Erectile Dysfunction

Medically Reviewed by Zilpah Sheikh, MD on May 21, 2024
10 min read

Erectile dysfunction (ED), also known as impotence, happens when you can't get or keep an erection of the penis that's adequate for the sexual satisfaction of both partners. While almost all men and people assigned male at birth (AMAB) have ED once in a while, at least 30 million American men have it regularly. Nearly all those who seek treatment for ED find some relief.

Erectile Dysfunction infographic

There are several types of ED. A doctor will try to find out which form is causing your symptoms before recommending a treatment. Some men may have more than one type of ED.

Vascular erectile dysfunction

An erection occurs when blood fills chambers in the penis, causing it to become firm. Vascular erectile dysfunction may happen if vessels that deliver blood to the penis become blocked or damaged. Some common causes of vascular erectile dysfunction include:

  • Clogged arteries. Having too much cholesterol and other gunk in your vessels — the same problem that can cause heart attacks — can slow blood flow to the penis.
  • Other diseases. High blood pressure, diabetes, and certain other diseases may cause vascular erectile dysfunction.
  • Side effects of treatment. Radiation and surgery for prostate cancer may damage blood vessels that deliver blood to the penis. Also, some treatments for diseases of the blood vessels can cause ED.
  • Long-distance bike riding. Long-term bike riding may damage the blood vessels (and nerves) needed to form an erection, but there is some controversy about this theory.

Neurogenic erectile dysfunction

While erections affect the penis, they are triggered by messages from the brain, which travel along nerves to the penis. ED can occur if those nerves are damaged or diseased. Some common causes of neurogenic erectile dysfunction include:

  • Stroke
  • Spinal cord trauma
  • Diseases such as multiple sclerosis and Parkinson’s disease
  • Cancers that affect the central nervous system
  • Surgery and radiation
  • Diabetes
  • Kidney or liver failure
  • Polyneuropathy (widespread nerve disease)

Hormonal erectile dysfunction

Hormones are chemical messengers in the body. Testosterone is a hormone made in the testicles that promotes male physical features and sex drive. If you have low testosterone levels, you may lack interest in sex, which can result in ED. Also, normal testosterone levels are necessary to maintain an erection.

Psychogenic erectile dysfunction

Some psychological problems can cause the body’s “fight or flight” response to become overly active, which may interfere with the work of nerves needed to cause an erection. Some causes of psychogenic erectile dysfunction include:

  • Performance anxiety (fear that you won’t satisfy your partner during sex)
  • Relationship problems
  • Feeling inhibited or shy about sex
  • Childhood sexual abuse
  • Fear of sexually transmitted diseases (STDs)
  • Widower's syndrome, a feeling of guilt some men have when forming a new relationship after a spouse dies

People with certain other psychological problems also have an increased risk for ED. For example, if you have depression, your risk for ED is 40% higher than someone who is not depressed.

In the past, doctors tended to blame erectile dysfunction on psychological problems or, with older men, on the aging process. Medical opinion has changed. While it takes longer to get aroused as you age, regular erectile dysfunction deserves medical attention. Also, the problem isn't usually psychological. Urologists now think physical problems contribute to most long-lasting cases of ED in men over 50.

Erectile dysfunction in older men

Erections mainly involve blood vessels. And the most common causes of ED in older men are conditions that block blood flow to the penis. These include hardening of the arteries (atherosclerosis) and diabetes. Another cause may be a faulty vein that lets blood drain too quickly from the penis. Other disorders, as well as hormonal imbalances and certain operations, may also cause ED.

The blood vessel processes that lead to an erection are controlled by your nervous system. Some medications can interfere with the nerve signals that make an erection happen. They include certain stimulants, sedatives, diuretics, antihistamines, and drugs to treat high blood pressure, cancer, or depression. But never stop taking a medication unless your doctor tells you to. Alcohol, tobacco, and illegal drugs, such as marijuana, may also contribute to ED.

Erectile dysfunction in younger men

In younger men, psychological problems are the most likely reason for ED. Poor communication with your partner, or differences in sexual preferences, can lead to tension and anxiety. The problem may also be linked to:

  • Depression
  • Fatigue
  • Stress
  • Feeling that you're not good enough
  • Sexual fears
  • Rejection by your parents or peers
  • Childhood sexual abuse

Having an alcoholic beverage can make you feel more relaxed, which helps some people get in the mood to have sex. However, alcohol is a sedative, so heavy drinking can make you too sleepy to perform. Drinking a lot of alcohol can also slow the flow of messages from the brain down the spinal cord. That’s why having too many drinks makes you clumsy, but it can also cause ED. Long-term, heavy drinking can also lower levels of testosterone, the male hormone, which is necessary to achieve and maintain an erection.

The symptoms of erectile dysfunction can vary from person to person. If you have ED, you might:

  • Be unable to get an erection at all
  • Get an erection sometimes
  • Have trouble keeping an erection long enough for sex
  • Lack desire for sex

When you see a doctor for ED symptoms, they'll try to find out whether you have another health condition that could cause the problem. They'll ask about your medical history, including questions about your sex life. You might have:

  • A physical. It will include an examination of your penis and testicles.
  • Blood and pee tests. These check for problems such as diabetes, heart disease, and low testosterone.
  • A mental health exam. This can reveal whether you have stress, depression, or other issues that could lead to ED.
  • An ultrasound. This allows your doctor to see whether blood flow problems are affecting your penis.

The treatment for your ED will depend on what's causing it, as well as what you and your partner think will work best. Your doctor can help you decide. Treatments include:

Medications. You take drugs such as sildenafil (Viagra), vardenafil (Levitra, Staxyn), and tadalafil (Cialis, Adcirca) as pills before you have sex. They work by increasing blood flow to your penis. This helps you get an erection once you're sexually excited.

Your doctor might prescribe testosterone if your levels of this hormone are low. It won't help if circulation or nerve problems cause your ED.

You can inject an ED medicine called alprostadil into your penis to help it fill with blood and quickly cause an erection. It's sometimes used in combination with other drugs. You may also insert alprostadil into your urethra (the small hole in your penis where urine comes out) as a suppository. That's a solid form of the medicine that gets dissolved by your body heat.

Lifestyle changes. Your doctor might suggest that you lose weight or start an exercise routine to improve your ED symptoms. They might also recommend that you stop smoking, drinking alcohol, or using marijuana or other drugs.

Counseling. If stress, depression, or relationship problems contribute to your ED, talking to a counselor could help.

Vacuum device. Also called a penis pump, this is a tube that fits over your penis. It includes a pump, which you use to suck air from the tube. This pulls blood into your penis to make it erect. You place an elastic ring around the bottom of your penis to keep it erect and take off the vacuum tube. After sex, you remove the ring to end the erection.

Surgery. Most men don't get surgery for ED. But in some cases, doctors will do an operation to repair your arteries to boost blood flow to your penis. Or they can implant a bendable or inflatable rod inside your penis that you adjust to make it erect.

You're more likely to develop ED if you have heart disease, high blood pressure, diabetes, and certain chronic diseases. Taking steps to avoid or manage these conditions effectively may help prevent ED. To minimize the risk for ED, try the following measures:

Eat a healthy diet. A 2020 study in JAMA Network Open found that men who ate lots of vegetables, fruits, nuts, legumes (beans, peas, and lentils), and fish but avoided red and processed meats had a reduced risk for ED.

Maintain a healthy weight. Obesity seems to increase the risk for ED, according to research.

Exercise regularly. Studies show that getting moderate or high levels of physical activity may reduce the risk for ED. Other research has found that men with ED who start working out regularly have improved erections.

Don’t smoke. Count avoiding ED as yet another reason to avoid tobacco and kick the habit if you smoke. One study found that smokers are 51% more likely than nonsmokers to have ED.

Watch your drinking. If you drink heavily, you're three times more likely to have ED than someone who never drinks alcohol.

Having an erection requires certain muscles around the lower abdomen to contract. These tissues, which are called pelvic floor muscles, can become weakened by diabetes and certain other diseases. Also, they may be damaged by surgery, such as a procedure to remove prostate cancer. Some research shows that toning these tissues with pelvic floor exercises (also called Kegel exercises) may help treat ED.

One study found that male patients with heart disease and ED who participated in a rehabilitation program that included Kegel exercises, in addition to increased physical activity and an educational component, improved their erections. On a scale of 5 to 25, with lower scores indicating ED, the men improved their scores by 6.7 points, on average.

Kegel exercises are easy to learn. First, identify your pelvic floor muscles. You can do that by making yourself stop midstream the next time you pee. Or pretend that you’re stopping yourself from passing gas. Both actions exercise the pelvic floor muscles. Be sure to only exercise the pelvic floor muscles, not your abs or other nearby muscles. You can do Kegel exercises standing, sitting, or lying down. Aim to do at least three sets of ten contractions a day.

Men who have difficulties with ED often experience another sexual problem, premature ejaculation (PE). When PE occurs, you are able to have an erection but ejaculate sooner than desired. By one estimate, 31% of men aged 18-59 experience PE at one time or another. Doctors believe that ED and PE may be linked. If a man or a person AMAB has had ED in the past, they may ejaculate quickly out of fear that they will quickly lose their erection.

There are various treatments for PE, including:

  • Counseling. Talking to a therapist may relieve anxiety or other psychological problems that are causing PE.
  • Behavioral therapy. A trained therapist can teach methods that help delay ejaculation.
  • Medication. Certain antidepressants may help overcome PE. Also, numbing creams and sprays can be applied to the penis to reduce sensitivity.

What’s more, getting effective treatment for ED can ease your anxiety about sexual performance, which often makes PE go away.

Having ED can cause serious problems in a romantic relationship. That’s because ED doesn’t just affect an individual — it’s often called a “couple’s disease.” Here are some ways to help support a partner with ED.

Talk. Your partner may be embarrassed about having ED, so getting the conversation started may be difficult. But it’s important to talk about the problem openly. Choose an appropriate time. Don’t raise the issue during or right after sexual intimacy.

Recommend treatment. There are effective therapies for ED, but shame and ego may keep some people from seeking them out. Do some research, learn about the options, and offer to accompany your partner to a doctor to discuss what might help. Counseling may be a good idea for some cases of ED. Again, offer to attend an appointment with your partner.

Encourage healthy behaviors. Eating a healthy diet, getting some exercise, and quitting smoking are good for all-around health and may help prevent ED.

Be creative. Snap out of your usual sexual routine and try some new ways to be intimate, such as longer foreplay and more touching.

Erectile dysfunction is a common condition. If you have ED, you are not alone. There are many treatments available for ED. Talk to your doctor about what option might work for you. There is a lot of evidence that lifestyle choices affect ED. A power outage below the belt is another good reason to eat nutritious foods, maintain a healthy weight, get some exercise, don’t abuse alcohol, and stay away from tobacco. ED can strain relationships. Teaming up with your partner to find a solution is the best strategy.

What is the usual age for erectile dysfunction?

ED can happen to any adult who has a penis, but the chances of having trouble in this department rise with age. That’s because conditions such as heart disease and diabetes become more common as you grow older. One large study found that by age 40, about 40% of men and people AMAB have ED compared to 70% of those age 70.

How do I deal with erectile dysfunction?

First, recognize that you have a very common problem. One large study found that over half of all men and people AMAB between ages 40 and 70 have had ED. Next, if ED has become a persistent problem, talk to a doctor. A variety of effective treatments are available.

Can I fix my ED naturally?

You may have seen ads or received email promotions for “natural” ED treatments. These products usually contain medicinal herbs, vitamins, minerals, and other dietary supplements that supposedly can fix erectile dysfunction. In fact, some of these supplements may help. For example, some natural ED therapies contain l-arginine, which could improve blood flow to the penis, a necessary step in forming an erection. But keep in mind that dietary supplements can cause side effects and may not mix well with other medicines you take. Talk to your doctor about any dietary supplement you use, for ED or any other reason.