Erectile Dysfunction: Everything You Need to Know

Erectile dysfunction (ED) is a medical condition characterized by trouble getting or maintaining an erection firm enough for satisfying sexual activity.

ED affects as many as 30 million men in the United States, making it one of the most common sexual health issues. While it’s often a chronic issue, temporary ED is also a thing. However, it’s best to get medical help instead of waiting and hoping it’ll disappear on its own.

The symptoms of ED can be mild, moderate, or severe. Depending on its severity, you might have:

• No erections at all (impotence)

• Erections that aren’t firm enough for penetration

• Erections that don't last as long as you want

• Firm erections sometimes, but not others

In addition to affecting your sex life and relationships, ED can also be an early warning sign of health conditions like diabetes and heart disease. In fact, you might think of the condition as your body’s way of telling you to talk with a doctor.

The most common erectile dysfunction symptoms are:

• Having trouble getting an erection

• Having trouble keeping an erection

• Getting erections that aren't as firm as you'd like them to be

Erectile dysfunction can have a few less obvious signs and symptoms. Other symptoms that may come along with ED include:

• Decreased sexual desire

• Loss of confidence

• Changes in your mood

• Stress in your relationships

• Anxiety

Depending on the underlying cause, you might also experience other associated problems, like trouble with ejaculation.

A healthcare provider can evaluate your symptoms when diagnosing you with ED and help determine the most appropriate treatment plan for you. So, be sure to tell them all the signs of erectile dysfunction you’re experiencing.

Under ideal circumstances, erections happen naturally when you become aroused. Like breathing and blinking, your body takes care of it subconsciously without you needing to dedicate much (or any) conscious thought. When you have ED, that’s not necessarily the case.

Many factors can contribute to ED and effectively remove that ability for your body to do its thing. Those possible factors include: 

• Nerve problems

• Hormonal imbalances

• Blood vessel damage

• Psychological factors

• Lifestyle choices

• Medication side effects

Considering that the physiology of getting an erection is actually pretty complex, understanding how various contributing factors to ED work is important. Let’s take a quick look at the science behind this common form of male sexual dysfunction.

Physical Causes of Erectile Dysfunction

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

Physical health issues that may contribute to ED include:

• Atherosclerosis (hardening or blocked arteries)

• Blood vessel disease

• Chronic kidney disease

• Heart disease (cardiovascular disease)

• Hypertension (high blood pressure)

• High cholesterol

• Type 2 diabetes

• Low testosterone

• Sleep disorders, like sleep apnea

• Injury from treatments for prostate cancer, including surgery and radiation therapy

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

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

• Multiple sclerosis

• Nerve damage

• Parkinson’s disease

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

ED Caused by Medications

Sometimes medications used to treat other health conditions cause side effects — including ED. Some common culprits include:

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

• Certain blood pressure medications

• Prescription sleep medications or tranquilizers

• Antiandrogens used for prostate cancer therapy

• Appetite suppressants

• Ulcer medicines

• Narcotic pain medications

Once you know which of your medications is contributing to your ED, your healthcare provider can help you figure out how to remedy the situation. 

A quick word of caution: If you develop ED after taking one of these medications, you should consult a healthcare professional before stopping your medication.

Psychological Causes of ED

Psychological factors are a common contributor to ED. Many men experience worsening erectile function during periods of psychological stress.

Some psychological contributors to ED include:

• Anxiety, including sexual performance anxiety

• Depression

• Feelings of guilt about sex

• Low self-esteem

• Relationship issues

• Stress

There’s some evidence to suggest that excessive pornography use could also play a role in erectile dysfunction. More research needs to be done in the area, but the thinking is that excessive pornography can lead to heightened expectations for sex, a lack of sexual satisfaction when those expectations aren’t met, and — as a result — erection problems.

ED can happen to anybody, but some people are at an increased risk. In general, ED is most common in older men. According to one estimate, the risk increases from 10 percent to 79 percent from ages 40 to 80 in men without any particular risk factors.

The Massachusetts Male Aging Study — a large survey of men ages 40 to 70 that was conducted in the 1980s but still stands as essential research — found that 40 percent of 40-year-old men had ED, while 70 percent of 70-year-old men had ED. 

Along with increasing age, the following are considered risk factors for ED: 

• High cholesterol

• Excessive alcohol consumption

• Recreational drug abuse

• Physical inactivity

• Vascular disease

• Having overweight or obesity

• Smoking

• Psychological trauma

• Pelvic surgery

• Some neurological conditions like Alzheimer’s disease or having a stroke

• Diabetes

• Taking medications associated with ED

Changing these habits can have a positive effect on your overall health. But making healthier choices is tough, so many people benefit from getting a little support. Working with a healthcare professional, physical trainer, or counselor can help you achieve your health goals.

To receive an ED diagnosis, you can visit your regular doctor, speak with a urologist, or talk with another healthcare professional. You can also connect with a licensed professional through our telehealth service to avoid needing to visit a clinic in person

During your visit, your provider may:

• Ask questions about your medical history

• Perform a physical exam

• Ask about your symptoms

There’s also the International Index of Erectile Function (IIEF), a questionnaire that some healthcare providers might use. Both the 15-question version and the five-question version can help your provider understand more about your erectile function, state of mind, and sexual satisfaction level.

Tests for Erectile Dysfunction

Although your healthcare provider might diagnose you withED based solely on your conversation, they might need you to take one or severalED tests. This will help themdetermine the possible cause(s) of your ED.

ED tests can include:

• Blood tests to check for underlying medical problems

• An ultrasound scan to observe blood flow

• 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 a device that checks for erections during the night

There are many treatment options available for erectile dysfunction. 

Your treatment plan will depend on the cause of your ED. If multiple factors are causing your ED, you might need a few treatments at the same time. Erectile dysfunction treatments may include:

• Erectile dysfunction medications

• Therapy, like cognitive behavioral therapy or sex therapy

• Healthy lifestyle changes, like eating a balanced diet and staying active

• Treating underlying contributing conditions

• Things like vacuum erection devices and penile implants

Erectile Dysfunction Medications 

Erectile dysfunction is usually treated with oral medications called phosphodiesterase type 5 inhibitors, or PDE5 inhibitors. 

This class of medication works by increasing blood flow to the penis, making it easier to get an erection when you're sexually stimulated. These medications don’t impact your libido or make you more aroused, but they do help everything work properly when you are.

The Food and Drug Administration (FDA) has approved four prescription PDE5 inhibitors for the treatment of erectile dysfunction. Approved erectile dysfunction medications include:

• Sildenafil, the active ingredient in Viagra^®

• Tadalafil, also sold under the brand name Cialis^®

• Vardenafil, the active ingredient in Levitra^® and Staxyn^®

• Avanafil, currently only available as the brand name Stendra^®

In some cases, these medications can come in a different form, either independently or compounded together. These other forms — such as Hard Mints by Hims — can make the experience of taking medication more enjoyable (and more discreet, in case that’s important to you). 

While PDE5 inhibitors are generally considered safe and effective, they can cause side effects such as a priapism (an erection that lasts longer than 4 hours). Additionally, PDE5 inhibitors may not be appropriate for people with certain health conditions.

Another option is alprostadil (Caverject^®), which is an FDA-approved injection that treats ED. It’s also available as a cream or a urethral suppository.

Other medical options for ED include BiMix^®, TriMix^®, and QuadMix^®. These are injectable medications that combine ingredients such as alprostadil, papaverine, phentolamine, and atropine in different combinations. Like the PDE5 inhibitors, these medications help increase blood flow to the penis through different mechanisms.

A healthcare professional can suggest the best ED medication for your specific needs. If one medication doesn’t work, they may change your dose 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 you emotionally — it's a good idea 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 health issues. Often, counseling and therapy are combined with ED medications to help restore confidence and sexual satisfaction more quickly.

Other ED Treatments

If PDE5 inhibitors, other medications, lifestyle changes, or therapy don’t work for you — or if you feel you’d benefit from additional intervention — you might consider exploring other treatment options for ED. 

These include:

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

• Penile implants. Also known as a penile prosthesis, these implants include bendable rods or inflatables that help the penis maintain an erect position.

• Eroxon^® Stimgel. Recently authorized by the FDA for erectile dysfunction, this is a non-prescription, non-medicated gel that’s applied to the penis and stimulates the nerves to promote 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 enclomiphene. You can talk to a licensed professional through our telehealth platform like Hims about whether you may be a candidate for TRT. If you are, your provider can write you a prescription, and you can order meds directly to your door — all without the need to go into a clinic.

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

While having ED becomes more common as you grow older, you can still minimize your risk of developing it at any age with the help of healthy lifestyle changes. 

You can reduce your risk of ED by:

• Eating a balanced, nutrient-rich diet

• Limiting consumption of alcohol

• Avoiding recreational drugs

• Quitting smoking

• Staying physically active and maintaining a healthy weight

• Managing stress in a healthy way

If this list seems a bit overwhelming, try one or two healthy habits at a time and slowly work toward improving your lifestyle.

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

When to See a Doctor 

Many men occasionally have difficulty getting an erection. Often, this is situational — like when you’re not particularly aroused or you have one too many drinks at dinner. 

If this sounds like you, and you only have trouble getting an erection every once in a while, it’s not usually cause for concern. But if it happens often, seems to be getting worse, or causes you distress, you may want to turn to a healthcare professional for help.

While urologists are specialists in the field, your primary care provider should also be able to help you manage ED. If going into a doctor’s office to talk aboutED doesn’t sound like your cup of tea, there are also telehealth platforms like ours that allow you to connect with a provider from the comfort of your own home. 

A healthcare provider will take your medical history, talk to you about your symptoms, order any necessary tests, and then give you recommendations on the best treatment options for you.

ED is a common sexual problem that can affect men of all ages, although it tends to become more common with advanced age.

It’s also a manageable condition for many of the men who experience it, thanks to a combination of medical treatment, therapy, and healthy lifestyle changes.

If you’re experiencing symptoms of ED, the best first step you can take is to talk to a healthcare professional. The sooner you seek help, the sooner you can get back to feeling confident and in control of your sexual health. 

You can talk to a licensed professional through our telehealth service to avoid the need to go to a clinic. That way, you can receive a diagnosis and treatment, if appropriate, at your convenience, without the need to leave home.

What’s the main cause of erectile dysfunction?

ED doesn’t have a single cause. Factors such as heart disease, diabetes, or psychological factors such as anxiety or depression often play a role. Often, multiple causes combine to create the problem.

Can erectile dysfunction go away on its own?

Occasional erection problems can resolve without treatment, especially if they’re due to stress or fatigue. However, if your symptoms are persistent or worsening, it’s important to seek medical attention to identify the underlying cause.

What’s the most effective treatment for ED?

The best treatment for ED depends on what’s causing your ED. Oral medications like sildenafil (Viagra^®) or tadalafil (Cialis^®) work well for many men. Others may benefit from therapy, vacuum devices, medical injections, or lifestyle changes. Your healthcare provider can help tailor a plan for your specific needs.

Can lifestyle changes really help with ED?

Yes, regular exercise, a healthy diet, quitting smoking, managing stress, and other healthy habits can improve your blood flow, your mental health, and your overall health. In turn, these benefits can enhance erectile function and overall well-being.

When should I see a doctor for erectile dysfunction?

If you frequently have trouble getting or keeping an erection, or if ED is affecting your confidence or relationships, it’s time to talk to a healthcare provider. They can identify any underlying medical conditions and help you find the most effective treatment.