Men's Health

Men’s Health Questions Answered: What is Erectile Dysfunction?

Men’s health topics are important to discuss with a doctor, but for many men it is difficult to have these conversations with their health care provider. Discussing sex, prostate health and hormonal imbalance can be uncomfortable, but understanding these conditions and how they affect overall health is critically important for every man.

Arnold Bullock, MD, Professor of Urologic Surgery at Washington University School of Medicine in St. Louis, specializes in men’s health. He encourages men to ask their questions and engage in honest conversations with their doctors. To help start this conversation, Bullock addresses the myths and answers some of the questions regarding a common men’s health condition: Erectile Dysfunction.

Five Myths Regarding Erectile Dysfunction

Myth #1: Erectile Dysfunction is only an elective medical problem.

This is incorrect. Erectile dysfunction (ED) is considered one of the top six medical issues for men. This puts ED in the same category as trauma, suicide, lung disease, diabetes and hypertension. Why? Because if a man has ED, there is a 90% chance that there is an organic cause. An organic cause would be any underlying medical condition that is resulting in ED for that man. Men may not know they have diabetes, high blood pressure or cholesterol levels over 300. Most men who have these major medical problems have ED before they show symptoms of these conditions. Even if you choose not to treat the ED, going to the doctor will help you uncover any of these underlying medical problems.

Myth #2: Once you have Erectile Dysfunction, there’s nothing you can do about it.

Not true. Most people who have ED have a mild case and will respond to pills by mouth. The problem is that a low percentage of men with ED ever ask for the medicine. Our biggest hurdle is getting men to overcome their embarrassment to talk about it. One of the most difficult parts of treating ED is just starting the conversation. Once a health care provider knows that a man has this problem, they can help by prescribing pills or referring the man to a specialist for other treatment options.

Myth #3: Erectile Dysfunction is in your head.

That’s another myth. Men might think their ED is because their partner gained weight or is postmenopausal. It’s important to remember that 90% of men who have ED have an underlying medical condition. If that’s the case, trying to justify it as being psychogenic is not helpful. Men believe ED is in their head because past researchers posited that might be true. While that research helped start a conversation about men’s health, it proved to be false. This myth gets perpetrated in popular culture, making it difficult to recognize that, for most men, ED is not psychogenic. The truth is that mental health can impact a man’s ability to achieve an erection. In fact, 92% of men with clinically diagnosed depression have ED. This does not mean that it is “in the patient’s head,” though. All cases of ED merit consulting a physician.

Myth #4: Pills cause men to have a heart attack, stroke, blindness or other adverse reactions.

It’s good for men to be concerned about their health, but this is another myth. If this were true, the pills would not be an option. The best thing a man can do is talk to their partner and their health care provider about their ED. Pills are an effective treatment option for most men healthy enough for sex, and including the partner in the conversation ensures that there is an open dialogue.

Myth #5: Pills are the only option.

Not many men have heard about other options for treating ED. I hope that, when a man talks to his doctor about ED, that doctor will send him to an expert in urology and men’s health, like myself. We can discuss the variety of options available. In fact, most of the options are covered by insurance.

Aside from pills, penile injection therapy is the most widely advertised treatment option. There is minimal discomfort with injection therapy. The needle is small—the same size as a diabetic person uses for insulin. The drawback is actually not discomfort, but lack of spontaneity. Using injections does not allow for the same spontaneous erections as other treatment options, such as an implant.

An implant is inserted by a one-and-a-half-inch incision. Like any surgery, there is discomfort for a week or so, but then you don’t feel it at all. I’ve had patients describe it like having a fake tooth—after a while you forget which tooth is fake! When a man has his ED definitively treated, he is often surprised to be restored to even better function than before he noticed symptoms of ED.

Erectile Dysfunction: Frequently Asked Questions

What is Erectile Dysfunction?

ED is the consistent inability to achieve an erection sufficient for satisfactory intercourse. As many as 30 million American men have ED. The majority of men with ED are sexually active, but they are having intimacy without a rigid enough erection for penetration or completion of intercourse.

What causes Erectile Dysfunction?

In about 90% of men, ED is due to an underlying medical condition that affects the blood supply or nerves to the penis. This is why it is so important to discuss ED with a doctor. For many men, it is a sign of other health problems. ED is most often secondary to a cardiovascular condition, such as hypertension, elevated cholesterol, myocardial infarction (heart attack) or peripheral vascular disease. Men with diabetes mellitus are also at high risk of developing severe ED. Mental health can impact a man’s ability to achieve an erection: 92% of men with clinically diagnosed depression have ED.

Can Erectile Dysfunction be cured at home?

There is no simple home remedy as a cure for ED. Mild to moderate ED can be improved by improving overall medical health and cardiovascular condition through exercise, weight loss, healthier diet and compliance to medications/regimens suggested by a health care practitioner. 

Can Erectile Dysfunction be fixed by a doctor?

There are many proven treatment options for erectile dysfunction.

Arnold Bullock, MD, wants men to understand Erectile Dysfunction and be open when discussing their health with a doctor.

Over 70% of men with mild to moderate ED respond to oral ED medications prescribed by their physician. This common treatment works for many men, but is not the only option.

Vacuum erection devices can be purchased online. They are effective at providing erections, but many men are not pleased with the discomfort of the penile ring, the degree of rigidity and lack of spontaneity. 

Penile injections are available through most Urology practices at a reasonable cost. There is no need to spend thousands of dollars at a “Specialty” Clinic to receive these injections, though. Typically, in the Urology office, a man is given a test dose. If effective, a prescription can be filled for a short-term trial.

Penile implants are considered the most effective treatment option, and have the highest satisfaction rate. Most men do not realize that the cost is covered by insurance. The implant is placed through a small incision in about an hour, and it should not be noticeable when naked. There are several implant options available depending on each man’s needs and wishes. Meeting with a urologist is the first step in deciding if a penile implant may be the right choice.

Treating Erectile Dysfunction with the Division of Urology

The Division of Urology is one of the busiest and most experienced centers for implant surgery in the Midwest. We also offer a multidisciplinary approach, which employs the combined expertise of urologists, interventional radiologists, endocrinologists and psychologists when it comes to making a diagnosis and developing a treatment plan.