Understanding erectile dysfunction

September 5, 2024

Swedish Health Team

[5 MIN READ]

A recent study predicts 322 million men around the world will experience erectile dysfunction by 2025.
Erectile dysfunction, or ED, is the persistent inability to get and/or maintain an erection that is sufficient for satisfactory sexual activity. It’s not a one-time event; it’s an ongoing pattern that continues over time.
A prosthetic urologist at Swedish Urology discusses erectile dysfunction, its health implications and the wide range of available treatment options.

Understanding erectile dysfunction

Erectile dysfunction is a common problem that affects millions of men of all ages. In fact, a recent study predicts that 322 million men worldwide will experience erectile dysfunction by 2025.

You’d think an issue that affects this many people would be a hot topic of conversation. And yet, many men find it embarrassing to discuss, and even more don’t want to admit they’ve experienced “bedroom issues.”

It's past time to change that. On a recent Talk with a Doc episode, James Kuan, M.D., FRCSC, a prosthetic urologist at Swedish Urology—First Hill, discussed erectile dysfunction, its health implications and treatment options. Here’s what he shared.

What is erectile dysfunction?

Dr. Kuan: Simply put, erectile dysfunction is the persistent inability to get an erection that is sufficient for satisfactory sexual activity. It's not a one-time event; it’s an ongoing pattern of difficulty getting and/or maintaining an erection.

What causes erectile dysfunction?

Dr. Kuan: The average guy will develop erection problems as a result of the things that put him at risk for the exact same things that cause heart attack or stroke: high blood pressure, high cholesterol, vascular disease, smoking, obesity and history of heart disease.

Diabetes is a more significant risk factor because it affects the nerves and blood vessels. Treatment for prostate cancer increases risk, as does extensive colon surgeries or radiation for things like colon cancer. Mental health disorders, depression, and excessive drug and alcohol use are also risk factors.

A lot of the common medications that people take for their blood pressure can also cause issues with erectile dysfunction. Many of the medicines that we use to treat prostate cancer are drugs that block testosterone – the male hormone that’s important in stimulating libido.

Drugs that can affect your ability to achieve and maintain an erection include alpha-blockers and alpha-reductase inhibitors. We prescribe these medications to help shrink the prostate when it enlarges, and sexual side effects occur in about 10 to 15% of men using these medications.

Men who use opioid pain medications can commonly have issues with erectile dysfunction. Similarly, men who use tranquilizer medications called benzodiazepines like Ativan or Valium may also experience problems.

Who experiences erectile dysfunction?

Dr. Kuan: Typically, we think of older guys over the age of 50, at which point, half of men will have experienced some degree of ED. As many as 20% of men in their 20s will have some erectile dysfunction. And that number goes up every 10 years. So 30% of men in their 30s, 70% of men in their 70s, and so on. That’s because of age – what I call the march of life – and then the accumulation of the risk factors that occur as we age.

How is erectile dysfunction treated?

Dr. Kuan: There are several treatments for ED.

Lifestyle modifications

Lifestyle modification is one of the few things we can offer that actually works to prevent further erectile dysfunction – essentially adopting a more heart-healthy way of life.

Your internist or cardiologist suggests a few things that will help you in the bedroom: exercise better, sleep better, manage stress better, address sleep apnea, decrease salt intake, control cholesterol, lose weight and quit smoking.

Medication

Presently, we have four medications that we will commonly prescribe:

Avanafil (Stendra).
Sildenafil (Viagra).
Tadalafil (Cialis).
Vardenafil.

Essentially what these are doing is addressing that dilation part of the erection, allowing more blood to flow into the penis and allowing that part of the erection to last longer. Men have to understand they have to be in the mood. You can’t take this and do your taxes. Nothing will happen. You have to stimulate the penis for this to work.

We recommend you take them in advance of sexual activity. They take a little bit of planning – about 30 to 60 minutes, depending on the drug. Cialis, however, can be taken daily because it stays in your system longer.

There’s about a 55 to 85% response rate, depending on why the erectile dysfunction is present. Most men will tolerate them, but the medications can have side effects, such as headache, heartburn, getting red in the face or having a stuffed-up nose.

Injection

We can teach men to inject medications directly into the penis. This bypasses the need for the drug to get absorbed and then circulate. Not all men are comfortable using an insulin-type needle to put medicine into the penis. That said, these are potent.

They’re very effective. With an injection, within five to 10 minutes, men can have a very rigid erection that lasts anywhere from 20 minutes to an hour.

It takes a little bit of training. Injections are usually done in the doctor’s office, and finding the correct dose may take some trial and error. But many men will use these injections for many years as long as they’re comfortable giving themselves a needle.

Most people have no side effects other than the pain of the needle. You can get some bruising and long-term scarring in the shaft of the penis, which could lead to lead to some curvature. An erection that lasts too long is a more common side effect of injections.

Vacuum penis pump

A vacuum penis pump is an external mechanical device. It’s a cylinder into which a man places his soft penis and uses a pump to create a vacuum that pulls blood into the penis, making it hard. A tight ring or band is then placed at the base of the penis and traps the blood inside.

Implant surgery

Implant surgery was developed 50 years ago, so it’s not a new technology other than advances in the materials and certain minor modifications. This procedure actually achieves all the check marks of the ideal treatment. Probably 80% or 90% of men have their surgery as an outpatient.

In general, there is some swelling in the first couple of weeks, and people stay close to home. By weeks four to six, most men are free to use their implants. We place these prosthetic devices inside the body, meaning nothing is on the outside. They essentially replace your own hydraulic system, which is a blood flow system.

A prosthetic system uses salt water. In the deflated position, the penis is soft. Then, the erection is activated by squeezing a pump about the size of a testicle through the skin of the scrotum. The pump pulls salt water from a reservoir, fills the cylinders and forms the erection.

It stays up until the man is finished and can push as hard as he wants. When he’s finished, there’s a small deflate button. This procedure has a 90+% satisfaction rate.

Can ED be prevented?

Dr. Kuan: There are modifiable and unmodifiable risk factors. We can’t change our genetics. We can’t change our age. We’re getting older, that’s the march of life, and it will happen no matter what. But we can change our lifestyles, what we eat, how we live. We can stop smoking if we smoke. We can do all the things to prevent diabetes.

The World Health Organization identifies our sexual health as a very important aspect of our being, and I completely agree with that 100%. Men aren’t alone, even though they can feel pretty desperate. First of all, I will say it may feel like a crisis, but it’s certainly not an emergency. The first thing someone needs to do is take a deep breath and understand that there are solutions. Urologists are equipped with a whole toolbox to help, not just a pill, a shot or surgery. It’s rare that we can’t find a solution to restore a man’s ability to have an erection and, in turn, a healthy sex life.

Learn more and find a physician or advanced practice clinician (APC)

Swedish Urology features board-certified urologists who are highly skilled in all aspects of general urology, including erectile dysfunction diagnosis and treatment. We utilize the latest technology for diagnosis as well as medical and surgical treatment.

Whether you require an in-person visit or want to consult a doctor virtually, you have options. Contact Swedish Primary Care to schedule an appointment with a primary care provider. You can also connect virtually with your provider to review your symptoms, provide instruction and follow up as needed. And, with Swedish ExpressCare Virtual, you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections and more. You can use our provider directory to find a specialist or primary care physician near you.

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