You might chalk it up to a stressful work week, an unresolved issue with your partner, or that third tequila shot at happy hour. And that’s okay: Not getting it up from time to time isn’t necessarily a cause for concern. But if your failure-to-launch issues are less situational and more of a regular thing, you’re likely experiencing erectile dysfunction (ED).
Defined as the inability to attain or maintain an erection “firm” enough for penetration, ED affects 30 million—or about 18.7 percent of—American men. Though it’s more common with age, younger guys aren’t immune, according to a study published in the International Journal of Clinical Practice.
If the numbers seem higher than you’d expect, that could be because ED is not something many men feel comfortable talking about with their friends or even their physicians; they may prefer to ignore it and just hope it goes away. But that’s a mistake. Before sweeping impotence under the rug, consider that there may be an underlying issue at play—one that could threaten your overall health.
Here are six conditions that could be sabotaging your time in the sack:
1) Heart Disease
Could going soft be a sign that your arteries are hardening? Possibly. Research shows that ED is a potent predictor of heart troubles. In fact, it’s as much of a risk factor as smoking or a family history of coronary artery disease.
“ED in some men can predate a significant heart event—heart attack, stroke—by about 10 years,” says Nelson Bennett Jr., MD, professor of urology at Northwestern University Feinberg School of Medicine, explaining why younger men with chronic erectile issues are of particular concern for him. Left untreated, high cholesterol and high blood pressure can damage blood vessels, causing them to lose their elasticity and hardening the arteries. This may cause plaque to build up inside the arteries, narrowing them and eventually blocking blood flow. “The blood vessels that go directly into the penis are three times smaller than the ones in your heart,” Dr. Bennett points out. “Those are likely to clog up first.”
That doesn’t mean you can’t reverse the trend. “I like to tell patients that what’s good for the heart is good for the penis,” says Dr. Bennett. Medication aside, you want to reduce stress, follow a healthy diet, and exercise regularly. In fact, doing aerobic exercise, like walking or swimming at a moderate to vigorous intensity for 40 minutes four times a week may significantly improve erectile function, especially if it is caused by cardiovascular disease, according to a study published in Sexual Medicine.
2) Peyronie’s Disease
If you’re noticing a more pronounced curve in your penis of late, you could be dealing with Peyronie’s disease. This connective tissue disorder causes penile deformities and affects roughly 1 in 100 men (and likely more, as many cases go undiagnosed).
It begins with a “microinjury” to the penis—one you may not notice or recall. “Only 20 percent of people will remember a specific injury,” says Stanton C. Honig, MD, a clinical urology professor and director of the Yale Medicine Male Reproductive Health/Sexual Medicine Program. “As you heal, scar tissue, or a plaque, may develop, which can cause the penis to curve or bend when erect, and narrow or shorten.”
Depending on the degree of curvature, sex may become painful for you and your partner. “A lot of times, the ED is related to situational anxiety,” he adds. “You might get super-anxious or embarrassed about your curved penis and lose your erection to some degree.”
Early diagnosis can help you get straightened out. “If it’s a moderate case, there are minimally invasive treatments, such as Xiaflex, the only FDA-approved treatment for this particular problem,” Dr. Honig says. A series of injections of these collagenase enzymes, spread out over six months, work to break down the scar tissue. When Peyronie’s disease is more severe, one of two surgeries may be required, both which may successfully reduce the deformity and eliminate pain.
3) Gum Disease
While poor oral hygiene isn’t shown to cause ED directly, there’s a correlation that could create problems for your package. A scientific review published in Andrology found “a significant association between erectile dysfunction and periodontitis,” a severe form of gum disease.
A specific bacteria in the mouth seems to be linked to ED. “It can elaborate [produce] toxins that can cause some local and full-body inflammation,” says Dr. Bennett. Chronic inflammation is known to damage blood vessels and decrease erectile blood flow. It also impairs the release of nitric oxide, which, he says, “is the chemical the body releases to get the party going.”
If your gums are tender or you’re spitting blood when you brush, head to the dentist for a checkup stat. And when he or she tells you to floss, just do it already. Gum disease has also been associated with heart attacks and diabetes, as well as other major health problems.
4) Sleep Apnea
Sawing logs most nights? Nodding off during the day? You may have obstructive sleep apnea (OSA), a serious disorder that causes you to stop breathing for 10- to 30-second increments—and can cause ED in the process.
“Sleep apnea leads to poor peripheral vascular circulation,” explains Elliot Justin, MD, FACP, emergency medicine specialist based in Bozeman, Montana, and founder of FirmTech, a technology firm focused on male sexual wellness. “People with it have more heart attacks and strokes and a higher incidence of ED.”
OSA appears to lower testosterone and restrict blood oxygen, two essentials for healthy erections. Add to that the other side effects of skimping on shuteye—stress, fatigue, an inability to concentrate—and it’s little wonder you can’t rise to the occasion.
Science is still looking for a definite association between obstructive sleep apnea and ED. According to an analysis of research looking into the topic and published in the International Journal of Impotence Research, there is only a slightly high risk for people with OSA to experience ED compared to those without OSA. However, this shouldn’t stop you from considering some non-invasive ventilation support to treat your ED. In a study published in Sleep Medicine, snoozing with a CPAP (continuous positive airway pressure) machine improved erectile function in patients with severe OSA. If that’s not comfortable for you, there are also mouthpieces that temporarily reposition the jaw or tongue, allowing air to flow through while you snooze.
And if you don’t need a cure for OSA, focus on not developing it. One thing you can do to help prevent you from experiencing both moderate to severe OSA and ED is to stay fit and maintain your weight; obesity and low levels of physical activity are associated with both conditions.
Type 2 diabetes may raise your risk of ED. Findings from the long-running Massachusetts Male Aging Study showed that men with the metabolic disorder tend to develop ED 10 to 15 years earlier than those without.
“There are two mechanisms at play,” says Dr. Justin. “Elevated blood sugar is a neurotoxin, so it actually saps, weakens, and eventually destroys nerve endings. Diabetes also leads to calcifications and plaque deposits, which damage blood vessels and reduce blood flow to the penis.”
But just because you have diabetes doesn’t mean you’ll get ED; managing your condition can prevent the nerve and blood vessel damage that can occur and that can lead to ED. “That’s why we stress the importance of going to the doctor early and modifying risk factors,” says Dr. Honig. “If you’re a couple of pounds overweight, not eating particularly well or exercising, it’s an opportunity to look at your lifestyle decisions and make a change.”
ED can be a downer, even leading to mental health issues, such as anxiety and depression. And it goes both ways: People with depression are 39 percent more likely to develop ED than those without the clinical disorder, according to a study in The Journal of Sexual Medicine.
The nervous system triggers erections, and if the system is depressed or distracted, that won’t happen. “When you’re depressed, you release a chemical that essentially takes the erection away,” explains Dr. Honig.
In addition to causing you to losing interest in many formerly pleasurable activities (ahem, sex!), depression can lead to self-medicating—say, with alcohol and other recreational drugs—which can increase your ED odds even more.
If any of this sounds like you, explore the source of your depression with a mental health professional. While it’s true that some antidepressants can cause ED, your doctor can work with you to find a drug in a different class or prescribe a lower dose to minimize the side effects.
Here’s a thought that may boost your mood: If you’re experiencing erectile dysfunction for whatever reason, your healthcare provider can help determine the root cause and treat it—no matter how small or serious it might be. All you have to do is talk to them about it.