Dealing With Erectile Dysfunction in 2020

Dealing With Erectile Dysfunction in 2020

For many men this is a sensitive – or even downright scary – subject. Since the dawn of time erections have always been associated with virility and masculinity; two of the most pivotal elements of being a man. For many, the inability to get an erection creates feelings of frustration, shame, embarrassment, stress, worry – basically any negative emotions there are, erectile dysfunction can invoke them. And whilst it can have an impact on your sex life, the worst thing is probably thinking that without an erection there are no/any more children. And it’s something as momentous as that which can drive the problem deeper and deeper underground.

The first thing to say is that whatever the nature of the dysfunction, don’t ignore it. It might be something that’s only happened once, or it might be something which is a regular occurrence. Whichever, hiding your head in the sand isn’t going to make it go away and it’s quite possible that it will make it worse.

The definition of erectile dysfunction

More commonly known as impotence, ED affects between 32-80 % of the male population. It’s most often found in older men over the age of 60, but that’s very far from being the only age that’s affected. ED is genuinely defined as not being able to get – or maintain – an erection. It can happen as a one-off or it can happen every time. ED can mean that you can’t get an erection at all, despite being aroused, and this is one of the most frustrating and upsetting situations there can be in the bedroom. It can badly impact your sex life and therefore your relationship, it can be very distressing and ultimately it can send someone’s mental health plummeting in a downward spiral. Psychological symptoms are very common with ED.

ED has various symptoms which can work together to form a perfect storm of sexual disengagement. If you’re in a relationship then it’s perfectly possible that allowing this issue to roll on and on will begin to have a negative impact as well. This sounds very much like a blame game, which is absolutely isn’t, but gently exploring what it might mean to others is an important part of dealing with it.

Signs and symptoms of ED

  • The most obvious, and clearly understood one, is not being able to get an erection at all. That’s the situation that most people identify ED as, quite reasonably. A man might struggle to achieve an erection during sex or even on his own when attempting masturbation. But that’s just one piece of the puzzle.
  • Difficulty in maintaining an erection. This is exactly as it sounds; the man is initially able to get an erection, but he cannot maintain it. This is just as distressing and frustrating as not being able to get one at all, but it’s sometimes seen as ‘better’ than complete impotence. But if anything, it’s worse. Being able to perform at first, and then failing dashes down the spirits even more.
  • Low self-esteem. It’s easy to see how this comes about when there’s a repeated cycle of ED. It can get to the very core and definitely make him feel like he’s less of a man.
  • Similarly, depression and anxiety are often found in this collection of symptoms. Whether caused by – or exacerbated by – ED, anxiety and depression have a big part to play in someone’s perception of themselves. When they’re caught in a vicious circle of feeling awful, then being made to feel worse by ED, it can be very damaging to mental health and be a big pit to crawl out of.
  • Worsening sex drive. Well, that’s an obvious one. How could anyone want to have sex if they can’t participate in a fundamental manner? The silly thing is, 9 times out of 10, the other partner really isn’t going to care. Physical limitations, whether permanent or temporary, are part and parcel of life and certainly not confined to sexual circumstances.

Whether it’s no erection at all, or brief periods without one, the reason behind it needs to be diagnosed and treated. Very often doctors are able to treat ED and bring a significant improvement to the problem. So don’t struggle on thinking that nothing can be done. We’ve all heard of the little magic blue pill, but it’s not the be all and end all of ED treatment. First of all, doctors will look at why they think this is happening.

How does ED develop?

It can have physical or psychological causes, or a mixture of both. Erections happen as a result of blood flow into the penile tissue. It’s comparatively rare for there to be anything wrong with the actual penis itself. Other triggers for ED include:

  • Diabetes
  • Obesity
  • High blood pressure
  • Heart disease
  • Some medicines
  • Intoxication

You might not necessarily link these conditions to not being able to achieve an erection, but they do have a big part to play. If the blood flow into the penile tissue is interrupted, or simply not very good, then that’s a root cause. Of course there might be something wrong with the tissue itself, that’s one option. Or there might be an underlying problem like Peyronie’s disease. This is where scar tissue forms around, or in, the shaft of the penis, usually linked to a trauma of some description, and if the blood flow to the periphery of the penis is reduced, then ED can make an appearance.


There’s no ‘one size fits all’ treatment for ED because it very much depends on the cause of the problem. You will need to be investigated, usually by your GP at the beginning and if they can’t find a reason, or can find a reason but aren’t in the best position to treat it, then you might be referred to a hospital clinic. And whilst Viagra exists, and is very effective for some men, it’s vital to get the bottom of why it’s happening so the cause can be treated and not just the symptoms. Very commonly ED can be treated effectively. As the causes are so wide, the treatment options vary tremendously too. If it’s your medicines that are causing it, you can be swapped onto different ones. If you have cardiovascular issues then treatment of those will improve the erection situation. There’s also psychological treatment available if necessary.

If you’re in a relationship then it’s very important to be open with your partner. People commonly assume that ED only affects men, but that’s very far from the truth. In fact, a number of partners will blame themselves for erectile problems – thinking perhaps they aren’t attractive any more/too fat/too ugly/small breasts, etc. Basically any insecurities that they have can be projected onto their partner’s erectile issues.

Basically, acknowledge the situation, get some professional medical help and begin dealing with the problem. There’s every chance that your ED can be treated successfully and you can go back to having a fulfilling sex life.

Stuart Brown
Doctor of Sexual Health at the NHS Royal London Hospital & Relationship Expert. Columnist at An advocate of safe sex. Avid Arsenal fan.

Follow Stuart on Twitter

Leave a Reply