What is Erectile Dysfunction?

Nothing will make a man with erectile dysfunction (ED) worse than seeing an ED commercial: bright, happy lights, lots of smiles, flirtatious gestures, attractive women, intimate touching, the sense that this guy just finished making the bed violently squeak. Nothing about this scenario helps anyone with ED feel better about it. Know what I mean?

To put it crassly, ED sucks – er, that is, it’s no fun. When Mr. Wizard is in a constant state of failure to launch, it can kill self-esteem for men and their partners that extends well beyond the bedroom. Women may wonder if they are no longer attractive to their partner. Men will feel frustrated, emasculated, and sexually “pent-up.” Such feelings only exacerbate the problem.

Unfortunately, many couples aren’t jumping at the bit to talk about the problem together. Whether men don’t want to own up to it or both partners would rather avoid talking about it, a flaccid sex life can destroy intimacy. Often times, men only begin to explore the problem when their partners push for it.

Contrary to popular belief, while getting older does increase your chances of struggling with ED, it is not simply a problem of aging. A recent study in the Journal of Sexual Medicine found that 26% of men who sought help for ED were under the age of 40 [1]. ED usually looksl like:

• Can’t get hard at all
• Can’t stay hard very long
• Can only get to a softish 45 degress (as opposed to a healthy 90 degrees)

Erectile dysfunction happens when the soft tissue lining the penis cannot maintain proper blood supply to the penis – especially due to atherosclerosis (hardening of arteries) of the penal artery. By “proper blood supply” we are talking about the amount of blood needed needed to get/maintain an erection long enough for sexual intercourse. How long is “long enough”? If your sexual fulfillment is droopy, it could be because of ED.

Getting back on top: A VERTICAL SOLUTION FOR HORIZONTAL PROBLEM

If this sound familiar, there are three options:

1. Do nothing
2. ED medication
3. Understand the root cause in an attempt to correct (or re-erect) it

Considering that ED medication is a multi-multi-billion-dollar industry, it’s clear which route many men are choosing. While it’s nice to relieve oneself and overcome this droopiness, getting at the source of the problem is healthier long term solution for many men. Ideally, this route will result in a vertical solution for a horizontal problem without the use of pharmaceuticals.

Root problems of male impotence are not always “a single thing,” but can be a combination of factors that work against phallic perkiness. Browse through this list of causes of erectile dysfunction and be honest about how many of these things you struggle with. Identifying the root cause of the problem may be the first step in getting back on top.

Poor circulation most common cause

Considering that an erection is generated by blood flowing into the penis, poor blood flow can seriously inhibit erections. Biologically, it is the the most common reason for a wilting phallus.  Poor blood flow can be the result of numerous health conditions, such as:

• Diabetes
• High cholesterol
• Hardening of the arteries
• Heart disease

Diabetes and heart disease are especially important in the conversation about ED. In the case of heart disease, ED can be an early warning sign of future heart trouble or underlying heart problems [2]. This makes sense, as sub-par heart functioning is not usually conducive to strong circulation.

With diabetes, high blood glucose causes hardening of the arteries and results in poor circulatio – a natural side effect is ED [3].

WHAT YOU CAN DO ABOUT IT RIGHT NOW: Get overall men’s health test, which test a whole range of important health markers for men such as prostate health, hormone health, etc.

Medications that can cause impotence

In addition to medical problems, certain medications can restrict blood flow and lead to ED as well. Some medications that may cause impotence are:

• Alpha-adrenergic blockers, such as tamsulosin (Flomax)
• Beta-blockers, such as carvedilol (Coreg) and metoprolol (Lopressor)
• Synthetic hormones, such as leuprolide (Eligard)
• Diuretics, such as furosemide (Lasix) and spironolactone (Aldactone)
• Central nervous system stimulants (i.e., amphetamines) or depressants such as alprazolam (Xanax), diazepam (Valium), and codeine
• Some serotonin reuptake inhibitors (Prozac, Paxil)
• Hair loss medication such as finasteride (Propecia) or dutasteride (Avodart)

This list is quite intimidating, as it covers a whole swath of different health concerns that many men take medication for. Perhaps the best solution here is to work with your healthcare provider to see about developing a functional treatment solution other than a pill (if possible).

WHAT YOU CAN DO ABOUT IT RIGHT NOW: Scan your list of medications. See any medications that are referenced above? If so, you may consult your healthcare practitioner to see about substituting that medication in order to see if ED goes away.

Endocrine disorders and Low Testosterone

The endocrine system is the quiet star of our bodies. It’s 20+ glands are responsible for producing hormones that literally regulate every cell in the body in terms of:

• Growth and development
• Metabolism
• Tissue function
• Reproduction

You are probably most familiar with the thyroid, which is the epicenter of our endocrine system. Our thyroid is critical for emotional well being, among numerous other bodily functioning. The endocrine system also produces the male hormone T, i.e., testosterone. While testosterone doesn’t play a direct role in the biology of producing an erection, it does affect sexual desire which plays an important role as primer for rising to the occasion, so to speak.

While this information doesn’t seem to be widely disseminated online, thyroid disease may have a high correlation to male impotence. When we are talking about thyroid disease we are usually talking about:

• Hypothyroidism
• Hyperthyroidism

In 2008, the Journal of Clinical Endocrinology and Metabolism published a study which found that 79% of the 71 tested men with hypothyroidism struggled with ED  – 37% of these men struggled with severe ED [4].

WHAT YOU CAN DO ABOUT IT RIGHT NOW: If you or your partner is struggling with ED and also exhibits other symptoms of hypothyroidism, we strongly suggest seeking your healthcare  provider or get thyroid testing. Likewise, getting testosterone levels tested is also extremely important – it’s inexpensive and private.

Depression, Stress, or Anxiety

There is a strong link between erectile dysfunction and depressive illness, though the causal relationship is unclear. Does depression lead to erectile dysfunction? Does ED stimulate the development of depression? Like many things, both are probably true depending on the person – as the saying goes, “different folks, different strokes.”

However, what is clear is that the high number of men with depression that also struggle with ED (comorbidity). Men with depression may be twice as likely to report ED than nondepressed men. We find similar trends in the relationship between high stress/anxiety and ED [5].

The takeaway here is that phallic problems can be a psychological phenomenon and/or a physiological one. The good news is that for many men, depression, anxiety, stress and other emotional disturbances are often episodic/temporary rather than lifelong/chronic.

Modern alternative methods of combating stress, anxiety, and depression that many people use are:

• Yoga
• Meditation
• Therapy
• Exercise
• Acupuncture
• Relaxation techniques
• Massage
• Sex therapy

WHAT YOU CAN DO ABOUT IT RIGHT NOW: Test cortisol levels. Check your blood pressure. Do personal assessment of energy and stress levels. Exercise. Take some quiet relaxation time once per week.

Low levels of vitamin D

A 2014 study in Italy found a rather eye-opening correlation between vitamin D and erectile dysfunction. Specifically, the study looked at vitamin D levels in 143 men with various severities of ED and found that 46% of the men were deficient in vitamin D3, while only 20% of men had optimal vitamin D3 levels [6].

Why does vitamin D3 have to do with a 90 degree sex-life? Vitamin D is a regulator of nitric oxide synthase (i.e., links two molecules to create nitric oxide) [7]. The bioactivity of nitric oxide plays a critical role as a chemical mediator and neurotransmitter in the erectile process [8]. In plain terms, there is a muscle in the arteries of the penis called the “smooth muscle” (great word for such a muscle, “smooth move”). This muscle needs to be relaxed in order to let in blood flow needed for an erection – nitric oxide triggers this muscle to relax [9].

To summarize:

• The penis has a muscle called the “smooth muscle” that needs to be relaxed for an erection
• Vitamin D3 is critical in synthesizing nitric oxide
• Nitric oxide relaxes the smooth muscle
• Vitamin D deficiency can result in too little nitric oxide to stimulate relaxation of smooth muscle

WHAT YOU CAN DO ABOUT IT RIGHT NOW: Simply put, get vitamin D testing. If you are low, take measures to get to optimal vitamin D levels.

Poor Diet

Diet does not “cause” ED in the same way that, say, poor blood circulation does. However, poor diets can significantly contribute to the type of health concerns that do directly cause ED. Unhealthy fats, sugars, and processed carbohydrates contribute to a whole slew of health problems:

• Plaque in arteries
• Diabetes
• Obesity
• Heart disease
• High blood pressure

And so on. Poor diet can also play a role in depression and stress (90% of serotonin in our bodies is made in our gut). In addition to preventing quality circulation, poor diet can also interfere the nitric oxide production.

In general, the Mediterranean diet is touted as being one of the healthiest in the world. Unsurprisingly, its emphasis on high intake of fruit, fish, and vegetables makes it one of the highest nitrate-rich diets in the world. Some foods high in nitrates are:

• Pomegranate
• Walnuts
• Spinach
• Oranges
• Beets
• Cranberries
• Walnuts

Nitric oxide, incidentally, is also important in helping regulate blood pressure by dilating arteries – another reason to consider how diet may play a role in ED [10].

WHAT YOU CAN DO ABOUT IT RIGHT NOW: Review your diet. Be honest about what you are eating. Get tested for vitamin levels.

References

[1] Paolo Capogrosso MD, Michele Colicchia MD, Eugenio Ventimiglia MD, Giulia Castagna MD, Maria Chiara Clementi MD, Nazareno Suardi MD, Fabio Castiglione MD, Alberto Briganti MD, Francesco Cantiello MD, Rocco Damiano MD, Francesco Montorsi MD, Andrea Salonia MD. One Patient Out of Four with Newly Diagnosed Erectile Dysfunction Is a Young Man—Worrisome Picture from the Everyday Clinical Practice. The Journal of Sexual Medicine. 2013 May 2013.

[2] Menezes A, Artham S, Lavie CJ, Milani RV, O’Keefe J. Erectile dysfunction and cardiovascular disease. Postgrad Med. 2011 May;123(3):7-16.

[3] Maria Ida Maiorino, Giuseppe Bellastella, and Katherine Esposito. Diabetes and sexual dysfunction: current perspectives. Diabetes Metab Syndr Obes. 2014; 7: 95–105.

[4] Krassas GE1, Tziomalos K, Papadopoulou F, Pontikides N, Perros P.Krassas GE, Tziomalos K, Papadopoulou F, Pontikides N, Perros P. Erectile dysfunction in patients with hyper- and hypothyroidism: how common and should we treat? J Clin Endocrinol Metab. 2008 May;93(5):1815-9.

[5] Perelman MA1.Perelman MA. Erectile dysfunction and depression: screening and treatment. Urol Clin North Am. 2011 May;38(2):125-39.

[6] Barassi A, Pezzilli R, Colpi GM, Corsi Romanelli MM, Melzi d’Eril GV. Vitamin D and erectile dysfunction. J Sex Med. 2014 Nov;11(11):2792-800.

[7] Andrukhova O, Slavic S, Zeitz U, Riesen SC, Heppelmann MS, Ambrisko TD, Markovic M, Kuebler WM, Erben RG. Vitamin D is a regulator of endothelial nitric oxide synthase and arterial stiffness in mice. Mol Endocrinol. 2014 Jan;28(1):53-64.

[8] Burnett AL1.Burnett AL. The role of nitric oxide in erectile dysfunction: implications for medical therapy. J Clin Hypertens (Greenwich). 2006 Dec;8(12 Suppl 4):53-62.

[9] Cartledge J, Minhas S, Eardley I. The role of nitric oxide in penile erection. Expert Opin Pharmacother. 2001 Jan;2(1):95-107.