What Does ED Feel Like?

Older man and woman holding hands while walking

This is an excellent question that many of our patients ask because while they know how they should or want to perform sexually, it’s often hard to distinguish whether they have erectile dysfunction or simply a transient concern that is making it difficult to achieve an erection or perform the way they want.

The textbook answer to this question is that when a patient consistently cannot achieve an erection or does not keep an erection through ejaculation, erectile dysfunction may be suspected. However, as is the case with many conditions, the answer is often somewhat nuanced. So, let’s discuss erectile dysfunction in the real world and how we approach it.

A Discussion on Age

No discussion on ED can occur without understanding age-related dysfunction. To this end, when we treat younger versus older men for erectile problems, the treatment protocols may be a little different. While erectile dysfunction due to structural and blood flow issues is certainly possible in younger men, there can be a psychological component that forms part of the cause. For example, as younger men, we often feel pressure to find and ultimately keep a partner. The result can be a single erectile dysfunction event that creates a cascade of anxiety and future dysfunction. To understand if the erectile function issue may be psychological, consider the following:

  1. Has the ED come on suddenly?
  2. Do you still get erections easily upon waking up?
  3. Do you feel you are watching more pornography than ever before?
  4. Are you having relationship issues?
  5. Have you been particularly stressed or anxious?

On the other hand, a man’s general health, both hormonal and physical, begins to decline after the age of 40. While psychological concerns can always be a part of the ED screening diagnostic process, it is usually a physical blood flow issue at this age and above. Cardiovascular and obesity issues can exacerbate this. It can also be worse in smokers.

Testosterone Levels

As men age, their testosterone levels decline gradually, starting around 40. This is a normal process characterized by loss of muscle tone, increased fatigue, and general physical and psychological decline. This can lead to, you guessed it, reduced libido and lessened ability to perform sexually. Fortunately, there are natural ways to increase testosterone, including losing weight and exercising more. There is also the possibility of treating clinically low testosterone (quite rare) using injection or medical therapy, always under the supervision of your men’s health specialist. In this regard, testosterone replacement therapy performed by men’s health clinics may show some effectiveness initially. However, many patients are not screened for other potential causes of their erectile dysfunction to their detriment.

As we age, the effects of excess weight and a sedentary lifestyle are also enhanced in the form of atherosclerosis or plaque buildup in the arteries. The diameter of the arteries that supply blood to the penis is significantly smaller than that of the peripheral (arms and legs) and coronary (heart) arteries. They, therefore, cope less readily with plaque buildup along their walls. As such, ED can often be the first sign of future cardiovascular issues and a great reason to see a qualified men’s specialist at the first signs of ED.

A Spectrum of Dysfunction

ED must also be treated as a spectrum of dysfunction and not as a black-and-white “it works, or it doesn’t work.” Many patients wait until they can’t perform at all to seek treatment. This can either result from wishful thinking that the dysfunction will pass or, ultimately, an embarrassment to see a professional about a condition they somehow believe has compromised the very fabric of what makes them a man.

Instead, men need to understand that dysfunction rarely hits them with full force, and instead, it is a gradual progression toward ever-worsening dysfunction. Unfortunately, if left untreated and undiagnosed, the dysfunction can reach a point where medication or even injections cease functioning. While a penile prosthesis or a penile implant is an excellent and highly satisfactory option for those with otherwise treatable erectile dysfunction, we always look to prevent the problem from worsening before pursuing treatment.

Of course, there are times when ED is expected and virtually unavoidable. Post-prostatectomy patients, for example, will almost universally experience ED, at least in the early months. For some, this may be permanent. Other patients with Peyronie’s Disease or trauma to the genital area may also experience moderate to significant loss of function.

If you are experiencing symptoms of erectile dysfunction, even seemingly intermittent, we encourage you to visit Dr. Natale for a comprehensive assessment of the potential cause.

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