What you need is real, honest information about what’s going on below your belt. So we’ve compiled a list of the 10 biggest bogus facts about ED—and the real truth you need to know.1. The falsehood: Erectile dysfunction refers to one specific penis problem
The truth: The definition of erectile dysfunction is not the same for every guy, says Daniel Williams, M.D., an associate professor in the department of urology at the University of Wisconsin School of Medicine and Public Health.
It’s usually defined as the inability to get and keep an erection that’s satisfying enough for sex.
Related: The Men’s Health Guide to Erectile Dysfunction: What Causes It, How to Fix It, and How to Avoid It
But some guys have problems getting erections in the first place, while others have difficulty maintaining an erection that lasts long enough for sex.
And in other cases, a man may be unable to get an erection that’s strong enough to penetrate during intercourse.
2. The falsehood: Erectile dysfunction only affects older guys
The truth: It’s true that the prevalence of erectile dysfunction does increase with age, but younger guys are by no means immune to it.
According to a study in the American Journal of Medicine, 85 percent of men ages 20 to 39 say they “always” or “almost always” can get and maintain an erection good enough for sex.
That means 15 percent of men have difficulty with their erections at least occasionally during sex.
When looking at men ages 40 to 59, 20 percent say they can usually get a good enough erection, while 12 percent say they only sometimes can, and 2 percent say they never can.
3. The falsehood: If you struggle in the bedroom once, you have erectile dysfunction
The truth: Few guys bat a thousand in the bedroom, and an off night is usually nothing to worry about, says Tobias Köhler, M.D., M.P.H., F.A.C.S., urology chair at Illinois’s Memorial Hospital.
Lots of times the cause can be traced to a temporary issue—say, you drank too much alcohol earlier that night, or were completely exhausted from a tough week at the office—that you don’t need to stress over.
On the other hand, if you notice your difficulty achieving or maintaining an erection lasts for three months or longer, that suggests a more chronic issue may be at play.
Make an appointment with your doctor to see what’s up.
4. The falsehood: Erectile dysfunction is all in your head
The truth: In many cases, erectile dysfunction is a combination of both physical and psychological factors, says Dr. Williams.
For instance, your ED may have a physical cause—usually a problem with your blood vessels that hampers blood flow to your penis.
But the more you stress about your problem, the more stress can play a role in making it even more difficult to achieve an erection.
So before you meet with your doctor, keep a log of when your erectile problems occur. That will help him or her determine what’s driving your ED—and figure out the best way to treat it.
5. The falsehood: ED means there’s something wrong with just your penis
The truth: Your erection—or lack of one—can actually alert you to underlying medical problems throughout your body.
For instance, take heart disease: Conditions like high blood pressure and high cholesterol can damage your blood vessels, impeding blood flow to your penis, Dr. Köhler says.
“The vessels that supply blood to your erection are only one to two millimeters in diameter,” he says. “Your heart’s are twice that size.”
That means your erection may take a hit years before you might suffer chest pains or other symptoms of heart disease.
Problems with your erection can also signal diabetes, low testosterone, or clinical depression.
6. The falsehood: Only a specialist can treat erectile dysfunction
The truth: In most cases, your primary care doctor is a solid place to start for your ED workup, says Dr. Williams.
He or she can order tests to check for related health conditions, such as a lipid panel to test for high cholesterol or a blood glucose test to check for diabetes.
Your primary care doctor can also prescribe first-line erectile dysfunction drugs called PDE5 inhibitors, which you probably know as Viagra or Cialis.
Still, you may need to see a urologist if those treatments don’t work, or if you have other urological issues along with your ED, like problems urinating or prostate problems.
7. The falsehood: Your bad habits don’t affect your penis
The truth: Your vices aren’t just bad for your health—they might be hurting your erection, too.
Take lighting up: Cigarette smoking can damage your blood vessels, impeding blood flow and making it difficult to get an erection.
One year after quitting, 25 percent of ex-smokers reported improvement in their erections, a study from Iran found.
Most recreational and illicit drugs—including marijuana—have been linked to erectile problems too, says Dr. Köhler.
Plus, cutting down on booze can also improve your erections. It helps the vessels in your body rush blood to your penis, keeping it there so you can perform, he says.
8. The falsehood: All erectile dysfunction drugs are the same
The truth: The meds you are most familiar with—Viagra, Cialis, and Levitra—all belong to the same class of drugs called PDE5 inhibitors.
These drugs all work the same way, by relaxing smooth muscles and increasing blood flow to the penis, says Dr. Williams.
Still, they do affect your body a bit differently, which is important to understand if you want to reap the greatest benefits from each.
For instance, drugs like Viagra and Levitra reach peak effectiveness in one hour, while Cialis takes about two.
Also, eating a heavy, fatty meal before popping Viagra and Levitra can reduce the effectiveness of the drug. So you should wait between 2 to 3 hours after eating a big meal to take those kinds.
9. The falsehood: You’re out of options if Viagra doesn’t work for you
The truth: If first-line ED drugs like Viagra or other PDE5 inhibitors don’t work for you, you have other options.
Your doctor may prescribe an injectable medication called alprostadil—known by the brands Caverject or Edex. These drugs work by relaxing the smooth muscles of your penis, opening up blood vessels and increasing blood flow, says Dr. Williams.
Injecting your penis—yes, with a needle—can be pretty scary, but most men say it doesn’t hurt as much as they feared, he says.
The good news? Not only are these drugs effective, but they also tend to be a lot more affordable than PDE5 inhibitors.
10. The falsehood: Taking testosterone will cure your erectile dysfunction
The truth: If your testosterone levels are in the normal range, raising them higher probably won’t help your erectile issues, says Dr. Williams.
That’s why it’s important to get your levels tested: A level of about 300ng/dl or below is usually considered low, and guys with those levels are considered candidates for treatment.
What’s more, even if you do have low testosterone, bringing your levels up to normal range may not be enough to fix all your erection woes. You still may need help from other ED treatments, like PDE5 inhibitors, he says.