Erectile Dysfunction

Was this helpful?
5

What is erectile dysfunction?

Erectile dysfunction (ED), also called impotence, occurs when a man is unable to achieve or keep an erection in order to have sex. While many men may experience impotence occasionally, frequent episodes could cause stress and relationship problems. Long-term erectile dysfunction affects about 10% of all men.

A penis becomes erect when the arteries relax and an extra supply of blood enters the penis. This blood becomes trapped, expanding the penis and holding the erect shape. When the veins open, the extra blood leaves the penis, leaving it soft again. There are many reasons, ranging from psychological to physical, why the blood flow may not harden the penis sufficiently.

Erectile dysfunction itself is not a serious medical condition, but it could be the sign of a different one. For example, undiagnosed heart disease or diabetes can cause erectile dysfunction, as can some medications.

If you are experiencing erectile dysfunction, speak with your doctor. There are some treatments that may help. It is also important to consult your doctor to rule out any diseases or conditions that could be causing it.

What are the symptoms of erectile dysfunction?

Erectile dysfunction can be occasional or frequent. Along with a reduced sex drive or desire, men with erectile dysfunction either cannot obtain an erection at all, or they get one but cannot keep it long enough to complete the sex act.

Seeing your doctor may help prevent occasional erectile dysfunction from becoming more frequent, and could help detect an undiagnosed disorder, which could be causing it.

What causes erectile dysfunction?

There are several mental and physical issues that could cause erectile dysfunction.

Psychological causes:

Men who are stressed, anxious or depressed could find it difficult to get and maintain an erection. Other related issues include:

  • Not being sexually stimulated enough

  • Performance anxiety

  • Relationship stress

Physical causes:

There are many health issues that could be linked to erectile dysfunction. The most common causes include:

  • Alcohol or drug use

  • Diabetes: Up to 50% of men with diabetes have erectile dysfunction.

  • Heart or vascular disease: If blood cannot flow smoothly through the blood vessels, it cannot reach the penis. 

  • Hormone-related disorders: Men who have thyroid disease or hormone imbalance, or who abuse hormones (usually for bodybuilding), can develop erectile dysfunction.

  • Neurological disorders, such as multiple sclerosis, stroke, spinal cord injury: These affect the nerves in the penis.

  • Obesity

  • Prostate cancer surgery and treatment

  • Side effects from medications, including antidepressants, anti-anxiety drugs, chemotherapy, glaucoma eye drops, and antihypertensives

  • Sleep disorders

  • Smoking

  • Surgery in the pelvic area or spinal cord

What are the risk factors for erectile dysfunction?

There are many causes for erectile dysfunction, so there are also many risk factors. Some are modifiable, which means steps could be taken to reverse the risk. Some can be modifiable or manageable, such as treating diabetes. Others are non-modifiable, which means nothing can be done to change them. While not all people with risk factors will get erectile dysfunction, the most common ones include:

Modifiable or manageable:

  • Alcohol use

  • Drug use

  • Medical conditions 

  • Mental health: Treating anxiety or depression could help improve erections.

  • Obesity and being overweight

  • Smoking

  • Taking hormones for bodybuilding

  • Taking certain prescription medications

     

Non-modifiable:

  • Age

  • Surgery or damage to the area

  • Treatment in the prostate or spinal area

Reducing your risk of erectile dysfunction

You may be able to lower your risk of erectile dysfunction by:

  • Removing the modifiable risk factors and working on treatments for physical and mental conditions that could be contributing to erectile dysfunction. If you suspect the problem may be related to a medication you’re taking, speak with your doctor or pharmacist. If ED is a side effect, ask if there is another drug or a way to reduce the risk of this side effect.

  • Following recommended treatment plans for any disease or condition, and following up as needed

It can be embarrassing to speak to your doctor about erectile dysfunction. However, it is important to remember that the doctor has seen and heard about this problem many times before. It is very common and there may be a simple solution.

How do doctors diagnose erectile dysfunction?

Doctors can diagnose erectile dysfunction by listening to the history of how often it occurs and the impact it has. However, diagnosing the cause may take some questioning and medical tests.

To diagnose your condition, your doctor or licensed healthcare practitioner will ask you several questions including:

  • How long have you experienced erectile dysfunction? When did you first notice it?

  • How often does it occur?

  • What medications (including supplements and over the counter) are you taking?

  • When you do get an erection, how does it compare to previous ones? Does it last?

  • Do you get involuntary erections or do you wake up with one?

  • Are you under a lot of stress or are there problems with your relationships?

  • Do you have any conditions already diagnosed?

Tests to diagnose the cause of erectile dysfunction

Tests, if needed, could include:

  • Blood tests, including for cholesterol and lipid profiles, glucose (blood sugar) levels, hemoglobin (to check for anemia), hormone levels, liver and kidney function, and thyroid function

  • Psychological exam

  • Ultrasound 

  • Urine test

There are also some tests that are specific to the penis and erections. They include:

  • Arteriography: An imaging test in which dye is injected into the artery that the doctor believes is blocked.

  • Combined intracavernous injection and stimulation (CIS): The penis is stimulated via injection or through sexual stimulation to see if an erection occurs.

  • Nocturnal tumescence (NPT): This test measures erections that may occur while asleep. 

  • Penile biothesiometry: Electromagnetic vibrations are sent to the penis to measure nerve function.

  • Vasoactive injection: Medication is injected into the penis to see if the arteries dilate (open).

What are the treatments for erectile dysfunction?

Erectile dysfunction treatment depends on the cause. Although urologists are the specialists most likely to see and treat erectile dysfunction, any number of specialists may become involved, depending on the nature of the problem.

Here are some of the available erectile dysfunction treatments:

Medications:

  • Oral drugs, such as sildenafil, tadalafil, vardenafil, and avanafil

  • Penile injections prior to sex

  • Testosterone replacement

  • Urethral suppositories

Implants and other devices: 

  • Inflatable penile prosthesis: This is a pump inserted into the penis, along with a small reservoir of saline solution implanted under the abdominal wall or in the scrotum. When someone wishes to have an erection, they trigger the pump, which releases the fluid to inflate the tube inside the penis. The tube can then be deflated after sexual activity.

  • Semi-rigid prosthesis: A semi-rigid prosthesis has a more solid shape than an inflatable prosthesis because it contains a semi-rigid rod that can be adjusted as needed. However, it means the penis is never completely flaccid.

  • Vacuum pump: This is a non-invasive treatment for ED. A cylinder is placed over the penis and a pump pulls air away to create a vacuum, causing the penis to swell.

Psychological therapies:

  • Couples therapy

  • Medications to manage depression or anxiety

  • Sex therapy

  • Talk therapy

Home remedies for erectile dysfunction

Home remedies are not proven to treat erectile dysfunction, but there are suggestions that some herbs and supplements may help. If you choose to take a supplement, discuss this with your healthcare provider as supplements of any kind could interact with medications and other supplements you may use. Those suggested as helpful for erectile dysfunction include:

  • Dehydroepiandrosterone (DHEA), a hormone taken as a supplement 

  • Ginseng

  • L-arginine, an amino acid found in protein-rich foods

     

Some men find help with complementary treatments, such as acupuncture.

How does erectile dysfunction affect quality of life?

Erectile dysfunction is not a serious medical condition that causes harm to someone’s physical health, but it can produce emotional strain and affect quality of life. Effects of ED include:

  • Anxiety

  • Depression

  • Feelings of inadequacy and low self-esteem

  • Inability to impregnate a partner

  • Relationship problems

Speaking with a mental health professional can help men cope with the emotional and psychological effects of erectile dysfunction.

What are the potential complications of erectile dysfunction?

Other than not being able to participate in sexual activity, there are few complications related to not being able to have sex due to erectile dysfunction. However, there are some potential complications associated with some ED treatments. They include:

  • Implant failure

  • Infection from surgery

  • Pain from injections and/or surgery

  • Side effects from medications

Was this helpful?
5
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Oct 6
View All Erectile Dysfunction Articles
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Erectile dysfunction. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776
  2. Erectile Dysfunction. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10035-erectile-dysfunction
  3. Erectile Dysfunction. Johns Hopkins. https://www.hopkinsmedicine.org/health/conditions-and-diseases/erectile-dysfunction
  4. Rew KT, Heidelbaugh JJ. Erectile Dysfunction. Am Fam Physician. 2016 Nov 15;94(10):820-827.
  5.  https://www.aafp.org/afp/2016/1115/p820.html
  6. Penile Implants. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/penile-implants/about/pac-20384916 
  7. Vacuum Constriction Devices. Cleveland Clinic. https://my.clevelandclinic.org/health/drugs/10053-vacuum-constriction-devices 
  8. Dietary supplements for erectile dysfunction: A natural treatment for ED? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/in-depth/erectile-dysfunction-herbs/art-20044394