Occasional Erectile Dysfunction: What It Means and Treatment

By: J. Abram McBride, MD

If your partner signals the “call to action” and your penis is an occasional no-show, you might feel embarrassed, apologetic, or even defensive.

But should you worry?

Well, like so many issues involving the male anatomy, the answer depends. An estimated 43% of all men experience erectile dysfunction (ED) at one time or another.

Sometimes the cause is evident, such as too much alcohol in the system or nervousness. Other times, however, even temporary or situational ED might hint at the onset of something more complicated.

Either way, occasional ED can be treated, as well as whatever causes it, once diagnosed. And thanks to continued breakthroughs in research, not all treatments require medication.

Visit our Male Sexual Health web page.

Why Erectile Dysfunction Occurs – Chronically or Occasionally

Erectile dysfunction describes a man’s inability to achieve and hold an erection hard enough for sexual intercourse and orgasm. Most commonly this occurs because the penis is not getting enough blood flow necessary for an erection, or due to damaged penile tissue.

ED occurs often. It is in fact the most common sexual problem men report, affecting nearly 30 million. If you experience ED about 20% of the time, it is likely situational or temporary ED and not considered a medical concern. But if you experience ED at least 50% of the time, it is a good idea to consult a urologist.

In either case, chronic or occasional ED could warn of a potentially serious disorder, or the onset of one. So if you notice an increase in or prolonged ED episodes, it could signal a worsening condition.

These conditions include:

• Cardiovascular (heart) disease – ED signals weak blood circulation because a penis requires blood to become rigid. If plaque builds up in the arteries, the blood vessels weaken and cannot fully open, slowing blood flow. This vessel narrowing, called endothelial dysfunction, tends to occur in penile blood vessels first, making ED an early indicator of heart disease.
• Kidney disease – Your kidneys clean the blood your heart pumps, so if your heart has trouble circulating blood, your kidneys get less nutrients and oxygen and waste can build up. Kidneys also regulate blood pressure and produce hormones, so any damage can upset blood vessels, nerve function, and hormone balance.
• Diabetes – With diabetes, the body is unable to make or respond to insulin, causing abnormal metabolism and elevated glucose (blood sugar) levels. High glucose can damage blood vessels and nerves, causing them to narrow. Recent research shows that nearly 66% of men with diabetes also have ED. Further, diabetes is a leading contributor to kidney disease.
• Some prostate treatments – More than 100 medications can cause ED, including some prescribed for prostate cancer of enlarged prostate (benign prostate hyperplasia). These drugs include testosterone inhibitors and converters (such as 5-alpha reductase inhibitors) that reduce hormone activity; radiation, which can damage nerves and blood vessels; and chemotherapy because it can reduce testosterone levels.
• Peyronie’s disease – Peyronie’s disease is a condition that causes the penis to curve or shorten during erection, a result of inflammation or a buildup of scar tissue (plaque) under the skin. While Peyronie’s disease might not prevent a man from getting an erection, it can make an erection painful and embarrassing. Note: Men with diabetes-related ED are four to five times more likely to develop Peyronie’s disease. Learn treatment options for Peyronie’s disease.
• Low testosterone ­– Researchers have linked low testosterone levels to a number of chronic conditions that contribute to ED, including diabetes and heart disease. Levels of the male hormone that feeds sexual desire and libido tend to decline with age, making erections more difficult. Access more information about low testosterone here.

Specific Causes of Occasional ED, and What You Can Do

Occasional ED can be situational or temporary and brought on by several factors:

Situational ED occurs in specific situations, such as with a particular partner or in certain settings, as well as when drinking alcohol.

Temporary ED tends to strike suddenly in any circumstance due to lifestyle factors such as stress, weight gain, smoking, recreational drug use, or heavy alcohol consumption. If you regularly participate in these latter activities, hold off for a time to see if your erection improves.

Additionally, both forms of ED can stem from psychological factors including guilt, stress, anxiety, and depression. These issues account for 10% to 20% of ED cases.

Should you experience one or more of these conditions, you can ask your doctor for a referral to a therapist.

When to See a Doctor for Occasional ED: Treatment Pathways

If you experience ED from time to time and you do not believe any of the above factors apply, consult with your doctor. A urologist can run tests to determine if your ED episodes stem from an underlying health issue or the side effects of a medication.

Together, you can then choose whether you’d like to undergo treatment, based on the cause. Among the common treatment pathways:

• Oral medication – Several drugs can improve blood flow to the penis, including Viagra, Levitra, Stendra, and Cialis. Talk to your doctor and pharmacist about existing conditions first to avoid potentially harmful side effects.
• Injection therapy – Some medications designed to expand the blood vessels can be self-injected into the base of the penis on an as-needed basis. These drugs should enable an erection within 10 minutes that lasts for no more than one hour.
• Penile pump – This hand-powered device works like a vacuum, drawing blood into the penis so it becomes erect. Once erect, the patient places a band around the base of the penis to maintain hardness. Note: The band will prevent ejaculation.
• Shockwave therapy – This painless, in-office approach is administered by a doctor using a wand-like device that delivers low-intensity pulses to the outside the penis, stimulating the tissue to improve blood flow. Treatment can be completed in two to three weeks. Read more about low-intensity shockwave therapy.
• Penile implants – A surgical option in which the physician inserts a stiffening device under the penile tissue. Patients have two options: a malleable implant (two bendable rods that produce a permanent erection that can be positioned into place when desired); or an inflatable implant (a fluid-filled system of two cylinders that can be inflated and deflated). Find more penile implant information here.

Remember, Occasional ED Can Signal Other Health Issues

Even occasional ED can be a “call to action” to talk to a trained doctor. Our specialists have these conversations every day. We know that getting to the cause of ED early might prevent it from worsening, and alert you to an underlying health concern. It also can give you peace of mind.

Erectile dysfunction is a healthcare issue you can manage. Click here to learn how erectile dysfunction is diagnosed and more details about treatment. To consult one of our physicians, review our list of providers at our Woodmen and Union offices.