Over the past 10 years, erectile dysfunction causes has almost doubled, according to Paduch. “This is partly due to the increased prevalence of obesity and diabetes, but also because patients and doctors are more knowledgeable.”
Paduch also notes that ED awareness has benefited from lots of publicity, thanks to television advertising for medications such as Viagra.
Broadly, erectile dysfunction causes can be either organic — meaning physiological — or psychological, or a combination of both.
One study estimates that nearly 20% of all men over the age of 20 in the United States live with erectile dysfunction.
The prevalence of erectile dysfunction is highly correlated not only with age, but also with cardiovascular risk factors. “Anything that is bad for your heart is also bad for your penis,” said Paduch. That’s why lifestyle changes such as smoking cessation, increased exercise and weight loss have shown to help treat erectile dysfunction, especially as men age.
But aging alone isn’t a sentence for ED, said Montague. “Men who are healthy are not expected to lose erectile function solely on the basis of age. However, with each decade of life there is a higher and higher rate of men with ED because of age-related disorders … which pile up and can cause erection problems.”
Paduch said men shouldn’t be afraid to discuss any sexual problems with their physician.
“We approach the issue in a matter-of-fact way, so most patients are not embarrassed, as you might think they would be.”
“There’s a real need for penile prosthesis, but this isn’t generally recognized by the public and even some medical professionals,” said Montague. “Not being able to have intercourse has been shown in numerous studies to cause low self-esteem depression.”
According to Montague, it’s common for men with ED to give up hope when better-known treatments — medicines such as Viagra and penile injections — don’t work. He said men should be given all of the options early on in treatment, including penile prosthesis.
Dr. Tom Lue, professor and vice chair of Urology at UC San Francisco, emphasized the patient’s lifestyle when treating ED.
“Number one is education,” said Lue. “That’s better than any surgery.”
He said he focuses holistic treatments, then prescribes medication if the problem isn’t solved. For instance, Lue said men experiencing daily, chronic stress can experience erectile dysfunction as a result. “Surgery is a last resort,” said Lue. “Penile implants are much more invasive and have a higher rate of complication, especially for patients with underlying conditions like obesity and high blood pressure.”