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Monday’s medical myth: erectile dysfunction is all in your mind

It’s perfectly normal for men to have an occasional problem gaining or sustaining an erection. But for some men, these difficulties are frequent and severe, making penetration impossible. This condition…

Around 90% of men with erectile dysfunction have a predominantly physical basis for their condition. Horia Varlan

It’s perfectly normal for men to have an occasional problem gaining or sustaining an erection. But for some men, these difficulties are frequent and severe, making penetration impossible. This condition is known as erectile dysfunction, or ED, and occurs when there is a reduced blood flow to the penis at the time of erection.

We now know that erectile dysfunction is in the pelvis, not in the mind – but this understanding is relatively recent.

During my formative years in medical training (late sixties, early seventies) I was taught that 90% of ED (then referred to as impotence) was psychological. All the educational sessions featured psychiatrists or psychologists, and most men who presented were sent to these experts for treatment.

Few treatments were available at the time. There were penile implants, vacuum constriction devices and testosterone therapies, but none were particularly effective. There was also a societal attitude that men should accept their time had come to cease having a sex life.

During the eighties there was evolving appreciation of the role of nitric oxide and endothelial cell function, which increased our understanding of penile neural and vascular mechanisms. This stimulated great interest for scientists working in ED medicine.

But undoubtedly the biggest catalyst for change came from Big Pharma. When Pfizer trialed sildenafil (Viagra) for the treatment of angina, the researchers fortuitously found that the male participants got erections. The pharmaceutical industry saw the potential for a safe and effective oral medication for the treatment of ED and got the drug to market.

Funds then flowed to facilitate more research about the causes of ED and the general implications for health. Large epidemiological studies showed that ED was much more prevalent than previously thought, affecting at least one third of men over 40 and increasing with age.

Researchers also uncovered strong links between ED and diabetes, high cholesterol, cigarette smoking, hypertension, obesity and heart disease. In retrospect, the association with conditions that affect the blood vessels and cause heart disease isn’t surprising, given the vascular nature of the erection process. There needs to be about a ten-fold increase in blood flow to sustain a hard erection.

A major development in ED medicine was the finding in 2005 that ED predicted a risk of heart disease. The researchers followed men aged over 50 for seven years and noted that if a man developed ED, he was at risk of subsequent coronary artery disease. Over a five year period this risk was 11%, indicating ED was a potent and significant predictor of high risk. Numerous studies have confirmed these findings.

Most recently, an Australian study showed the same increased risk applied to men in the 20-to-50 age range. It’s also been shown that among diabetic men, those who have ED are much more likely to have significant undiagnosed coronary artery disease – and the severity of ED predicts the severity of the heart disease.

As well as these vascular conditions, ED can also be caused by prescription medicines, drug and alcohol abuse, hormonal problems, prostate and bowel surgery and pelvic injuries, and spinal cord diseases. In some men, of course, the cause may be purely psychological, or related to depression and anxiety disorders.

It’s now estimated that 90% of men with ED have a predominantly physical basis for their condition – so we’ve come full circle in our understanding of erectile dysfunction. But this doesn’t preclude the possibility that these men might suffer from secondary psycho-sexual consequences, or that targeted psycho-sexual treatment will be helpful.

The knowledge that ED might be a symptom of a physical health problem should serve as yet another reminder for men to seek help for this treatable condition. The good news is that with the right information – and the right attitude – men can (and should) overcome it.

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7 Comments sorted by

  1. Sue Ieraci

    Public hospital clinician

    The Australian study linked in the article found that

    "Younger age at first manifestation of ED, cigarette smoking, presence of comorbidities and socioeconomic disadvantage were all associated with higher hazard ratios for subsequent atherosclerotic CV events."

    Why not incorporate this message into anti-smoking education for young men - much more likely to strike a chord than the gangrenous toe pictures.

    1. Dianna Arthur


      In reply to Sue Ieraci



      Now if we could link male perpetrated violence to erectile dysfunction...

      Not sure what to do about bullying from either sex.

  2. Nicholas Herrero


    I suffer from ED, but none of the indicators listed - age is the only possible cause - I'm over 60, don't smoke and drin moderately. Since diagnosis I've used Viagra but lately switched to Cialis, which I find much more useful.While Viagra delivers a short term erection - around three hours - it also delivers headaches and acute flushing in my case.

    Cialis on the other hand allows for spontaneity, because it lasts for 36 hours - which doesn't meran i hav an erection for 36 hours but am able to achieve one, with the right stimulation - an attractive and willing partner. It is much more like a normal sex life.

    I would be interested in some medical discussion of the various drugs, their dangers, disadvantages and strengths

  3. Rod Andrew

    Editor, teacher, engineer

    The article says ED is caused by vascular conditions and can also be caused by prescription medicines, drug and alcohol abuse, hormonal problems, prostate and bowel surgery and pelvic injuries, and spinal cord diseases.
    What about ageing? When does it become not a 'dysfunction' but 'normal'?
    Should a 60-year-old expect to be the same as a 20-year-old?

  4. Mark Baker


    I strongly disagree with this article - and not just because the stench of 'big pharma' is all over it!
    I have always maintained good-to-excellent dietary and circulatory health, and there is not a single moment of obesity or diabetes in my personal or family's medical background. Nevertheless, I've experienced (suffered from?) ED, periodically, for 15yrs. I do NOT discount outright, a physiological cause or causes for ED, however, I am certain it/they are not the MAIN cause.
    In my experience…

    Read more
  5. Tom Kruzbrick

    Manager at Andropenis Australia

    I believe Erectile dysfunction can be caused by mental issues such as stress and lack of attraction to ones partner etc. however I also believe that cardiovascular health is paramount to being able to gain and maintain a strong erection.

    For any men who maybe having issues, try and increase your cardiovascular exercise to at least 3 times a week for 20 minutes, really try to get up a sweat and get the heart rate going, although some may have to work their way up to this depending on the current level of fitness.

    I would almost guarantee that most will see a marked improvement in erection quality and overall sexual health within a couple of weeks. Having good circulation is very important for erections and to realize why you just need to look into how exactly a male biologically gains an erection.

    All the best, Tom.

  6. Sherry B. Morgan

    logged in via Twitter

    ED seems to be more than just an age-related issue because even younger men can experience the untimely symptoms. Circulation is the key towards erection and anything that can hamper it will most likely result to ED. Some medicines are especially designed to overcome this problem and, with the right dosage, guarantees the optimum results. You can get some info here: