Erectile dysfunction is a taboo topic.

Every man should be able to get an erection at any time. Pretty much everyone believes this myth. And it is the reason why erectile dysfunction is associated with shame for many men. They believe they are a failure if they can’t get an erection. But in the vast majority of cases, erectile dysfunction is caused by a physical problem. Professor Nicolas Diehm from the Centre for Erectile Dysfunction sees numerous cases every day. In this article he answers the top five questions on male sexuality.

1. What is erectile dysfunction?

“Erectile dysfunction (ED) is the persistent inability to get and keep an erection firm enough for satisfactory sexual intercourse. The problems have to happen routinely over a longer period of time to be classified as erectile dysfunction. Having erection trouble from time to time isn’t necessarily a cause for concern. There are many stages between a very high erectile capacity and the absolute impossibility of an erection. If a man no longer responds to medication at all, this is considered severe erectile dysfunction. This affects around 10% of all patients.”

2. How common is erectile dysfunction and who is affected by it?

“Erectile dysfunction is very common. A study conducted in Massachusetts, USA, shows that around 52% of men between the age of 40 and 70 suffer from erectile dysfunction. In Switzerland, it is around 350,000 men. Young men are also affected – we see about three patients a week who are around 20 years of age. However, erectile function also tends to decrease naturally with age. The stage at which men feel stressed as a result of erectile dysfunction is very individual. Some of my patients are 40 years old and only come to see me at the request of their wives, whereas one of my patients is 90 and sexuality is still very important to him.”

3. What causes erectile dysfunction?

“Contrary to hasty diagnoses that have been made in the past, erectile dysfunction is very rarely caused by psychological factors alone. Vascular diseases are by far the most common cause, affecting up to 70% of patients. Clogged arteries (atherosclerosis) restrict blood flow to the penis, so it cannot swell. Veins are often the problem with young men: Although enough blood flows into the penis, the veins cannot hold it and it flows out again too quickly. Erectile dysfunction can also be caused by nerve or hormonal disorders, but that is rare. Lifestyle can also be key in mild forms, with extra weight, stress and smoking affecting erectile performance.”

4. How can erectile dysfunction be treated?

“If it’s a very mild form, the first step is to reduce stress, exercise, eat healthily and stop smoking. I also recommend that you talk to a urologist and angiologist to see if they can find a cause. If the veins are draining too fast, pelvic floor exercises can help or, failing that, the next treatment option is to close the veins using tissue adhesive. If the problem is caused by a narrowing of the vessels and medication no longer helps, a stent, similar to ones used for the heart, can be used to open up the narrowed or closed arteries. In this case, any risk factors have to be treated and your lifestyle adjusted.”

5. Why is it important to talk to your doctor about erectile dysfunction?

“Erectile dysfunction can – but may not necessarily – be a cause of great anxiety for a man. It often affects his relationship, quality of life and well-being. It can even cause depression. Furthermore, erectile dysfunction may be an early warning sign to help prevent a possible heart attack or stroke. As the arteries in the penis are very small, any blockage – which could later lead to a heart attack or stroke – is noticed there first. This makes it possible to intervene early on so that the vessels don’t change any more.”