erectile dysfunction

Erectile dysfunction (impotence or erection problems) is the inability to get and/or keep an erection. Read: definition of erectile dysfunction. It is known that with age these types of problems can occur more strongly and break the harmony between couples.

The causes of erectile dysfunction can be multiple and provoked either by organic factors (cardiovascular disorders, for example) or psychological factors ( stress , anxiety ).

The typical symptom of erectile dysfunction is, as its name suggests in part, the inability to achieve an erection. Sometimes, there are also problems with the duration of the erection and, therefore, a difficulty in maintaining it during the sexual act. We speak of erectile dysfunction if these conditions persist for at least three months.

There are currently three major drugs or molecules on the market for the treatment of erectile dysfunction. There is sildenafil (Viagra® and generics), verdenafil (Levitra® or Vivanza®) and taladafil (Cialis®). The doctor will give you more information about the most suitable molecule.
You should know that these three molecules can cause side effects such as headaches, palpitations, dizziness, nausea, etc.
There are also treatments that are not based on the use of these three molecules, including psychotherapy in cases of erectile dysfunction of psychological origin.

Finally, some good advice can help you overcome erection problems and have a great conversation between the couple. It is known that erectile dysfunction increases massively with age so don’t be shy about talking about it, you are by far not alone. Your doctor can also give you excellent advice.

In addition, it is recommended to do an electrocardiogram before using sildenafil citrate, because in cases of heart problems, this medicine should be used with great caution.


functioning of the erection

After sensory stimulation (sight, smell…) and in a context that could lead to sexual excitement, the penis fills with blood. This is called an erection. Achieving and maintaining (for a long period of time) an erection during intercourse can sometimes be deficient, hence the notion of erectile dysfunction or erectile dysfunction.

Definition of erection problems

Erectile dysfunction (impotence or erection problems) is defined as the inability to obtain and/or maintain an erection, a necessary condition for satisfactory sexual intercourse.

With age, erectile dysfunction can occur more often and strongly disrupt the life of a couple. Consequently, the interest in talking seriously internally in the couple and with a health specialist, since there is often an effective treatment to be suggested.


It is estimated that 150 million men worldwide are affected by erectile dysfunction. That panel, already impressive, could double within the next five years.

In the population aged between 40 and 70 years, the incidence of erectile dysfunction is approximately 50%. After the age of 70, an estimated 70% of men experience erectile dysfunction.

However, it remains difficult to obtain accurate and reliable statistics, especially for young men. Because this is actually taboo, young men for “macho” reasons are likely to have difficulty admitting their erectile dysfunction problems, including researchers as well.


The main causes of erectile dysfunction are mostly organic factors (vascular, neurological or hormonal aspects that affect the nerves, vessels and cavernous body of the penis) or psychological factors (anxiety at the time of reporting, etc.).

The most common causes of erectile dysfunction include:

– high blood pressure

– Several other cardiovascular diseases (cholesterol, heart problems).

– Depression , anxiety  and other psychological disorders

– Hormonal problems (testosterone concentration including decreased testosterone in the blood,  thyroid problems …)

– A diabetes

– Abuse of toxic substances such as: tobacco, alcohol, coffee (in high doses), drugs such as marijuana. According to Swiss urologist Dr. Mattarelli de Liestal interviewed in 2017 by the Swiss health magazine TopPharm Ratgeber , some of his young patients aged 20 years and over who smoke marijuana several times a day, suffer from severe erectile dysfunctions to the point of being totally impotent.

– Stress , the anguish of not achieving an erection. Penis blood vessels are among the thinnest in our body. In cases of stress, which normally leads to an increase in the concentration of cortisol, these vessels can contract and lead to erectile dysfunction.

– A prostate problem (for example after cancer or surgery)

– neurological disorders

– The age

– Side effects of certain medications: antidepressants (fluoxetine,…), antihypertensives, beta-blockers, anxiolytics. Finasteride (a medicine used for hair loss in men and some prostate problems).

– Poor sleep quality, according to a study carried out in 2009 in São Paulo, cited by the newspaper Folha de Sao Paulo, on November 11, 2009. Sleep disorders can cause erectile difficulties. Too little sleep is also a risk, it is estimated that a short night of sleep can increase the risk of erectile dysfunction by three times.

– Overweight and obesity .

– Gout can be a cause of erectile dysfunction. A study released in June 2014 at the EULAR Congress (European League Against Rheumatism – European League Against Rheumatism in Portuguese), which was held in Paris, showed that men with gout suffer more from erectile dysfunction.

– Sitting on a bicycle seat for long periods. This is a reversible cause, meaning less cycling reduces or stops erectile dysfunction.


The typical symptom of erectile dysfunction is the impossibility of achieving an erection of the penis, this means that the penis cannot get hard enough (lack of rigidity) which does not allow the partner to penetrate properly. In addition, the man may have difficulties in maintaining (duration) an adequate erection during the sexual act until ejaculation.

Finally, the man often does not have a spontaneous erection in the morning. We speak of erectile dysfunction (erection disorder) when these problems last for 3 months or more.

We talk about erectile dysfunction (erection problems) when these problems last for 3 months or more.


The diagnosis is relatively simple to ask the doctor privately, followed by a discussion with the patient.

That said, it will be important for the doctor to correctly identify the cause of erectile dysfunction in order to find the most appropriate therapy, sometimes simply treating the cause can lead to the end of erectile problems.

It may also be useful to carry out a blood test and obtain the dosage, for example, of certain sex hormones (testosterone, for example). Other tests may be ordered by the doctor.

For an accurate diagnosis and more complete information about the symptoms of this condition, ask your general practitioner or urologist (a specialist in erection problems) for advice.


Even occasional erectile dysfunction can lead to anxiety before each act of intercourse, (mild)  depression , lack of self-confidence and the deterioration of the couple’s relationship.

That is why it is important and advisable to treat erectile dysfunction.

Erectile dysfunction and cardiovascular risks

Increased frequency of erection failures, even slightly, may signal a higher risk of cardiovascular disease and premature death, according to a study published in February 2013. And the risk increases with the severity of erectile dysfunction.

“The results of this study indicate that all men who suffer from mild, moderate or severe erection problems should immediately consult a doctor and insist on cardiac examinations”, said Rob Grenfell, one of the heads of the Australian institute “Heart Foundation Cardiovascular Health ” who conducted the study.

“The risk of developing cardiovascular disease and premature death increases with the severity of erectile dysfunction in men with and without a history of cardiovascular disease,” adds Emily Banks of the Australian National University.

“We found in this research that erectile dysfunction is associated with a higher risk of heart attack , heart failure , vascular disease and electrical problems of the heart,” says Emily Banks.

Erection failure is not in itself a cardiovascular risk, but a possible sign (symptom) of cardiovascular problems. The physician will then complete tests to investigate a potential for heart or vascular disease.

When to consult?

The absence or scarcity of morning (or night) erections that are common in many men, premature ejaculation or an erection that does not last throughout intercourse are possible indicators of incipient erectile dysfunction. In this case, it is advisable to consult a doctor.

It is worth noting that from a medical point of view, erectile dysfunction can be a sign of cardiovascular disease as well as a serious risk of myocardial infarction. The physician may then request a complete check-up of the patient, including in particular the cardiac and cardiovascular systems in general.


Until recently (1998) the only effective treatment for erectile dysfunction was surgery (penis prosthesis).

Currently oral therapy (swallowing medication) against erectile dysfunction which is a great advantage for the patient.

In Brazil there are currently (in our opinion) three main drugs against erectile dysfunction. These drugs belong to the class of phosphodiesterase 5 inhibitors, which act as vasodilators. These molecules (or active principles) are the following:

–  Sildenafil (Viagra®, the best-selling molecule on the market).

Effect : Viagra® causes an erection when sexual stimulation occurs between 20 and 40 minutes after administration. Viagra® has an effect that can last from 3 to 4 hours. Avoid the use of alcohol concomitant with the use of Viagra.

Also, do not use coronary vasodilators (nitrate-based drugs used, for example, in the case of pectoral angina).

Main side effects: redness of the face, pain in the groin, headaches,…

– vardenafil (Levitra®)

Effect : Levitra® can cause an erection for at least 30 to 45 minutes after absorption and sexual stimulation is required to trigger an erection. The effect lasts for 4 to 5 hours which means you can plan to have sex (usually one) up to a few hours after administering the medicine, once sexual stimulation has occurred. An advantage of sidenafil is that this molecule can act at a very low dosage and have a more selective action.

Main side effects: upset stomach,..

 Tadalafil  (Cialis® )

Effect : Cialis® can cause an erection for at least 30 to 60 minutes after absorption and sexual stimulation is necessary to trigger an erection. The effect lasts for 24 to 36 hours, which means that lovemaking can be planned (usually one) several hours later, with sexual stimulation. This allows for a more peaceful sex life as intercourse can occur several hours after the drug is administered.

Main side effects: upset stomach,..


– These medicines are sold under medical prescription and a previous and accurate diagnosis by the doctor is necessary (to exclude certain cardiovascular diseases,…).
– For your safety, do not buy these drugs on the Internet (risk of counterfeit drugs and lack of diagnosis by the doctor).

Mechanism of action of these drugs: these three drugs act in the corpus cavernosum region (part of the penis that can fill with blood) as vasodilators, thanks to the inhibition of phosphodiesterase 5, an enzyme present in the penis. This favors the influx of blood into the corpora cavernosa, which in turn can lead to penile erection.

Other treatments

– There are also other treatments that combat erectile disorders, such as psychological therapies, implants (surgery), or drugs to inject into the penis.
– These treatments can be used in patients who do not react to phosphodiesterase inhibitors (Viagra®,…), as is the case, for example, with certain diabetics.

Other treatments
– Mainly in the United States, some doctors prescribe testosterone especially in case of erectile dysfunction caused by a low concentration of testosterone in the body.
– As noted at the beginning of the Treatment section, implants or penile prostheses are still used in some cases.
– A pump that creates a vacuum, placed over the penis also allows some patients to regain an erection.
– Surgical methods that target the blood vessels of the penis are rarely used.
– Alprostadil:
Alprostadil (prostaglandin E₁) is a drug indicated against erectile dysfunction. Unlike phosphodiesterase 5 inhibitors (see above), it also works in the absence of erotic stimulation. This medication can be injected into the penis, applied as a cream, or injected into the urethra.

Herbal medicine

The first natural treatments come from traditional Chinese or African medicine. These therapies are often quite old.

When we think of plants, we often speak of aphrodisiacs or medicinal plants, these drugs have more effects on desire than on causing the erection itself (unlike the drugs mentioned in “ treatment ”) and these effects are only rarely scientifically proven, in the However, ginseng  appears to be an exception to the rule. A study published at the end of 2012 showed the effectiveness of the plant in cases of mild to moderate erectile dysfunction (more information on ginseng).

Here are some plants, possibly aphrodisiacs:

– Ginger , which must be taken in the form of a tablet, capsule or juice.

– Maca , which must be taken in capsule form

– The gingko , which could improve blood flow in the penis and relax its smooth muscles.

– Ginseng , to be consumed in the form of tea or capsules (caution: it can cause interactions with MAOIs, a class of antidepressants).

– Catuaba is an aphrodisiac.

– According to a study carried out by researchers at the University of Texas, published in May 2015, consuming caffeine in moderate portions, such as drinking 2 to 3 cups of coffee a day, would reduce the risk of suffering from erectile dysfunction by 42%. The researchers, however, were unable to demonstrate a cause and effect link, but did find a correlation between erectile dysfunction and caffeine consumption. A possible cause of the effect of caffeine, according to the American researchers, could come from a relaxation of the muscles and arteries of the penis. This study was published in the journal PLOS One.


– Try to develop a good discussion in the couple about their problems. Sometimes there is a relationship problem and therefore couples therapy can be very helpful. Confidence in the partner plays a central role in the therapy of erectile problems.

You should know that with age, as we’ve seen from statistics, the problem of erectile dysfunction is very common, so don’t be ashamed because you are by far not the only couple concerned.

Discuss with your doctor as he will advise you better. There are effective treatments!

– Adopt a healthy lifestyle, avoid substance abuse such as tobacco and alcohol, try to maintain a healthy diet and practice sports, as this favors blood circulation, and in this case, blood circulation in the penis has a favorable effect about the pathology.

– Avoid buying drugs against erectile disorders on the Internet. The famous blue pill, Viagra®, from the New York laboratory Pfizer, fights erectile disorders and can be found for sale on countless websites around the world, but this medicine is often faked and, in addition to being useless, its consumption can be very dangerous to health.
In addition, like all medicines, it can have side effects (cardiovascular) so before starting treatment it is necessary to consult a doctor to carry out a previous examination (diagnosis).

– Try to lower your stress state and get enough sleep.

– If possible, consult a psychologist or psychiatrist to talk about your erection problems and the anxiety generated by this problem.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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