Erectile dysfunction affects an estimated 335 million men worldwide. Despite its prevalence, however, erectile function (and lack thereof) is something few men feel comfortable talking about. In fact, one recent poll found that men would much rather talk to their provider about their weight and mental health than their sex life and erectile dysfunction.
Unfortunately, the lack of conversations between men and their healthcare providers about erectile dysfunction and difficulties has led to the perpetuation of misinformation on this common condition. There are huge misconceptions about the age men are often impacted by erectile dysfunction, for one, suggests board-certified family medicine and regenerative anti-aging medication specialist Gowri Reddy Rocco M.D., M.S., an expert committed to helping men preserve fertility, sexual function, and hormone health as they age. The factors that contribute to erectile dysfunction, as well as the treatments for the issue, are also poorly understood, he says.
In order to replace erectile dysfunction fiction with fact—and hopefully empower men to talk to their healthcare providers about their sexual well-being—we put together this myth-debunking guide with the help of doctors who specialize in men’s sexual health. Read on to get your facts straight on six common misconceptions about erectile dysfunction.
- ABOUT OUR EXPERTS: Gowri Reddy Rocco M.D., M.S., is a board-certified family medicine and regenerative anti-aging medication specialist committed to helping men preserve fertility, sexual function, and hormone health as they age. Justin Houman, M.D. is a board-certified urologist who specializes in sexual health, infertility, and erectile dysfunction and the Senior Medical Advisor at sexual wellness platform Cake.
Myth: If You Struggle Once, You Have ED
By definition, erectile dysfunction is the persistent inability to get and maintain a sufficient (a.k.a. firm enough) erection for sexual intercourse, explains Justin Houman, M.D. a board-certified urologist who specializes in sexual health, infertility, and erectile dysfunction and the Senior Medical Advisor at sexual wellness platform Cake. The key word here? Persistent.
So long as no additional symptoms are also present, a one-off instance of a ropey rod likely doesn’t warrant a visit to the urologist or a self-diagnosis. The occasional medium-rare erection could be caused by temporary interferences, such as too much alcohol or drugs in the system, exhaustion, or sky-high stress levels after a rough week at work, according to Houman. Indeed, stress and alcohol use are common causes of occasionally not being able to get or maintain an erection, according to the National Health Service.
“If erectile dysfunction becomes an ongoing issue, however, you need to talk to a healthcare provider like a urologist or endocrinologist,” says Houman. Erectile dysfunction is an early symptom of health concerns like cardiovascular problems, high blood pressure, insulin resistance and diabetes, and hormonal imbalances, explains Rocco. So, talking to a healthcare provider and getting screened for underlying conditions after three (or more) months of erectile issues, is essential for your overall health.
Myth: All Men Get ED Eventually
Erectile dysfunction isn’t like a fascination with fishing, in that it eventually affects all men of a certain age. “While it is true that the risk of ED increases with age, erectile dysfunction doesn’t actually affect all men when they age,” says Houman. Data from the American Urological Association suggests that 59 percent of men between 70 and 79 years old experience mild to severe symptoms of erectile dysfunction. While that certainly qualifies as the majority, it’s by no means all.
Whether or not an individual eventually gets erectile dysfunction depends on a wide variety of factors, including overall health and predisposition to or presence of underlying health conditions like diabetes, hypertension, and heart disease, says Houman. An individual’s lifestyle choices, including alcohol consumption, tobacco use, exercise habits, and diet also play a role, as do psychological factors like stress, he says.
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“Regular exercise, maintaining a healthy weight, resolving insulin resistance by eating a low-sugar diet, and getting good quality sleep all help a man maintain his ability to get an erection as he ages,” says Rocco. Per research published in the journal Sexual Medicine, 40 minutes of moderate- to vigorous-intensity aerobic exercise four times per week is adequate for decreasing the risk of erectile dysfunction in aging men. Meanwhile, another study shows that those who ate diets higher in fruits, vegetables, whole grains, nuts and legumes, and omega-3 fatty acids, and lower in red meat, artificial sugars, and trans fats, were more likely to report good or very good erections (and fared better than those who ate other diets).
Myth: ED is An Old Person’s Problem
Just as not all old men will have erectile issues, not all people with ED are old. “Men in their 20s and 30s can also experience erectile dysfunction,” says Houman. A 2017 review published in Sexual Medicine Reviews reports that the prevalence of ED in men under 40 may be as high as 30 percent.
“Young men should also know that erectile dysfunction is more common in men who drink alcohol, smoke cigarettes, use nicotine products, and smoke marijuana,” says Rocco. One 2021 review published in Urologia Internationalis reported a significant association between regular alcohol consumption and erectile dysfunction. Meanwhile, one study published in the American Journal of Men’s Health reported that rates of ED are twice as high in cannabis users than in non-users.
For young men, lifestyle factors such as stress are likely to contribute to symptoms of ED, Rocco adds. That’s because stress leads to neurochemical and neuroendocrine changes in the brain as well as endocrinological (hormonal) changes in the body, which disrupt normal erectile function. As such, any younger men experiencing inconsistent erections or who are otherwise worried about erectile difficulties should consider implementing stress-management protocols (like yoga, body scanning, and meditation), he says.
Myth: ED Signals A Lack Of Attraction To Your Partner
According to research published in the journal Biochemical Research International, the partners of people with ED often suspect their attractiveness is to blame. But “erectile dysfunction has nothing to do with your sexual attraction to your partner,” notes Rocco. “It is normal for people to struggle with ED and is not a sign that you’re not attracted to your partner anymore.” ED is far more likely to be caused by poor health choices or an underlying condition related to cardiovascular or hormone health, he says.
Rather than blaming your partner(s) for your limp willy, Rocco says it’s important to reflect on your recent exercise, eating, and drinking habits, as well as your stress levels and medication. If you’ve been drinking every weekend, altered your prescription drug line-up, been sedentary, have gained weight, or have been loosey-goosey with your diet, odds are those are the things contributing to ED, he says.
Worth noting, though, is the fact that underlying relationship issues can contribute to erectile function. As Houman explains, stress and mental health disorders are leading causes of erectile dysfunction—and relationship stress falls under this umbrella. As such, if there are any underlying gripes in your relationship, it will likely help your sex life (and overall connectedness) to talk about it. (A couples therapist is a good resource for people who do not feel comfortable addressing underlying issues without an intermediary).
Myth: ED Meds Start and Stop with Viagra
Due to a combination of name recognition and commercial virality, many people (wrongly) assume that erectile dysfunction medications start and stop with Viagra.
Viagra, Aronix, Liberize, and Nipatra are all brand-new versions of a drug called sildenafil, which is a type of ED medication that works by disabling an enzyme in the body called PDE5, which stops penile blood vessel muscles from fully relaxing. While highly effective, Viagra and other sildenafil medications are just some of many medication treatment options for ED, says Houman.
There are other medication options for erectile dysfunction, too. One option is called tadalafil, which is sold under the brand names Cialis and Adcirca. Tadalafil medications also block the PDE5 enzyme and have been found to be about as effective as sildenafil options. The main difference between the two drug types is duration of efficacy; sildenafil remains effective for four to six hours after ingestion while tadalafil stays in the system for closer to 48 hours.
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Notably, sometimes trouble-shooting erectile dysfunction involves removing medication from your line-up (with doctor approval), rather than adding one. “Erectile dysfunction is the side effect of a lot of over-the-counter and prescription medications, especially blood pressure medications,” says Rocco. Many antidepressants, antihistamines, beta-blockers, and painkillers also list erectile dysfunction as a potential side effect. If you have new-onset ED, he suggests bringing it up with your provider. They may be able to suggest an alternative dosing schedule or medication if needed.
Testosterone Replacement Therapy (TRT) is another good option for men experiencing ED, since low testosterone levels (defined as blood levels of testosterone under 300 ng/dL) are a common contributor to erectile dysfunction, according to Rocco. In fact, sexual and erectile dysfunction is one of the most common symptoms of low testosterone levels, with nearly 70 percent of men with low T reporting this issue.
The exact relationship between testosterone and erectile function is not fully understood. However, physiologically, testosterone has been shown to support healthy penile blood flow, so as testosterone levels dip, penile blood flow (and thus erectile function) becomes impaired. Meanwhile, psychologically, testosterone is an important ingredient in the ability to have sexual fantasies or daydreams. In fact, low testosterone levels have been linked with reduced sexual fantasizing and, as a result, reduced ability to get and maintain an erection during solo sex when imagination is key.
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For folks in whom low testosterone is the sole cause of erectile dysfunction, supplementing with TRT will support erectile health, says Houman. However, TRT is not a universal cure-all. “TRT on its own won’t necessarily fix erectile dysfunction if there are other underlying contributors,” he says.
To determine whether or not you are a candidate for TRT, Rocco recommends getting your testosterone levels evaluated. Explore whether TRT is right for you at Whole Health Rx by The Vitamin Shoppe.
Whether it’s Viagra, TRT, or another medication, in the event that you are prescribed erectile dysfunction medication, Rocco recommends taking additional steps to support your health. Regularly exercising, logging quality sleep, cutting down on all processed sugars and foods, prioritizing nutrient-dense foods, cutting out alcohol and smoking, and managing stress are all important for erectile and overall health, he says.