Erectile dysfunction

Erectile dysfunction, or ED, is the inability for a man to get and/or maintain an erection firm enough for sex. Most men have problems with erections from time to time, but ED that happens routinely is not normal – and can be treated. Erectile dysfunction can also be a sign of serious underlying medical conditions that require treatment as well.

Senior couple enjoying one another's companySenior couple enjoying one another's companyMan talking to provider

What are the causes and risk factors for erectile dysfunction (ED)?

ED can be caused by health problems, emotional issues or both.

Some known risk factors are:

  • Age: being over 50.
  • Cardiovascular disease.
  • Diabetes and high blood sugar.
  • High blood pressure.
  • High cholesterol.
  • Lack of exercise.
  • Obesity.
  • Smoking.
  • Using drugs or drinking too much alcohol.

ED can indicate other health problems. Your primary care provider can help.

ED can be an early sign of a more serious health problem, so your primary care provider will evaluate you for possible physical and emotional causes.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, part of the U.S. Department of Health and Human Services and the National Institute of Health, the following diseases and conditions can cause ED:

  • Type 2 diabetes. Men who have diabetes are two to three times more likely to develop ED than men who do not have diabetes.
  • Heart and blood vessel disease.
  • Atherosclerosis.
  • High blood pressure.
  • Chronic kidney disease.
  • Multiple sclerosis.
  • Peyronie’s disease.
  • Injury from treatments for prostate cancer, including radiation therapy and prostate surgery.
  • Injury to the penis, spinal cord, prostate, bladder or pelvis.
  • Surgery for bladder cancer.
  • Taking certain medicines. ED can be a side effect of many common medicines, including blood pressure medicines, antiandrogens, antidepressants, tranquilizers, appetite suppressants and ulcer medicines.

Psychological or emotional factors may make ED worse, and you may develop ED if you have one or more of the following:

  • Fear of sexual failure.
  • Stress about sexual performance or guilt about certain sexual activities.
  • Anxiety.
  • Depression.
  • Low self-esteem.
  • Stress in your life in general.

What are the symptoms of erectile dysfunction (ED)?

(and when to see your primary care provider)

Typical symptoms include:

  • Trouble getting an erection.
  • Trouble maintaining an erection.
  • Reduced sexual desire.

You should talk to your doctor if you are experiencing these symptoms, especially if you:

  • Are experiencing other sexual problems like premature or delayed ejaculation.
  • Are having problems with your self-esteem and emotional health, or with your relationship with your partner.
  • Have diabetes, digestive and kidney diseases, or heart disease.

How is erectile dysfunction (ED) diagnosed?

A physical exam and medical history review are often enough for a doctor to diagnose and suggest possible treatment options for erectile dysfunction. However, if you have chronic health conditions or there is suspicion of an underlying cause, further tests or consultation with a specialist may be necessary. Tests may include:

  • Physical exam. Thorough examination of the penis, testicles and assessment of nerve sensation.
  • Blood tests. Laboratory analysis of a blood sample to check for signs of heart disease, diabetes, low testosterone levels and other health conditions that may contribute to ED.
  • Urine tests (urinalysis). Similar to blood tests, urine tests are conducted to detect signs of diabetes, kidney disease or a testosterone deficiency, all which can potentially cause ED.
  • Ultrasound. Usually performed by a specialist, this test utilizes high frequency sound waves to generate a video image that helps the doctor evaluate if there are blood flow problems within or to the penis.
  • Psychological exam. Your doctor may ask questions to assess potential psychological causes of erectile dysfunction, such as depression.

These diagnostic procedures assist in identifying underlying factors and guide appropriate treatment strategies for erectile dysfunction.

What are the treatment options for erectile dysfunction (ED)?

Your primary care provider will develop a personalized treatment plan based on any underlying conditions and your overall health. Treating ED is based on taking care of your heart and vascular health, and directly treating the symptoms of ED with proven products and procedures.

Your plan will help you address any risk factors, and may include one or more of these safe treatments:

  • Phosphodiesterase type 5 inhibitors (PDE5 inhibitors). Oral pills that increase penile blood flow, including Viagra (sildenafil citrate), Levitra (vardenafil HCl), Cialis (tadalafil) and Stendra (avanafil). You would take a pill an hour or 2 before having sex.
  • Testosterone therapy. Used in cases where low testosterone is at fault. May be combined with PDE5 inhibitors.
  • Vacuum erection device. Causes an erection that can last for up to 30 minutes. With proper training, 75 out of 100 men can get a working erection.
  • Alprostadil – Intracavernosal route (ICI) or Urethra route (IU) therapies. Can be prescribed if PDE5 inhibitors don’t work. With ICI, alprostadil is self-injected into the side of penis with a very fine needle. With IU therapy, your provider places a tiny medicated pellet of the drug in your urethra.
  • Surgical penile implants. A surgeon inserts a penile implant, or penile prosthesis, in your penis. There are 2 types:
    • Semi-rigid implant (bendable). The simplest kind, made from 2 easy-to-bend rods that are usually made of silicone.
    • Inflatable implant. Fluid-filled cylinders are placed lengthwise in the penis, with tubing joining them to a pump placed inside the scrotum. When the pump is engaged, pressure in the cylinders inflate the penis and makes it stiff.
  • Surgery to bypass penile artery damage. Used for younger men who have suffered severe pelvic trauma.

Lifestyle changes and home remedies for ED

You can prevent and treat ED with some simple steps:

  • Exercise. Can help you increase blood flow, lose weight and treat some underlying conditions.
  • Get treatment for alcohol or drug problems.
  • Lose weight, if appropriate.
  • Quit smoking. If you have trouble quitting, your primary care provider can help.
  • Therapy for relationship issues. Relieving emotional stress can help more than just ED.

FAQs about erectile dysfunction

How common is erectile dysfunction?

Approximately 1 in 10 men suffer from long-term erectile dysfunction. The prevalence of erectile dysfunction often increases with age, but can occur at any stage of life.

What causes erectile dysfunction?

Erectile dysfunction can be caused by various physical, psychological, or lifestyle factors. Common physical causes include cardiovascular disease, diabetes, hormonal imbalances, obesity, and certain medications. Psychological causes may include stress, anxiety, depression, or relationship issues.

Can erectile dysfunction be cured?

Erectile dysfunction can often be effectively treated, allowing for improved sexual function. While a complete cure may not always be possible, various treatment options such as medications, lifestyle changes, therapy, and medical interventions can significantly improve erectile function and restore sexual performance for many individuals.

Is erectile dysfunction preventable?

While it may not always be preventable, adopting a healthy lifestyle can help reduce the risk of erectile dysfunction. Maintaining a balanced diet, regular exercise, avoiding smoking and excessive alcohol consumption, and managing stress can contribute to overall sexual health.

Can medications cause erectile dysfunction?

Yes, certain medications can contribute to erectile dysfunction in some cases. These may include antidepressants, blood pressure medications, ulcer medications, antipsychotics, muscle relaxants, and medications that affect hormone levels. If you suspect your medication is causing ED, consult with your healthcare provider.

Are there any natural remedies or supplements for erectile dysfunction?

Some natural remedies and supplements have been suggested to help with erectile dysfunction. However, their effectiveness is often not well-established, and they may not be regulated or safe. It’s important to consult with a healthcare professional before using any natural remedies or supplements.

Can erectile dysfunction affect relationships?

Yes, erectile dysfunction can have a significant impact on relationships. It may lead to feelings of frustration, embarrassment, and decreased sexual intimacy. Open communication, support, and seeking professional help can help couples navigate these challenges and find solutions together.

Is erectile dysfunction a sign of an underlying health condition?

Yes, erectile dysfunction can sometimes be an early warning sign of an underlying health condition. It is particularly associated with cardiovascular disease, diabetes, high blood pressure, and hormonal imbalances. If you experience persistent or recurrent ED, it’s important to consult with a healthcare professional to rule out any potential underlying health issues.


The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Symptoms & Causes of Erectile Dysfunction (

MedlinePlus: National Library of Medicine. Erectile Dysfunction (

Family Doctor – The American Academy of Family Physicians: Erectile Dysfunction (