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.

ED can have far-reaching effects

ED can cause stress, affect your self-confidence, and contribute to relationship problems.

ED is a very common problem with many proven treatment options, but it can be embarrassing to talk about, even with your primary care provider.

Ask your provider about proven ED treatments

ED is usually not permanent, so know that your provider is ready to help you treat your ED and any underlying conditions so you can put ED in the past.

Causes and risk factors for 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.

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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.

Symptoms of 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.

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Treatment options for 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.

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

MedlinePlus: National Library of Medicine. Erectile Dysfunction (