To a healthy young man, erectile dysfunction (ED) may seem unthinkable. You can probably remember times (think back to high school) when you wished it wasn't so easy to get an erection.
But as you age -- and especially when you have diabetes -- you may notice some changes. Maybe it takes more coaxing to get erect than it used to. Sometimes it may take more direct stimulation of the penis, whereas merely a daydream or the suggestion of sex was once enough. Or perhaps your erections aren't quite as firm as they once were, but they're still good enough. These are normal changes.
Being unable to have or keep an erection adequate for sexual activity is the defining mark of erectile dysfunction. The problem may manifest itself in several ways. If the dysfunction:
Is transient or appearing only occasionally, the problem is not likely to be serious; all men experience problems with erections at some time in their lives.
Develops gradually and persistently, there is probably a physical cause; this is generally the case with chronic impotence.
So, when is it erectile dysfunction and when should you seek help? Let's consider a few scenarios:
1. You come home one evening after a long and stressful day at work. Your partner wants to have sex. You think you'd like to also, but you just can't get an erection. The next time you try, everything is fine.
In this case, your problem probably doesn't need medical treatment. It's normal to have erection problems on occasion, as long as it's rare. If it starts to happen more often or lasts more then a few months, you may want to talk to your doctor about it.
2. Sometimes when you try to have sex, you get only partially erect. Your erection isn't rigid enough to enter your partner.
In the most severe cases of erectile dysfunction, a man isn't able to get even slightly erect. But there are degrees of erection problems. Even mild erectile dysfunction is worth discussing with your doctor.
3. You can get a good erection, but after you start to have intercourse you can't maintain it.
This can be very frustrating for you and your partner. Even though you are able to get an erection, if it doesn't last long enough to complete sexual intercourse, you may have erectile dysfunction.
Erectile dysfunction can be caused by a medical problem like diabetes, heart disease, or depression. Physical problems cause an estimated 80% of cases of erection problems. The other 20% of erection problems are psychological. For a long time, doctors thought that erectile dysfunction was mostly "all in one's head." Now they know that is not true. Still, the mind plays a big role in getting an erection. Maybe you're losing your erection during sex due to anxiety or other issues between you and your partner. Your doctor can help you determine the cause.
4. Your doctor prescribes a new medication and you notice that it's more difficult to get an erection than it was before you started taking it.
Side effects of drugs cause up to 25% of erectile dysfunction. Prescription drugs that may affect sexual function include:
Blood pressure medicine
Talk to your doctor about switching to a different drug that's less likely to cause problems. If that's not an option, ask about treatment options for erectile dysfunction.
5. You smoke about a pack of cigarettes a day, or you have several alcoholic drinks every night. It's difficult for you to get an erection sometimes.
Drinking too much alcohol can lead to erectile dysfunction. While a glass of wine may help you and your partner get in the mood, heavy drinking can really hamper your sexual performance. Smoking can also cause difficulties getting erections because it damages your blood vessels. One large study showed a link between cigarette smoking and declining sexual function. Lifestyle modification -- such as limiting alcohol use and quitting smoking -- can do a lot to solve the problem.
SOURCES: American Diabetes Association, "Complications of Diabetes in the United States." American Urological Association, "Management of Erectile Dysfunction." Cappelleri, J.C., Rosen, R.C., "The Sexual Health Inventory for Men (SHIM): a 5-Year Review of Research and Clinical Experience," International Journal of Impotence Research, 2005; 17(4):307-319. The Mayo Clinic, "Erectile Dysfunction." Miller, T.A., "Diagnostic Evaluation of Erectile Dysfunction," American Family Physician, Jan. 1, 2000. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), "Erectile Dysfunction." National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), "Sexual and Urologic Problems of Diabetes." Shiri, R., et al., "Effect of Life-Style Factors on Incidence of Erectile Dysfunction," International Journal of Impotence Research, 16(5):389-394, 2004.