Identifying the Causes & Symptoms of ED in Primary Care Patients

In the United States alone, 20–30 million men struggle with symptoms of erectile dysfunction (ED). 1 Historically, the medical and scientific community believed that ED primarily affects men over age 40. However, recent data now shows that it is common in close to a third of all men younger than 40. 2

Physical or psychological disorders, or both, may cause problems in achieving or maintaining an erection. Physical causes of ED are more common in older men, whereas men under age 40 typically experience emotional issues leading to ED. 3 Identifying the causes leading to a patient’s ED can help identify the best plan of treatment.

Physical Causes

In many cases, the inability to achieve or maintain an erection can signal a more extensive underlying health condition that needs treatment. Therefore, recognizing ED symptoms in patients has more significant implications for clinicians outside of ED treatment alone.

Understanding the connection between erectile dysfunction and the medical disorders which can cause it could lead to early conversations or screening for primary diseases.

Vascular diseases account for 50% – 70% of physical-related causes of ED. Such causes include coronary heart disease, hypertension, and high cholesterol. Atherosclerosis alone is the primary vascular risk factor for ED cases in men over age 60. 4

A successful erection requires input from the autonomic and somatic nerves, with the hypothalamic and limbic pathways also having notable importance. Therefore, it is not uncommon for neurological disorders to be connected with risk factors for ED. 5 Types of conditions to watch for include multiple sclerosis, Parkinson’s disease, Multiple Sclerosis, surgery to the prostate or bladder, diabetic neuropathy, or nerve damage from a stroke. 6

Trauma to the pelvic region, penile nerve or artery injuries, injuries to the spinal cord, or Peyronie’s disease are closely associated with ED. Likewise, chronic illness, certain medications, and colon cancer may also contribute.

Low hormone levels may play a role in ED and prolonged tobacco, alcohol, or drug use involving substances that affect the central nervous system or damage the blood vessels. 7

Psychological Causes

It is also essential to note that mental health issues play a factor in either causing or worsening erectile dysfunction symptoms. Stress, performance anxiety, depression, and medications used to treat these conditions often affect the brain’s ability to send signals to the central nervous system that trigger an erection. 8

Symptoms of ED 

Erectile dysfunction symptoms might include:

  • Trouble getting an erection or keeping an erection for an extended amount of time
  • Reduced sex drive
  • Feelings of embarrassment or shame
  • Low self-esteem
  • Premature ejaculation
  • The inability to have an orgasm or delayed ejaculation

Challenges With Recognizing Symptoms

ED is not something most men are comfortable talking about openly, and often, men suffer in silence. Out of the millions of men who experience ED, only 5%–10% seek medical help or request treatment. 9 Therefore, it is vital that physicians recognize the physical or emotional causes of ED and adopt a systematic approach to drive conversations with at-risk patients.

Men over the age of 40 or with existing conditions such as cardiovascular disease, diabetes, depression, or other diseases associated with common ED risk factors should be screened routinely. 10

Talking about sexual functions can be a private matter and a source of embarrassment and discomfort for your patients. However, clinicians must find reassuring ways to approach the topic to benefit at-risk patients.

Even though ED can be embarrassing to talk about, clinicians need to drive the topic. This conversation will help combat the silence and shame that patients associate with ED by normalizing conversations, and it may lead to critical health discoveries.

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Sources:

1.      https://www.auanet.org/guidelines/guidelines/erectile-dysfunction-(ed)-guideline

2.      Boston University School of Medicine, 2002 & The Journal of Sexual Medicine, 2013

3.      https://www.medicalnewstoday.com/articles/316215#ed-with-age

4.      https://my.clevelandclinic.org/health/diseases/10035-erectile-dysfunction

5.      https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4896824/

6.      https://www.forhims.com/blog/neurological-ed

7.      https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776

8.      https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776

9.      https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC1557658/

10.    https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776