Erectile dysfunction (ED) is a frustrating issue that affects many men. In fact, a 2018 review in Sexual Medicine found up to one-third of guys experience erectile dysfunction at some point in their life. The National Institutes of Health puts the number of American men with ED at 30 million.
It's not uncommon to have trouble getting an erection after a night of partying or because of a lack of sleep. But should it be a regular occurrence? No. And if it is, you'll want to find its root cause so you can correct the issue with medication or lifestyle alterations.
One of the underlying causes of ED is obesity, especially when carrying weight in the midsection. However, what exactly is excess belly fat's relationship with ED, and how do you solve the problem?
What is erectile dysfunction?
In simple terms, ED is the consistent inability to get or maintain an erection suitable for penetrative intercourse. It can be caused by physical or psychological factors, or a combination of both.
"Generally, the most common causes are vascular-related, or related to the blood vessels," said Darshan Patel, M.D., an assistant professor in the urology department at UC San Diego School of Medicine, part of the University of California system. "But other common causes include psychogenic [mental] causes and neurogenic causes, so related to nerves that provide an on-and-off switch for erectile function."
Does excess belly fat cause ED?
"There's certainly an association between central adiposity, or having a larger waist, and erectile dysfunction," Patel said, adding this association isn't just a simple metric of being overweight; waist circumference matters.
A man with a 42-inch waist is 50 percent more likely to experience erectile dysfunction than a man with a 32-inch waist, according to Harvard Health.
Considering how many cases of ED are caused by vascular issues, it makes sense that fat, especially around the belly, can interfere with the arteries in the penis. It affects arteries in the heart, too.
"Arteries in the heart are a certain size, but the ones in the penis that provide the blood to an erection are about half the size," Patel explained. "So they tend to get clogged up sooner than the ones in the heart."
Plus, men with belly fat may have more fat overall.
"Guys that carry a lot of weight around their waist generally have more subcutaneous fat as well as visceral fat," Patel said.
Subcutaneous fat is fat right below the skin, he explained. Visceral fat is deeper fat that attaches to organs within the abdomen and elsewhere in the body.
"Both [types of fat] are correlated with cardiovascular disease, diabetes or metabolic syndrome, all of which essentially are risk factors for erectile dysfunction," Patel added.
The final piece of the puzzle is the association between elevated body fat and higher estrogen levels. Increased estrogen levels in men, which can be caused by obesity, can adversely affect libido and desire, said Gil Weizer, M.D., a urologist with Northwell Health in Chappaqua, New York.
Who's at risk of experiencing ED?
People who smoke, eat a poor diet and have a sedentary lifestyle are at an increased risk of developing ED, according to Weizer.
"Having said that, in my general urology practice of 20-plus years, I have seen [people with ED] of all ages, some as young as late teens and early 20s," he added.
While there is an association between obesity and ED, not every man with an elevated body mass index (BMI) experiences or is at risk of developing ED. BMI, a measure of body fat based on weight and height, is not intended to be an accurate predictor of health. Patel gave an example of an athletic man, like a linebacker in American football.
"Their BMI is going to be elevated," he said. "But they're not necessarily going to be at a higher risk of developing ED."
What can you do about ED?
"The good news is there are multiple treatments with excellent success rates," Weizer said.
Medical interventions and lifestyle tweaks can help people manage ED.
First, seek a medical opinion
"Sometimes it's embarrassing to bring up this sensitive issue to your provider, but there are a lot of avenues that can be explored," Patel said. "We see a lot of patients that don't even have a primary care doctor coming in to see us for issues related to erectile dysfunction, which is great."
He also noted there are now direct-to-consumer telehealth providers that may be helpful.
"If someone is experiencing ED, I recommend getting a full physical exam looking for high blood pressure, cholesterol and any cardiac or pulmonary issue," Weizer said.
Consider weight loss
If you're overweight or carrying excess belly fat, weight loss can help address erectile dysfunction. Weight loss is also helpful in addressing comorbidities such as low testosterone.
"Generally, guys that lose 10 percent of their body weight, if they are overweight, have an increase of a hundred points in their testosterone levels," Patel said. "[That] can certainly tie into improvement in sexual function."
Focus on manageable lifestyle tweaks
You don't have to overhaul your whole life and eliminate all the things you enjoy to combat ED.
Focus on eating a balanced diet, which can still include your favorite foods in moderation. Limit alcohol, especially beer and high-calorie drinks. Quit smoking. Take up exercise.
In addition to cardio exercise, Patel recommended strength training.
"[It] tends to boost testosterone and provide the most sustainable results in terms of weight loss for these patients," he said.
Men may find it helpful to reduce psychosocial stressors, whether they originate with sex and relationships or other areas of life, such as work.