Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. It’s sometimes referred to as impotence, although this term is now used less often.
Occasional ED isn’t uncommon. Many men experience it during times of stress. Frequent ED, however, can be a sign of health problems that need treatment. It can also be a sign of emotional or relationship difficulties that may need to be addressed by a professional.
What causes an erection?
ED can occur because of problems at any stage of the erection process. An erection is the result of increased blood flow into your penis. Blood flow is usually stimulated by either sexual thoughts or direct contact with your penis.
When a man is sexually excited, muscles in the penis relax. This allows for increased blood flow through the penile arteries, filling two chambers inside the penis. As the chambers fill with blood, the penis grows rigid.
An erection ends when the muscles contract and the accumulated blood can flow out through the penile veins.
There are many possible causes of ED, and they can include both emotional and physical conditions. Common causes include:
- cardiovascular disease
- diabetes
- hypertension, or high blood pressure
- high cholesterol
- obesity
- low testosterone levels or other hormone imbalances
- kidney disease
- increased age
- stress
- anxiety
- depression
- relationship problems
- certain prescription medications, such as those used to treat high blood pressure or depression
- sleep disorders
- drug use
- consuming too much alcohol
- using tobacco products
- certain health conditions, such as Parkinson’s disease or multiple sclerosis (MS)
- damage to the pelvic area through injury or surgery
- Peyronie’s disease, which causes scar tissue to develop in the penis
ED can be caused by only one of these factors or by several of them. That’s why it’s important to work with your doctor so that they can rule out or treat any underlying medical conditions.
Treatment for ED will depend on the underlying cause. You may need to use a combination of treatments, including medication or talk therapy.
Medications
Your doctor may prescribe medication to help you manage the symptoms of ED. You may need to try several medications before you find one that works. The following oral medications stimulate blood flow to your penis to help treat ED:
- avanafil (Stendra)
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra, Staxyn)
Alprostadil (Caverject, Edex, MUSE) is another medication that can be used to treat ED. It can be administered in two ways: as a penile suppository or as a self-injection at the base or side of the penis.
Testosterone therapy (TRT) may also be recommended if you have low levels of testosterone.
Medications used for other conditions may cause ED. Talk to your doctor about your medications and whether they could be causing your symptoms. There may be others that you can take instead. Never stop taking medications without first talking to your doctor.
Medications for ED can cause side effects. If you’re experiencing unpleasant side effects, talk to your doctor. They may be able to recommend a different medication.
Talk therapy
A number of psychological factors can cause ED, including:
- stress
- anxiety
- post-traumatic stress disorder (PTSD)
- depression
If you’re experiencing psychological ED, you may benefit from talk therapy. Over several sessions, you and your therapist will discuss:
- major stress or anxiety factors
- your feelings around sex
- subconscious conflicts that could be affecting your sexual well-being
If ED is affecting your relationship, consider speaking with a relationship counselor as well. Relationship counseling can help you and you partner reconnect emotionally, which may also help your ED.
Vacuum pumps
This treatment uses the creation of a vacuum to stimulate an erection. Blood is drawn into the penis as the device is used, leading to an erection.
A vacuum pump device consists of a few different components:
- a plastic tube, which you place over your penis
- a pump, which works to create the vacuum by drawing air out of the plastic tube
- an elastic ring, which you’ll move to the base of your penis as you remove the plastic tube
The elastic ring functions to maintain the erection, holding the blood in the penis and preventing it from returning to circulation. It can be left in place for 30 minutes.
You may have ED if you regularly have:
- trouble getting an erection
- difficulty maintaining an erection during sexual activities
- reduced interest in sex
Other sexual disorders related to ED include:
- premature ejaculation
- delayed ejaculation
- anorgasmia, or the inability to achieve orgasm after ample stimulation
Speak with your doctor if you have any of these symptoms, especially if they’ve lasted for 3 or more months. They can help determine whether your symptoms are caused by an underlying condition that requires treatment.
Testing for ED can involve a variety of steps, including a physical examination and taking your health and sexual history. Additional tests may be performed to determine if your symptoms are caused by an underlying condition.
Physical exam
You should expect a physical exam where your doctor will listen to your heart and lungs, check your blood pressure, and examine your testicles and penis. They may also recommend a rectal exam to check your prostate.
Psychosocial history
Your doctor will ask you questions or request that you fill out a questionnaire about your symptoms, health history, and sexual history. The responses can help them evaluate the severity of your ED.
Some questions that you may be asked include:
- How long have you been experiencing ED? Did it come on suddenly or gradually?
- Are you having any problems with feeling sexual desire, ejaculating, or reaching orgasm?
- How often do you have sex? Has this frequency changed recently?
- How firm are your erections? Is this affected by particular situations or types of stimulation?
- Do you wake up in the morning or in the middle of the night with erections?
- How’s your current relationship? What expectations do you and your partner have for each other? Have there been any changes?
- Have you recently been experiencing a lot of stress?
- What medications are you currently taking? Do you use tobacco, alcohol, or nonprescription drugs?
- Do you have any underlying conditions or have you had any surgery on or injury to your pelvic area?
Additional tests
Your doctor may perform additional testing to help diagnose your ED. Tests can include:
- Ultrasound. An ultrasound can be used to examine the blood vessels of the penis to determine if there’s a problem with penile blood flow.
- Nocturnal penile tumescence (NPT) test. A portable, battery-powered device, worn on the thigh, is used to evaluate the quality of your nocturnal erections. Data is stored in the device, which your doctor can access later.
- Injection test. During this test, a medication is injected into your penis to stimulate an erection. This allows your doctor to evaluate the firmness of the erection and how long it lasts.
- Urine tests. Urine tests can be used to check for diabetes or other underlying health conditions.
- Blood tests. Blood tests can be used to check for conditions such as diabetes, heart disease, thyroid issues, and low levels of testosterone.
Certain exercises can also help with ED.
Kegel exercises
Kegel exercises are simple movements you can do to strengthen your pelvic floor muscles. Here’s how:
- Identify your pelvic floor muscles. To do this, stop peeing midstream. The muscles you use to do this are your pelvic floor muscles.
- Now that you know where these muscles are, contract them for 3 seconds. Then release them.
- Repeat this exercise 10 to 20 times in a row, three times a day.
A small 2005 study compared two groups of men with ED. The first group of men performed regular pelvic floor muscle exercises with a physiotherapist. They also received biofeedback and advice on lifestyle changes. The second group only received advice on lifestyle changes.
Men in the first group saw their penile function improve significantly after 3 months of regular pelvic floor muscles exercises. Men in the second group saw little improvement after 3 months.
For the next 3 months, all participants were given at-home exercises to perform. After 6 months in total had elapsed, 40 percent of all participants (including some men who had belonged to the second group) had regained normal erectile function.
A 2019 literature review also concluded that pelvic floor exercises were effective at treating both ED and premature ejaculation. However, the ideal exercise plan (in terms of conditions such as frequency and intensity) wasn’t identified.
You may find that it’s easier initially to do Kegels while lying down. Eventually, you can start trying them when you’re sitting or standing.
Aerobic exercise
Moderate to vigorous exercise is not only good for your overall health, but also can increase blood flow, possibly helping with ED. Examples include running and swimming.
A review of 10 studies examined the effect of aerobic exercise on ED. From their review, investigators concluded that 160 minutes of weekly exercise for 6 months could lead to a decrease in erectile problems.
Another study examined physical fitness and testosterone levels in 87 men with ED. Researchers found that testosterone levels were negatively correlated with levels of body fat and abdominal fat. This suggests that exercise may increase testosterone in addition to reducing body fat.
Before you start a new exercise plan, you should always discuss it with your doctor. This is particularly important for people with heart disease or another underlying condition that could be aggravated by vigorous activity. Learn more about exercise and ED.
Yoga
Yoga can help to relax your mind and body. Since stress or anxiety can cause or contribute to ED, practicing yoga may be an effective way to ease ED symptoms.
There are many risk factors that may increase your likelihood of developing ED. These risk factors are often related to blood flow and circulation. Other risk factors can include injuries.
One important risk factor for ED is increasing age. As you get older, you may find that it’s more difficult to get or maintain an erection. You may also notice that you may require more direct stimulation to get an erection.
Additional risk factors for ED include:
- having a medical condition such as cardiovascular disease or diabetes
- having a psychological condition such as anxiety or depression
- having overweight, particularly obesity
- sustaining an injury to or having surgery on your pelvic area
- taking certain medications, such as antidepressants or blood pressure medications
- undergoing specific medical treatment, such radiation therapy for cancer
- using tobacco products, drugs, or alcohol
There are several steps you can take to help prevent ED. Many of these steps involve making healthy lifestyle changes. Therefore, they’re not only good for preventing ED, but also for improving your overall health.
Follow the advice below to help prevent ED:
- Keep medical conditions such as heart disease and diabetes under control.
- Make sure that you get regular exercise.
- Maintain a healthy weight.
- Focus on eating a healthy diet.
- Find ways to reduce or manage stress.
- Seek help if you’re experiencing anxiety or depression.
- Quit smoking.
- Only use alcohol in moderation.
- Avoid using drugs that haven’t been recommended by your doctor.
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