Understanding Erectile Dysfunction

Erectile dysfunction — difficulty getting or keeping an erection firm enough for satisfying sex — is one of the most common health concerns men face. It becomes more frequent with age, but it is not an inevitable part of aging, and in most cases it can be addressed.

How common is it?

ED is far more common than most men assume. A significant share of men experience some degree of it during their lives, and the likelihood increases with each decade of age. If you are dealing with it, you are in very large company — and there is no reason to face it without help.

What causes ED?

An erection depends on healthy blood flow, intact nerve signaling, adequate hormones, and the right psychological state. A problem in any of these areas can contribute to ED. The most common causes include:

• Vascular factors. Reduced blood flow is the single most common cause. Conditions that affect the blood vessels — high blood pressure, high cholesterol, diabetes, heart disease — frequently show up as ED.
• Hormonal factors. Low testosterone and other hormone imbalances can play a role.
• Neurological factors. Nerve signaling can be affected by diabetes, certain surgeries, or injuries.
• Psychological factors. Stress, anxiety, depression, and relationship strain can all contribute — sometimes alone, often alongside physical causes.
• Lifestyle and medications. Smoking, excess alcohol, inactivity, and certain prescription medications can each be a factor.

Because ED often has more than one cause, a proper evaluation matters. It can also be an early warning sign of a broader health issue, particularly cardiovascular disease — which is one reason it is worth taking seriously rather than ignoring.

When should you see a doctor?

It is reasonable to see a urologist if difficulty with erections happens regularly, persists for more than a few weeks, or is causing you distress. You do not need to wait until the problem is severe. An evaluation can identify what is driving your symptoms — and, just as importantly, rule out or catch underlying health concerns early.

Treatment options

The good news is that ED is highly treatable, and there are more options today than ever. They generally fall into two groups:

• On-demand symptom management. Oral medications such as sildenafil and tadalafil support an erection for the hours they are active. They work well for many men. Learn about ED medications →
• Cause-directed treatment. ErectionWave™ low-intensity shockwave therapy and the P-Shot® aim at the underlying tissue and blood flow rather than a single occasion. Learn about ErectionWave™ →

For many men, the right answer involves more than one approach. The starting point is always a thorough evaluation with Dr. Shusterman, who will identify the contributing causes and recommend a plan suited to your individual situation.