Erectile dysfunction getting you down? Here are three things to know | Canada Voices

Ask a Doctor is a series of physician-authored columns offering insights and advice on common health topics. It is not a substitute for seeking medical care.

One of the most common conversations I have with patients is about something many people find awkward to talk about: erectile dysfunction (ED). Often, patients will bring it up at the end of an appointment, just as I have my hand mid-turn on the doorknob, about to leave the exam room. ‘Junior’s not getting the job done,’ a patient might say sheepishly, or ‘It ain’t happening down there, doc – it’s not working.’ Usually, the patient is slightly embarrassed, speaking as a child would after he’d eaten all the cookies from the cookie jar.

Yet in my experience, most doctors are actually very open to talking about erectile dysfunction – a condition which affects close to 50 per cent of Canadian men aged 40-88, according to the Canadian Men’s Health Foundation. And because ED can be the sign of potentially serious underlying health conditions, it’s important to see a doctor if you have symptoms. The good news is there are several effective treatments for ED.

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If you are experiencing symptoms, here are three things to know to help you get the conversation started.

1. ED has various causes

There are four main causes of ED: psychogenic, vascular, hormonal and neurologic.

Psychogenic ED is often caused by psychological disorders such as anxiety or depression, which can lower sex drive and sexual arousal. Some anti-anxiety and antidepressant medications can also reduce libido and erection strength. In addition, strained sexual relationships or performance anxiety can lead to psychogenic ED. If you are still having morning erections upon wakening, and/or if you are still able to masturbate, your ED is likely psychogenic in nature.

However, being “psychogenic” doesn’t make ED any less “real.” Penile erections are co-ordinated by the parasympathetic (“rest and digest”) nervous system, so any stressful experience that activates the opposing, sympathetic (“fight or flight”) nervous system can reduce or eliminate an erection, including among young men.

Vascular ED is due to insufficient blood flowing to the penis or being retained by penile tissue. High blood pressure, a history of smoking, high cholesterol, diabetes, or pre-existing cardiovascular disease are all risk factors for developing vascular ED. Common medications treating these conditions, such as blood pressure medications (e.g. beta-blockers) can also cause ED as a side effect.

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Hormonal ED usually results from testosterone deficiency or thyroid issues that affect sex drive. This type of ED can also result from alcoholism, opioid abuse, and various medical treatments such as androgen-deprivation therapy for prostate cancer.

Neurologic ED is caused by inhibition of or damage to the nerves that regulate penile erections. A variety of conditions can lead to this, including diabetes and neurologic diseases such as spinal cord injury. Alcohol and most drugs with addictive potential (including marijuana, cocaine and ecstasy) can all cause ED by affecting the nervous system.

2. The right treatments work

As with many health issues, social media is awash these days with people promoting non-medical treatments for ED such as over-the-counter supplements. These treatments may not work and are often being pushed by people looking to make a profit. The truth is that most forms of ED can be reliably treated by lifestyle changes, counselling, and/or prescription medication.

A group of medications known as phosphodiesterase type 5 (PDE5) inhibitors are most commonly used to treat ED. These medications increase blood flow to the penis to initiate and sustain erection. They can be taken as needed or daily, keeping in mind that some (i.e. Cialis) last longer than others (i.e. Viagra or Levitra).

Since PDE5 inhibitors enhance blood flow not just in the penis, but throughout the body, they can have systemic side effects, such as headaches or a flushed face. These side effects are generally tolerable for most men. However, PDE5 inhibitors should not be taken in conjunction with certain other medications, such as alpha-blockers used to treat prostate conditions, or nitrates used to treat heart conditions, as combining these medications can cause a dangerous drop in blood pressure.

While it’s possible to obtain ED medications through online men’s health clinics, my advice is to consult with a doctor who knows your full medical history and can perform the appropriate workup for ED (including a physical exam if needed), as well as monitor your health over the long term.

There are other, more invasive forms of treatment as well, such as penile injections or implants, which your doctor can refer you to a urologist to discuss.

For psychogenic ED, relationship counselling and other types of psychotherapy are also effective. Vascular and hormonal ED can often be mitigated through lifestyle changes such as weight loss and healthy eating– strategies which can also help prevent ED in the first place.

3. ED should not be ignored

Understandably, ED is a difficult subject for men to discuss openly. Erectile dysfunction has often been equated (incorrectly) to loss of masculinity. I hope this article makes it crystal clear why this is not the case: there are many causes of ED, and it can be treated effectively.

Moreover, erectile dysfunction is often the canary in the coal mine for life-threatening conditions such as coronary artery disease and diabetes. As such, erectile dysfunction could warrant bloodwork and further investigations by your doctor.

If you are experiencing ED, please do not hesitate to speak with a doctor. I know that I always welcome the discussion, even if my hand is already on the doorknob!

Dr. Yan Yu is a family physician in Alberta and the Northwest Territories and a founder and director of Joyce Health, an online child and adolescent psychiatry clinic. He works in a wide range of clinical settings, including in rural and remote communities, and creates medical education videos in his spare time.