You Ask — We Answer
Dr. Fabio Castiglione Urologist London
Is erectile dysfunction (impotence) just part of aging?
Not necessarily. It is true that a man’s risk for erectile dysfunction (impotence) increases as he gets older, but lots of older men still have rigid enough erections and satisfying sex.
Men can develop impotence at any age. Often, ED is a sign of other health issues, like diabetes, dyslipidemia, hypertension and cardiovascular disease.
However, it’s common – and normal – for erections to change as a man gets older. He might find that he needs more time and stimulation to become aroused. His erections might not be as rigid as they were when he was younger, or they might not last as long as they used to.
Changes in erections aren’t always a disadvantage. Needing more time or stimulation can give couples the opportunity for more intimate sharing. They might discover other sexual activities that are exciting.
Declining testosterone levels at midlife can be partially responsible for changing erections.
In some men, as they age, their testosterone levels gradually decline. Some people call this situation “male menopause,” or andropause, but the decrease is subtle compared to what women experience during menopause. Men’s testosterone levels can drop about 1% each year starting around age 30.
Still, testosterone is an important hormone for erections, and low testosterone can be a cause of ED. “Low T” has also been linked to diminished sex drive, weakness, fatigue, and moodiness. Testosterone replacement therapy can help, but men should always check with their doctor before starting any testosterone treatment.
If you are having trouble with erections, see your doctor for a checkup. As mentioned above, ED is often caused by underlying health conditions like diabetes, dyslipidemia, hypertension, cardiovascular disease, and obesity. Treating such conditions is important for your overall health, and you’ll likely see your erections improve. Sometimes lifestyle changes, like exercising, losing weight or quitting smoking, improve erectile function.
And if you don’t have an underlying health problem, it will be good to rule that out.
Keep in mind that there are several treatments available for ED, including medications, suppositories, intracavernous injections, vacuum devices, and penile implant procedures. Not all treatments are appropriate for all men, but chances are, there are options for you.
Do vitamin D levels have any impact on a man’s erections?
Vitamin D is an important nutrient for our overall health. And some experts believe vitamin D deficiency might interfere with a man’s erections.
Sometimes called the “sunshine vitamin,” vitamin D helps the body process calcium to strengthen bones. It’s also important for nerves, muscles, and the immune system.
The body makes vitamin D when the skin is exposed to sunlight. Vitamin D can also be found in certain foods, such as fish and fortified cereals. Some people also take vitamin D supplements.
In 2016, the journal Atherosclerosis published a study by American researchers examining the relationship between vitamin D deficiency and erectile dysfunction (ED). The research team collected data from 3,390 men between the ages of 20 and 85. The men were considered to have vitamin D deficiency if their levels were below 20 ng/mL. Almost a quarter of the men had ED.
The scientists determined that the prevalence rates of vitamin D deficiency were 36% for men with ED and 29% for men without ED. Men with ED tended to be older, less active, and in poorer health.
It was unclear why vitamin D deficiency was linked to ED in this way. It’s possible that low levels of vitamin D could lead to damage in the blood vessels of the penis. Such damage could lead to atherosclerosis (hardening of the arteries), which would make it more difficult for blood to flow into the penis for an erection.
Another theory involves nitric oxide, an important element for erections.
Vitamin D helps the body make this compound, but if a man is deficient, less nitric oxide can be produced.
More research is needed to determine if increasing vitamin D levels would improve erections for men with ED. In the meantime, men with erection problems are encouraged to see their doctor. Many factors can contribute to ED, and a full checkup can determine the cause and, in turn, the appropriate treatment.
What is the difference between sexual performance anxiety and erectile dysfunction (ED)?
Sexual performance anxiety and erectile dysfunction (ED) are both troublesome issues, and it’s possible for a man to have both. But they do have some clear differences.
A man with sexual performance anxiety occurs worries about his sexual function or his ability to please his partner sexually. He might have questions like these:
Will I be able to get a firm erection?
Will I ejaculate too quickly?
Will I have an orgasm?
Does my partner find me attractive?
Is my penis big enough?
Am I sexually skilled enough?
Will my partner reach orgasm?
What will happen if my partner is not sexually satisfied?
Men who use pornography can develop sexual performance anxiety if they compare their real life experiences to what they see in adult films and videos. Usually, such depictions are not realistic, but men may feel nervous or inadequate if they don’t perform the same way.
Sometimes, a man may become so concerned about his performance that he develops erectile dysfunction (ED). The anxiety triggers the production of stress hormones (such as epinephrine and norepinephrine) which can narrow blood vessels in the penis and make it difficult for blood to flow in and form an erection.
Erectile dysfunction (ED) occurs when a man cannot get and maintain an erection firm enough for sex. As noted earlier, ED can be a result of performance anxiety. But health situations can affect erections, too. Here are some examples:
High blood pressure
Cancer treatment (such as prostatectomy – removal of the prostate gland)
Medication side effects
Attention deficit (especially in young men)
Sometimes, ED leads to performance anxiety. A man who has had trouble with erections in the past may become anxious about his ability to perform
While it’s possible to have both sexual performance anxiety and ED, it doesn’t always happen this way. Men who feel confident in the bedroom and in their relationships can still develop ED.
Fortunately, both ED and sexual performance anxiety can be treated.
Men with performance anxiety may consider sex therapy. A therapist can help men work through their concerns, adjust their expectations, and become more focused on the pleasure of sex. For example, a man who is concerned about a small penis might be relieved to learn that his length is in the average range. Or a man who worries about his partner’s orgasm may learn ways to ask his partner what he or she likes.
If the man is in a relationship, it’s often a good idea for his partner to come to therapy with him. Sometimes, partners are the source of pressure and anxiety due to their own worries, sexual problems, or lack of knowledge. Attending therapy together can help a couple with relationship tension, too.
Men with ED have a variety of treatment options, including medications, self-injections, vacuum devices, and penile implants.
sexually in the future.