. Impotence and its medical and physiological correlates: results of the Massacheusetts male aging study. J Urol. 1994;151:54–61. doi:https://doi.org/10.1016/S0022-5347(17)34871-1
- Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med. 2003;139(3):161-168. doi:10.7326/0003-4819-139-3-200308050-00005
- Epidemiology of ED - sexual medicine. Bumcbuedu. 2018. http://www.bumc.bu.edu/sexualmedicine/physicianinformation/epidemiology-of-ed/. Accessed March 5, 2018.
- Nunes KP, Labazi H, Webb RC. New insights into hypertension-associated erectile dysfunction. Curr Opin Nephrol Hypertens. 2012;21(2):163-170. doi:10.1097/MNH.0b013e32835021bd
- Esposito K, Maiorino M, Bellastella G. Lifestyle modifications and erectile dysfunction: what can be expected? Asian J Androl. 2015;17(1):5. doi:10.4103/1008-682X.137687
- Steers WD. Pharmacologic treatment of erectile dysfunction. Rev Urol. 2002;4 Suppl 3:S17-25.
- Au A, Stuyt JG, Chen D, Alagramam K. Ups and downs of Viagra: revisiting ototoxicity in the mouse model. PLoS One. 2013;8(11). doi:10.1371/journal.pone.0079226
- Cunja J. Sildenafil. RxList.com. https://www.rxlist.com/consumer_sildenafil_revatio_viagra/drugs-condition.htm#what_are_warnings_and_precautions_for_sildenafil. Accessed June 12, 2018.
- Morales AM, Mirone V, Dean J, Costa P. Vardenafil for the treatment of erectile dysfunction: an overview of the clinical evidence. Clin Interv Aging. 2009;4:463-472.
- Cunja J. Vardenafil. RxList.com. https://www.rxlist.com/consumer_vardenafil_levitra_staxyn_odt/drugs-condition.htm#what_are_side_effects_of_vardenafil. Accessed June 12, 2018.
- Brock G, Ni X, Oelke M et al. Efficacy of continuous dosing of Tadalafil once daily vs Tadalafil on demand in clinical subgroups of men with erectile dysfunction: a descriptive comparison using the integrated Tadalafil databases. J Sex Med. 2016;13(5):860-875. doi:10.1016/j.jsxm.2016.02.171.
- Cunja J. Tadalafil. RxList.com. https://www.rxlist.com/consumer_tadalafil_adcirca_cialis/drugs-condition.htm#what_are_side_effects_of_tadalafil. Accessed June 12, 2018.
- Cho MC, Paick JS. Udenafil for the treatment of erectile dysfunction. Ther Clin Risk Manag. 2014;10(1):341-354. doi:10.2147/tcrm.s39727
- Burke RM, Evans JD. Avanafil for treatment of erectile dysfunction: review of its potential. Vasc Health Risk Manag. 2012;8(1):517-523. doi:10.2147/VHRM.S26712
- Avanafil tablet. WebMD. https://www.webmd.com/drugs/2/drug-165503/avanafil-oral/details. Accessed June 12, 2018.
- Paick JS, Ahn TY, Choi HK, et al. Efficacy and safety of mirodenafil, a new oral phosphodiesterase type 5 inhibitor, for treatment of erectile dysfunction. J Sex Med. 2008;5(11):2672-2680. doi:10.1111/j.1743-6109.2008.00945.x
- Mendes GD, dos Santos Filho HO, dos Santos Pereira A, et al. A phase I clinical trial of lodenafil carbonate, a new phosphodiesterase type 5 (PDE5) inhibitor, in healthy male volunteers. Int J Clin Pharmacol Ther. 2012;50(12):896-906. doi:10.5414/CP201624
- Kupelian V, Link CL, McKinlay JB. Association between smoking, passive smoking, and erectile dysfunction: results from the boston area community health (BACH) survey. Eur Urol. 2007;52(2):416-422. doi:10.1016/j.eururo.2007.03.015
- Arackal BS, Benegal V. Prevalence of sexual dysfunction in male subjects with alcohol dependence. Indian J Psychiatry. 2007;49(2):109-112. doi:10.4103/0019-5545.33257
- Collins CE, Jensen ME, Young MD, Callister R, Plotnikoff RC, Morgan PJ. Improvement in erectile function following weight loss in obese men: The SHED-IT randomized controlled trial. Obes Res Clin Pract. 2013;7(6):e450-e454. doi:10.1016/j.orcp.2013.07.004
- Khoo J, Tian HH, Tan B, et al. Comparing effects of low- and high-volume moderate-intensity exercise on sexual function and testosterone in obese men. J Sex Med. 2013;10(7):1823-1832. doi:10.1111/jsm.12154
- Kamenov Z, Fileva S, Kalinov K, Jannini EA. Evaluation of the efficacy and safety of Tribulus terrestris in male sexual dysfunction - a prospective, randomized, double-blind, placebo-controlled clinical trial. Maturitas. 2017;99:20-26. doi:10.1016/j.maturitas.2017.01.011
- Do J, Choi S, Choi J, Hyun JS. Effects and mechanism of action of a Tribulus terrestris extract on penile erection. Korean J Urol. 2013;54(3):183-188. doi:10.4111/kju.2013.54.3.183
- Ferrini MG, Kovanecz I, Sanchez S, Umeh C, Rajfer J, Gonzalez-Cadavid NF. Fibrosis and loss of smooth muscle in the corpora cavernosa precede corporal veno-occlusive dysfunction (CVOD) induced by experimental cavernosal nerve damage in the rat. J Sex Med. 2009;6(2):415-428. doi:10.1111/j.1743-6109.2008.01105.x
- Choi HK, Seong DH, Rha KH. Clinical efficacy of Korean red ginseng for erectile dysfunction. Int J Impot Res. 1995;7(3):181-186.
- Hong B, Ji YH, Hong JH, Nam KY, Ahn TY. A double-blind crossover study evaluating the efficacy of Korean red ginseng in patients with erectile dysfunction: a preliminary report. J Urol. 2002;168(5):2070-2073. doi:10.1097/01.ju.0000034387.21441.87