7 Common ED Myths Uncovered

There are many misconceptions about erectile dysfunction and its causes. Get the facts to straighten out any confusion about ED.

By Katherine Lee

Medically reviewed by Cynthia Haines, MD

Erectile dysfunction, or ED, is a common problem affecting up to 30 million American men. Despite its prevalence, erectile dysfunction is often misunderstood. Here are some common ED myths and the facts to dispel them.

ED Myth No. 1: Tight Underwear Can Cause Erectile Dysfunction

Truth: “There is no research showing that wearing tight underwear can lead to erectile dysfunction,” says Alan W. Shindel, MD, clinical instructor and fellow of andrology at the University of California at San Francisco. However, tight underwear may contribute to infertility. Keeping testicles too close to the body raises their temperature and hinders sperm production.

ED Myth No. 2: ED Occurs When You’re Not Attracted to Your Partner

Truth: While a lack of attraction — or even some trouble in the relationship — can contribute to erectile dysfunction, the majority of ED is physiological. “The trouble starts with a biological reason, which can lead to confidence issues, avoiding sex, fear of failure, and then avoiding your sex partner,” Shindel explains.

ED Myth No. 3: Erectile Dysfunction Is a Normal Part of Aging

Truth: Erectile dysfunction is not an inevitable part of growing older. “Like arthritis and heart disease, erectile dysfunction is just more common in older men,” says Shindel. “Certain health conditions increase in likelihood with age, as does erectile dysfunction.” ED can also be a warning sign of another condition, such as cardiovascular disease. The penis is a vascular organ, and therefore any condition that interferes with blood flow in the body can affect erections.

ED Myth No. 4: Erectile Dysfunction Only Affects Older Men

Truth: While older men have a higher incidence of erectile dysfunction, impotence can happen to men of any age. Younger men who have diabetes, high blood pressure, or cardiovascular problems are at particularly high risk.

ED Myth No. 5: Erectile Dysfunction Is Best Treated With Oral Medications

Truth: Erectile dysfunction medications don’t work for everyone, and they’re not usually the first line of treatment. Doctors initially recommend healthy lifestyle changes such as quitting smoking and losing weight. The next step might be to identify possible medications that could be causing erectile dysfunction or to try psychotherapy. Eventually, oral medications may be prescribed to increase blood flow to the penis and achieve erection.

ED Myth No. 6: Erectile Dysfunction Is Only an Emotional Issue

Truth: It was once believed that erectile dysfunction was solely psychological. Today, experts believe physiological factors are at the root of most erectile dysfunction cases. Physiological causes can be related to health conditions, such as diabetes, kidney disease, or high blood pressure, or a medication side effect. These physical factors can also contribute to emotional ones. “When a man experiences erectile dysfunction, he can become anxious or depressed, and the erectile dysfunction can become a source of psychological stress,” says Shindel

ED Myth No. 7: Erectile Dysfunction Cannot Be Caused by Riding a Bicycle

Truth: Cycling is linked to a higher risk of erectile dysfunction. “If you fell asleep in a very awkward position in a chair, you’d get pins and needles in a part of the body to which the blood wasn’t flowing properly,” says Irwin Goldstein, MD, clinical professor of surgery at University of California at San Diego, director of sexual medicine at Alvarado Hospital, and director of San Diego Sexual Medicine. “When you ride a bike, most of your body weight is on the crotch, causing damage by crushing endothelial cells.”

ED is a complex issue with many possible causes and many possible treatments. The best way to discover what's behind your ED is to talk openly with your doctor and get an accurate diagnosis.

Last Updated: 01/12/2010

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Diabetes Awareness: By the Numbers

Type 2 diabetes is a serious condition that has now reached near-epidemic levels. With these facts, you can help spread diabetes awareness.

By Wyatt Myers

Medically reviewed by Pat F. Bass III MD, MPH

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As we enter Diabetes Awareness Month in the United States, health experts are hoping to put a renewed effort into fighting the diabetes epidemic. Type 2 diabetes is a serious health condition that not only affects your lifestyle, but can put you at risk for many other health issues, including high blood pressure, stroke, and nerve damage. Many Americans are at risk for type 2 diabetes, and the diabetes population continues to grow around the world.

“Diabetes and its twin calamity, obesity, is a problem not only in this country. It is a global problem, surpassing malnutrition,” says Joel Zonszein, MD, of the Clinical Diabetes Center at Montefiore Medical Center in New York City.

If you look at the growing number of people with diabetes, particularly type 2 diabetes, it’s easy to see why health experts are saying we have a diabetes epidemic. Here’s a look at the numbers:

• An estimated 366 million people around the world have diabetes, or about 5.2 percent of the global population.
• There are 4.6 million diabetes-related deaths each year.
• About 25.8 million Americans have diabetes, or about 8.3 percent of the population.
• About 95 percent of Americans with diabetes have type 2 diabetes.

In adults 20 years and older, nearly 2 million new cases of diabetes were diagnosed in 2010. Those cases are part of the more than 8 percent of Americans with diabetes, but the American Diabetes Association (ADA) estimates that by 2050 more than 30 percent of American adults could have diabetes.

A big concern with diabetes is that many people are unaware that they have the condition. An estimated 7 million people have undiagnosed type 2 diabetes, which is frightening considering that diabetes requires constant care. This is one reason why diabetes awareness is so important.

What’s Behind the Risk of Type 2 Diabetes

Genetics, or family history, is an important risk factor for type 2 diabetes for many people in this country, says Dr. Zonszein. But by far the biggest risk factor is a poor diet and unhealthy weight.

“Obesity is a growing health problem that results from overeating — especially an unhealthy diet — and not enough exercise,” he says. “With increasing urbanization and changing modes of transportation, it’s no wonder that obesity has rapidly increased in the last few decades around the world.”

Being overweight puts a strain on your body and can cause a number of health conditions, including heart disease, high blood pressure, arthritis, and of course, diabetes. As more people have become overweight, the number of people with these conditions has also grown. Therefore, the biggest components of diabetes prevention are a healthy diet and exercise tomaintain a healthy weight.

Diabetes Among Young People

Diabetes is affecting more younger people than ever before. At one time, type 2 diabetes was called “adult-onset diabetes,” as it was primarily diagnosed in people 40 years or older. Over the past two decades, says Zonszein, health care providers have been seeing more and more children with type 2 diabetes. The Centers for Disease Control and Prevention estimates that 215,000 children and teens now have diabetes.

“The epidemic of obesity and the low level of physical activity among young people, as well as exposure to diabetes in utero, may be major contributors to the increase in type 2 diabetes during childhood and adolescence,” Zonszein explains.

To fight these numbers, parents, teachers, and other adults can teach children how to make healthy food choices and stay active, whether through sports, playing with friends, or walking, biking, and jogging more often.

The Prediabetes Scare

Another aspect of the diabetes epidemic is the growing number of people who have prediabetes — a condition where a person’s blood sugar level is higher than normal but not high enough to be diabetes. According to the ADA, 79 million people in the United States have prediabetes.

It’s important for people with prediabetes to make lifestyle changes to protect their health. Studies have shown that prediabetes is likely to develop into diabetes within 10 years. “Before people develop type 2 diabetes, they almost always have prediabetes,” says Zonszein. In addition, prediabetes may put you at risk for heart disease and stroke.

If you have diabetes, encourage your loved ones to get tested. Testing for prediabetes and making the lifestyle changes necessary to keep it from developing into full-blown diabetes are the best steps someone can take to protect their health.

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The impact of diabetes on workforce participation: results from a national household sample

Health Services Research, Dec, 2004 by Sandeep Vijan, Rodney A. Hayward, Kenneth M. Langa

BACKGROUND

Diabetes has staggering health and economic effects. There are an estimated 16-17 million people with diabetes in the United States (Centers for Disease Control and Prevention 2002) and, given the aging of the population, changes in ethnic makeup, and the dramatic increase in obesity and sedentary lifestyles in the United States, the prevalence of diabetes is increasing at an epidemic rate (Boyle et al. 2001). In 1997, a cross-sectional analysis found that the direct medical cost of diabetes care was more than $44 billion (American Diabetes Association 1998). However, the effects of lost productivity have been felt to be even more substantial (American Diabetes Association 1998).

The indirect costs of diabetes are largely related to the disability resulting from complications of the disease, rather than to the disease itself. Microvascular diabetes complications, such as retinopathy, nephropathy, and neuropathy, are the leading causes of blindness, end-stage renal disease, and nontraumatic amputation, respectively, in the United States (National Institutes of Health 1995). Even more important is macrovascular disease (including coronary artery disease, stroke, and peripheral vascular disease). Patients with diabetes have two to four times the risk of macrovascular disease and mortality compared to age and sex-matched controls; as a result, more than 70 percent of patients with diabetes die from these complications (Abbott et al. 1987; deGrauw et al. 1995; deMarco R et al. 1999; Donahue and Orchard 1992; Hadden et al. 1997).

Although the numbers of disabling diabetes complications are staggering, many are preventable, and appropriate therapy could lead to substantial reductions in complications and associated disability. However, the true economic impact of diabetes remains unclear. While there are a number of past studies of the costs of diabetes, these analyses have substantial limitations and often reach widely disparate conclusions because of differences in data sources and methodology. For example, these studies have been forced to look at indirect costs by compiling data from multiple sources, have had nonrepresentative data sources, or have not examined the economic impact of all diabetes-related disabilities (American Diabetes Association 1998; Gregg et al. 2000; Ramsey et al. 2002; Gregg et al. 2002). To date, no studies have been able to use a consistent or representative data source to identify the impact of diabetes on workforce participation. Understanding the economic impact of diabetes on workforce-related outcomes allows a more complete understanding of the cost-effectiveness of diabetes treatment programs, and may provide a rationale for employers to begin to address workplace programs to improve health.
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Using the Health and Retirement Study (HRS), we analyzed the effects of diabetes on workforce participation and lost productivity. The HRS is a longitudinal survey designed to follow a national sample of U.S. adults born between 1931 and 1941 (and their spouses) as they make the transition from active working status into retirement. The HRS provides an excellent opportunity to overcome limitations with prior studies and to better estimate the impact of diabetes on economic productivity.

METHODS

Data

The HRS is a national longitudinal cohort study that is funded by the National Institute on Aging and is conducted by the Institute for Social Research at the University of Michigan (Juster and Suzman 1995). Approximately 70,000 households, obtained from an area probability sample, were screened to identify all age-eligible respondents (51 to 61 years of age). The HRS is a nationally representative survey of households, not of individuals. For example, if a spouse is outside of the age range specified in the study, they were still included in the dataset; therefore, the complete HRS dataset is not a perfectly representative sample of those 51 to 61 years of age at the time of the study. Thus, we restricted our analyses to the age-eligible population in the HRS.

Census tracts containing a high density of African Americans and Florida residents were oversampled two to one. All spouses were interviewed regardless of age because of the frequency of dual-earner couples and the influence of spouses in the retirement decision. The overall response rate was 82 percent. Information was collected for domains including demographics, health status, housing, family structure, employment, work history, disability, retirement plans, net worth, income, and health and life insurance. To date, five waves of data collection have been completed; the first was in 1992, and the ensuing four waves were collected at two-year intervals through 2000 (Health and Retirement Study 2003).

Variables

Classification of Outcome Variables: Work Status and Duration. The HRS has detailed information on the work status of the study participants. For the cross-sectional analyses using wave 1 data, we subdivided the population into those who were and were not working outside the home. Those who were working outside the home were asked whether they missed work days in the prior year due to illness, and if so, the total number of days. Subjects who were not currently working were subdivided into those who reported being retired, those who reported being disabled, and those who were homemakers. Of note, there are different possible definitions of disability; we examined both those with self-reported overall disability and also those who were not working specifically due to a health condition, although we used self-reported disability in our main analyses. Dates of retirement and disability were used to determine the duration of each outcome. In the case of those disabled at baseline, we also projected their future lost income through the year 2000 in a separate analysis. This analysis took into account the reported rates of returning to work among those disabled at baseline.


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