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  • Writer's pictureDr Ruth Briant-Jones

Erectile Dysfunction: A Growing Issue

Erectile dysfunction (ED) is another of those 'taboo' topics that people don't like to talk about. Classed as an 'embarrassing' problem, it's one that many men keep to themselves. And, it is many men; studies reporting major difficulties with getting and maintaining an erection demonstrate numbers from around 5% - 25% of men under the age of 40, with minor to moderate issues occurring in up to 40% of men under 40. Those numbers rise with age; around 50% of men aged 50+ are believed to experience ED.

As part of my work, I run a lifestyle medicine clinic for an andrology clinic based on Harley Street. Andrology is the study of male hormones. As such, I see a large number of men suffering with ED. It's a major problem - not just in terms of the physical difficulties it causes, but in terms of the psychological impact it has too. According to the research, the numbers suffering with it are rising. So why is this?

ED is caused by a number of issues, including psychosexual, anatomical and hormonal problems. In the vast majority, however, ED is caused by something called endothelial dysfunction. The endothelium is the thin internal layer of cells found lining all of the arteries in the body, including within the penis. The endothelial cells play a vital role in the function of the arteries, releasing (amongst other things) substances that cause the artery to constrict or dilate. For an erection to happen, the arteries supplying blood to the penis need to relax (dilate) to increase blood flow, and once there is an increased amount of blood in the penis, there is compression of the veins (which carry the blood away from the penis), which means that the blood stays in the penis and an erection is maintained. When the endothelial layer starts to function incorrectly, those messages telling the artery to dilate or constrict don't get through, and so an erection cannot happen. As our society and lifestyle have changed, so too has the prevalence of this problem. Evidently, the way many of us live is negatively impacting our health, and ED is a prime example of this.

Endothelial dysfunction is one of the first signs of cardiovascular disease. So, any of the habits or factors you might associate with heart disease are implicated here:

- smoking

- poor diet

- obesity

- lack of exercise

- high stress

- + many more

These lifestyle factors cause oxidative stress on endothelial cells, and they start to not function properly, releasing less nitric oxide, which is what is required to make the artery dilate. Other conditions such as diabetes or high blood pressure are also associated with endothelial dysfunction.

All sounds pretty dire, I know. The good news is that endothelial dysfunction can be reversed. And, ED can be a very valuable warning sign that some lifestyle factors need to be addressed before any other cardiovascular conditions develop. Given how much ED affects those who suffer with it, it's good motivation to make those lifestyle changes.

So, some top tips to tackle ED:

1. Smoking: Stop smoking. This is a major cause of oxidative stress and endothelial dysfunction - and it's terrible for our health in general.

2. Alcohol: Reduce your alcohol intake if it's excessive (sorry). While moderate alcohol consumption is associated with improved endothelial dysfunction, excess consumption has the opposite effect. Stay within the recommended weekly amount as a general guide (14 units/week).

3. Exercise: Exercise often, including strength training. This strengthens your cardiovascular system, reduces sarcopenia (muscle loss associated with ageing), and improves mood. All important in ED.

4. Weight: If you are overweight, lose the excess. Excess fat puts more stress on your system, alters your hormonal balance, and puts you at higher risk of high blood pressure, diabetes, and a myriad of other conditions.

5. Diet: Eat a balanced diet, with plenty of fruit and vegetables. I don't prescribe to extreme diets, cutting out major food groups, but different approaches work for different bodies and cultures. If, for example, going low carb works for you, do it.

6. Stress: If you're constantly stressed, your hormone levels change, and you are prone to making less healthy choices. Add some time to your schedule to consciously de-stress. Re-connect with an old hobby, find a new one, or simply find some quiet time for yourself.

7. Medication/supplements: You may be considering or may have used medication such as Viagra. While this can be effective, it is not tackling the cause of the problem, and realistically without tackling the root cause, the problem will only get worse. Supplements, in conjunction with these core lifestyle changes, may help restore your endothelial function. These will always be based on your personal factors though, so I won't make generic recommendations here.

Erectile dysfunction is seen by many men I speak to as an unsolvable issue, one that is too embarrassing to talk about, and therefore something that must be something that is suffered with silently. Take heart though; working on lifestyle changes can really make a big difference to this condition - and in making these changes, you could well be significantly reducing the risks of developing a whole host of other conditions too.


Are you suffering with erectile dysfunction? Ready to tackle it once and for all? A consultation with a lifestyle medicine specialist could help. To arrange a free scoping call, book online now. In person and virtual consultations are available.

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