Erectile Dysfunction: Causes, Symptoms, and Treatment

Medically Reviewed By Matt Coward, MD, FACS
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Erectile dysfunction (ED), formerly known as impotence, occurs when a person cannot achieve or maintain an erection. Many psychological and physical issues can cause ED. Treatments typically include medications, implants, and therapy. Although many males experience ED occasionally, frequent episodes could cause stress and relationship problems. According to the Urology Care Foundation, ED is the most common sex-related issue that males report to their doctors.

Read on to learn more about the causes, symptoms, and treatment options associated with ED.

Sex and gender terms

Sex and gender exist on spectrums. This article will use the term “male” to refer to a person’s sex assigned at birth.

What is erectile dysfunction?

A man waters plants
Ana Luz Crespi/Stocksy United

ED itself is not a serious medical condition, but it could be a symptom of an underlying disorder. For example, heart disease, diabetes, and some medications can cause ED.

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. The extra blood leaves the penis when the veins open, leaving it soft again.

With ED, blood flow may not harden the penis sufficiently.

What are the causes of erectile dysfunction?

Many psychological and physical issues can cause ED. The sections below look at some of these possible causes in more detail.

Psychological causes

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

  • insufficient sexual stimulation
  • performance anxiety
  • relationship stress

Physical causes

Many health issues can trigger ED. Some common physical causes include:

  • alcohol or drug use
  • diabetes
  • heart or vascular disease
  • hormone-related disorders
  • neurological disorders
  • obesity
  • prostate cancer surgery and treatment
  • side effects from certain medications, such as antidepressants, antianxiety drugs, or chemotherapy drugs
  • sleep disorders
  • smoking
  • injuries to the pelvic area or spinal cord

What are the symptoms of erectile dysfunction?

The main symptom of ED is the inability to achieve or maintain an erection. This may happen occasionally or frequently.

Seeking treatment may help prevent occasional ED from becoming more frequent and help detect an underlying disorder that may be causing it.

How do doctors diagnose erectile dysfunction?

Doctors can diagnose ED by assessing your symptoms along with your medical and sexual history. They may also need to run some blood tests to check for substance levels or assess organ function. These blood tests can check your:

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

Doctors can also perform a psychological exam, an ultrasound scan, and a urine test to help confirm the diagnosis.

Some tests are specific to the penis. For example, a penile Doppler ultrasound scan involves injecting the penis with a drug that causes an erection. A doctor then uses an ultrasound probe to measure blood flow in your penis.

You may also receive a vasoactive injection, which helps doctors determine if the arteries in your penis can dilate.

What are the treatments for erectile dysfunction?

ED treatment depends on the cause.

Although urologists are the specialists most likely to treat ED, other specialists may become involved depending on the nature of the problem.

Below are some of the available ED treatments.

Medications

Some common medications that can treat ED include:

  • certain oral drugs, such as sildenafil, tadalafil, and vardenafil
  • penile injections before sex
  • testosterone replacement
  • urethral suppositories

Implants and other devices

Your doctor may recommend implantable or external devices to treat ED, including:

  • 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 get an erection, they can trigger the pump, which releases the fluid to inflate the tube inside the penis. The person can then deflate the tube 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 that the penis is never completely flaccid.
  • Vacuum pump: This is a noninvasive treatment for ED. It involves placing a cylinder over the penis. A pump then pulls air away to create a vacuum, causing the penis to swell.

Psychological therapies

Psychological treatment options can include:

  • couples therapy
  • medications to manage depression or anxiety
  • sex therapy
  • talk therapy

Home remedies for erectile dysfunction

Home remedies are not proven to treat ED, but there are theories suggesting that certain herbs and supplements may help. If you choose to take a supplement, discuss it with your doctor first. Some supplements can interact with medications.

Some papers suggest that l-arginine, which is an amino acid present in protein-rich foods, may help treat mild to moderate ED. Some males may also benefit from certain complementary treatments, such as acupuncture.

What are the risk factors for erectile dysfunction?

There are many risk factors for ED. Some are adjustable or manageable, while others are not. The following sections look at some of these factors in more detail.

Adjustable or manageable risk factors

  • alcohol use
  • drug use
  • certain medical conditions 
  • anxiety or depression
  • obesity and overweight
  • smoking
  • hormone use for bodybuilding
  • certain prescription medications

Nonadjustable risk factors

  • 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 ED by avoiding certain risk factors, such as alcohol consumption, drug use, and smoking. You can also seek treatment for any physical or mental health conditions that could be contributing to ED.

If you suspect that the problem may be related to your medication, speak with your doctor or pharmacist. If ED is a side effect, ask if there is another drug you could take.

Be sure to follow your doctor’s treatment plan for any disease or condition.

It can be embarrassing to speak with your doctor about ED. However, it is important to remember that doctors have seen and heard about this condition many times before. It is very common, and there may be a simple solution.

How does erectile dysfunction affect your quality of life?

ED is not a serious medical condition that harms your physical health, but it can lead to emotional strain and affect your quality of life. Some effects of ED may include:

  • anxiety
  • depression
  • feelings of inadequacy and low self-esteem
  • an inability to impregnate a partner
  • relationship problems

Speaking with a mental health professional may help you cope with the emotional and psychological effects of ED.

What are the potential complications of erectile dysfunction?

The main complication of ED is not being able to participate in sexual activity.

There are also some potential complications associated with certain ED treatments, including:

  • implant failure
  • an infection related to surgery
  • pain from an injection or surgery
  • side effects from medications

FAQ

Below are a few more commonly asked questions about ED. Dr. Matt Coward has medically reviewed the answers.

What is the difference between erectile dysfunction and impotence?

Largely, people use the terms “ED” and “impotence” interchangeably. However, “ED” often implies the occasional inability to get or sustain an erection, while “impotence” often implies an inability to have an erection at all.

Is erectile dysfunction permanent?

ED is typically treatable with medications or surgery. Addressing the underlying causes of ED and implementing lifestyle changes can help you avoid the condition.

Can erectile dysfunction medications cause side effects?

There can be mild side effects associated with medications to treat ED. These can include headaches, a flushed face, or an upset stomach. A small percentage of males may also experience temporary disturbances to their vision, such as seeing the color blue in the background.

Can erectile dysfunction cause male infertility?

Although ED is not a direct cause of male infertility, the two conditions can result from similar causes. Male infertility typically occurs due to low sperm counts, sperm irregularities, or blockages in the delivery of sperm.

Summary

ED occurs when a male is unable to achieve or keep an erection. There are many reasons, both psychological and physical, that the penis may not harden sufficiently. Some of the most common causes include anxiety, diabetes, vascular conditions, and medication side effects.

ED itself is not a serious medical condition, but it could indicate an underlying disorder. Your doctor can diagnose the cause and determine the best treatment option.

If you are experiencing ED, talk with your doctor to discuss your options for lifestyle changes and treatments.

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Medical Reviewer: Matt Coward, MD, FACS
Last Review Date: 2022 May 23
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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.