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What does it take for a man to have a good erection? This is a question that plagues many men who are trying to overcome sexual challenges. When I say a “good” erection, I mean an erection that is satisfying for both yourself and your partner. For many of our patients in Toronto, Vancouver, and other parts of Canada, achieving a “good” erection is a daily challenge

When seeking to resolve this issue, it is a good idea for men to understand the main cause of erectile dysfunction as well as being aware of risk factors and other contributing causes. A thorough diagnosis that recognizes the underlying reason for sexual difficulties will help you find the best treatments for your erectile issues.

What is the most common cause of erectile dysfunction?

The best way to understand erectile dysfunction is to take a look at what’s happening inside your body, especially where blood flow is concerned. This is because an erection involves blood flowing to the penis. This process allows the penis to become hard. For this reason, the main cause of erectile dysfunction is something called endothelial dysfunction.

The endothelium is the lining on the inside of your blood vessels. They are important in regulating four things:

  1. Vascular tone: the extent to which your blood vessels constrict or dilate
  2. Cellular adhesion: the process whereby cells interact and attach to a surface
  3. Thromboresistance: the resistance of a blood vessel to thrombus formation, a thrombus being a stationary blood clot along the wall of a blood vessel
  4. Vessel wall inflammation: blood vessels become swollen in response to injury, infection, or illness

The endothelium is what causes vasodilation of the vessels in the penis, resulting in a full erection. So, in essence, the main cause for erectile dysfunction from a biological perspective is damage to the endothelium. Any form of chronic inflammation caused by hypertension, diabetes, high cholesterol, obesity, gout, and other inflammatory conditions can harm this function.

Here’s how it works: When we get excited, either through touch or visual stimulation, messages are sent to the endothelium of the penis to release a substance known as nitric oxide (NO). This chemical is responsible for vasodilation by accumulating something called cGMP. This nucleotide relaxes the blood vessels and allows blood to flow into the penis. When there is damage to the endothelium, there is less nitric oxide, which results in a non-fully erect penis. This is how drugs like Cialis or Viagra work. They prevent the breakdown of cGMP, which allows nitric oxide to be continually be released over a longer duration of time.

How can I prevent erectile dysfunction?

Now that we’ve identified the main cause of erectile dysfunction, it’s time to work backwards to determine a resolution.

To prevent or minimize erectile dysfunction, you must first start caring for your cardiovascular health. Believe it or not, common advice for reducing the risk of heart attacks and strokes is the very same guidance that can help you prevent ED. This is because same conditions that cause heart disease can cause erectile dysfunction. Consistent exercise, managing your weight by watching what you eat, and keeping your blood pressure in check are all important parts of many successful erectile dysfunction treatment plans. These simple changes may go a long way in helping you combat and overcome erectile dysfunction.

Identifying your personal risk factors for erectile dysfunction

Whether you have just started experiencing erectile dysfunction or have been working to manage it for a long time, chances are endothelial dysfunction is at the root of the issue. But what is causing it and how can you resolve it? This main cause of erectile dysfunction shows many warning signs and has many associated risk factors. Take a look at the list below to see how many apply to you.

Behaviours and Conditions that Put Men at a Higher Risk for Erectile Dysfunction Include:

  • A family or personal history of heart disease
  • Type two diabetes and prediabetes (read more about this risk factor here)
  • Inflammatory conditions
  • Obesity
  • High blood pressure
  • High cholesterol
  • An inactive lifestyle (for example, working a desk job and not regularly getting exercise)
  • An unhealthy diet
  • Smoking
  • Taking medications related to blood flow (these may be required for your health, but considering current prescriptions is a good idea when trying to understand the causes of your ED)

There are many benefits to addressing these issues. Along with helping treat ED, these lifestyle changes can prevent a man’s likelihood of developing heart disease. Since heart disease is one of the leading causes of death in Canadian men, this is good news. I often include lifestyle change recommendations into the erectile dysfunction treatment plans I develop for patients in Toronto and Vancouver.

Is my cardiovascular health the only thing that can cause ED?

Blood flow and heart health are the main cause of erectile dysfunction, but there are other causes of erectile dysfunction which may be at play in a man’s individual situation. While these factors may restrict blood flow, they do not necessarily relate back to a person’s heart health or lifestyle. These can include:

  • A history of prostate issues, particularly if a man has undergone a prostatectomy
  • Penile injuries and damage to the tissue within the penis (this can be sustained through sexual injury, car accidents, and more)
  • Numbness or a lack of sensation in the penis (research shows that excessive bike riding  can have this result for some men over time)
  • Neurological issues that affect the brain’s ability to communicate with the reproductive system. This can include Alzheimer’s disease, Parkinson’s disease, tumours, epilepsy, and multiple sclerosis.
  • Use of drugs that affect the central nervous system, including depressants (Xanax, Valium, alcohol etc), or stimulants (cocaine, amphetamines)
  • Use of various other drugs that may influence reproductive processes, such as cancer chemotherapy medications or synthetic hormones
  • Psychological, emotional or relationship issues

At Men’s Health Clinics like FullMast, a doctor will ask questions about all these risk factors in order to determine the causes of your individual ED issues. While the main cause of erectile dysfunction is always considered, these factors may also play a role.

Why does erectile dysfunction become more common as we age?

While ED can strike at any age, statistics demonstrate a considerable increase in erectile dysfunction (ED) with increasing age: up to 75% of men who are 75 years of age or older suffer from erectile dysfunction. So what happens to men as they age? Why does it become more difficult to have an erection and why are erections not as hard or long-lasting as they once were?  Perhaps most importantly, can erectile dysfunction be prevented as we age and can the downward progression be altered? The answer to both these questions is a resounding “yes.”

Many people I meet in my Vancouver and Toronto erectile dysfunction clinics ask me about the relationship between age and ED, stating that it was “so much simpler” when they were young. The truth is that the process of getting an erection was never simple for your body, even if it once occurred without much visible effort. A complex chain of biological processes must occur to produce an erection. This includes psychogenic, neurogenic, vascular, hormonal, and muscular events. An interruption to these processes can get in the way of getting an erection. As we age, there is an increased likelihood of us experiencing health issues related to erectile dysfunction, particularly heart health which is the main cause of erectile dysfunction. By keeping an eye on a man’s overall health, we can often prevent, minimize, or treat his erectile issues.

Why does erectile dysfunction matter for Canadian men?

Sexual health can play into a person’s personal health, self-esteem, and well-being. It can also have an influence on the health of romantic relationships. Evidence shows that many couples prefer sexual intercourse where the male partner has a fully erect penis. Also, many couples report missing the feelings of excitement and pleasure that come from this particular form of intercourse. They also report a happier sense of “coupling” when sexual intercourse is enjoyable for both partners. A man with a non-erect penis may still have an orgasm and ejaculate during sexual intercourse, but for many men and for many couples, this may not be enough.

If you are a Canadian man seeking more information about the possible causes and treatments for your erectile dysfunction, click here to contact us today for a free and fully confidential consultation.

Written by Dr. Ron Mayer, FullMast’s Chief Medical Officer