Talking about sexual performance issues can be challenging. But it’s important to engage with the issue and educate yourself about the different causes of erectile dysfunction, particularly if you’re struggling with a performance issue and don’t know how to tackle it on your own.
It’s also important to understand the difference between erection problems caused by a condition like mild performance anxiety, and one that’s caused by a more serious health problem, like atherosclerotic heart disease.
In many cases, taking an erectile dysfunction medication - like sildenafil - will help you to manage the symptoms of erectile dysfunction. However, you may also be able to improve your symptoms by making changes to your lifestyle and diet.
In this article, you will learn about the different causes of erectile dysfunction, and how to help manage problems with your erection.
What is erectile dysfunction?
Erectile dysfunction (or ED) is defined as the persistent inability to attain and maintain an erection sufficient to allow for satisfactory sexual performance. It is a common problem. Studies conducted in China, the US, Germany, and Brazil show that erectile dysfunction affects 16-40% of the adult male population with approximately 150 million new cases reported every year.
Although older men are more likely to develop erectile dysfunction, the condition can develop at any age. Research conducted in Italy showed that one in every four patients seeking help for erectile dysfunction is under the age of 40.
Research suggests that erectile dysfunction is becoming more common, with scientists at the Boston University School of Medicine estimating there will be 322 million new cases per year by 2025 - an increase of almost 170 million cases of erectile dysfunction per year. Prescriptions for ED medications - like sildenafil, tadalafil and vardenafil - are also on the rise.
Erectile dysfunction is a complex issue that’s linked to a number of different health conditions. It can develop as the result of conditions like cardiovascular disease, hypertension, or multiple sclerosis, but it can be caused by overconsumption of alcohol, performance anxiety, or weight gain.
Medication may be one way to produce and maintain an erection, but you may also be able to tackle erectile dysfunction by making changes to your diet or lifestyle.
What causes erectile dysfunction?
Erections are complicated. They develop as part of a multistage process that starts when mental or physical stimulation prompts your central nervous system to release the substance nitrous oxide. Nitrous oxide encourages the arteries that supply your penis with blood to widen, allowing blood to infuse the soft tissue that lines your penis.
Because it relies on the vascular, endocrine and central nervous systems, many health conditions can impede this process, including:
- Atherosclerosis which causes your arteries to narrow and harden, limiting the amount of blood that can reach your penis
- Diabetes which affects both the blood supply and the nerve endings in your penis
- High blood pressure which can damage the arteries that feed the penis
- Multiple sclerosis which affects your central nervous system
- Parkinson’s disease, which affects your brain’s ability to release important hormones
- Nerve or spinal injuries
- Hormonal conditions like hyperthyroidism or Cushing’s syndrome
- Peyronie's disease, which affects the tissues in the penis
Certain medications are known to cause temporary erectile dysfunction in men, including some antihypertensives, diuretics, antidepressants, antihistamines, and medications which contain steroids, among others.
Several lifestyle factors are also connected to erectile dysfunction, including:
- Lack of exercise
- Recreational drug use
- Drinking alcohol
Many risk factors are shared with cardiovascular disease (CVD), such as some of these lifestyle factors (smoking, lack of exercise, obesity) as well as others, like diabetes mellitus, high cholesterol and hypertension.
It’s important to note that erectile dysfunction is often an early warning sign for cardiovascular disease. If you are struggling to get or maintain an erection, you should always see a doctor to rule out or treat any underlying conditions like cardiovascular disease.
Psychological conditions like depression, anxiety, stress, and relationship issues are also linked to persistent problems with erectile dysfunction.
It is always worth considering the steps you can take to minimise the potential for sexual performance issues.
What can I do to improve erectile dysfunction?
If you are worried that you may be suffering from erectile dysfunction, or you are having problems maintaining an erection, you should book an appointment with your doctor as soon as you can. They will be able to discuss the problem, access any medication you may be taking, and do a physical examination.
Your doctor may also arrange some tests to identify or rule out any underlying causes. These tests may include looking for risk factors for cardiovascular disease, such as a blood sugar level test and a blood test for cholesterol and other fats (lipids).
If your erection problems are linked to a lifestyle factor or psychological condition like performance anxiety, you may be able to improve erectile problems - or stop them getting worse - by making positive changes to your diet and lifestyle.
There is some evidence that altering lifestyle factors can improve erectile function, though more studies are needed in this area. Because erectile dysfunction shares many of the same risk factors as cardiovascular disease, making positive changes to your diet, lifestyle, and exercise regime can improve your cardiovascular health as well as your general health.
These lifestyle changes include:
There is a strong link between erectile dysfunction and obesity. The exact reasons for this link are not fully understood. Weight loss is also associated with a number of related benefits, including a reduced risk of type 2 diabetes and atherosclerotic heart disease.
Healthy weight loss is important, however. Fad diets and rapid weight loss regimes are rarely effective, and many carry their own health risks. For best results, aim to lose between 1lb and 2lb per week by:
- Cutting down on junk food, or foods high in sugar
- Eating more fruit and vegetables
- Eating more whole grain foods, like brown pasta or brown rice
- Exercising for at least 150 minutes per week
- Drinking more water
- Making sure you’re eating regular meals to reduce the temptation to snack
If you need some help formulating a weight loss plan, you will find some helpful information in our guide to healthy weight loss.
Giving up cigarettes
The chemicals in cigarette smoke can damage your heart. Several studies have shown that smoking significantly increases the risk of erectile dysfunction because smoking limits the blood supply to the penis.
If you’re serious about giving up cigarettes, you could:
- Write a list of the reasons you want to quit
- Develop a plan to cope with your cravings, including ways to distract yourself
- Explore nicotine replacement therapies, such as patches, tablets, lozenges, gum and a nasal spray
- Exercise more, to combat cravings
- Enlist the help of family members or friends who can keep you on track
If you’re in the UK, look to your Local Stop Smoking Service.
You can also find some helpful tips on the key times to quit smoking.
Reducing alcohol consumption
Heavy drinking can interfere with your nervous system, and may prevent you from getting an erection.
Drinking too much alcohol can also cause other problems, such as disrupting your hormone levels, which could hinder your ability to get or maintain an erection. To keep your health risks from alcohol as low as possible, you should aim to consume less than 14 units per week.
You can make the process of cutting down on alcohol easier by:
- Setting yourself a daily limit
- Setting yourself a weekly budget for alcohol
- Choosing lower strength drinks
- Making smaller drinks
Here are some tips on cutting down the amount you drink. Your doctor may also be able to help you reduce your alcohol consumption.
Reducing anxiety and stress
Stress and anxiety are linked to erectile problems. This can include worries about work, money, your relationship, or family matters.
If you find that you are experiencing occasional erectile problems, or that your erectile dysfunction seems to come and go depending on the situation, it is more likely to be caused by stress or anxiety.
You can't always prevent stress, but there are some things you can do to manage your emotions and reduce the impact that stress is having on your life. This includes:
- Exploring mindfulness which can help to improve your mental wellbeing
- Using calming breathing exercises
- Talking to your friends or family members about your problems
- Taking regular exercise
- Making sure you are eating healthily
- Making sure you get enough sleep
Tackling performance anxiety
If you feel pressure to perform during sex, worry about your ability to please your partner, or find you’re nervous about having sex, you may struggle to get or maintain an erection.
This issue may pass as you and your partner get more comfortable with each other, but performance anxiety can be a self-perpetuating problem.
If you fail to perform once, you may feel anxious the next time you engage in sexual activity. Over time, this problem can sometimes lead to persistent erectile dysfunction.
Talking to your partner may help to reduce your anxiety. Pick a time when you are both relaxed to engage in an honest and open discussion about your anxieties. You may find this helps to put your mind at ease.
Sometimes, counselling for couples or sex therapy can be useful. Alternatively, you could try cognitive behavioural therapy (CBT).
CBT is designed to help you stop negative thinking patterns, which can change the way you feel about situations and the way your body responds to scenarios that you find stressful or hard to manage.
CBT can be delivered in different ways. It can be done one-on-one, in a group, or through a self-help book. You can even use an online service from the privacy of your own home, and for this, try Braive.
Braive offer a range of online courses designed to help you manage anxiety and stress. Most of these courses use live-illustration videos to pass on important skills and methods for dealing with stressful situations, which can prove useful if you’re struggling with performance anxiety.
Try CBT with Braive
Find an online course to help you manage anxiety and stress
Erectile dysfunction is a multifaceted issue that affects a lot of men. It can be the result of an underlying medical issue. But there are lifestyle changes you can make to improve ED, including:
- Losing weight
- Giving up cigarettes
- Exercising regularly
- Reducing your alcohol consumption
- Tackling stress and anxiety in a positive way
Addressing these factors may improve your ability to get and maintain an erection as well as improving your general health.
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