Erectile dysfunction: Understanding the causes and solutions
Demystifying a common health issue
Erectile dysfunction, meaning the persistent difficulty in achieving or maintaining an erection sufficient for satisfactory sexual relations, is a much more common reality than one might think. It can affect men of all ages and is in no way a sign of virility, desire, or performance.
It is important to distinguish erectile dysfunction (a mechanical issue) from libido (sexual desire). It is above all a health issue, often the first symptom of another medical condition. The good news is that very effective and safe solutions exist. Talking about it is the first step.
Understanding the causes: A physical issue first and foremost
Contrary to popular belief, the vast majority (about 80%) of erectile dysfunction cases have a physical cause, not a purely psychological one. An erection is a complex vascular phenomenon: it requires good blood circulation.
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Cardiovascular causes (the most frequent):
Very often, erectile dysfunction is an early warning sign of cardiovascular problems. Conditions like hypertension, high cholesterol, diabetes, or obesity can damage blood vessels and reduce blood flow to the penis. -
Medication-related causes:
Several medications can impact erectile function (certain antidepressants, blood pressure medications, etc.). This is a key point to discuss with your pharmacist, as alternatives often exist. -
Other physical causes:
Hormonal causes (low testosterone), neurological issues, or lifestyle factors (smoking, alcohol) are also possible. -
And psychology?
Stress, performance anxiety, or depression can of course play a role, but they are more often a consequence of erectile dysfunction than an initial cause.
The solutions: The pharmacist's approach
A wide range of options exists today. A discussion with a healthcare professional is the first step to finding the treatment that best suits your needs and your health status.
Oral treatments
These are the best-known medications. They work by relaxing the muscles of the blood vessels in the penis, allowing for better blood flow in response to sexual stimulation.
- Sildenafil (Viagra®) and Vardenafil (Levitra®): "On-demand" options whose effect lasts for 4 to 6 hours.
- Tadalafil (Cialis®): The "weekend pill," whose effect can last up to 36 hours. A low-dose daily option is also available.
- Avanafil (Stendra®): A newer option notable for its rapid onset of action (as early as 15 to 30 minutes).
Local and injectable options
If oral treatments are not effective or are contraindicated, other high-performance solutions exist:
- Intracavernosal injections: This is a very effective method. It involves self-injecting a medication directly into the corpus cavernosum of the penis. Besides commercial products (e.g., Caverject®), there are custom sterile preparations like Triple-Mix. This mixture is known for producing an immediate and very predictable erection. This option, while high-performance, is more costly, requires comfort with self-injection, and carries a small risk of priapism (a prolonged erection). Close medical and pharmaceutical follow-up is therefore essential.
- Other options: Intraurethral suppositories (MUSE®) and the vacuum erection device.
Testosterone replacement therapy
Only for men in whom a hormone deficiency has been diagnosed.
The advisory role and safety at the pharmacy
Your pharmacist's role is crucial for navigating these options safely. Numerous drug interactions are possible with treatments for erectile dysfunction, which is why it is essential to always consult us before starting.
Important Safety Warning: The combination of these medications with nitrates—used for chest pain (nitro) or present in "poppers" (amyl nitrite)—is absolutely contraindicated. This mixture can cause a drastic and potentially fatal drop in blood pressure.
Trusted resources
- Sexual Medicine Society of North America (SMSNA): A very high-quality resource managed by experts, with detailed and reliable patient information.
- Canadian Men's Health Foundation: A Canadian organization dedicated to men's health that addresses the topic.
- Canadian Urological Association: Offers reference medical information.
- Sex & U by the SOGC: An excellent basic page on the subject.
