What Is Erectile Dysfunction?
By Johnathan P Cumberwell
Erectile dysfunction (‘ED‘), also known as impotence, is the persistent inability to achieve and maintain a penis adequately erect, for successful penetrative sexual intercourse.
Therefore, if you are not able to get hard enough for penetrative sex, or if you lose your erections during sex, and this is a frequent problem, you are struggling with erectile dysfunction.
ED is becoming more and more common by the day, and Truelibido estimates that approximately 20% of all men worldwide suffer from this condition.
The causes of erectile dysfunction are many and varied, but most of them have to do with lifestyle. In other words, the vast majority of erectile dysfunction is caused by an unhealthy lifestyle.
Let’s understand the details of erectile dysfunction.
Erectile Dysfunction Explained
The definition of erectile dysfunction is: The persistent inability to get and maintain erections sufficiently hard for successful penetrative sex.
Let’s break this down:
This definition means that ED is: 1) Problems getting an erection to start with, and (or) 2) problems keeping this erection for long enough to finish intercourse, and 3) that this problem is of a long-term nature.
Let’s dig a little deeper into this.
ED normally comes gradually. Meaning, when you start struggling with erectile dysfunction, the first sign is normally that you start losing your erections during sex.
In other words, you get erections just fine, but from time to time your erections fade during sex.
Then as the ED develops, you will typically find that this becomes more and more common: It gets increasingly challenging to maintain erections during sex.
And then as the ED gets more severe, the next step is often to start having trouble getting a full erection in the first place.
This means that ED isn’t simply an ‘on / off’ event, but we can instead think of ED as a range from 0-100. 0 meaning never having any problems with erections, 50 meaning having trouble half of the time, and 100 meaning always having problems.
Let’s get to the last part of the definition of erectile dysfunction: What is meant by ‘persistent’ or ‘long-term’ difficulties.
You may have been unable to ‘get it up’ at certain times in your life. There can be a number of reasons for this, and we will explore these shortly.
It’s normal to not get hard enough erections for sex, every now and then. Sometimes the body simply doesn’t work properly.
This happens to many of your bodily functions from time to time. You get sick every now and then, you are exhausted sometimes, sometimes you lose your voice, sometimes your back may hurt.
Therefore it’s also normal to not function sexually 100% perfectly all the time. It is important to understand this because:
The definition of erectile dysfunction also entails that it is something that happens again and again, and that it lasts for several weeks, months, or even years.
The condition erectile dysfunction = medium or long-term persistent difficulties, not the one-off events.
So if you couldn’t get it up last October, and also once about 2 years ago, you are not struggling with erectile dysfunction. 😊
By the way, erectile dysfunction is different from another common male sexual problem: Low sex-drive (libido). Although the two are very connected. You can learn more about sex drive here.
Before we move on, I wanted to touch upon one important aspect of erectile dysfunction.
Dealing with erectile dysfunction can be challenging. But there is one aspect of ED that makes it even more challenging: The fact that we men have a very difficult time opening up and talking about it.
We normally don’t talk to our friends about our ED, we often don’t talk to our partners about it, and we even shy away from telling our doctors about it.
We are so embarrassed to open up about our ED, that it can severely complicate our lives. We make life difficult for ourselves.
I think it’s a combination of having big egos, lots of pride, and also that we are scared of anyone finding out that we don’t work like teenagers ‘downstairs’.
Speaking from experience, opening up can take a load off the shoulders. And your partner may even be grateful and appreciative for your openness.
Now that we can answer the question ‘what is erectile dysfunction’, let’s also try to understand the mechanics of how you get an erection.
How Does A Man Get An Erection?
The penis is flaccid most of the time. But when you get ‘turned on’, your penis normally becomes erect.
But what is the process behind this? How do you get an erection?
Let’s start from the beginning:
Your penis is kept in a flaccid state because something called the smooth muscles inside your penis, are in a state of contraction.
To help you understand this, let’s think of a clenched fist:
When you clench your fist, several of the muscles in your hand contract in order to make this motion happen. When you let go of this clench, the muscles relax and are no longer contracting.
Similarly to the muscles of a clenched fist, the smooth muscles in your penis also contract to keep your penis flaccid.
These smooth muscles squeeze and clench around the blood vessels in your penis, which in turn forces almost all the blood to flow out of your penis.
The only blood that is allowed to enter your penis, is for maintenance purposes.
By the way, what makes this almost constant clench in your penis possible, is the mineral calcium.
Only when the smooth muscles in your penis stop this clenching and instead relax, is blood allowed to flow into your penis.
But how and when do these smooth muscles start to relax?
This happens when you get ‘turned on’.
Which means that you have some form of sexual stimulation (sexual thought, kiss, touch, etc.).
When this happens, your brain starts producing the neurotransmitter dopamine.
This dopamine then sends a message to the blood vessels in your penis: Produce nitric oxide!
Through a chain-reaction of events, this nitric oxide causes the level of calcium to decline.
This allows the smooth muscles in your penis to relax. Now the tight clench is gone.
Now that these muscles relax, blood flows into your penis and and fills it up. When your penis is fully filled with blood, you have an erection.
This is a complex process involving many elements and steps, but there are three agents that are of crucial importance: Dopamine, nitric oxide and testosterone.
Dopamine kicks off the entire process of getting an erection, and is therefore paramount.
Nitric oxide is another essential part, because this is what causes your calcium levels to drop, which again opens the gates for blood to flow into your penis.
Testosterone, the primary male sex hormone, supports and controls anything sexual going on in your body. Therefore, you need adequate level of testosterone in order for the process to function properly.
Dopamine and nitric oxide also depend on testosterone in order to do their tasks properly.
Now that we understand both erectile dysfunction and how you get an erection, let’s take a look at how common erectile dysfunction is around the world.
How Common Is Erectile Dysfunction World-Wide?
It may actually be more common than you think.
By aggregating these studies and surveys, we can get a pretty decent estimate of how common erectile dysfunction is around the world.
Although I need to say that there is one potential problem with this information:
A considerable amount of this information is in the form of self-reported surveys. Meaning, men filling out info about themselves without there being an actual test or control. This is problematic because the answers will often be subjective.
And also in some cases probably not honest. Meaning, some men are probably embarrassed to say ‘Yes I struggle with ED’, and instead say ‘No’.
Which means that the actual numbers may be higher than the reported numbers.
Nonetheless, we should be able to obtain some reasonably good estimates based on this information.
So what do the numbers say?
Based on these reports and studies, this is what the numbers say about the prevalence of erectile dysfunction world-wide:
- Age group 20-29: 5-10%
- Age group 30-39: 10-30%
- Age group 40-49: 15-40%
- Age group 50-59: 25-50%
- Age group 60-69: 35-70%
- Age group +70: 50-75%
What are the takeaways from these numbers?
First of all, many young men struggle with erectile dysfunction. And by young, we are talking about men in their 20’s and 30’s.
A second take-away is that erectile dysfunction is common all over the world. It seems to be more prevalent in certain countries, but it is nonetheless a condition that affects men world-wide.
A third take-away is that ED gets more and more common as we get older.
A fourth, and perhaps the key takeaway, is that about 20% of all men world-wide struggle with erectile dysfunction.
Let’s look at the implications of this:
There are approximately 8 billion people on planet earth. About half are men, which gives us 4 billion men.
20% of 4 billion men are 800 million men.
Based on this analysis, the Truelibido estimate is that there are about 800 million men worldwide who struggle with erectile dysfunction.
That is a very large number. As a comparison, there are fewer than 350 million people in the U.S.
Needless to say, this is an enormous health issue.
Now that we also have an estimate of how common erectile dysfunction is world-wide, let’s try to understand the most common factors that cause erectile dysfunction.
What Are The Causes Of Erectile Dysfunction?
In order for you to get an erection, your penis needs to be filled with blood.
And in order to maintain that erection, this blood needs to remain in your penis to keep it firm and hard.
The keys here are bloodflow and blood pressure.
If there is anything stopping the blood from flowing freely to and inside your penis, you will normally find it more difficult to get an erection.
And also, if the blood pressure inside your erect penis drops, the erection will normally taper off. This is often referred to as ‘venous leak’ (blood ‘leaking’ back out of the erect penis).
Therefore, ED will normally always be a result of impaired bloodflow or blood pressure.
There are several factors that can directly or indirectly weaken this bloodflow, and therefore cause erectile dysfunction.
Let’s take a look at the most common ones.
Low Testosterone Production
If you produce less testosterone than you should, you are likely to struggle ‘getting it up’.
Because testosterone is the primary male sex hormone that underlies and supports anything sexual going on in your body.
Therefore, adequate levels of testosterone are essential for you to function sexually. The ability to get an erection, to produce sperm and to have a sex drive – all depend on testosterone.
Then what causes testosterone production to be less than optimal?
Inadequate testosterone production can be caused by a number of factors.
Some of the most common ones are: An unhealthy diet, too much stress, too little sleep, not enough sunshine, smoking, drinking, drugs, side effects of certain medications, polluted air, mental problems, and chemicals found in cosmetic and cleaning products.
Low Nitric Oxide Production
Nitric oxide is essential in order for you to get erections. It is one of the elements that you simply have to have enough of, in order to function sexually
Because it is nitiric oxide that opens the gates that allow blood to flow into your penis, fill it up and produce an erection.
With inadequate production of nitric oxide, sufficient amounts of blood cannot enter your penis. And hence, you will normally not be able to get and sustain erections.
What can cause nitric oxide production to be less than ideal?
As with low testosterone production, there are many factors at play. A diet containing too much fat and sugar, and too few essential nutrients, can impair your nitric oxide production.
So can physical inactivity, smoking, drinking, drugs, air pollution, inadequate sleep and the side effects of certain medications.
Low Dopamine Production
If you produce less dopamine than you should, you are also likely to struggle with erectile dysfunction.
This is because dopamine is the catalyst that sets off the entire process of getting an erection.
When you have a sexual thought, dopamine is produced in your brain. This in turn sends signals down your spinal cord, to the nerves in your penis.
These signals then instruct nitric oxide to open the floodgates, and let blood rush into your penis.
So if your dopamine production is low, your signals will be weak or may not arrive at all. And therefore, the entire process may suffer.
What causes your dopamine production to be sluggish?
Again, there are several factors. Some of the most common ones are: A poor diet, lack of exercise, overexposure to sexual stimulation, lack of sunshine, stress, not enough sleep, and mental problems.
As you get older, your cells start to operate slower and divide less often than before.
And cells are in all your organs. They are everywhere. As the cells become slower, your organs also become slower.
This means your blood vessels get less good and transporting blood, you liver less good at filtering toxins, and your erectile structures less good at responding to sexual stimulation.
Your body’s ability to produce testosterone, nitric oxide and dopamine also declines.
As a result, you will normally find it more difficult to get and maintain erections as you get older. It’s just a fact of life.
However, the body is an amazing ‘thing’. And it is possible, with a very healthy lifestyle, to keep the body (and mind) operating at very high levels, even well into old age.
So although our abilities decline as we age, there’s still a lot we can do to stay young and healthy.😊
If you want to learn more about this, you can read this guide.
Diabetes, High Blood Pressure, And Cardiovascular Diseases
Diabetes, high blood pressure, and cardiovascular diseases are conditions that are often linked with being out of shape and eating poorly.
Meaning, they are lifestyle diseases. They normally happen because we live unhealthy lives.
In fact, these conditions would probably not exist if we ate super healthy and exercised every day.
Did you know that in parts of the world where people live super healthy, these conditions are almost totally absent? What does that tell you?
These conditions can cause all kinds of problems, including:
- Damages to the blood vessels
- Blood clots
- Build-up of plaque inside arteries (atherosclerosis)
- Blockage of arteries
- Thickening of the blood
- Insulin resistance
- Increase of free radicals
- Reduced production of nitric oxide
- Reduced production of testosterone
- Reduced production of dopamine
All of the above are likely to reduce the free flowing of blood to and inside your penis.
And as we already know, anything that reduces this bloodflow can cause erectile dysfunction.
A note on diabetes:
Did you know that ED tends to develop 10-15 years earlier in diabetic men than in non-diabetic men?
Many men with diabetes also develop a muscle disease called myopathy.
This can cause your corpora cavernosa (those chambers inside your penis that fill will blood) to stop working properly. This can then make it difficult to obtain and maintain erections.
We have one more step of our journey to understanding erectile dysfunction.
But before get there, let’s first quickly summarize where we are:
Erectile dysfunction is caused by poor bloodflow and poor blood pressure inside the penis.
This poor bloodflow is in turn normally caused by low production of testosterone, low production of nitric oxide, low production of dopamine, aging, high blood pressure, cardiovascular diseases or diabetes.
But what causes your dopamine or nitric oxide production to slow down? And what causes high blood pressure and these other problems?
Most of the time, these problems are caused by an unhealthy lifestyle. In other words, ultimately, it is normally an unhealthy lifestyle that is responsible for the disruptive bloodflow to your penis. Which again causes ED.
Let’s explore these factors:
Unhealthy Lifestyle Factors That Can Cause Erectile Dysfunction
Too Frequent Orgasms
After having an orgasm, most men normally feel tired and out of energy. Many men just want to sleep.
And often after you have had an orgasm, it often takes time before you want sex again, right?
Well, having an orgasms is a big deal for your body and mind. It’s exhausting and takes a lot of effort.
Also, when you have an orgasm, you send off your very best of you (your sperm) to create new life.
Let’s not forget that your sperm is an unusually nutritious liquid, and it takes significant effort to keep creating this. Particularly if you ejaculate more often than what is normal frequency.
Having an orgasm is a very strenuous task for your body.
In addition, you are probably not designed to do this (create life), very often. Maybe we human beings, are only really designed to have sex (or mate) a few times a year.
Let’s look at the animal kingdom. Most animals mate very infrequently, perhaps once a year. And very few species engage in recreational sex. Meaning, most species only ‘have sex’ when it’s time to procreate.
Therefore, if you have orgasms every day. Or every other day. Or very frequently, you will probably deplete and exhaust your reproductive system. It just can’t handle all the ‘sex-for-fun’.
The result of this?
You will normally find it more and more difficult to get and maintain erections. Or in other words, you are likely to start struggling with erectile dysfunction.
Pornography And Masturbation
Watching Pornography and masturbating can completely ruin your ability to function sexually.
The term is called porn-induced erectile dysfunction.
But why is pornography and masturbating so harmful?
It has more than one negative effect, but first and foremost, pornography and masturbation can numb your brain to dopamine.
Your dopamine receptors can be so overwhelmed with dopamine that they stop working.
Let’s explore this:
Your brain was not designed for virtual sex. It was not designed for a never-ending supply of gorgeous sexual partners. Quite the opposite: You brain was probably designed for relatively infrequent sex.
When you watch porn and masturbate, your brain produces an extreme amount of dopamine.
And when there is a big excess of dopamine floating around your brain, the poor dopamine receptors in your brain have to work overtime to process all the dopamine.
And as they work overtime, they get tired. Then exhausted. Then numb. And if you continue, they can die.
At that point, it doesn’t really matter how much dopamine you produce. Because you can’t use it. It just floats around your brain with nowhere to go.
Let’s have a look today’s porn. Because porn in the old days (think magazines) wasn’t nearly as bad.
A key problem with pornography today is that it is so incredibly easy to access. You can watch porn anywhere, anytime. All you need is a smartphone or computer, and you can have virtual sex whenever you want.
Another key problem is that advances in technology has made the quality of the porn (video, audio) amazingly real. With every passing day, pornography becomes closer and closer to real life.
Now there is even virtual pornography with smart goggles and sensors, which blurs the lines between reality and imagination. At one point the distinction between real sex and fantasy will probably disappear.
Yet another problem with porn is that it offers never-ending novelty. You can have virtual sex with a new partner every 5 minutes (or every 30 seconds), you can be with a white woman, black, Asian, old, young, have a threesome, group sex, sex in public – there are no limits.
As a result, this pornography can produce incredible sensations in you with almost no effort. In this world, you are in total control. You are king.
And this, your brain cannot handle.
It makes your brain numb.
If you watch porn and masturbate frequently, you will normally be accustomed to such extreme dopamine release, that being naked in bed with a real woman may not get you excited.
You may struggle ‘getting it up’. And you may struggle ‘keeping it up’.
This is how porn and masturbation can cause erectile dysfunction.
A Poor Diet
If you don’t eat well, you are also significantly more likely to suffer from erectile dysfunction.
Every second of every day, your body needs appropriate amounts of vitamins, minerals, fatty acids and other essential nutrients, in order to function optimally.
If you don’t give your body these nutrients, what happens?
Your body has no chance to function optimally.
Let me share an example:
Let’s say your body is instructed to synthesize a certain hormone. And let’s say that this hormone needs vitamin B6 in order to be created. And let’s assume you don’t have enough vitamin B6. Then what happens?
Well, you won’t be able to manufacture that hormone.
As a result, the functions in your body that rely on this hormone, will now work slower. Or perhaps even stop working completely.
Speaking for myself, when I eat poorly, one of the first functions to stop working is my ability to get erections. I also often lose my sex-drive.
My sexual functions simply need ultra clean, high performance food in order to put up a star performance.
This is also the case for many men. Probably yourself included.
Also, if you eat more calories than you burn, your blood will likely contain more glucose, triglycerides and bad cholesterol than it should.
This will thicken your blood, which will make it flow less smoothly through your veins, and can also increase your blood pressure. It is also likely to cause build-up of plaque on the inside walls of your arteries, which can develop into atherosclerosis.
Neither will help bloodflow to and inside your penis.
Regarding diet, one side of the coin is to consume healthy foods and drinks, so that you provide your body and mind with all they need.
The other side of the coin, is the damage you do to yourself by consuming unhealthy foods and drinks.
Therefore, if you don’t provide your body and mind with all the essential nutrients they need, and you consume unhealthy foods and drinks on top of this, you hit yourself with a double whammy.
A note on sugar and salt:
Consuming too much sugar is also likely to contribute to erectile dysfunction.
If you consume more sugar (glucose) than your burn, this will float around your blood. It may make your blood thicker, increase blood pressure and cause atherosclerosis.
Excess sugar can also increase your levels of the free radical superoxide. Your antioxidants kill these free radicals. But if you have more free radicals than antioxidants, these free radicals can run rampage in your body.
Also, antioxidants protect nitric oxide from free radicals. With less antioxidants to protect your nitric oxide, your nitric oxide level is likely to drop.
A high salt intake can increase your blood pressure. When you have too much salt in your blood, your kidneys struggle to filter out water from your blood.
As a result, your blood contains too much water. And hence pressure increases.
High blood pressure can damage your arteries, can cause atherosclerosis and can alter bloodflow.
Excess salt in your blood also decreases your arteries ability to produce nitric oxide.
All of the above can lead to erectile dysfunction.
We are supposed to breathe clean air. Not cigarette smoke, nor any kind of smoke.