Ask the Doc :: What Is Erectile Dysfunction?

In this edition of Ask the Doc, resident expert Dr. Tavi Doron defines exactly what erectile dysfunction is and why regular erections are actually a really important indicator of a man's health.

He also takes a look at the main differences between popular erectile dysfunction medications like Viagra, Cialis, and Levitra including onset times, side effects, and how they work to shed a little light on the science behind erectile dysfunction.

When Do I Officially Have "Erectile Dysfunction?"

Q: I can only get hard enough for sex about half of the time. Does that mean I have "erectile dysfunction?"

A: There's a common misconception that erectile dysfunction (ED) is an all or nothing type of thing. In other words, you either have ED or you don't. In reality, ED is a spectrum ranging from someone who never has a problem getting and maintaining a "satisfactory" erection to someone who's never able to get and/or maintain an erection. Most people with ED are somewhere in between those two extremes.

Erections are surprisingly complicated. Your brain, nerves, heart, blood vessels, and a whole lot of hormones have to work in perfect harmony or nothing happens. If you miss a single step in the process, you're in for a big letdown.

Some men may struggle to get an erection sometimes. Others may be able to get an erection all the time, but have difficulty maintaining it. Still other men may have some combination of the two. These are all examples of erectile dysfunction, and each of these men will benefit from ED medication.

Why Are Erections So Important?

Q: Why is erectile dysfunction such a big deal? Aren't there more pressing health issues for men to worry about than erections?

A: Regular erections are actually a really important indicator of men's overall health. No, seriously. Erections matter.

Erectile dysfunction is one of your body's first warning signs that serious problems like hypertension, nerve damage, cardiovascular disease, hormone problems, clinical depression, or a host of other conditions may impacting your regular bodily functions. That's why we like to call erectile dysfunction your "check engine light."

The blood vessels in the penis are smaller than other parts of your body, which means that problems-like cardiovascular disease-are likely to show up as erectile dysfunction before they manifest as a heart attack or stroke in the larger blood vessels leading to your heart or brain.

The interesting thing (and silver lining) about erectile dysfunction is that ED symptoms often occur years before stroke or heart attack, making ED a great diagnostic tool for investigating your risk factors for other conditions. Take your erections (or lack of erections) seriously, because they're great indicators of a healthy manhood.

How Do ED Meds Work?

Q. How do erectile dysfunction medications even work? Do different medications work for different types of ED?

A: Viagra and Cialis both belong to a class of medications called phosphodiesterase 5 inhibitors (PDE 5 inhibitors for short). There are two other drugs in this category like Levitra and a lesser known one called Stendra, but all of these drugs essentially work the same way.

PDE 5 inhibitors increase a chemical called cyclic GMP (cGMP), which allows certain muscles to relax and blood to flow into the penis causing an erection. That said, there are slight differences between the individual medications.

What are the Main Differences Between Viagra and Cialis?

Q: What are the main differences between Viagra and Cialis, and is one better than the other?

A: Sildenafil (the active ingredient in Viagra) typically works in about 30 minutes and last for 6-8 hours. Tadalafil (the active ingredient in Cialis) takes about 2 hours to start working (although it's faster in some people) and works for 24-36 hours.

While both medications are very effective-approximately 85% of patients will achieve a satisfactory erection with either-Cialis will be in your system for more than a full day. That can be a big pro or major con depending on your history, risk factors, and lifestyle.

You might not need 36 hours of "effectiveness." Also common side effects, like nasal congestion or flushing, will fade more rapidly as the medication leaves the bloodstream if you opt for Viagra over Cialis. Then again, this extra long effective half-life can benefit couples who aren't sure when they're likely to have sex and want to build in a little spontaneity. It all depends on your needs.

ED meds also interact with fatty foods differently. Viagra and Levitra can both be affected by a high fat meal, whereas Cialis isn't affected by food intake. Translation: A heavy meal can make Viagra and Levitra less effective, which is something to consider.

Lastly, Cialis has the option of low dose daily dosing or as needed dosing, while Viagra and Levitra are both taken only as needed.

Choosing "the right" medication for you depends on your health, risk factors, and how you and your partner plan to use the medication.

? Do you want rapid onset or prolonged duration?
? How do you react to the drug in terms of side effects?
? What's your medical history, and what other medications are you taking?
? What does it mean to achieve a "satisfying erection?"

Aside from the immediate benefits, ED medications also help men be more confident. Medication takes a lot of uncertainty out of whether men will get an erection when they want one, especially if they work with their partner and doctor to get the dosage and medication that works best for their lifestyle, no matter where they fall on the erectile dysfunction spectrum.

Dr. Tzvi Doron is board certified family doctor and the Clinical Director of Roman. He's a member of the American Osteopathic Association (AOA) and the American Academy of Family Physicians (AAFP).