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Erectile Dysfunction: Causes, Symptoms & Treatments

Mike Bohl, MD, MPH, ALM

Reviewed by Mike Bohl, MD

Written by Sian Ferguson

Published 11/09/2020

Updated 01/11/2024

It’s normal to occasionally have trouble getting or maintaining an erection. But if you frequently find it difficult to get an erection or maintain a firm enough erection to have sex, you might have erectile dysfunction (ED).

If you do have erectile dysfunction, there are two things you need to know. First, you’re not alone. Second, it’s  typically treatable. 

Sometimes referred to as impotence, erectile dysfunction affects as many as 30 million men in the United States. In fact, it’s one of the most common causes of male sexual dysfunction.

But just because it’s common doesn’t mean you have to live with it. Thanks to the wonders of modern medicine, there are quite a few  management options for ED, from medications to talk therapy and healthy lifestyle changes.

Coping with erectile dysfunction doesn’t have to be hard — pun intended. Let’s learn more about what causes erectile dysfunction and how it can be treated.

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According to the Urology Care Foundation, erectile dysfunction is defined as having trouble getting or keeping an erection firm enough for sex.

In other words, you might:

  • Not get erections at all

  • Get erections that aren’t firm enough to have sexual intercourse

  • Get erections but struggle to maintain them long enough to have sexual intercourse

  • Get firm erections, but only sometimes

ED may be a chronic issue, but temporary erectile dysfunction is also a thing. In any case, it’s best to get medical help instead of waiting and hoping it’ll disappear on its own. 

Most men face occasional ED — so if you’ve had difficulty getting an erection once or twice, it’s not always cause for concern. But if it happens often, and if it’s progressively getting worse, seeking medical help is crucial. 

Not only can ED affect your sex life and relationships, but it can also be an early warning sign of a health condition like diabetes or cardiovascular disease. In that way, erectile dysfunction could be your body’s way of telling you to get a thorough physical.

Various issues can cause erectile dysfunction. But before we get into the weeds on that, let’s back up for a second and talk about how erections work.

Your penis contains two primary erectile chambers called the corpora cavernosa. These regions of spongy tissue run along the left and right sides of your penis. 

When you feel aroused, your brain sends signals to the arteries that supply blood to the penis. This causes the smooth muscles to relax. Blood then increases in flows into the corpora cavernosa through the penile arteries

As blood flows into the spongy tissue, your penis becomes stiffer — and voila! You have an erection.

A fibrous membrane called the tunica albuginea wraps around the corpora cavernosa, and when pressure builds up inside the penis from increased blood flow, venous outflow is blocked. This keeps blood in the penis and helps you maintain an erection during sex.

Pretty amazing, right?  

It’s a complex process — and if, at any point, something goes wrong, it can cause erection problems.

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Erectile dysfunction can occur for a range of reasons. Sometimes, it’s caused by one or several physical problems affecting blood flow or nerve function. In other cases, it may be due to a psychological issue that affects your self-confidence or sexual arousal.

It’s possible that multiple erectile dysfunction causes are at play at the same time. For example, stress and a medical condition might both be contributing to your ED.

Physical Causes of Erectile Dysfunction

Since your cardiovascular system, nervous system and endocrine system are all involved in erectile function, medical conditions affecting these systems can lead to ED. 

Physical health issues may contribute to ED include:

  • Atherosclerosis (hardening or blocked arteries)

  • Blood vessel disease 

  • Chronic kidney disease

  • Heart disease 

  • Hypertension (high blood pressure)

  • Hyperthyroidism (high levels of thyroid hormone)

  • Hypothyroidism (low levels of thyroid hormone)

  • Injury from treatments for prostate cancer, including radiation therapy 

  • Injury to the genitals, urethra, spinal cord, prostate, bladder or pelvis

  • Multiple sclerosis 

  • Nerve damage

  • Low testosterone levels

  • Parkinson’s disease  

  • Peyronie’s disease, a condition where the penis becomes curved, often resulting from scar tissue

  • Sleep disorders, like sleep apnea  

  • Surgery on the genitals, spinal cord, prostate, bladder or pelvis

  • Type 2 diabetes

These health problems won’t necessarily automatically cause ED. But if you’re struggling to get erect, one or more of the above conditions could be related.

Certain medications might also contribute to ED, including:

  • Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs)

  • Antiandrogens used for prostate cancer therapy

  • Appetite suppressants that make you less hungry

  • Blood pressure medication

  • Prescription sleep medication or tranquilizers

  • Ulcer medicines

If you developed ED after taking one of these medications, it’s important not to stop taking your meds or change your dosage without consulting a healthcare professional. Make an appointment to get medical advice — an expert can help you figure out whether you need to adjust your medication.

Psychological Causes of ED

Your mind is a pretty powerful thing. Anxiety can give you stomach cramps, embarrassment can make you blush, and stress can make you sweat.

Since you need to be sexually aroused to get erect, your mental state can affect your erectile function.

Some psychological contributors to ED include:

There’s some evidence to suggest that excessive pornography use could lead to a lack of sexual satisfaction, which can, in turn, affect erectile function. 

Of course, ED can also weigh on your mental health. For instance, it may cause a lack of intimacy between you and your partner, leading to relationship problems or stress. 

To avoid getting stuck in this cycle, consider speaking with a therapist. Talk therapy can be an excellent way to address the issues at the root of your ED while enhancing your overall quality of life.

Lifestyle Causes of Erectile Dysfunction

Certain (unhealthy) habits can affect erectile function, too. These lifestyle factors might make you more likely to experience cardiovascular or nervous system issues, for example.

The following are considered risk factors for ED: 

  • Drinking too much alcohol

  • Not being physically active

  • Overweight or obesity

  • Smoking

  • Using certain recreational drugs

Changing these habits can have a positive effect on your overall health.

But making healthier choices can be tough, and you might need extra support when improving your lifestyle. Working with a healthcare professional, physical trainer or counselor can help you stay on track.

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Erectile dysfunction can have a few additional symptoms aside from, well…struggling to get an erection.

ED symptoms can include:

  • Low self-esteem

  • Depressed mood

  • Relationship difficulties

  • Difficulty getting a partner pregnant

Again, many people may be unable to get an erection from time to time. This doesn’t automatically mean it’ll be a constant problem. 

However, if it happens often, and if it’s bothering you, it’s worth seeking medical advice.

To treat your erectile dysfunction, a medical professional will first have to diagnose the issue.

So the first thing you need to do is talk to a healthcare provider. You can visit your regular doctor, see a general practitioner, make an appointment with a urologist or speak with another healthcare professional.

During your visit, your provider will:

  • Ask questions about your medical history

  • Perform a physical exam

  • Ask about your symptoms

You might feel a bit shy sharing these details with someone, but remember they’re there to help you. The more accurate your answers, the better your provider can address your concerns.

Tests for Erectile Dysfunction

Although your healthcare provider might diagnose you with erectile dysfunction based solely on your conversation, they might need you to take one or several erectile dysfunction tests. This will help them determine the possible cause(s) of your ED. 

ED tests can include:

  • Blood tests to check for underlying medical problems that may affect erectile health

  • An ultrasound scan to see if a blood flow issue is causing ED 

  • An intracavernosal injection (aka injection test), which involves injecting the penis with medication to see if it’s possible to get an erection 

  • A nocturnal erection test, which involves wearing a penile device while sleeping to check if you can develop an erection at night

Armed with your test results, your provider will help you work out the most effective form of treatment.

ED can be incredibly frustrating to deal with. The good news is that there are several treatments for erectile dysfunction. 

Your treatment plan will depend entirely on the cause of your ED. If multiple factors are causing your ED, you might need a few treatments at the same time. For example, a healthcare professional might suggest lifestyle changes alongside medication and talk therapy.

Erectile Dysfunction Medications 

Erectile dysfunction is usually treated with oral medications called PDE5 inhibitors. These work by increasing blood flow to the penile tissues, thus making it possible to get an erection when sexually stimulated. 

The FDA (U.S. Food and Drug Administration) has approved a number of prescription PDE5 inhibitors for the treatment of erectile dysfunction. 

Common erectile dysfunction medications include:

While these drugs are generally considered safe and effective, they can cause side effects. Additionally, PDE5 inhibitors may not be appropriate for people with certain health conditions.

A healthcare professional can suggest the best ED medication for your specific needs. If one medication doesn’t work, they may change your dosage or have you try a different drug. 

Treatment for Psychological Erectile Dysfunction 

If your mental health is affecting your erectile function — or, conversely, if ED is weighing on ou emotionally — you’re wise to get mental health support. 

You may benefit from different types of therapy, such as:

  • Sex therapy (by yourself or with a partner)

  • Couples counseling

  • Individual therapy

Many therapists are specifically trained to address men’s health issues, which can include sexual dysfunction.

Healthy Lifestyle Changes 

Certain healthy choices can help prevent erectile dysfunction. If you already have ED, making positive changes to your lifestyle could improve your symptoms and prevent the condition from getting worse.

You can reduce your risk of erectile dysfunction by:

  • Eating a balanced, nutrient-rich diet

  • Limiting consumption of alcohol 

  • Avoiding recreational drugs

  • Quitting smoking

  • Staying physically active

  • Managing stress in a healthy way 

This list might seem a bit overwhelming. Try one or two healthy habits at a time and slowly work toward improving your lifestyle. 

The best thing about these techniques is that they can benefit you beyond the bedroom by supporting your overall mental and physical well-being.

Want to learn more? Our guide to naturally protecting your erection shares other techniques you can use for the management of erectile dysfunction. 

Other ED Treatments

If PDE5 inhibitors or therapy don’t work for you — or if you need a little something extra — you might want to explore other treatment options for ED. 

These include:

  • Vacuum erection devices. These work by pulling blood into the tissues inside your penis. You’ll typically need to use a vacuum erection device with a cock ring to maintain an erection during sex.

  • Injectable ED treatments. ED injections like alprostadil help increase blood flow to the penis.

  • Penile implants. Also known as a penile prosthesis, an inflatable implant like the Penuma can be placed inside the penis to help create an erection. 

  • Surgical treatment. If your ED is caused by damage to your arteries, you may need vascular surgery.

  • Topical ED creams. Applied directly to the penis, topical ED creams improve blood flow to penile tissues, allowing you to get an erection.

  • Testosterone replacement therapy. If your ED is caused by low testosterone levels, you might consider testosterone replacement therapy (TRT) or an alternative, like off-label clomiphene.

Although these approaches aren’t generally first-line treatments for ED, your healthcare team may suggest trying them if necessary. 

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Erectile dysfunction is a common issue. Luckily, it’s also a treatable one.

By taking action early and talking to a healthcare provider, you can treat erectile dysfunction and enjoy a fulfilling, satisfying sex life.

Here’s what to keep in mind:

  • Erectile dysfunction can be caused by multiple issues. If you have ED, numerous issues could be to blame — including physical health issues, psychological factors and unhealthy habits.

  • Multiple ED treatments are available. Just as there are many potential causes of ED, there are many potential erectile dysfunction treatments. This can include ED medication, talk therapy and healthy lifestyle changes.

  • It starts with looking for help. ED can be a symptom of many (serious) health issues, so it’s important to get it checked out if you experience the condition regularly. It may be your body’s way of asking for a little self-care. 

Ready to seek help for ED? We can put you in contact with a licensed medical professional right away. Get started here.

16 Sources

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  3. Dhaliwal, A. & Gupta, M. (2023, April 10). PDE5 Inhibitors. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK549843/
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  5. Dwulit, A.D. & Rzymski, P. (2019). The Potential Associations of Pornography Use with Sexual Dysfunctions: An Integrative Literature Review of Observational Studies. Journal of Clinical Medicine. 8 (7), 914. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679165/
  6. Erectile Dysfunction. (2018, June). Retrieved from https://www.urologyhealth.org/urology-a-z/e/erectile-dysfunction-(ed)
  7. Erectile Dysfunction: Definition and Facts. (2017, July). Retrieved from https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts
  8. Panchatsharam, P.K., Durland, J. & Zito, P.M. (2023, May 1). Physiology, Erection. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513278/
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  12. Sooriyamoorthy, T., Leslie, S.W. (2023, May 30). Erectile Dysfunction. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK562253/
  13. STENDRA- avanafil tablet. (2017, August). Retrieved from https://www.accessdata.fda.gov/spl/data/41d308f4-9a6a-48bb-b7a0-d63da9818078/41d308f4-9a6a-48bb-b7a0-d63da9818078.xml
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Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Mike Bohl, MD

Dr. Mike Bohl is a licensed physician, a Medical Advisor at Hims & Hers, and the Director of Scientific & Medical Content at a stealth biotech startup, where he is involved in pharmaceutical drug development. Prior to joining Hims & Hers, Dr. Bohl spent several years working in digital health, focusing on patient education. He has also worked in medical journalism for The Dr. Oz Show (receiving recognition for contributions from the National Academy of Television Arts and Sciences when the show won Outstanding Informative Talk Show at the 2016–2017 Daytime Emmy® Awards) and at Sharecare. He is a Medical Expert Board Member at Eat This, Not That! and a Board Member at International Veterinary Outreach.

Dr. Bohl obtained his Bachelor of Arts and Doctor of Medicine from Brown University, his Master of Public Health from Columbia University, and his Master of Liberal Arts in Extension Studies—Journalism from Harvard University. He is currently pursuing a Master of Business Administration and Master of Science in Healthcare Leadership at Cornell University. Dr. Bohl trained in internal medicine with a focus on community health at NYU Langone Health.

Dr. Bohl is Certified in Public Health by the National Board of Public Health Examiners, Medical Writer Certified by the American Medical Writers Association, a certified Editor in the Life Sciences by the Board of Editors in the Life Sciences, a Certified Personal Trainer and Certified Nutrition Coach by the National Academy of Sports Medicine, and a Board Certified Medical Affairs Specialist by the Accreditation Council for Medical Affairs. He has graduate certificates in Digital Storytelling and Marketing Management & Digital Strategy from Harvard Extension School and certificates in Business Law and Corporate Governance from Cornell Law School.

In addition to his written work, Dr. Bohl has experience creating medical segments for radio and producing patient education videos. He has also spent time conducting orthopedic and biomaterial research at Case Western Reserve University and University Hospitals of Cleveland and practicing clinically as a general practitioner on international medical aid projects with Medical Ministry International.

Dr. Bohl lives in Manhattan and enjoys biking, resistance training, sailing, scuba diving, skiing, tennis, and traveling. You can find Dr. Bohl on LinkedIn for more information.

Publications

  • Younesi, M., Knapik, D. M., Cumsky, J., Donmez, B. O., He, P., Islam, A., Learn, G., McClellan, P., Bohl, M., Gillespie, R. J., & Akkus, O. (2017). Effects of PDGF-BB delivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon in vivo. Acta biomaterialia, 63, 200–209. https://www.sciencedirect.com/science/article/abs/pii/S1742706117305652?via%3Dihub

  • Gebhart, J. J., Weinberg, D. S., Bohl, M. S., & Liu, R. W. (2016). Relationship between pelvic incidence and osteoarthritis of the hip. Bone & joint research, 5(2), 66–72. https://boneandjoint.org.uk/Article/10.1302/2046-3758.52.2000552

  • Gebhart, J. J., Bohl, M. S., Weinberg, D. S., Cooperman, D. R., & Liu, R. W. (2015). Pelvic Incidence and Acetabular Version in Slipped Capital Femoral Epiphysis. Journal of pediatric orthopedics, 35(6), 565–570. https://journals.lww.com/pedorthopaedics/abstract/2015/09000/pelvic_incidence_and_acetabular_version_in_slipped.5.aspx

  • Islam, A., Bohl, M. S., Tsai, A. G., Younesi, M., Gillespie, R., & Akkus, O. (2015). Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair. Clinical biomechanics (Bristol, Avon), 30(7), 669–675. https://www.clinbiomech.com/article/S0268-0033(15)00143-6/fulltext

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