ED Facts: What Is Erectile Dysfunction and How Common Is It?

This podcast is for you. The Modern Man I'm Dr. Anne Truong, your host. I'm an intimate health medical doctor and best selling author of the book Erectile Dysfunction Fix. I'll do a deep dive into sexual health and performance and how it affects men of all ages and backgrounds. So let's get started and be sure to visit my website@sexualhealthformenpodcast.com for more information.

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Welcome. In this episode I will define what ED is and the many causes of ed. Some of you may know, and some of it you may be surprised to find out Erectile dysfunction or ED is trouble attaining and sustaining an erection sufficient for satisfying sexual intercourse. ED is not simply failing to have an erection one night after you've had several drinks or even for a week or more during a time of intense emotional stress. Nor is ED the inability to have an erection soon after orgasm. At least 25% of the time the penis doesn't get firm enough or gets firm but softens too soon. ED develop gradually. One night it may take longer or require more stimulation to get an erection, and another time an erection may not be as firm as usual or it may end before orgasm. When this happens more than 50% of the time, it will become a source of distress for you or your partner. Then it is worrisome and needs treatment. There's a myth that if you have an erection, you may not have ed. That is not the case at all. Even though you have ed, you can still experience orgasm and ejaculation. That's because erection and orgasm involve different muscles and nerves, and I'll go over that in a later episode. According to the National Institute of Health, ED affects some 30 million men in the United States. Worldwide, the number of men diagnosed with ED could reach an estimated 322 million by 2025. However, when it comes to ED statistics and research in this country, the gold standard continues to be a large study called the Massachusetts Male Aging Study or the MMAS Study. This study found that 43% of men aged 40 to 70 had some degree of ED from minimal to severe level. In another study in 2012 in the American Journal of Men's Health, they found that men under 40 20% have ED and men in the 40s 40% have ED and men in the 50 50% have ED and men in the 60s 60% have ED and men in the 70s 70% have ED and men in the 80s 80% have ED. Often, erectile difficulties are the result of a medical condition that becomes more prevalent with age, or it may reflect the treatment of such a condition, such that erection difficulties or potential side effects of many medications, trauma or surgery in the pelvic region. In the past, most cases of ED were thought to be psychological in origin or the result of factors such as performance anxiety or more generalized stress. While these issues can cause ED 80 to 90% of the time, the problem can be traced to physical conditions that restrict blood flow, hamper the nerve functioning, or both. Often the culprit behind ED is insufficient blood supply to the penis because of clogged arteries, a condition called atherosclerosis. In fact, in up to 30% of men who see their doctors about ED, the condition is the first sign that they have cardiovascular disease or or disease of the heart and the blood vessels. In 2019, a review of a published research study found that men with ed have a 43% increased risk of heart disease compared with men who do not have ed. This is very significant. So if there is a complete loss of nighttime erection, it is likely due to vascular or blood vessel disease or nerve disease. ED usually develop from a mix of psychogenic and physical factors. How do you differentiate between mental or physical ed? Well, the psychological onset of ED is usually abrupt and you can have nighttime erections and it may occur with one partner and you can get an erection with masturbation or with erotic stimuli other than intercourse. The physical cause of ed? The onset is usually gradual. No nighttime erection. An ED occurs with all partners and no erection with erotic stimuli. Do you know that men typically have 3 to 5 erection per 8 hours of sleep? And how do you know you have nighttime erection? Well, you do the nocturnal tumescent test. This is a test to see if your erection may be caused by psychological issues. You wrap a piece of non perforated, non sticky tape around the penis before you go to bed. Then you go to sleep as usual and then in the morning you check to see if the tape has been broken. If the tape is broken, this might be a sign that you have nighttime erection but that you don't necessarily have trouble with the physical creation of an erection but you might have non physical issues such as psychological so risk factors in men in the US over 40 years old for ED number one race blacks are more at risk than Hispanics and Hispanics are more at risk than white Education level. If your education level is less than high school, more at risk than those with high school and beyond Marital status widow are the most at risk followed by divorced and separated followed by single which is the least smoking status Current smoker are the most at risk followed by former smoker followed by never smoke Body mass index of over 30 is a risk factor 30 BMI and blood pressure those that have treated blood pressure are actually more at risk than those with untreated blood pressure compared to those that have no blood pressure at all. The next is high cholesterol and diabetes History of heart disease History of benign prostatic enlargement or BPH the normal male sexual function involves coordinated interplay between six systems in your body for an erection to occur. 1 Blood and blood vessels number 2 who hormone number 3 emotion number 4 nerve number 5 brain number 6 muscle so let's go over the broad categories of physical causes of ed. Number one Vascular risk factors for ED such as heart disease Atherosclerotic disease causing narrowing or clogging of the arteries in the penis preventing the necessary blood flow to the penis to produce an erection Hypertension diabetes high cholesterol smoking major surgeries such as prostate surgery and radiation to the pelvis Number two Neurological factors for ED such as spinal cord injuries and brain injury Parkinson disease Alzheimer's disease multiple sclerosis Peyronie's disease scarring of the penis penile fracture three Hormonal factors such as hypogonadism or low testosterone hyperprolactin hyper and hypothyroid hyper and hypocortisol release Diabetes, adrenal disorders chronic liver disease, chronic kidney failure and AIDS number four drug induced causes of E.D. this account for a quarter of ED cases. In the show notes you will see a detailed list of the medication that can cause ed. Some are over the counter medication like anti ulcer medication Antihistamine medications such as Pepcid, Tagamet, Zantac High blood pressure medicine such as diuretics beta blockers One of the top reasons why men stop medication, especially high blood pressure medicine because of the side effect of ed. Next is antidepressants such as Zoloft, Paxil, Celexa, Prozac, Amitriptyline Antipsychotic anti androgen such as Proscar Recreational drug opioid pain medication 5 psychogenic factors such as performance anxiety, past traumatic experiences, relationship problem anxiety and depression Stress Number six Lifestyle factors such as obesity, smoking lack of sleep you need at least seven hours of sleep sedentary activity or no exercise obstructive sleep apnea restless leg syndrome Number seven Other factors such as systemic sclerosis or or scleroderma and Peyronie's disease, prostate cancer treatment such as brachytherapy or radiation, or even prostate surgery. Interestingly, the frequency of sexual activity is the predictor of ed. So men who have sex less than once a week develop ED at twice the rate as men who had sex more than once a week. So, like your muscles, the more you use it, the better it is. So I recommend having sex at least two to three times a week. An erection occurs when there is a balance between mental and physical state. But it would be misleading to regard ED as as strictly one or the other. Either psychological or physical. Often both contribute to ED. In fact, more than 80% of men who have ED as a reaction to an underlying physical illness go on to develop psychological issues that further hamper erection. For example, a man may develop ED as a side effect of a medication and then becomes so anxious about his sexual performance that he continues to have trouble with erection even after he stopped the medication. So in the next episode, I will dive deeper into the vascular causes of ED or low blood flow, nerve damage, smoking, alcohol, diabetes, obesity, and bicycling. So, see you in the next episode.