Erectile Dysfunction: Symptoms, Causes & Treatments
Reviewed by Vicky Davis, FNP
Written by Our Editorial Team
As a man, it’s normal to occasionally have trouble getting or maintaining an erection. However, if you frequently find it difficult to get an erection or to maintain a firm enough erection to have sex, you might have erectile dysfunction (ED).
ED can vary in severity from a mild, temporary issue that gets in the way of pleasurable sex to a serious one that stops you from having sex at all. A diverse range of factors can all play a role in its development, including your physical and psychological health.
The good news is that erectile dysfunction is almost always treatable, generally with medication, therapy or changes to your lifestyle.
Below, we’ve explained what erectile dysfunction is, as well as the symptoms you may develop if you’re affected by ED.
We’ve also discussed the most common causes of erectile dysfunction, as well as the process your healthcare provider may use to diagnose this condition.
Finally, we’ve covered the treatment options that are available for ED, from erectile dysfunction medications to exercises, healthy habits and more.
What is Erectile Dysfunction?
Erectile dysfunction is the inability for a man to get and maintain an erection that’s firm enough to have penetrative sex. ED is also referred to as impotence, but the term “impotence” is used less often when referring to this common condition.
Erectile dysfunction affects around 30 million men in the United States and hundreds of millions worldwide. According to data from the Massachusetts Male Aging Study (MMAS), 52 percent of men aged between 40 and 70 have mild to moderate ED.
Although the term “ED” is often associated with a complete inability to get an erection sufficient fox sex, the reality of erectile dysfunction is that it can vary hugely in severity.
You may have ED if you:
Can get a normal erection, but find it difficult to maintain it during sex
Find it difficult to get an erection every time you want to have sex
Can’t get an erection at all, even when you’re sexually stimulated
Our guide on how to know if you have ED goes more into detail about common signs that you’re affected by erectile dysfunction. For some men, ED is a short-term problem that happens every now and then. For others, it may be a long-term issue that develops over the course of years or decades.
Erectile dysfunction can occur for a variety of reasons. Sometimes, a psychological issue such as stress or feelings of guilt can trigger ED. In other cases, ED can be a sign that you may also have an underlying physical health problem.
Certain habits, such as your use of tobacco products, medications or alcohol can also contribute to erection issues and make it harder for you to maintain a fulfilling sex life.
When ED occurs at a bad moment, it can hurt your self-confidence. Luckily, erectile dysfunction is one of the easiest forms of sexual dysfunction to treat, either with FDA-approved medications, non-pharmaceutical treatments or a mix of both.
How Erections Work
While getting an erection may seem simple, like many other bodily functions, it’s actually kind of amazing.
From a physical standpoint, your penis grows in size when you’re sexually aroused as the result of a complex sequence of events and balancing act that involves your nervous system, vascular system and — you guessed it — the erectile tissue of your penis.
Here’s what’s going on:
Inside your penis, there are two erectile chambers called the corpora cavernosa. These areas of soft tissue run along the left and right sides of your penis, extending all the way from your pelvis to the head of your penis (the glans penis).
When you’re sexually aroused due to physical or mental stimulation, your brain initiates an erection by sending chemical messages to the penis. This causes the muscles of the corpora cavernosa to relax and allows blood to flow in via the penile arteries.
One particular chemical (cyclic GMP/cGMP) relaxes the corpora cavernosa and allows blood to flow into the base of the penis. As blood flows into the soft tissue of the penis, it expands and becomes firmer.
As the penis expands, a fibrous membrane called the tunica albuginea wraps around the corpora cavernosa, stopping blood flow from flowing out of the penis and maintaining the erection during sex.
Following orgasm and ejaculation, the process occurs in reverse. The muscles inside the penis start to contract, stopping blood flow into the tissue and promoting blood flow back into the circulatory system.
Like many other bodily functions we often take for granted, this process happens entirely behind the scenes while you’re focused on, well, more interesting things going on in front of you.
Erections can last from less than one minute to one hour or longer. Our guide to how long your erection should last goes into more detail about the process of developing an erection, as well as steps that you can take to maintain your erections for longer.
Symptoms of Erectile Dysfunction
The most common symptom of erectile dysfunction is exactly what you’d expect — difficulty with getting and/or maintaining an erection during sexual activity. If your ED is persistent, it may also cause mental symptoms, such as reduced confidence and less interest in sexual activity.
Below, we’ve listed several of the most common symptoms of ED, as well as how each one may affect you.
Difficulty Getting an Erection
One of the most obvious signs of ED is difficulty getting an erection. You might find it difficult to get hard, even if you’re in the mood for sex. In some cases, you might find it challenging to get any erection, while in others you may find it difficult to get a firm enough erection for sex.
Difficulty Maintaining an Erection
In addition to making it difficult to get an erection, ED can involve difficulty keeping an erection during sexual intercourse.
Even if you can get an erection before sexual activity without much difficulty, you may find that it’s difficult to stay hard while you’re having sex. Even if you don’t fully lose your erection, you may notice that your penis becomes less firm during sexual intercourse.
This loss of penile firmness can affect your enjoyment of sex and may make it difficult to reach orgasm and ejaculate.
Loss of Interest in Sexual Activity
Because of its effects on sexual performance, erectile dysfunction can cause sometimes result in psychological problems, such as sexual performance anxiety, depression or a reduced level of interest in sex.
When ED is severe or persistent, it can also affect your relationships and contribute to reduced intimacy and an unfulfilled sex life.
Painful Penile Erections
Sometimes, erectile dysfunction can develop because of Peyronie’s disease, a health condition that involves a curve in the penis caused by scar tissue. When erectile dysfunction occurs with Peyronie’s disease, it can involve painful erections.
I Think I Have ED. When Should I See My Healthcare Provider?
If you’re worried about erectile dysfunction, it’s best to talk to your healthcare provider as soon as you experience multiple incidents in which you find it difficult to develop and/or maintain an erection during sex.
It’s especially important to talk to your healthcare provider if you’ve had persistent difficulty with erections that’s lasted for several months.
It’s common to deal with occasional issues maintaining an erection, especially if you’ve recently consumed alcohol or taken other medication prior to sex. If you find it difficult to get or maintain an erection once every few weeks or months, you may not have clinical ED.
However, it’s important to seek help if you frequently experience these symptoms. ED is highly treatable, and getting expert help early can help you to identify its cause and work out the most effective ED solution.
Erectile Dysfunction Causes
Erectile dysfunction can occur for a range of reasons. Sometimes, it’s caused by one or several physical problems that affect blood flow or nerve function. In other cases, it may be caused by a psychological issue that affects your self-confidence or sexual arousal.
Physical Causes of Erectile Dysfunction
Since erections depend on proper nerve function and healthy, consistent blood flow, a variety of physical issues can potentially cause ED. Physical causes of erectile dysfunction include:
Cardiovascular disease. Because blood flow plays such an important role in erections, common forms of heart disease such as coronary artery disease (CAD) are often linked to erectile dysfunction.
Hypertension (high blood pressure). Elevated blood pressure can damage your blood vessels and reduce blood flow throughout your body. This may cause or worsen erectile dysfunction.
Atherosclerosis (clogged arteries). When your arteries become clogged due to plaque buildup from high cholesterol, it can reduce blood flow. This can cause or worsen erectile dysfunction.
Diabetes mellitus. Erectile dysfunction is closely associated with diabetes. Both type 1 and type 2 diabetes may reduce blood circulation and nerve function, both of which are important for healthy erections.
Chronic kidney disease. Having kidney disease can significantly increase your risk of developing erectile dysfunction. Approximately 70 percent of men with end stage renal disease are affected by ED.
Hormonal imbalances. Some hormonal conditions, such as hypothyroidism (low levels of thyroid hormone) and hyperthyroidism (high levels of thyroid hormone) are associated with ED. Lower than normal testosterone levels may also play a role in sexual health issues such erectile dysfunction.
Multiple sclerosis (MS). Erectile dysfunction is common in men with multiple sclerosis, often as a result of neurological complications, psychological factors and side effects of some multiple sclerosis medications.
Metabolic syndrome. Research has linked ED with metabolic syndrome, a combination of diabetes, high blood pressure and obesity. Metabolic syndrome is associated with an elevated risk of heart disease and stroke.
Parkinson’s disease. Parkinson’s disease is linked with several sexual health problems in men, including a reduced level of sexual interest, ejaculation disturbances and erectile dysfunction.
Physical damage to the penis. Damage to the penis and surrounding area, whether it’s from prostate/bladder surgery, radiation therapy or injuries, can affect nerve function and blood flow and potentially cause erectile dysfunction.
Sleep disorders. Some sleep disorders, such as obstructive sleep apnea, are linked to erectile dysfunction. One study found that 51 percent of men with sleep apnea also had some degree of ED.
Medications. Some medications, including blood pressure medications, medications for prostate cancer therapy, prescription sleep aids, stomach ulcer medications and appetite suppressants, can cause or contribute to ED. Erectile dysfunction can also occur as a side effect of certain antidepressants, including several selective serotonin reuptake inhibitors (SSRIs) used to treat clinical depression, anxiety and other mental health disorders.
Psychological Causes of Erectile Dysfunction
Sexual arousal is both physical and psychological. When you’re feeling mentally unwell or under stress, you may find it harder to get an erection. Psychological causes of ED include:
Depression. Depression often causes sexual symptoms, including a reduced libido and difficulties feeling sexual aroused. If you have depression, you might find it more difficult to get an erection before and during sex.
Sexual performance anxiety. It’s normal to occasionally feel anxious about sex. When this anxiety is overly severe or persistent, it may affect your ability to feel aroused and/or get and maintain an erection.
Feelings of guilt about sex. You might find it harder to relax and achieve an erection if you feel guilty about certain types of sexual activity, or about engaging in sexual activity at all.
Relationship issues. If you’re going through relationship issues that affect your level of trust in or attraction to your partner, this could affect your sexual function and contribute to erectile dysfunction.
Pornography usage. Although the link between porn and erectile dysfunction isn’t quite crystal clear, some research suggests that problematic porn consumption could lead to a form of erectile dysfunction called porn-induced ED.
Our guide to the psychological causes of erectile dysfunction goes into greater detail about how the factors above may affect your erections and sexual performance.
ED treatments, delivered
No matter the treatment plan, the best place to start is somewhere.
Risk Factors for Erectile Dysfunction
Erectile dysfunction can potentially affect men of all ages and backgrounds. However, like with other medical conditions, certain factors may increase your risk of developing ED.
Common risk factors for erectile dysfunction include:
Age. Erectile dysfunction becomes more common with age. In one review, researchers noted that men have a roughy 40 percent chance of developing ED by age 40, with this risk increasing by 10 percent with each additional decade.
Obesity. Weight and erectile dysfunction are closely linked. Research shows that many men presenting with ED have a high BMI, and that your risk of developing ED increases by a substantial amount if you have high levels of body fat.
Tobacco use. Nicotine and other chemicals inside cigarettes, cigars and other tobacco products can damage your cardiovascular system. If you smoke, you have a higher risk of developing erectile dysfunction.
Alcohol consumption. While the occasional drink won’t harm your sexual functioning, consuming large amounts of alcohol or drinking on a regular basis may cause erectile dysfunction.
Recreational drug use. Both legal and illegal drugs can affect your sexual health and contribute to ED. For example, use of marijuana is linked to several sexual problems, including erectile dysfunction.
Lack of physical activity. You may have a higher risk of developing ED if you get little or no exercise. Living a sedentary lifestyle is also associated with other risk factors for ED, such as obesity and vascular disease.
Erectile Dysfunction Diagnosis
Medical professionals use a variety of methods to diagnose erectile dysfunction and determine the most effective impotence treatment option for you.
If you think that you have erectile dysfunction, it’s important to talk to a professional to receive an accurate diagnosis. You can do this by:
Talking to your regular healthcare provider
Scheduling an appointment with a specialist, such as a urologist
Talking to a healthcare provider about ED online
Discussing ED With Your Healthcare Provider
When you talk with a healthcare provider about ED, they’ll likely perform a physical examination and ask you certain questions about your sexual history and general medical history.
During your physical exam, your healthcare provider may check for signs of heart issues, weak blood flow or other physical issues that could cause or contribute to ED.
As part of the process of evaluation of erectile dysfunction, you may need to tell them:
How long you’ve been experiencing ED symptoms and how frequently these symptoms affect you
How confident you feel about your ability to get and maintain an erection during sex or masturbation
How often you can maintain your erection during penetrative sex
How often you’re able to enjoy satisfying, fulfilling sex with your partner
Whether or not you frequently wake up with an erection (morning wood)
If you currently use, or have recently used, any medications that may affect your erectile health and/or sexual performance
If you currently use, or have recently used, any illicit drugs
If you smoke cigarettes, use other tobacco products or drink alcohol frequently
If you have any underlying conditions that may affect your cardiovascular health
If you’ve ever undergone surgery that may affect your blood flow or nerve function
It’s important that you provide accurate, detailed information to your healthcare provider, even if it initially feels embarrassing to talk about your erections and sexual performance.
Remember that your healthcare provider’s goal is to provide an accurate diagnosis and helpful, effective treatment. Giving accurate, thorough information helps your healthcare provider in the assessment of erectile dysfunction and makes issues with diagnosis less likely.
The more information you can give, the better your healthcare provider will be able to suggest an effective treatment that improves your erections and sexual performance.
Tests for Erectile Dysfunction
Your healthcare provider may be able to diagnose you with erectile dysfunction based solely on the information you provide in response to their questions.
However, in some cases, you may need to take one or several erectile dysfunction tests to give your healthcare provider more information about your symptoms and general health.
These tests may reveal the potential causes of your erectile dysfunction, or simply provide more information about your erectile health and sexual performance.
Several different tests are used to diagnose erectile dysfunction. These include:
Blood tests. Your healthcare provider may request a blood sample for testing. This will be sent to a lab, where it will be analyzed for any signs of underlying medical problems that may affect your erectile health. Blood testing can often reveal treatable health issues that may contribute to ED, such as atherosclerosis (clogged arteries), chronic kidney disease, diabetes and hormonal health issues.
Ultrasound scan. If your healthcare provider suspects that your ED is related to a blood flow issue, they may suggest that you undergo an ultrasound scan to analyze the flow of blood into and out of the erectile tissue of your penis. The type of test is performed using a handheld ultrasound device. You may need to use medication before this test to ensure that you can develop an erection.
Intracavernosal injection (injection test). This type of test involves injecting your penis with a medication to see if it’s possible for you to get an erection. A medical professional may monitor how firm your erection is and how long it lasts. This type of test may reveal physical health issues that prevent you from developing and maintaining an erection.
Nocturnal erection test. Often referred to as a nocturnal penile tumescence (NPT) test, this test involves wearing a device around your penis while you sleep to check if you can develop an erection during the nighttime. It’s common to get three to five erections per night. This type of test can help to provide information about whether your ED is caused by a physical or psychological issue. Although it’s far from perfect, you can carry out a basic version of this test at home using paper or postage stamps by following the instructions in our guide to self-testing for ED.
Most of these tests are performed in your healthcare provider’s office. You may need to perform several tests to help your healthcare provider accurately diagnose erectile dysfunction and work out the most effective form of treatment.
Erectile Dysfunction/Impotence Treatment Options
Although erectile dysfunction can be a frustrating issue when it occurs, it’s usually an easy one to treat.
To treat ED, your healthcare provider will look at your symptoms and the potential cause of your erectile dysfunction. Based on your needs, they may prescribe ED medication, suggest therapy or recommend a combination of different treatment approaches.
Erectile Dysfunction Medication
Erectile dysfunction is typically treated with oral medication. Currently, there are several drugs for ED that have received approval from the FDA. The most common are sildenafil (the active ingredient in Viagra®), tadalafil (Cialis®), vardenafil (Levitra®) and avanafil (Stendra®).
These medications belong to a class of drugs called PDE5 inhibitors, which work by increasing blood flow to the tissue inside your penis. This makes it easier to get an erection after sexual stimulation. Currently, all are prescription medications.
All of these medications are common first-line treatment options for ED. However, there are a few key differences between them that may make one a better choice for you than others:
Sildenafil is the most widely-used ED medication on the market. It’s been available since 1998 and is sold as a generic medication or as Viagra. It starts to work in approximately one hour and provides relief from ED for approximately four hours per dose.
Vardenafil is a short-acting ED medication that’s available as a generic medication or as Levitra. It has similar effects to sildenafil and usually starts to work in one hour, but has a slightly longer-lasting effect within your body.
Avanafil is a newer, more selective ED medication. It begins working in 15 to 30 minutes and is less likely to cause side effects than older medications for ED. Currently, avanafil is only available under the brand name Stendra.
Oral PDE-5 inhibitors are safe, effective options for the treatment of erectile dysfunction in most men. However, they can cause side effects. Our complete guide to Viagra side effects goes into more detail about what to expect, and what to be aware of, before using these medications.
We offer several erectile dysfunction medications online, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate.
Psychological ED Treatment
Erectile dysfunction isn’t always caused by physical factors. From depression to anxiety, many cases of erectile dysfunction have their root in mental health issues that can affect the way you think and feel about sex.
Some mental health disorders may also weaken your sexual desire, which may have additional effects on your sexual response and performance.
If your erectile dysfunction is linked to a psychological issue, there are several treatment options that may be effective. These include:
Sex therapy. This is a specialized form of counseling that’s intended to help people with sexual difficulties overcome them. Some research suggests that sex therapy may help to treat psychological ED.
Cognitive-behavioral therapy (CBT). This type of therapy involves learning techniques to change thought patterns and behavior. It’s sometimes combined with techniques used in sex therapy to treat issues such as erectile dysfunction.
Counseling. When erectile dysfunction is caused by anxiety or depression, talking with a therapy provider may help. You can take part in counseling locally or from your home with our online therapy services.
Other ED Treatments
In addition to medication and therapy, other forms of treatment for erectile dysfunction can often produce benefits. These include:
Vacuum erection devices. Vacuum devices create an erection by pulling blood into the tissue inside your penis. You’ll typically need to use this type of device with a cock ring — a device that fits around the base of your penis — to maintain your erection during sex.
Alprostadil. Alprostadil is an injectable treatment for ED. It works by causing blood to flow into the penis. The effects of alprostadil are instant, making it a fast and effective option for when oral drugs for ED don’t work.
Penile implants. Also known as a penile prosthesis, an inflatable implant can be placed inside the penis to help create an erection. This type of device is installed surgically by a urologist or other medical professional.
Surgical treatment. If your ED is caused by arterial damage that causes venous outflow or a blockage, it may need vascular surgery. Surgery for ED is generally only used when prescription drugs and other medical treatments aren’t effective.
Topical ED creams. Creams are one of several future treatment options for ED that are currently being studied. One cream, called Vitaros®, is sold as a prescription medication in the UK but has yet to receive FDA approval in the United States.
Testosterone replacement therapy (TRT). If you have low testosterone levels that are affecting you sex drive, erections and sexual functioning, your healthcare provider might prescribe testosterone. Our guide to testosterone replacement therapy goes into more detail about testosterone treatments, as well as their potential side effects and safety risks.
Erectile Dysfunction Prevention
Changing your lifestyle and habits can help prevent erectile dysfunction. If you already have ED, making healthy changes to your lifestyle may also improve your symptoms and help you to have a normal sex life without the use of medication.
You can reduce your risk of erectile dysfunction by:
Quitting smoking. Smoking can damage your cardiovascular system and increase your risk of experiencing ED. It can also make you more likely to develop other health issues, including heart disease and cancer. If you smoke, try to quit.
Eating a balanced diet. Eating a healthy diet helps to keep your blood pressure in the normal range, which can help to reduce your risk of ED. Try to limit your intake of foods high in simple sugars, saturated fats and sodium while prioritizing healthy ingredients.
Limit your alcohol consumption. It’s okay to enjoy a beer, glass of wine or cocktail on occasion. However, excessive drinking can contribute to ED. Try to limit your intake of alcohol to one or two small servings per day.
Avoid using illicit drugs. Many recreational drugs can affect your sexual performance, health and function. For example, some drugs may affect your ability to become aroused or contribute to psychological issues that can cause ED.
Keep yourself physically active. Working out improves your sexual function by making your heart stronger and improving blood flow. Try to spend at least 30 minutes exercising on a daily basis, even if it’s just a quick walk or bike ride around your neighborhood.
Our guide to naturally protecting your erection shares other techniques that you can use for the management of erectile dysfunction.
Learn More About Treating Erectile Dysfunction
Erectile dysfunction is a common issue. Luckily, it’s also a treatable one. By taking action early and talking to your healthcare provider, you can treat erectile dysfunction and enjoy a fulfilling, satisfying sex life.
Interested in learning more about erectile dysfunction? Our guides to the most common erectile dysfunction medications, the main causes of erectile dysfunction and talking about ED with your partner cover three important aspects of treating ED.
You can also access FDA-approved ED medications online via our telehealth platform following a consultation with a licensed healthcare provider.