Not All Erectile Dysfunction Is Permanent
Restraining orders. Lapses in reason. Permanent hairdos (oxymoronically). These are all things that are generally temporary, as their duration and effects are not meant to last forever. Well, you can add one more item to that list: erectile dysfunction (ED). At least for some men, ED has an expiration date.
Yes, the inability to achieve and maintain an erection firm enough for sex can take a variety of forms. Some men can't get an erection at all at any time. Some can get an erection when they masturbate but not with a partner. Others can get an erection but then quickly lose it, or it's not hard enough.
To complicate matters further, ED has a wide variety of causes. There can be more than one cause of a man's ED, and he may even experience multiple types of ED.
One type that urologists often see is short-term or temporary ED.
ED that goes away
While a man may feel like a million different factors can cause short-term ED, the causes can broadly be categorized as either psychogenic or organic, according to Seth Cohen, M.D., an assistant professor of urology and the director of sexual medicine at NYU Langone Health in New York City.
Psychogenic means the ED stems from the brain. Cohen said the most common psychogenic cause of temporary ED is anxiety: performance anxiety, anxiety about dating, anxiety about a first-time sexual experience with someone.
"Typically, that's a short-lived erectile problem," he said, adding that erections usually go back to normal once the man starts to get more comfortable with a partner. ED that occurs only during certain circumstances is referred to as "situational ED."
Stress is one of the top causes of short-term ED, because it causes the body to increase production of the hormone epinephrine. High levels of epinephrine can make it difficult for the smooth muscles in the arteries of the penis to relax, which is necessary for an erection to occur. Stressors at home and work, marital and relationship issues, depression and low self-esteem can all contribute to psychogenic ED.
Organic causes of ED involve conditions that physically impair the delivery of adequate blood flow to the penis. This vascular problem could be the result of a host of conditions, including diabetes, cardiovascular disease and obesity.
'A vicious cycle'
Short-term ED isn't always either psychogenic or organic; it can be a combination of the two.
"Even with purely organic [ED], they may have a psychogenic component, meaning once you've failed once or twice with someone, even though your penis is not working now, it's in your head," Cohen explained. "They're constantly thinking, 'I don't know, maybe I'm going to fail.'"
Performance anxiety is one of the top causes of temporary ED that Neel Parekh, M.D., sees in his practice.
"It's kind of a vicious cycle. It's always in the back of their mind moving forward that they're going to have an issue with their erections, so they lose confidence, and it just self-perpetuates," said Parekh, a clinical assistant professor of urology at Cleveland Clinic, adding that if these patients work on ways to regain their confidence, temporary ED will go away and erections will return to normal.
Diet can also contribute to short-term ED. A 2020 cohort study found a healthier diet of vegetables, fruits, nuts, legumes and fish, and a lack of processed and red meats, was associated with a lower risk of developing erectile dysfunction.
During the COVID-19 pandemic, men have had erectile problems related to the virus. Fortunately, for most men, erections returned once they recovered.
"This is also likely a temporary decline in erection quality until [the virus has] cleared completely," Parekh said. "You can probably see [the return of function] three to six months after the COVID infection."
Porn addiction is another potential cause of temporary ED, Parekh said. Some studies suggest that regular online porn consumption may contribute to ED and stopping porn use could reverse the negative effects. Parekh sometimes refers patients who are dealing with porn addiction to a licensed sex therapist.
Diagnosing and treating temporary ED
In determining the type of ED and its cause, a urologist reviews a man's medical and sexual history. During the first three months of a man presenting with ED, Parekh counsels them on lifestyle changes, such as exercise, eating a healthy diet, losing weight and getting adequate sleep. If he finds psychogenic stressors, he may counsel them on stress management.
After three months, a condition is typically considered chronic. If a patient has ED for three months or longer, Parekh generally moves on to medical therapies, usually phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil (Viagra) and tadalafil (Cialis).
Martin Kathrins, M.D., said he doesn't push patients with short-term ED into medical therapy, but he also doesn't want to deny patients who would benefit from a PDE5 inhibitor. The treatment depends on the indications.
"It may be blood testing for a cardiometabolic condition, it may be psychotherapy, it may be working on the relationship with a couples counselor," said Kathrins, an assistant professor of surgery at Harvard Medical School and a urologist at Brigham and Women's Hospital in Boston. "It doesn't mean that we're providing a medical or surgical intervention, but we would provide at least some counseling for those patients, try to make a diagnosis and go from there."
'The nice thing about low-dose Viagra or Cialis is they don't really have addictive potential.'
If a man with ED has an underlying medical condition, treating the condition may also resolve the ED, Kathrins said. For instance, if a patient gets his diabetes under control or a severe testosterone deficiency is addressed with testosterone replacement therapy, the ED can be corrected.
A potential cause of longer-term temporary ED is nerve damage. For example, pelvic surgery for rectal cancer can disrupt the pelvic nerves. A patient can often recover with a nerve-sparing operation, but it's going to take 18 to 24 months, Kathrins said.
Cohen said he's not quick to prescribe ED medications to everyone. He wants to know what's causing the ED and whether it can be fixed without medical therapy.
"The nice thing about low-dose Viagra or Cialis is they don't really have addictive potential," he said.
That's why he sometimes prescribes ED meds to young men who are experiencing short-term ED due to performance anxiety. These men don't have diabetes, high blood pressure or excessive weight, but they just keep getting stressed out about performing sexually.
"Why can't that person try a Viagra or Cialis so they don't strike out and they can have a nice sexual intimate moment?" Cohen said.