Some medical conversations are less fun than others — especially those that involve issues below the belt. Take erectile dysfunction, a condition that causes difficulty getting and maintaining an erection, for example.
ED affects nearly 30 million men and people assigned male at birth in the US. Common as this experience is, it may be difficult to bring up to a primary care doctor or even know who you should see for help. While people with ovaries are encouraged to see an ob-gyn annually, there’s no equivalent recommendation for people with penises.
Luckily, there are lots of effective treatments for erectile dysfunction, ranging from non-invasive to surgical. We break down where you should seek treatment and what that might be, so you can resume your sex life without stress.
What causes erectile dysfunction?
Erections occur when a penis fills up with blood and becomes hard and rigid, typically in response to sexual arousal. Erectile function relies on the functioning of many different body parts, such as your muscles, nerves, hormones and blood vessels.
“People with erectile dysfunction are unable to have an erection that’s satisfactory for sexual intercourse,” says Dr. Robert Valenzuela, a urologist with Mount Sinai in New York.
Some of the most common causes of erectile dysfunction include:
- Diabetes
- High blood pressure
- High cholesterol
- Heart disease
- Obesity
- Smoking
- Pelvic surgery
- Anxiety/Trauma
- Certain Medications
“Certain blood pressure medications, along with medications for depression and anxiety, can interfere with erectile function,” says Dr. Yooni Blair, an assistant professor of urology at the University of Michigan School of Medicine. Opioids and recreational drug use can also cause ED.
Anyone with a penis can develop ED, but Blair says medical risk factors for ED generally increase with age.
What should you do if you have ED?
“If it’s a one and done scenario, there’s probably not too much to worry about,” says Dr. Michael Eisenberg, a professor of urology at Stanford Medical School. “But if it’s a consistent issue, talk to your doctor, because there’s a lot that can be done.”
People with penises may fail to get an erection up to 20 percent of the time. But if failure occurs around 50 percent of the time, it’s probably a sign you need help.
Typically, you should start by booking an appointment with someone you feel comfortable with, like your primary care provider. They can refer you to a specialist, like a urologist, a doctor that specializes in the urinary tract and issues with male genitalia. Depending on your insurance coverage, you also might be able to bypass your PCP and go straight to a urologist.
There’s no one test for ED; instead, your provider will ask you about your symptoms and try to identify the underlying cause, whether through a physical exam, blood tests, or an ultrasound to better understand what’s going on with your penis and the surrounding area.
How is ED treated?
How ED is treated depends on what’s causing it. Lifestyle modifications, such as eating a more nutritious diet, exercising more and/or quitting smoking, can all help improve conditions that contribute to ED.
If the cause is psychological, then Valenzuela says your provider might recommend psychotherapy to help improve your thoughts and emotions around sex. Your doctor may also tweak your medication regimen if they think your ED stems from a drug you’re taking.
Some treatments for erectile dysfunction include:
- Over-the-counter vacuum erection devices that constrict the penis with a band and temporarily increase blood flow to the area
- Medications that open up blood vessels in the penis, such as Viagra and Cialis
- Suppositories you insert in the urethra before sex
- Penile injections you insert before sex
- Surgical insertion of a device that keeps the penis rigid enough for sex
Most doctors start with the least invasive option and move forward with other options only if a patient doesn’t improve. Some patients, Eisenberg says, need treatment indefinitely, while others only need temporary treatment while they improve a medical condition.
It can be tough to speak up about your erection problems, but it’s important to seek treatment as soon as you notice ED symptoms affecting your sex life and mental well-being.
Generally speaking, the sooner you see a medical provider, the better outcome you’ll have. “Seeing a provider earlier on may help in making sure it doesn’t progress further,” says Blair.