What is ‘ED’?
Erectile Dysfunction (commonly called ‘ED’) is just one of a larger group of conditions affecting sexual function in men. Getting and keeping an erection is a key component to sexual function (as if you needed reminding), and ED is defined as the inability to either get or maintain one hard enough for sexual activity. Separate from other conditions like premature or delayed/absent ejaculation, ED deals specifically with whether the penis can get hard in the first place, and if so how hard and for how long.
How Common is It?
Trouble getting/staying hard every now and then is actually relatively common (i.e. that big night out, lack of sleep or significant stress) but a diagnosis of ED comes when difficulty starts to routinely impact things.
While surveys differ slightly from region to region, roughly 10% of men under 40 suffer some form of ED but that can jump up to 25% or even more when we include occasional troubles. As we grow older getting an erection becomes (ironically) harder. Up to 50% of 50 year olds and 70% of 70 year olds for example have at least mild forms of ED. It’s common, and if you’re moving through it you’re definitely not alone.
What Causes it?
ED can have a number of causes and while (when it’s doing what it’s meant to) hardening up might seem like flipping a switch, the physiology behind your average erection is actually pretty complex. A mixture of hormones, nerves, musculature, heart health and blood vessels combo up behind your everyday hard on.
A hit to any part of this delicate system can wreck havoc on erections, and some common causes include:
- Uncontrolled Diabetes
- Heart Disease
- Hormone Imbalances
- Neurological Disorders
- Certain medications
- Alcohol & Drug Use
- Anxiety and Depression
What’s the link between erections & mental health?
Particularly for younger men, the mental health side of things can be a significant contributor to ED. And in the absence of cardiovascular, neurological or other causes your mind is the leading cause for troubles down below.
Getting hard is more than just physical, and it’s difficult for the brain to coordinate the necessary steps that allow for a normal erection to happen when mental health struggles are in play. Anxiety, depression, significant stress and tiredness/fatigue can all offer hits to the system. Longer term, our mental health’s impact on hormones and heart health can also play a role.
‘Performance Anxiety’ is the common term used to describe the impact that anxiety in particular can have on a lad’s ability to get or keep an erection. And while we don’t exactly talk about it over beers, this one’s relatively common and something many men move through.
Concerns around appearance or sexual performance, or anxiety provoking memories of past experiences that didn’t go so well, drive anxiety before and during sex that block the brains ability to signal it’s go time. Diving deeper still, relationship troubles, incompatibilities in the bedroom or other factors affecting our mind’s ability to get in the mood can also drive things.
The tricky part comes when anxiety, worries and overthinking build up and get worse each time it happens. When it gets to this point a lot of guys find themselves in a vicious cycle or snowball that’s hard to get out of on your own – anxiety around stepping up to the plate means it doesn’t happen, and that only makes the anxiety (and the difficulty getting hard) worse the next time round.
What do we do about it?
Number one with ED is getting things checked out with your doctor – but I get that this is easier said that done. Anxiety and shame around talking about sexual health struggles block a lot of men from seeking help, but the first step in getting things back on track is figuring out the cause.
It’s important to rule out physical causes for ED, and so a check up, set of blood tests and other investigations might be needed. From here it’s working with your doctor to treat any reversible physical causes, and discussing potential treatments. Medications (like that little blue pill), equipment to assist things and even surgical options are now available but it’s important these are tailored to you and the cause.
When mental health is felt to be behind things there’s no reason this needs to be shied away from either. Treating depression, drug/alcohol issues and anxiety properly can help get things down below back up and firing, so it’s important these are diagnosed and treated.
And for Performance Anxiety?
When it comes to performance anxiety specifically, working through this with a mental health professional has high success rates. When relationship strains or more complex psychological issues are behind things, this is often even more the case and the more severe it is or the longer it’s been going on for the more we might need the extra help. Combining mental strategies with short term use of a medication to tackle ED can offer further benefits, but it’s key that if the cause is anxiety related that this gets addressed.
Tackling performance anxiety in particular means cutting that vicious cycle. Step number one is always acknowledging what’s happening. From there things that can help are talking to your partner openly about it, getting individual or couples support if needed and retraining the brain to relax when it comes to sex.
Practising a simple breathing or relaxation technique daily and (especially) before and even during sex can help, as it’s key that body/brain can relax enough for things to happen. Ramp up your mental health basics by reducing alcohol and drug use, and focus on getting enough sleep and some regular exercise.
Taking steps to slow down and stick to things that bring less anxiety in the bedroom (like foreplay or non-penetrative sex) as a way of ‘building up’ to sex itself can be another technique. Step by step, the anxiety around things and performing itself can gradually reduce.