What is Erectile Dysfunction (ED)?

Now that we have an understanding of penile erections, let’s talk about erectile dysfunction.  Erectile dysfunction is defined as inability to achieve or maintain an erection sufficient for sexual performance.

Erectile dysfunction used to be thought of as a psychological disorder, but this is no longer the case.  Erectile dysfunction can be due to vascular, neurologic, muscular, and hormonal factors.  Medications can also impact the ability to achieve and maintain an erection.

Who does ED affect?

52% of people with a penis aged 40-70 years old have erectile dysfunction.  This means that about 1 in 2 people experience this! While it is most common between ages 40-70, younger people are also affected by ED.  It is predicted that ED will affect 322 million people by 2025.  

General health of the individual (including obesity, high blood pressure, and high cholesterol), type 2 diabetes, cardiovascular disease, genitourinary health, and psychological disorders are risk factors for erectile dysfunction.  Obesity, cardiovascular disease, and type 2 diabetes (diabetes mellitus) are all associated with increased inflammation and overall decrease in availability and activity of nitric oxide (NO).  NO influences genital blood flow during erection and when NO is affected, ED can be present.  Hormonal disruption associated with the above comorbidities and diseases can exacerbate and further contribute to ED.

What are the causes of erectile dysfunction?

• Vascular disorders: Reduced blood flow due to occlusion or blocks in the arteries surrounding the penis can result in Erectile dysfunction.  Furthermore, bicycle seats compress the muscles, nerves, and veins and can contribute to ED.

• Neurogenic disorders: People with multiple sclerosis and epilepsy are more likely to be affected by ED.  Trauma or surgery in the hip, spine, or pelvis can impact the nerves innervating the pelvic floor and nerves participating in erection.  Some surgeries or trauma can directly impact the pudendal nerve which impacts the persons ability to achieve an erection.  Lower spinal surgeries can also impact the nerves that innervate the pelvis and genitals and contribute to ED.

• Peyronie’s Disease: The etiology or origin of Peyronie’s disease is not well understood.  However, it is characterized by plaque build up and excessive fibrosis of the tunica albuginea (part of the penis) can cause penile curvature and thus ED.  Those with PD are more likely to experience ED.  

• Medications: Antidepressents, finasteride, anxiolytics, neuroleptics, NSAIDs, and muscle relaxants can contribute to ED. 

• Radical prostatectomy: A prostatectomy is when the prostate is removed due to cancer of the prostate. Removing the prostate can result in urinary incontinence and erectile dysfunction.

• Smoking

Image of artery. Arteris that become blocked in the penis and other areas of the body can affect the ability to acheive and maintain and erection.

Treatments for Erectile Dysfunction

Lifestyle changes and modifications are the most important ways to address and reduce ED.  In the process of changing on’s lifestyle, heart health improves, weight improves, and overall decrease in inflammation can all improve erectile dysfunction.  Lifestyle habits include reducing alcohol consumption, smoking cessation, and exercise.

Physical therapy can help you safely return to exercise if you have any questions.  Finding and maintaining a sustainable exercise routine can be difficult and sometimes daunting, however, a PT can help you make these changes over time while addressing pain or discomfort limitations.  Furthermore, because we know the pelvic floor muscles must be able to contract to sustain an erection, if these muscles are weak or overactive (sometimes causing them to be too tight), then a pelvic health PT can help to address these symptoms.

This photo shows how the muscles of the pelvic floor surround the bulb and crura of the penis. When contracted, they are able to maintain blood in the penis and assist in erection. Physical therapists can help to patients understand and control these muscles to be able to achieve and maintain and erection.

References:

Maiorino MI, Bellastella G, Esposito K. Lifestyle modifications and erectile dysfunction: what can be expected?. Asian J Androl. 2015;17(1):5-10. doi:10.4103/1008-682X.137687

Hussein AA, Alwaal A, Lue TF. All about Peyronie's disease. Asian J Urol. 2015;2(2):70-78. doi:10.1016/j.ajur.2015.04.019

Yafi FA, Jenkins L, Albersen M, et al. Erectile dysfunction. Nat Rev Dis Primers. 2016;2:16003. Published 2016 Feb 4. doi:10.1038/nrdp.2016.3

de Lira GHS, Fornari A, Cardoso LF, Aranchipe M, Kretiska C, Rhoden EL. Effects of perioperative pelvic floor muscle training on early recovery of urinary continence and erectile function in men undergoing radical prostatectomy: a randomized clinical trial. Int Braz J Urol. 2019;45(6):1196-1203. doi:10.1590/S1677-5538.IBJU.2019.0238