Everything you need to know about erectile dysfunction

Erectile dysfunction (ED) is incredibly common. In fact, it is the most common form of sexual dysfunction experienced by people with penises. 

Studies have consistently shown that 1 in 3 male-bodied people will experience erectile difficulties at some point in their lives. And as AMAB (assigned male at birth) people get older, this percentage increases to 50 percent. A 2019 review of several studies found that the global prevalence of ED ranges between 3 percent and 76.5 percent, showing both its commonality and variance.

ED “is a pattern of difficulty achieving or maintaining an adequate erection during most partnered sexual activities,” explains Dr. Bailey Hanek, an AASECT-certified sex therapist, and consultant for the Between Us Clinic. “Technically, to qualify as ED, these difficulties must be present for at least six months during at least 75 percent of sexual activity, though most people experience significant distress before meeting those criteria,” Hanek adds.

It’s important to note that while “erectile dysfunction” is still widely used, the clinical term has been updated to “erectile disorder” because it is less pathologizing and stigmatizing. Dysfunction is a really sucky term that makes people feel broken, tbh.

Let’s break down what ED is, the reasons why it happens, and how you can deal with it. ED is nothing to be embarrassed or ashamed about. It happens to so many people. With that being said, we understand that it can be incredibly distressing. We’re here to help. 

How erections work: The basis for understanding ED

The first thing we need to understand is how erections actually happen. If we don’t know how an erection works, we can’t understand what happens when they don’t work. 

Erections are much more complex than we give them credit for. They are legit mercurial beasts. They manifest from a slew of deeply complex physiological and psychological processes in the body and brain.

When AMAB people get erections, blood flows into the chambers of the penis and causes the penis to stiffen. The veins in the penis compress, keeping the blood in the penis — and keeping it hard. 

Want more sex and dating stories in your inbox? Sign up for Mashable’s new weekly After Dark newsletter.

This whole process is possible because of a series of signals exchanged between the brain and the penile tissue. When the tissue around the penis is stimulated, a signal is sent to the brain, which sends a reinforcing signal back to the tissue to begin erection. This can also work the other way around. When the signal starts in the brain (sexual desire), the brain sends a signal to the penile tissue. It is an elaborate messaging system.

What usually happens next: When the penis reaches climax, the brain sends a signal to the genitals that it’s time to make the erection go down.

What is erectile dysfunction?

Now, let’s get into the meat (sorry) of how erectile disorder comes into the equation. The brain-body signals that are constantly flowing to keep the penis aroused and hard are disrupted. This leads the brain to tell the genitals that it’s not time to have an erection anymore, and thus the erection goes down before we want it to. 

This happens to a lot of people, in a lot of circumstances – and it isn’t always due to erectile disorder. It’s only classified as erectile disorder if, as Hanek mentioned, this occurs in 75 percent of sexual experiences. Of course, with the cultural conditioning we have around penis-in vagina (PIV) intercourse being the only form of “real sex” and the worship of hard erections as a designation of masculinity, it makes sense that losing your erection -— however often it happens — would be very upsetting.

Why erectile dysfunction happens

OK, spoiler: The reasons ED happens are nearly as complicated as the process of erections themselves. There are a lot of factors to consider – but they fall into three buckets: psychological, biological, and lifestyle factors.

Psychological factors

• Culture and society

The pressure we put on erections is an erection inhibitor. Moushumi Ghose, MFT, a licensed sex therapist, says that the cultural pressure we have around hard erections being “the ultimate sign of masculinity” really impacts the ability to get and maintain one. Nothing can make an erection go down faster than a bunch of social pressure being applied to it.

• Anxiety

“Erectile disorder is often an extreme expression of anxiety,” Ghose says. This can present as the primary reason for ED, or as a secondary response to ED. Meaning, you have anxiety and therefore, you have erection problems – or you have erection problems and this leads to anxiety about getting erections. It’s a vicious cycle.

• Poor self-esteem 

When we have poor self-esteem, it leads to feelings of inadequacy. “When [an AMAB person] thinks of the partner as outside of their league, or someone that they may not be able to please or impress, this can also lead to anxiety about performance, [and] insecurities about inadequacies,” Ghose explains. These feelings are linked to anxiety.

Biological factors

• Chronic medical conditions

Diabetes and high blood pressure can cause ED. “Damage to blood vessels and nerves as a result of these two conditions can lead to poor circulation and thus decreased blood flow to the penis,” says Dr. Anika Ackerman, a urologist specializing in sexual medicine. “Blood pressure medications are also known causes of ED.” 

Other medical conditions linked to ED are heart disease, hypertension, and prostate issues, Hanek adds.

• Hormone levels

“As men age, testosterone declines and this can lead to ED,” Ackeman explains. This is especially true if you’re over 40. Always seek medical advice and testing for T levels.

• Surgeries

Certain surgeries that impact blood vessels or the spinal cord can cause ED. “Spinal cord and brain injuries can also cause ED,” Ackerman says. “Surgeries on the prostate, bladder or penis may [also] lead to ED.”

Lifestyle factors

• Smoking

Smoking is directly linked to ED because it disrupts blood vessel function.

• Alcohol use

Alcohol disrupts the spinal cord-brain-body messaging system. Excessive alcohol use can also lead to lowered testosterone levels.

• Sedentary lifestyle 

When we don’t exercise, our bodies and sex lives can suffer. Being sedentary can cause inflammation and reduce blood flow to the penis.

4 expert-approved strategies for improving erectile problems

• Therapy

Therapy can be hugely beneficial in dealing with the mental health issues that are causing – or are caused by – erectile disorder. “In order to really truly get to the bottom of this, your anxiety will need to be dealt with,” Ghose says. “I often use a variety of tools with my clients ranging from reeducation, to learning what they’ve learned about their manhood being tied to having an erection.”

• Mindfulness

Mindfulness allows us to become more in-touch with our bodies and sensations – all while reducing anxiety. “Mindfulness and meditation strategies help train the mind to focus with intention, which is a robust defense against anxiety,” Hanek explains. “These strategies can be practiced on one’s own, though working in conjunction with a sex therapist yields the best results.”

• Medication

PDE-5 inhibitors (think: Viagra, Cialis, Tadalafil) are medications that work by turning off the signal to the brain that the erection should go down. It’s important to note that while these drugs work to help maintain an erection, they don’t initially produce it. Ghose also adds that these drugs can be useful, but are usually only a temporary fix. Mental health support may still be required for lasting results.

• Lifestyle changes

If you smoke, drink, or don’t work out, it might be time to change up those habits. “Lifestyle changes are important,” Ackerman says. “Eating healthy and exercising are at the top of the list. Sometimes, people are able to reverse diabetes and high blood pressure by lifestyle changes alone.” Better lifestyle = better erections. ‘Nough said.

ED is a very distressing condition and it affects many people. You’re not alone and there are varied options for treatment. Seek out medical and mental health professionals to help you on your journey.