What Is Erectile Dysfunction (ED)? Symptoms, Causes, Diagnosis, Treatment, and Prevention

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.

There are many causes of ED. Sometimes the culprit is another health issue, including heart disease and diabetes.

Understanding the signs and causes of ED is the first step toward achieving a better sex life. (1)

If you have ED, you might experience: (2)

• Trouble getting an erection
• Trouble keeping an erection for a long enough period of time
• Reduced sex drive
• Feelings of embarrassment or guilt
• Low self-esteem

Symptoms of Other Sexual Disorders

Some sexual disorders are related to ED and may cause similar symptoms to ED, such as: (3)

• Premature ejaculation (ejaculating too soon)
• The inability to have an orgasm after sufficient stimulation
• Delayed ejaculation (when ejaculation takes too long)
  

An erection occurs when blood fills the penis. Normally, when a man becomes sexually aroused, blood vessels, muscles, nerves, and hormones work together to create an erection. Symptoms of ED can occur when this process is disrupted.

Some men experience symptoms only occasionally. For others, the symptoms are constant and interfere with their sexual relationships.

ED is a complex condition that can be caused by a variety of factors. Often, there’s more than one issue that’s responsible for ED. (2)

Physical Causes

Other medical conditions can cause ED symptoms. Common physical causes include: (1)

• Heart disease or atherosclerosis (inflammation and narrowing of the arteries)
• High blood pressure
• High cholesterol
• Obesity
• Diabetes
• Stroke
• 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)
• Parkinson’s disease
• Multiple sclerosis (MS)
• A brain or spinal cord injury
• Chronic kidney disease
• Nerve disorders
• Hypogonadism (a condition in which the body doesn’t make enough testosterone)
• 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

Certain prescription medicines can cause ED, too. These may include: (2)

• Diuretics (pills that increase urine flow and reduce blood pressure)
• Antihistamines (including H1- and H2-receptor antagonists)
• Antidepressants
• Parkinson’s disease drugs
• Antiarrhythmics (drugs for irregular heartbeat)
• Tranquilizers and sedatives
• Muscle relaxants
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Hormones
• Chemotherapy medications
• Prostate cancer drugs
• Anti-seizure 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

Psychological factors that may lead to ED include: (1)

• Depression
• Anxiety
• Other mental health disorders
• Stress
• Feeling self-conscious or nervous about sex
• Relationship problems

Often, psychological problems accompany medical conditions.

The Role of Hormones in Erectile Dysfunction

Sometimes, ED happens when your hormones are out of balance. Your doctor may perform a blood test to check your hormones.

Other Factors to Consider Regarding ED

ED can also be caused by tobacco or alcohol use.

Additionally, surgeries or procedures that target the spinal cord or pelvic area can lead to ED. Radiation therapy to the testicles can also cause impotence. (1)

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

But if underlying conditions are a suspected cause for your ED, you may need certain tests, such as: (1)

• 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.
• Psychological Exam Your doctor might screen you for depression or another mental health disorder that could be linked to ED symptoms.

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 all the medications you take
• If you have any other health conditions
• If you drink alcohol or use tobacco products

Additionally, it’s a good idea to share any life changes or stressors that could be affecting your mental health, such as the death of a loved one, a job change, the birth of a child, or trouble in your relationship. Also discuss any recent weight gain.

RELATED: Learn More About Diagnosing Erectile Dysfunction: Tests and Screenings, Early Diagnosis, and Your Doctors 

Prognosis of Erectile Dysfunction

The prognosis for men with ED is generally favorable.

While many cases of ED are caused by medical conditions that can’t be cured, various treatment options can help restore sexual function.

ED that’s caused by psychological factors, hormone issues, or injuries to the penis can usually be effectively treated. (4)

The duration of ED depends on what causes it and how you respond to your treatment. Many men notice an immediate improvement when they start on medication or another form of treatment. (4)

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, including:

• Oral Drugs Popular medicines like sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) work by boosting the effects of nitric oxide — a chemical that relaxes muscles in the penis. Note that 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).
• Injections Some medicines can be injected or placed inside the penis to help create an erection.
• Testosterone Your doctor may recommend that you take this hormone if your levels are very low. (1)

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 an elastic ring that helps you maintain an erection.

Surgery is also an option for some men with ED. During this procedure, doctors place penile implants in the penis. There are different types of procedures, depending on your goals and preferences. (1)

Counseling and Therapy

Often, men with ED benefit from talking to a therapist, especially if they suffer from depression, anxiety, or low self-esteem. If relationship problems are a factor, couples therapy may be useful. (1)

Alternative and Complementary Therapies

Many supplements and alternative therapies are marketed with claims to help men with 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.

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

Other alternative therapies that may help reduce stress, and in turn, ease ED symptoms, include: (1)

• Acupuncture
• Massage
• Meditation
• Yoga
  

RELATED: Learn More About Treatment for Erectile Dysfunction: Medication, Alternative and Complementary Therapies, Surgery Options, and More

Prevention of Erectile Dysfunction

Certain measures can help you lower your risk of ED. These include: (1)

• Eating a healthy diet
• Stopping smoking
• Losing excess weight
• Exercising daily
• Maintaining normal blood pressure and cholesterol levels
• Getting help for alcohol or drug addiction problems
• Learning about the side effects of medicines you take
• Considering couples counseling if you and your partner are having trouble communicating
  

ED can lead to complications, including: (2)

• Low self-esteem
• Stress
• Anxiety
• Relationship issues
• A lack of intimacy
• An unfulfilling sex life
• Inability to get your partner pregnant
  

According to the American Urological Association, ED affects as many as 30 million men in the United States. (2)

Studies show that about 5 percent of men have full-blown ED by age 40, and that percentage jumps to 15 percent for men by age 70.

Mild and moderate ED affects about 10 percent of men per decade of life. That means 50 percent of men in their fifties suffer, 60 percent of men in their sixties, and so on.

Older men are more likely to take medication for health problems, which could influence their risk. (5)

Many conditions are closely related to ED and may contribute to symptoms, including the following: (6)

• Heart disease
• Diabetes
• High blood pressure
• Depression
• Obesity
• Peyronie’s disease 
  

If you’re battling ED, you’ll want to arm yourself with credible information. Here are some of Everyday Health’s top resources.

Urology Care Foundation

Urology Care Foundation is an organization that supports and improves urological care by funding research, developing patient education, and pursuing financial support. They offer downloadable fact sheets and patient guides to help you understand ED.

Mayo Clinic

The Mayo Clinic is a go-to resource for data about ED. From diagnosis to treatment, this site can help you learn about your options when it comes to your sexual health.

National Institute of Diabetes and Digestive and Kidney Diseases

The NIDDK provides relevant and detailed information about ED, treatments, prevention strategies, and clinical trials.

American Association of Sexuality Educators, Counselors, and Teachers (AASECT)

The AASECT aims to promote the understanding of human sexuality and healthy sexual behavior. The organization certifies sex therapists and lets you search for professionals in your area.