As any man who’s suffered from bedroom issues knows, erectile dysfunction (ED) can take a major toll on self-esteem and romantic relationships. In the absence of a cure, as many as 30 million American men suffer from ED, and 30 percent of those are age 70 and older.
While ED mostly impacts older men, age usually has nothing to do with it. Fox News went to the experts to identify six medical risk factors that are linked with ED. If you suffer from any of the conditions below, they may be at the root of your performance problems.
1. Heart disease
For the majority of men with ED, cardiovascular problems such as arteriolosclerosis, or hardening of the arteries, and high cholesterol are at the root of the issue.
That’s because, to achieve an erection, the arteries must allow blood to flow throughout the body, not just in the penis. “Anything that clogs up your arteries or narrows arteries is going to affect blood flow,” Dr. Dudley Danoff, a urologist in Los Angeles and author of “The Ultimate Guide to Male Sexual Health,” told Fox News.
In fact, studies suggest men diagnosed with ED can have a heart attack or stroke within three to five years.
To check blood flow, your doctor may order a penile doppler ultrasound study, which includes an injection to cause an erection, along with ultrasound imaging. “If the rate of blood entering the penis is too low, we know that’s usually do to arterial disease,” Dr. Peter Stahl, assistant professor of urology at Columbia University Medical Center in New York City, told Fox News.
Your doctor will refer you to a cardiologist and you may be prescribed a PDE5 inhibitor medication like Viagra, which studies show can help ED and your heart.
In fact, men who had heart attacks and were prescribed PDE5 inhibitors or alprostadil, another type of medication for ED, were 40 percent less likely to be hospitalized for heart failure than men who were not using the drugs, according to a study presented at the American College of Cardiology's 66th Annual Scientific Session in March.
2. Neurological problems
Any medical condition that affects the brain, the spinal cord or the small autonomic nerve fibers that send nerve signals from the spinal cord to the penis and from the penis to the spinal cord can lead to ED.
Men who have multiple sclerosis, spinal cord injuries or a degenerative disc disease, or those who have had surgery or radiation for prostate, bladder or rectal cancer, can be affected. The most common neurological condition that leads to ED — and the most difficult to treat — is diabetic neuropathy, or nerve damage that occurs with diabetes.
Although vasodilator medications can help, they will only work in men who have some nerve function, Stahl said.
3. A “leak”
Veno-occlusive dysfunction, or venous leak, is a problem with the penis’ ability to trap blood. The penis has two erection chambers that expand and compress the veins that drain blood from the penis. Due to age, diabetes or other problems, the erection chambers can lose their elasticity and their ability to expand sufficiently.
“No matter how fast blood rushes in, it leaves just as fast, so those patients can never achieve fully rigid erections,” Stahl said.
Veno-occlusive dysfunction requires invasive treatment procedures or even a penile implant.
Hormonal problems, such as thyroid dysfunction or pituitary tumors or malfunction, can lead to ED.
Although testosterone deficiency plays a part, those hormone levels affect libido, not erectile function. “If a man’s libido is low, that certainly can affect his erections, but it does it indirectly,” Dudley said.
What’s more, it can be hard to tell whether ED is related to low testosterone, as men with low T can also have symptoms like fatigue, and weaker erections. “Whether or not that is related to testosterone deficiency or usual things like not sleeping enough, poor lifestyle and lack of exercise, is very difficult to discern,” Stahl said.
Although testosterone replacement therapy isn’t a standard treatment for ED, studies suggest it improves erectile function in men with both ED and testosterone deficiency, Stahl said.
When men have performance anxiety, the sympathetic nervous system gets activated, adrenaline is produced, and blood flow gets diverted away from the penis, which can result in a mild loss of rigidity, albeit initially, Stahl said.
Yet the anxiety can lead to more anxiety, lessening blood flow to the penis and affecting a man’s ability to get an erection. “It can happen to anybody, and it can be very difficult to break cycle,” Stahl said.
One way to tell whether ED is related to anxiety or another medical condition is to have a nocturnal penile tumescence (NPT) test. Using a device similar to a blood pressure cuff, the test will measure your ability to get an erection during sleep, when psychological barriers are absent.
If you get erections, it’s likely not related to a physical problem. In that case, talk to your doctor or a therapist about things you can do to prevent ED.
Finasteride, used to treat prostate enlargement and male pattern baldness, can cause ED and, in a small subset of patients, permanent sexual dysfunction.
Drugs for high blood pressure like beta blockers, thiazide diuretics and calcium channel blockers may cause mild ED. SSRIs and SNRIs for depression and anxiety can also affect arousal, desire and orgasmic function. Yet trying a different type of medication is usually all that’s necessary to reverse the effect.