Erectile Dysfunction: Symptoms, Causes and Treatment

Erectile dysfunction, or ED, means trouble getting or keeping an erection firm enough for satisfying sex ^2,3. It can happen at any age, but becomes more common with age ^2,4.

ED is not a natural or unavoidable part of getting older ⁴. Repeated problems can point to a physical, emotional, or mixed cause ^2,3.

ED may also have blood vessel-related causes ^2,3. A medical review can find possible causes and guide safe care ^1,2.

This guide explains ED signs, causes, tests, treatments, and reasons to seek care.

ED involves ongoing or repeated problems with erections ⁶. The erection may not become firm enough, or it may end before sex is complete ^5,6.

An erection needs input from the brain, nerves, hormones, muscles, and blood vessels ^6,9. Problems in any of these areas can affect erection strength.

ED is sometimes called impotence ^4,8. However, ED is the more common medical term.

ED can affect self-esteem and add stress to close relationships. Some people feel embarrassed about raising the topic with a clinician ⁸.

Still, ED is common and can often be treated ^4,9. Treatment may target the cause, improve sexual function, or do both ¹.

Erection problems become more common as people age ^2,4. Health issues that develop with age can add to the risk ¹⁰.

For example, heart disease, diabetes, high blood pressure, and obesity become more common with age ¹⁰. Health conditions can contribute to ED ^3,10.

Erections may change with age ^8,10. Yet repeated erection loss should not be dismissed as aging alone ⁴.

ED symptoms can differ between people and situations. The main patterns include changes in erection strength, timing, or reliability.

Common signs may include the following patterns:

Difficulty getting an erection does not necessarily mean reduced sexual desire ⁶. However, low testosterone can affect both erections and interest in sex ⁶.

Other sexual problems can look similar to ED. A clinician can help separate erection trouble from other concerns.

An occasional erection problem is common ^6,9. It may go away with little or no treatment ⁶.

Stress, tiredness, frustration, or anxiety can affect an erection ⁸. Alcohol and other substances may also play a role ^5,8.

One difficult sexual experience does not always mean ED is present. Repeated or ongoing problems deserve a medical discussion ^4,7.

Morning and nighttime erections may give useful clues about the cause ⁶. A clinician should assess those clues with the rest of your history.

Symptoms may worsen with certain medications or substance use ¹⁰. Some people may need further evaluation ¹⁰.

ED often has more than one cause ^2,3. Physical and emotional factors can occur at the same time ^2,9.

Blood vessel disease is an important cause of ED ^2,3. The penis needs enough blood flow to become firm and stay firm ⁸.

Possible physical causes include these health conditions:

Peyronie’s disease involves scar tissue within the penis ^3,10. It may cause a curve and can occur with ED ^3,10.

ED may be a presenting sign of diabetes ^2,3. This link is especially important when the cause involves poor blood flow.

The penile arteries are smaller than many heart arteries. Blood flow problems may therefore affect erections before clear heart symptoms appear.

Vascular ED can appear before coronary disease, heart attack, or stroke. Cardiovascular risk factors linked to ED include high blood pressure and high cholesterol ^2,3.

Thoughts and emotions can cause or worsen erection problems ^5,9. They may act alone or occur with a physical cause ^2,3.

Possible mental and emotional factors include:

Fear of losing an erection can increase sexual pressure. Counseling can help lower anxiety and stress about sex ^1,7.

Many prescription and nonprescription medicines can affect erections ^5,8. The timing of symptoms may help show whether a medicine plays a role.

Medicine groups linked with ED include:

Do not stop or change a prescribed medicine on your own ¹. A clinician may adjust the dose or choose another medicine ¹.

Smoking is linked with heart and blood vessel disease ¹. Those diseases can lead to ED ¹.

Heavy alcohol use and recreational drugs may contribute to ED ⁵. Low activity levels may also increase the risk ⁵.

Excess weight may contribute to erection problems ². It can also raise the risk of diabetes and high blood pressure ¹.

Diagnosis often starts with a detailed conversation and physical examination. Testing then depends on the findings and possible causes ^2,7.

A clinician may evaluate an erection problem ⁶. Questions may cover whether erections occur during sleep and how long the trouble has lasted ⁶.

The clinician may ask whether erections occur during sleep or upon waking ⁶. This detail can offer clues about physical and emotional factors ⁶.

Other questions may cover:

A partner may join the discussion when the patient agrees ^2,3. The partner may offer another view of symptoms and treatment goals.

A focused examination can look for blood flow, nerve, hormone, or structural problems. It may begin with blood pressure and pulse checks.

The clinician may examine the penis and testicles. This can reveal plaques, a curve, infection signs, or changes in testicle size.

Body hair patterns and breast changes may offer hormone clues. A nerve examination can look for signs of brain, spinal cord, or nerve disease.

The clinician may also assess overall heart and blood vessel health. This matters because vascular disease is a common cause of ED ^2,3.

Selected tests can look for health problems linked with ED ^2,7. The right tests depend on your history and examination.

Possible laboratory tests include:

If testosterone is low, more hormone tests may follow ². These may include luteinizing hormone and prolactin tests ².

Not everyone needs advanced testing. More testing may help when the cause is unclear or symptoms are complex ^2,9.

Penile ultrasound uses sound waves to view blood flow in the penis. A clinician may first inject medicine that increases blood flow.

A nighttime monitor can record erections during sleep ⁶. The results may help separate physical and emotional causes ⁶.

An office injection test can show how the penis responds to increased blood flow ¹⁰. It may also help guide treatment choices ¹⁰.

Complex or treatment-resistant ED may need specialist assessment ². Lifelong or injury-related problems may also need more detailed care ².

ED treatment depends on the cause and the person’s goals. Health conditions and personal preferences also guide the choice.

Clinicians try to treat an underlying cause when possible ¹. Care may include lifestyle changes to help prevent diabetes and high blood pressure or improve testosterone levels ^1,2.

Daily health changes may improve erections and overall health ¹. Useful changes can include:

Exercise, healthy eating, and weight loss may improve erections for some people ². These steps also address several health risks linked with ED ^1,2.

PDE5 inhibitors are common oral ED medicines ¹. They improve blood flow into the penis ¹.

Examples include sildenafil, tadalafil, vardenafil, and avanafil ^6,7. These medicines require sexual stimulation to help produce an erection.

They differ in dose, duration, and possible side effects. Side effects may include headache, flushing, stuffy nose, or stomach upset.

These medicines are not right for everyone. A clinician should review heart health, blood pressure, and current medicines first.

Never combine a PDE5 inhibitor with a nitrate medicine. Nitrates include nitroglycerin and medicines used for chest pain.

This mix can cause very low blood pressure. Always tell the prescriber about every medicine and supplement you use ^1,3.

Counseling may help when stress, anxiety, or depression affects erections ^1,9. It can also help with relationship concerns ^1,6.

A counselor may help address emotional issues that affect ED ¹. Sessions may include a partner when that feels helpful ¹.

Sex therapy may be useful for performance fears or complex sexual concerns ^2,7. Mental health care may be considered for complex ED ^2,9.

A clinician may consider testosterone when testing shows a low level ^1,6. Low testosterone can make it difficult to get an erection ⁶.

Testosterone testing may be warranted in men with diabetes ^2,7. Testosterone is not described as a treatment for every case of ED ^1,6.

A vacuum erection device uses a tube and pump ¹. The device draws blood into the penis to create an erection ¹.

An elastic ring helps keep the erection in place ¹. The penis may feel cold or numb while using the device ¹.

Bruising can occur, though it often clears within days ¹. The device may weaken ejaculation without reducing orgasm pleasure ¹.

Injected medicine can raise blood flow and quickly cause an erection ¹. A clinician teaches the correct way to give the injection ¹.

Possible effects include mild bleeding or an erection lasting too long. Scar tissue may rarely form at injection sites.

Medicine can also be placed inside the urethra ^1,7. The urethra is the tube that carries urine out of the body.

Urethral medicine may cause burning or minor bleeding. A clinician can explain safe use and possible side effects ^1,7.

Most people with ED do not need surgery ¹. Surgery may be considered when other choices do not help enough ¹.

A penile implant can use an inflatable pump or a flexible rod ¹. A surgeon should explain the benefits and possible side effects ¹.

Artery repair may help some younger people with a specific blood flow injury ¹. It is not a general treatment for every case of vascular ED ¹.

Talk with a clinician before taking herbs or sexual performance supplements ^1,6. Supplements may interact with medicines or cause other problems ¹.

Do not order ED medicine online before getting medical advice ¹. Unsafe sources may sell products without proper medical review.

Shockwave, platelet-rich plasma, and stem cell treatments remain experimental. They are not ready for routine use outside suitable research studies.

If erection problems keep returning, schedule a medical appointment ⁸. Ongoing problems may point to a health condition needing care ^4,9.

A primary care clinician can begin the evaluation. The visit may lead to tests, treatment, or a specialist referral.

Arrange an assessment if ED occurs with diabetes or heart risks ⁸. New ED may be the first sign of vascular disease or diabetes ^2,4.

Penile curvature, pelvic surgery, or spinal cord injury may be linked to ED ^3,5. These details may help reveal hormone, tissue, or nerve problems ^3,5.

Some ED treatment effects need care right away:

Complex ED may need care from more than one specialist ². The type of specialist depends on the likely cause ².

A sexual medicine specialist may assess complex ED ². An endocrinologist may help with complex hormone problems ².

A cardiologist may assess unstable heart disease or major heart risks ². A mental health professional may address deep emotional or relationship concerns ².

A medication review can help identify drugs that may be causing ED ^1,7. Do not change prescribed treatment without medical guidance ¹.

Healthy daily habits may prevent ED or ease its symptoms ¹. Key steps include:

These steps support blood vessel health and erectile function ^1,2. They may also lower risks linked with heart disease and diabetes ^1,2.

ED is common and treatable ^4,9. It is not an unavoidable part of aging ⁴.

Repeated symptoms may involve blood vessels, nerves, hormones, medicines, or emotional health ^2,3. More than one cause may be present ^2,3.

This guide covered erectile dysfunction symptoms, causes, testing, treatment, and when to seek care. A medical review can identify causes and guide safer treatment choices ^1,2.