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DISEASE BACKGROUNDER 

EMBARGOED: 12:01AM AEDT, TUESDAY, NOVEMBER 26, 2024

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About erectile dysfunction

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About erectile dysfunction

  • Erectile dysfunction (ED) is defined as the persistent inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance.1,2

  • It is one of the most common urologic problems in men worldwide,3 mainly afflicting those aged 40+ years.4

  • ED affects more than 50 per cent of men aged over 45 years of age.5 The risk of developing ED from the age of 45 and onward, increases by 11 per cent each year for Australian men.6

  • Yet despite its commonality, ED is often neglected.7

  • ED features as an important health issue in The Australian Government’s National Men's Health Strategy 2020-2030 for men.8

  • Commonly referred to as the ‘couples disease’, ED impacts both the man and his partner.9

  • In fact, ED is a shared sexual disorder for both the men with ED and their sexual partners, although this is not well understood by affected couples.10

  • Partners of those living with ED experience lower sexual satisfaction in correlation with their partner’s degree of ED.11

  • There is often an underlying medical condition that causes ED.12

  • Recognition of the early signs and symptoms of ED is crucial, and may be indicative of other medical conditions. Symptoms of ED can often present as the first sign of cardiovascular (a group of disorders of the heart and blood vessel) disease, diabetes, high blood pressure and high cholesterol.12,13

 

Prevalence of ED in Australia

  • An estimated one in five men living in Australia over 40 experience erectile dysfunction.14

  • The risk of developing ED is age-related, with approximately 20 per cent of men aged 45-55 years,8 26 per cent of men aged 50-59 years, and 40 per cent of men aged 60-69 years, living with ED.15

  • In an Australian study of 101,674 men, 39 per cent had no ED, 25 per cent had mild, 19 per cent had moderate and 17 per cent had complete ED. Almost all men 75+ or older reported having moderate/ severe ED.6

  • In the same study, all men aged 75+ years reported experiencing moderate to severe ED. Those who engaged in more physical activity reported a lower incidence of ED within this age group.6

  • Globally, estimates suggest 322 million men will be affected by ED worldwide by 2025 – an increase from 152 million men in 1995.11

  • Given our nation’s aging population, the prevalence of ED will increase as men live longer, 16 with the proportion of men aged 65+ years forecast to reach 21 per cent by 2050. 16

  • Although ED increases with age, younger men also report experiencing the disease (11 per cent aged 18-24 years).8

 

Causes & risk factors

  • ED occurs when blood flow to the penis is limited, or the nerves, smooth muscles and tissues are damaged.5,17 

  • The development of ED is linked to ageing. Over time, a man’s likelihood of developing ED increases.

  • Stress is also considered to be a risk factor for ED.8  

  • ED can be caused by physical or psychological factors, or a combination of both.17 However, there is no single cause.1,7

  • Overall, the risk of developing moderate to complete ED is higher among Australian men from a low socio-economic background, who have a high body mass index, are sedentary, smoke, and are living with diabetes, heart disease, and depression/anxiety, compared with men free from these risk factors.6

  • ED can be caused by any disease process that affects the penile arteries, nerves, hormone levels, smooth muscle tissue and lining.4

  • Eighty per cent of ED cases occur due to the problems of the blood vessels that bring blood to and from the penis. The vessels may be blocked, narrowed, or may be due to other causes.18 

  • Conditions frequently associated with ED that heighten risk include cardiovascular disease, diabetes, obesity, high blood pressure and high cholesterol.

  • Common causes of ED include:1, 9

    • Cardiovascular disease 

    • Diabetes

    • Medicines e.g. blood pressure medication/ antidepressants

    • Surgery (e.g. prostate, bladder, colon, rectal)

    • Trauma/injuries to the brain/nerves/spinal cord and endocrine system

    • Prostate cancer treatment

    • Lifestyle choices (smoking, excessive alcohol, obesity, lack of exercise)

    • Hormone problems.

 

Medical conditions linked with ED

 

Cardiovascular disease

  • ED is a precursor for cardiovascular disease. This is due to the hardening of the arteries caused by plaque build-up – atherosclerosis – that limits blood flow to various parts of the body. The arteries supplying blood to the penis are much smaller than those supplying blood to the heart. Consequently, cardiovascular disease may first present as difficulty achieving an erection.19

  • In fact, ED may be an early indication of damage to cell lining, and a predictor, and a precursor of other forms of heart disease.18

  • Studies reveal cardiovascular disease is diagnosed within five years of development of ED, reinforcing the importance of a man discussing sexual function with a healthcare professional. 4,20,21

 

Diabetes

  • Diabetes damages the blood vessels and nerves that supply the penis with blood to form an erection. The constant change in blood sugar levels can also cause nerve damage, which can lead to a loss of sensation in the feet and hands, and can affect sexual performance.19

  • Men living with diabetes have a greater risk of developing ED. More than 50 per cent will develop ED within a decade of developing diabetes.12

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Prostate cancer

  • ED is known as a potential complication of prostate cancer treatment.22 It may affect the nerves that control erections, potentially taking up to two years, or longer to regain sexual function.23

  • The most obvious determinant of post-operative erectile function is what erectile function was like prior to the operation. Post-operative erectile dysfunction is compounded in some patients by pre-existing risk factors.22

  • Penile rehabilitation following prostate surgery may help the nerves responsible for erections, to recover after surgery. Should this prove unsuccessful, varying treatment options are available.23 

  • With the advent of nerve-sparing procedures, some men may regain their pre-existing erectile function up to a year or longer following prostate cancer treatment. Importantly, the journey is different for every man, noting some may fail to recover their ability to have a natural erection.22

  • Following any form of pelvic surgery, ED is not uncommon. The nerves that control an erection lie very close to the prostate, and may be injured by being cut, or separated from the prostate during surgery. This may cause temporary, or permanent difficulty with achieving an erection, although sexual desire is not usually affected.22

 

Others

  • A study published on over 250,000 men found that around 40 per cent were living with ED had hypertension, and 42 per cent had hyperlipoidemia (an abnormally high level of lipids in the blood). 4, 24

  • Obesity has also been found to be associated with a 50 per cent increase in ED, compared with men of normal weight.4

 

Impact on quality of life

  • ED affects the man living with the condition, and their partner, 25 and can cause relationship difficulties,3 due to reduced relationship satisfaction 25 from poor self-esteem, and limited intimacy.19

  • ED has detrimental social and psychological effects on the quality of life of affected individuals, and their sexual partners.10

  • Physical symptoms of ED are often associated with depression, a loss of self-confidence, loss of intimacy in a relationship, and reduced quality of life.15

  • Several worldwide studies have demonstrated men living with ED have a poorer quality of life than men free from ED, regardless of their age. 25

  • ED is also associated with anxiety, anger, frustration and guilt. 25

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Diagnosis & management

  • ED is often under diagnosed, and consequently, under-treated.26

  • A personal history and physical examination sets the groundwork for the management and diagnosis of ED.

  • Screening tests may need to be conducted to identify underlying conditions, such as diabetes, cardiovascular disease, or other conditions affecting the nerves and blood flow to the penis.4,19

  • Many men lack the opportunity to discuss ED for various reasons, including embarrassment, cultural barriers or taboos, scepticism of treatment success, and a reluctance to raise the topic with a doctor.7

  • Concerningly, sexual function is rarely discussed between a doctor and patient, with research suggesting this is due to patient embarrassment with initiating a sexual health conversation with a doctor.  Men do however, wish to be asked about their sexual function, and to be granted an opportunity to discuss their concerns with their doctor.20

  • Furthermore, men may choose not to seek treatment for their ED because they do not consider it a  bona fide health problem that requires treatment, but rather, mistakenly deem it a normal part of ageing.27

  • Perceptions and attitudes towards ED and its treatment are partly influenced by cultural and psychosocial factors.27

  • About 3 in 10 men reporting with ED seek medical attention and contact their health practitioner. 16,27

  • Lifestyle modifications, such as increased physical activity, weight loss, improved diet, smoking cessation, and improved management of other underlying medical conditions have been shown to help prevent ED. 4,28

  • Sexual partners of men living with ED can play an important role in its management and improvement in quality of sex life. They should therefore, be involved in the assessment of, diagnosis, education, counselling, and choice of treatment.10 

  • Lack of active involvement of the partner in current medical treatment may contribute to a low recovery from, and unsatisfactory rehabilitation from ED.10  

​

Treatment of ED

  • The most common barriers to the treatment of ED include treatment ineffectiveness, side effects, the quality of a man’s intimate relationships, and the cost of treatment.14

  • Despite the introduction of many new ED treatments to market, this has not led to men actively seeking treatment for their condition.27 Evidence does however, suggest that with the availability of new, effective treatments for ED, those affected are more likely to seek help.29

  • Importantly, ED is treatable, and men living with ED should seek professional advice.4

  • Successful treatment of ED has been shown to improve quality of life.30

  • Factors that may influence treatment success include partner inclusion, clinician suitable patient selection, and ongoing patient support and education.15

  • The most effective approach for ED treatment is best determined by the individual patient (and his partner), within the context of the patient’s history, values, and treatment goal.29

  • There are both short-term and long-term solutions that can effectively treat ED.22

  • Both non-surgical and surgical ED options are available.22

  • Non-surgical options include oral medicines, vacuum pumps, injections, or urethral suppositories.23

  • Surgical options include penile implants – a permanent, long-term solution for ED.23

 

Should lifestyle modifications prove unsuccessful, or inappropriate, the following treatment options can be explored:

  • Oral medicine14

  • Counselling and education14

  • Vacuum devices and rings14

  • Penile injections15

  • Hormonal therapies15 and

  • Combination therapies – a use of multiple treatments.15  

 

In addition, men living with ED can be also be recommended for a penile implant/prosthesis as another management strategy.23

  • Penile implants have been used for more than 40 years in men living with ED, and are a long-term option.23

  • There are two types of penile prosthesis implants – inflatable and non-inflatable. Implanted into the penis, they offer concealed support for an erection. 31,32

  • Penile implants are effective and reliable, they have helped more than 500,000 men return to an active and satisfying sex life.31

  • 97 per cent of patients report satisfaction rates with their implants and would suggest treatment to others.33

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ends#

 

For more information regarding erectile dysfunction, please contact Kirsten Bruce and Sam Jacobs from VIVA! Communications on:
T              02 9968 3741 | 1604
M            0401 717 566 | 0422 654 404
E              kirstenbruce@vivacommunications.com.au | sam@vivacommunications.com.au

 

References

  1. HF - About ED fact sheet. Boston Scientific; 2019.

  2. Rew KT, Heidelbaugh JJ. Erectile Dysfunction. Am Fam Physician. 2016;94(10):820-7.

  3. Langarizadeh MA, Salary A, Tavakoli MR, Nejad BG, Fadaei S, Jahani Z, Forootanfar H. An overview of the history, current strategies, and potential future treatment approaches in erectile dysfunction: a comprehensive review. Sexual Medicine Reviews. 2023;11(3):253-67.

  4. Leslie SW, Sooriyamoorthy T. Erectile Dysfunction.  StatPearls. Treasure Island (FL)2024.

  5. Hard Facts: Boston Scientific;  [Available from: https://www.hardfacts.com.au/home.html].

  6. Weber MF, Smith DP, O'Connell DL, Patel MI, de Souza PL, Sitas F, Banks E. Risk factors for erectile dysfunction in a cohort of 108 477 Australian men. Med J Aust. 2013;199(2):107-11.

  7. Ohad Shoshany DJK, Christopher Love. Much more than prescribing a pill – Assessment and treatment of erectile dysfunction by the general practitioner. Royal Australian College of General Practitioners. 2017;46(9).

  8. National Men's Health Strategy 2020 - 2030. Australian Government Department of Health; 2019.

  9. Erectile dysfunction: a partner's point of view. In: Scientific B, editor.: Boston Scientific; 2017.

  10. Li H, Gao T, Wang R. The role of the sexual partner in managing erectile dysfunction. Nature Reviews Urology. 2016;13(3):168-77.

  11. Kessler A, Sollie S, Challacombe B, Briggs K, Van Hemelrijck M. The global prevalence of erectile dysfunction: a review. BJU Int. 2019;124(4):587-99.

  12. treatED, Understanding the impact of diabetes on erectile dysfunction. Diabetes Australia: Diabetes Australia.

  13. Erectile dysfunction healthdirect: healthdirect; 2023 [Available from: https://www.healthdirect.gov.au/erectile-dysfunction.

  14. Catherine Kirby LP, Caroline Giles. GP management of erectile dysfunction. Australian Family Physician. 2009;38:637-41.

  15. Ian A R Smith NM, Prem Rashid. Erectile dysfunction – when tablets don’t work. Australian Journal for General Practitioners. 2012;39:301-5.

  16. Holden CA, McLachlan RI, Pitts M, Cumming R, Wittert G, Agius PA, et al. Men in Australia Telephone Survey (MATeS): a national survey of the reproductive health and concerns of middle-aged and older Australian men. Lancet. 2005;366(9481):218-24.

  17. Patient brochure - Find the ED solution that's right for you. Boston Scientific; 2019.

  18. McMahon CG. Current diagnosis and management of erectile dysfunction. Med J Aust. 2019;210(10):469-76.

  19. Hard Facts - FAQs about ED: Boston Scientific;  [Available from: https://www.hardfacts.com.au/resources/faq.html].

  20. Schlichthorst M, Sanci LA, Hocking JS. Health and lifestyle factors associated with sexual difficulties in men – results from a study of Australian men aged 18 to 55 years. BMC Public Health. 2016;16(3):1043.

  21. Fang SC, Rosen RC, Vita JA, Ganz P, Kupelian V. Changes in erectile dysfunction over time in relation to Framingham cardiovascular risk in the Boston Area Community Health (BACH) Survey. J Sex Med. 2015;12(1):100-8.

  22. Patient brochure - Prostate cancer is a journey, now it’s your time to be in the driver’s seat with your recovery. Boston Scientific; 2016.

  23. Everything below the belt. 2023.

  24. Seftel AD, Sun P, Swindle R. The prevalence of hypertension, hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. J Urol. 2004;171(6 Pt 1):2341-5.

  25. Elterman DS, Bhattacharyya SK, Mafilios M, Woodward E, Nitschelm K, Burnett AL. The Quality of Life and Economic Burden of Erectile Dysfunction. Res Rep Urol. 2021;13:79-86.

  26. Arduca P. Erectile dysfunction - a guide to diagnosis and management. Australian Family Physician. 2003;32(6):414-20.

  27. Low W-Y, Ng C-J, Choo W-Y, Tan H-M. How do men perceive erectile dysfunction and its treatment? A qualitative study on opinions of men. The Aging Male. 2006;9(3):175-80.

  28. Paulsen LH, Sørensen Bakke L, Jarbøl DE, Balasubramaniam K, Hansen DG. Associations between lifestyle, erectile dysfunction and healthcare seeking: a population-based study. Scand J Prim Health Care. 2020;38(2):176-83.

  29. Eric Chung ML, Michael Gillman, Chris Love, Darren Katz, Graham Neilsen. Urological Society of Australia and New Zealand (USANZ) and Australasian Chapter of Sexual Health Medicine (AChSHM) for the Royal Australasian College of Physicians (RACP) clinical guidelines on the management of erectile dysfunction. Med J Aust. 2022;217(6):318-24.

  30. Williams P, McBain H, Amirova A, Newman S, Mulligan K. Men’s beliefs about treatment for erectile dysfunction—what influences treatment use? A systematic review. International Journal of Impotence Research. 2021;33(1):16-42.

  31. Hard Facts - Surgical Treatments | Penile Implants: Boston Scientific;  [Available from: https://www.hardfacts.com.au/treatment-options/penile-implants.html].

  32. Chung E. Penile prosthesis implant: scientific advances and technological innovations over the last four decades. Transl Androl Urol. 2017;6(1):37-45.

  33. Bernal RM, Henry GD. Contemporary patient satisfaction rates for three-piece inflatable penile prostheses. Adv Urol. 2012;2012:707321.

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