While erectile dysfunction (ED) can be an embarrassing condition for men to seek treatment for, it should not be. In fact, often times erectile dysfunction serves as a warning sign of a more serious cardiovascular problem. Urologist Landon Trost, MD, discusses the most common questions he hears about ED. 1. Q: What is erectile dysfunction? A: Erectile dysfunction, or ED, is the inability to achieve or maintain an erection firm enough for intercourse. Typically, there are no other telling symptoms that lead up to ED, so a change in the state of the erection is usually the only sign of its onset. Sometimes, it’s just a one-time episode, with normal erectile function returning soon after. It’s really only considered erectile dysfunction if it becomes a chronic issue. 2. Q: What’s the best way to bring up erectile dysfunction with a doctor? A: Talking about ED can be understandably embarrassing, but as a urologist, I talk about it on a daily basis. In fact, even when my wife and I go out to dinner with friends, it seems to be a normal topic of conversation. As difficult as it may seem to you, it’s not weird for us at all. A one-time occurrence may not be an issue, but after at least a few instances of a failed erection, you should bring it up with a doctor. Often, ED is an initial warning sign for cardiovascular disease, which means the sooner you get your ED checked out, the sooner we can address the potential other issues (and hopefully cure your ED in the process). So rather than bringing it up in passing at the end of an appointment, be sure to have another appointment dedicated only to this issue. That way we’ll have the time to rule out other health issues and find the best treatment. 3. Q: What are the treatment options? A: There are a number of treatment options available, the most common of which is oral medication -- you’ve probably heard of a few of these already. They are taken on an as-needed basis, 30 to 60 minutes before sexual activity. For those who are unsuccessful in taking oral medications or don’t meet the health requirements, there are intraurethral suppositories and injectables. Both also are taken as needed. Suppositories involve inserting a pellet into the urethra through the tip of the penis, while injectables are injected with a needle into the base of the penis. As they are both local treatments, they can reduce the risk of unwanted side effects. Additionally, there are vacuum devices, which go directly over the penis and pull out air, causing blood to rush into the penis because of the created vacuum. Though used less often, surgery is also an option. This involves implanting a penile prosthesis along with a manual pump to achieve an erection. Since it is a permanent procedure, be aware that a natural erection can never be achieved again. Of course, most of my patients who opt for the procedure say they wouldn’t get the procedure if they were achieving a natural erection anyway. Before any medical treatments are administered, though, we recommend some shifts in your lifestyle, which include exercising, getting enough sleep, and eating right. ED can stem from stress, inactivity, smoking and drinking, depression, and any other number of mental and physical factors that can be addressed through a healthier lifestyle. 4. Q: How often is ED a sign of something more serious? A: Unfortunately, ED is most often a sign of something more serious. Because obtaining an erection involves healthy blood flow, erectile dysfunction often means that cardiovascular disease, high blood pressure, or high cholesterol could be the culprit. I like to say the penis is much like a barometer for the rest of the body--a measure that something more serious exists or is on the way. On a related note, ED can also stem from an unhealthy lifestyle, including smoking, alcohol and drug use, and obesity, which can all lead to more serious health issues down the road. While a younger man with ED is usually suffering from some kind of mental block, he should get checked for physical causes as well. ED at a younger age could actually indicate an even more serious underlying case of heart disease than in an older man with ED. 5. Q: What age group is it most likely to affect? Can young men get it, too? A: Truthfully, all age groups beyond puberty can be affected by ED. But most often we see it in older men, meaning above the age of 40. If we look at all men age 40 to 70, about 52% of them have some degree of ED. It’s important to note that ED usually affects different age groups in different ways. It’s more likely a younger man’s erectile dysfunction stems from some kind of stress-related event--changing jobs, starting a new relationship, moving--that’s affecting him mentally and emotionally. A younger man’s ED could also be caused by a prescription medication they are taking for something else, like an anti-anxiety drug. In contrast, an older man with ED most likely has some other physical issue at play, such as diabetes or high blood pressure. So while a younger man is most likely to have what’s known as psychogenic ED, an older man is more likely to suffer from what we call organic ED. 6. Q: What’s the difference between ED and ejaculatory dysfunction? A: Although they often occur in conjunction with each other, they are separate issues. Ejaculatory dysfunction includes premature ejaculation, delayed ejaculation, or painful ejaculation, whereas erectile dysfunction is the inability to even achieve or maintain an erection. While a man can suffer from both, they usually arise from different causes. ED is most often a sign of cardiovascular disease, or in younger men, emotional stress. Delayed ejaculation is more often caused by diabetic nerve damage in the male organs, antidepressants, or even idiosyncratic sexual behavior (specific needs to achieve orgasm), while premature ejaculation may not be due to any specific abnormality in the majority of cases. Ejaculatory dysfunction, a common cause of premature ejaculation, can also play a role in ED. So while they can coexist, ED and ejaculatory dysfunction are not one in the same. 7. Q: Is ED permanent or only temporary? A: For younger men, because it is usually an emotional or psychological issue, it should be temporary. Whether suffering from some type of emotional trauma, or nervousness from engaging with a new partner, overthinking and worrying about maintaining an erection can have the adverse effect. Once addressed with proper therapy, the erectile function should return to normal. This can be the case for older men as well, but more often there is an underlying cardiovascular issue in the works. If it’s found to be a sign of diabetes, high blood pressure, or heart disease, then ED could potentially be a lifelong issue. Luckily, ED can be treated, for the most part, if the underlying health issues are addressed. As men get older, their chance of experiencing ED grows as well. Like the rest of the body, there is a progressive loss of function, and eventually, it gets to the point where the penis won’t even respond to medicine, leaving surgery as the last and only option. But fear not: I’ve had several patients get the implant who are extremely happy with it and tell me their sex life has never been better.