Erectile Dysfunction: What is “Normal”?
If you are reading this article, something has motivated you to look into this well known phenomenon. Maybe you, yourself, have had the challenge of maintaining an erection. Maybe you are a caring partner who wants to know more about how to address this vulnerable topic. Maybe you are just curious about what is “normal” and what makes you not normal from everyone else who has a penis. All of these curiosities are fair to think about. The true answer to what is “normal” is that all of it is normal and everything is abnormal at the same time. You may be asking yourself “why have such a vague answer to such a complex question?” and you are right to ask that! Because it is such a complex question it does require a true complex answer.
In this article, hopefully, I will address everything you may be questioning or worrying about with your partner’s, your lover’s, or your own erection and normalizing these fears, anxieties, and bodily functions. Throughout this article I will be generalizing the applicable population of people who have penises. This is to ensure that all populations of penis havers are addressed. I would like to address that a majority of the research available studies CIS gender males, however, I will refer to the population of penis havers as generalized and non-exclusionary as possible. I will also refer to erectile dysfunction as erectile dissatisfaction. This is to hopefully ensure that any guilt or shame of this topic is made less clinical and more individually empowering.
So, Statistically What is “Normal?”
Erectile dissatisfaction is a complex yet common sexual disorder that affects nearly 18-47% of people with penises within the United States. The percentage that erectile dissatisfaction affects is so wide due to the complexity of the causation of the disorder as well as the consideration of it being associated with increasing age. Although the likelihood of erectile
dissatisfaction does increase with age, this is not a guaranteed factor of the causation of erectile dissatisfaction.
Some quick percentages of erectile dissatisfaction:
This research comes from multiple studies that record both people who are challenged by ED and people who have not experienced ED. It may be worthwhile to note that these studies may not address the spectrum of ED which may be as acute as being unable to perform due to effects of alcohol, or as severe as being unable to produce an erection due to a prostatectomy. Additionally, some studies use self report data in which people may downplay their struggles and/or may not report truthfully. It is important to understand that this data is factual but may not be fully representative of this issue.
20s: Your risk for ED is low, affecting about 8% of the population.
30s: Your risk for ED is common, affecting about 50% of the population.
40s: Your risk for ED is low to common, affecting about 20%-40% of the population.
50s: Your risk for ED is common and is on the rise, affecting about 50%-60% of the population. 60s: Your risk for ED is common to high, affecting about 40%-70% of the population.
70s: Your risk for ED is high, affecting about 80% of the population.
70 and older: Your risk for ED is common to high, affecting 50%-100% of the population.
What May be the Cause of ED?
The causes of erectile dissatisfaction is vastly complex and may have a million different origins. This means that the origin of erectile dissatisfaction is unique and individual to everyone, which also means treatment for erectile dissatisfaction will be unique and individual to everyone. Typical erectile function can be seen as a biopsychosocial process where there is coordination of psychological, neurological systems, endocrine, vascular, biological, social, and health systems are all engaged to work together. Think of it as a group project, every single person needs to put in their best effort to produce a project that achieves a passing grade. Let's say your social and psychological systems don’t get along with the rest of your group. What happens then? You may get a C on this group project. Yes you passed but is this a satisfying grade? All of these intricate details of the body are trying their best to produce an erection. For some people this may be a mindless procedure, while for others this may be a challenging achievement that requires a lot of effort.
The cause of erectile dissatisfaction can be endless, however it can be broken down into two categories: organic and psychological. Organic causes can be classified as having to do with biological factors that occur within bodily function that may naturally hinder the ability to form an erection. Psychological causes can be classified as having to do with the mental component that may hinder the ability to form an erection. Organic causes make up about 80% of people who have erectile dissatisfaction. Some organic causes include neurogenic, hormonal, cardiovascular, arterial, drug/alcohol induced, and increasing age. Psychological causes may be pre-existing mental illnesses in people that may trigger the effects of erectile dissatisfaction.
What Does Treatment Look Like?
The management and treatment of erectile dysfunction ranges in a stepwise manner that starts at non-intrusive, progresses to minimally intrusive, then progresses to surgically intrusive. The least intrusive treatment usually correlates with psychological and minor organic causes while the most intrusive treatment usually correlates with serious organic causes that may be harmful and comorbid to other illnesses and disorders. During the initial visit, you can expect the doctor to interview you and focus on sexual history, sexual performance, as well as general attitude towards sex.
Treatment of erectile dysfunction can be very customizable, however success of treatment is highly variable based on the cause of the dissatisfaction, improvement of mental illnesses, relationship status/partner support, as well as lifestyle changes. It is worth noting that if you are in a romantic/sexual relationship partner involvement is a highly valuable tool to use during the treatment process. When introducing medical treatments it may be beneficial to seek therapeutic help from a sex therapist or a couple’s sex therapist.
Non-Intrusive: Pills and Penis Pumps
Pills and penis pumps are considered to be first line treatments for erectile dissatisfaction. Pills, also known as Viagra, Cialis, or ‘The Little Blue Pill,’ are the most commonly commercialized form of treatment for erectile dissatisfaction. Pills have at least a 65% success and pleasure rate and work well with people who are experiencing erectile dysfunction due to depression, anxiety, and SSRIs.
Penis pumps are used as a non-medicine treatment that may help in aiding an erection. These may be suggested or prescribed by a doctor to either jump start an erection or stimulate blood flow to the penis. Penis pumps have about a 30-75% chance of success and pleasure, however they do have a wide range of side effects including (but not limited to) delayed ejaculation, bruising, and cold/numbness feeling in the shaft of the penis.
Minimally Intrusive: Suppositories and Injection
Suppository and injection are considered to be second line treatments of erectile dissatisfaction. Both of these medications are recommended to utilize partner involvement in getting trained on how to administer these medications. The suppositories are small suppositories that are inserted into the urethra before intercorse then massaged in to disperse the medication and stimulate an erection. Suppositories have about a 45-65% chance of success and pleasure, however the dropout rate of suppositories is 39% which is considerably higher than first line treatments due to the nature of the discomfort of a urethral suppository.
Injections are semi invasive shots that are directly injected into the erectile tissue with a small needle before intercorse. These shots do require in-office training for the patient, partner training is also highly recommended to encourage consistent use of the medication. Injections have about a 94% chance of success and pleasure, however the dropout rate is higher than suppositories standing at 46-80% rate considering pain that is caused to the erectile tissue during injection.
Surgically Intrusive: Penile Prosthesis
Penile prosthesis are considered to be the third and last line of treatment. Penile prosthesis are a surgical prosthetic to ensure an erection occurs when the patient pleases. There are two different penile prosthesis surgeries, semi-rigid and inflatable. The semi-rigid prosthetic is a device that stays semi-erect at all times. An inflatable prosthetic is a hydraulic device that is inserted into the shaft of the penis and the scrotum. Both types of prosthetics have about a 92-100% chance of success and pleasure rate, however these surgeries come with high fees and penile disfigurement due to the invasiveness of the surgery.
What Does This Mean for Your Sex Life?
Experiencing erectile dissatisfaction means that your sex life might look different than it was before. It is important for you and your partner to keep a positive mindset. It may be easy to feel shame and guilt from both parties when someone is unable to produce an erection. It may also be easy to rush into unpleasurable intercorse when an erection is produced in fear of losing this captured erection. Both of these reactions are very common in people who have been challenged with erectile dissatisfaction.
You may be thinking “how can I have sex with erectile dissatisfaction?” The good news is that out of all the questions I have stated in this article, this is the easiest to answer. CONTINUE TO HAVE SEX!!!! Continue to have sex when you can produce an erection. Continue to have sex when you cannot produce an erection. Continue to have sex when you’re happy with your erection. Continue to have sex when you’re frustrated with your erection. Continue to make an active and positive effort for your own sexual wellbeing. The better question is “what can I do to continue to work through this dissatisfaction with my erection while also continuing to have pleasurable sex?” This can be achieved by understanding your penis, having open and honest conversations with the people who are involved, being mindful of the emotions that may come up, understanding that sex isn’t always penetrative, understanding what good enough sex is, and learning how to be realistic and positive.
If you want to read more erectile dissatisfaction and intimacy please read the follow up article “Erectile Dissatisfaction and Your Sex Life.”
If you need any help in understanding or processing anything you read in this article I would suggest reaching out and setting up an appointment for sex therapy with any of our specialized therapists at Enhancing Intimacy Austin.
This article was written by Jesse Ryan, LMFT Associate at Enhancing Intimacy Counseling. If you'd like support around erectile dysfunction/dissatisfaction, call our office to schedule an appointment with Jesse. 512-994-2588
