What Is Erectile Dysfunction (ED)?

Erectile dysfunction (ED) is the inability to get and keep an erection during sex. Some men have occasional trouble getting or keeping an erection, which can be normal. But when the problem becomes frequent or continues for an extended time, you should see a doctor.

Understanding the signs and causes of ED is the first step toward achieving a better sex life.

Signs and Symptoms of Erectile Dysfunction

• Reduced sex drive
• Trouble getting an erection
• Trouble keeping an erection

Causes and Risk Factors of Erectile Dysfunction

An erection occurs when blood fills the penis. During sexual arousal, blood vessels, muscles, nerves, and hormones work together to create an erection. Symptoms of ED can occur when this process is disrupted.

Physical Causes

• Heart disease or atherosclerosis (plaque buildup that narrows your arteries)
• High blood pressure
• High cholesterol
• Obesity
• Diabetes
• Stroke
• Parkinson’s disease
• Multiple sclerosis
• Metabolic syndrome (a cluster of risk factors that includes high blood pressure, elevated insulin levels, high cholesterol and triglycerides, and increased body fat around the waist)
• Pelvic or spinal cord injury
• Chronic kidney disease
• Low testosterone levels
• Peyronie’s disease (scar tissue inside the penis)
• Sleep disorders

Tell your doctor if you have any of these problems and have symptoms of ED.

Medications That May Contribute to Erectile Dysfunction

• Diuretics (water pills)
• Antihistamines
• Antidepressants
• Appetite suppressants
• Codeine and oxycodone
• Sedatives
• Ulcer medications
• Nonsteroidal anti-inflammatory drugs
• Chemotherapy medications

It’s important to tell your doctor about all the drugs you take, including nonprescription ones, so they can determine if any of your medications could be responsible for your symptoms.

Psychological Causes of Erectile Dysfunction

• Depression
• Anxiety
• Stress
• Relationship problems

Other Causes and Related Conditions

Using tobacco, alcohol, and illicit drugs can cause ED, especially when used long term.

• Premature ejaculation (ejaculating too soon)
• Delay or inability to have an orgasm after sufficient stimulation
• Inability to be aroused

How Is Erectile Dysfunction Diagnosed?

To diagnose ED, your doctor may ask you some questions and perform a physical exam.

• Blood Test A blood sample may help your doctor look for signs of diabetes, low testosterone, or other issues, such as liver or kidney disease.
• Urine Test A urine test can look for markers of diabetes and other health issues.
• Psychological Exam Your doctor might screen you for depression or another mental health condition that could be linked to ED symptoms.
• Ultrasound Your doctor may use a sound wave test to see if you have blood-flow problems.

What Should You Tell Your Doctor About Symptoms?

When talking to your doctor, be as open and honest about your symptoms as possible. Tell your healthcare provider how often you have symptoms and how long you’ve had them.

You should also tell your physician about these areas:

• All the medications you take
• Other health conditions
• If you drink alcohol or use tobacco products

Treatment and Medication Options for Erectile Dysfunction

Several treatment options are available to help ED. Sometimes, resolving underlying medical conditions will also improve your ED symptoms.

Medication Options

There are several types of ED medications:

• Oral Drugs Popular medicines such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) work by boosting the effects of nitric oxide, a chemical that relaxes blood vessels in the penis. Drugs in this class (PDE-5 inhibitors) are not appropriate for patients who take nitrates in any other form because the combination can lead to severe hypotension (low blood pressure).

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• Injections The medication alprostadil (Caverject, Edex) can be injected inside your penis to help create an erection. Other medications may be placed in your urethra.

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• Testosterone Your doctor may recommend that you take this hormone if your levels are low.

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Devices and Surgery

Your healthcare provider may recommend a vacuum device, also called a penis pump, to help you get an erection. The pump helps pull blood into your penis so you can achieve an erection that lasts long enough for sexual intercourse. It’s paired with a tension ring that helps you maintain an erection.

Counseling and Therapy

Complementary and Integrative Therapies

Always talk to your doctor before trying any supplement or treatment for ED.

Although some companies market “herbal Viagra” and other treatments for ED, the U.S. Food and Drug Administration (FDA) warns that these products may contain potentially harmful drugs, contaminated formulations, or unknown dosages of pharmacologically active medications. They can also interact with other medications you take.

Lifestyle Changes and Prevention of Erectile Dysfunction

• Stopping smoking
• Losing excess weight
• Exercising regularly
• Controlling high blood pressure and cholesterol
• Getting help for alcohol or drug addiction problems
• Considering couples counseling if you and your partner are having trouble communicating

Erectile Dysfunction Prognosis

The prognosis for men with ED is generally favorable.

While incurable medical conditions may cause ED symptoms in some people, treatment can help restore sexual function.

Complications of Erectile Dysfunction

• Low self-esteem
• Stress
• Anxiety
• Relationship issues
• Depression
• Inability to get your partner pregnant

The Takeaway

• Erectile dysfunction leads to difficulty getting or keeping an erection, and may affect half of men ages 40 to 70.
• Frequent ED might point to underlying health issues, from depression and anxiety to heart disease and diabetes.
• Treatment options range from medications, devices, and surgery to counseling and therapy. Talk to your doctor about what might work best for you.
• Lifestyle changes such as stopping smoking, exercising regularly, and controlling high blood pressure and cholesterol levels could improve symptoms.