Erectile Dysfunction Symptoms, Causes & Treatment Options

Erectile dysfunction refers to the inability to achieve and maintain an erection. It can be distressing and interfere with having a satisfying sex life. Fortunately, there are treatments available for this common condition.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Erectile Dysfunction?

Summary

People with erectile dysfunction have difficulty with getting and keeping erections. It is commonly seen in older men - in fact, more than 30% of men between ages 40 and 70 have ED [1] - but can also occur at a young age. Erectile dysfunction is often a sign of an underlying medical issue involving hormones, blood flow to the penis, or nerves in the penis, but it can also be associated with psychological factors.[2] Distress associated with impaired erections can cause significant sexual and relationship problems. Although this is a chronic disorder, treatments including addressing the underlying cause, medications, and procedures can be effective.

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Erectile Dysfunction Symptoms

Main symptoms

The main symptoms of erectile dysfunction are difficulty with erections and the resulting effects on sex life.

  • Difficulty with erections: This may occur during sexual intercourse, masturbation, or both. Difficulty getting an erection may occur every time sexual activity is attempted, or intermittently; in addition, it may be possible to get an erection but then challenging to maintain it long enough for intercourse.[3]
  • Performance anxiety: ED often leads to significant anxiety about the ability to get an erection, which interferes with the enjoyment of sex.
  • Decreased interest in sex: This may occur due to underlying anxiety or depression, or as a consequence of distress about the inability to achieve an erection.

Other symptoms

While the symptoms above are typical of erectile dysfunction, other symptoms may or may not be seen based on the cause of ED.

  • Breast enlargement and/or hair loss: Hormonal abnormalities affecting testosterone levels can cause these symptoms along with ED.[4]
  • Pain in the penis
  • Bending or shortening of the penis

Erectile Dysfunction Causes

The process of getting an erection is complex, involving stimulation by nerves, proper functioning of the hormonal system, and blood flow into the penis.[5] This means that medical conditions affecting each of these systems can lead to erectile dysfunction. Medications affecting nerves, hormones, and blood flow can also contribute to ED. In addition, injuries, whether from accidental trauma or surgeries, can cause damage that leads to ED. Psychological arousal plays a role in erections, so mental and relationship problems are often also involved.

Erectile dysfunction becomes more common with age, but it is not just a normal part of aging. In addition, it can occur in younger people. Just as in older men, ED in younger men should be seen as a possible sign of an underlying condition that can be diagnosed and treated.[6]

Medical or physical conditions

Injuries and chronic medical conditions can cause changes in the penis or in the rest of the body that contribute to erectile dysfunction.

  • Injury: Acute or chronic injuries to the penis can cause scar tissue, giving the penis a bent or shortened appearance and leading to ED.[7]
  • Prostate cancer treatment: Erectile dysfunction is a common side effect of medication or surgery used to treat prostate cancer. This occurs due to decreased testosterone levels (and injuries to structures of the penis, in the case of surgery).[8]
  • Underlying medical conditions: Common chronic medical conditions such as diabetes, high blood pressure, and obesity can play a role in ED.

Psychological causes

Mental stimulation is just as important as physical stimulation for getting an erection. This means that psychological factors can contribute to erectile dysfunction.

  • Mental health disorders: Anxiety and depression can cause erectile dysfunction and decreased interest in sex.
  • Relationship problems: Difficulties in a relationship with a sexual partner can also make it more difficult to achieve erections.

Substances

Multiple drugs, either prescribed by a doctor or recreational, can cause or exacerbate erectile dysfunction.

  • Medications: Categories of medications that can contribute to erectile dysfunction include antidepressants, antipsychotics, and blood pressure medications.[2]
  • Nicotine
  • Illicit drugs

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Treatment Options, Relief, and Prevention for Erectile Dysfunction

Treatment

Drug therapy is usually the first choice for treatment of ED. However, procedures and even surgeries can be considered if medications are not effective.

  • Oral medications: The most common treatment for erectile dysfunction is a medication called a PDE-5 inhibitor, which increases the amount of a substance called nitrous oxide, allowing blood to remain in the penis.[2, 9] One example is sildenafil (Viagra). The medication will be taken daily or within an hour before sex, depending on the specific drug prescribed. Physical stimulation is still required for an erection to occur.
  • Procedures and non-oral medications: If oral medications are not effective, there are other options. A medication called alprostadil can be placed in the urethra (the opening at the tip of the penis where urination and ejaculation occur) or can be injected directly into the penis. Alternatively, a vacuum pump can be placed over the penis. Alprostadil and the vacuum device both work by stimulating blood flow into the penis. Unlike oral medications, these treatments will lead to an erection even without physical stimulation.
  • Surgeries: When no medications or procedures have been successful, surgical intervention is the next step. Surgical treatment of erectile dysfunction can involve inserting a prosthetic device into the penis. Depending on the type of prosthetic, the penis will be erect all the time or only when an inflatable device is used.[2] Alternatively, vascular surgery to open up blocked arteries can improve ED by allowing more blood flow into the penis.[9]
  • Treating underlying conditions: In addition to using the treatments above, identifying and addressing underlying medical conditions can help with erectile dysfunction. Uncontrolled diabetes, high blood pressure, and high cholesterol levels will all worsen erectile dysfunction; medications and lifestyle changes to better manage these conditions can help with ED. Testosterone can be prescribed if low testosterone levels are thought to be the cause of ED.[10]

Prevention

Medications, procedures, and surgeries are effective options for treating erectile dysfunction. However, other changes that are not targeted treatments can also go a long way toward improving ED and having a more satisfying sex life.

  • Lifestyle changes: Abdominal obesity is associated with a greater risk of erectile dysfunction; this is likely in part due to the link between a greater amount of fatty tissue and lower testosterone levels.[2] As a result, weight loss can help improve symptoms of erectile dysfunction. A doctor or other medical professional can help develop a weight loss plan including changes in diet and exercise. A relatively small change like walking 30 minutes a day can help with ED and improve overall health. Eating fruits and vegetables, whole grains, and foods high in vitamins including D and B12 can also be beneficial.[11]
  • Avoid substances: As mentioned previously, many recreational and/or illicit substances can contribute to erectile dysfunction. Cutting back on or quitting nicotine can improve symptoms of ED. Cocaine, opiates, and other illicit drugs can also worsen erectile dysfunction and should be avoided.
  • Talk to a medical professional about your medications: Many types of medications can worsen erectile dysfunction. ED is a particularly common side effect of selective serotonin reuptake inhibitor (SSRI) antidepressants such as sertraline (Zoloft) and fluoxetine (Prozac); other medications that contribute to ED include antihypertensive and antipsychotic medications.[2] The management of erectile dysfunction should include a full review of medications by a medical professional to identify drugs that can be stopped or replaced in order to help decrease symptoms.
  • Counseling: Relationship challenges and problems with mental health can be all or part of the reason for erectile dysfunction, particularly in younger men. Medication treatment can still be used in these cases, but concurrent psychotherapy can also be helpful.[12]

When to Seek Further Consultation for Erectile Dysfunction

Medical evaluation is important for anyone with erectile dysfunction due to the condition’s effects on physical, emotional, and relationship health. In addition, certain side effects of medications and devices used to treat ED should prompt medical treatment.

  • Physical health: ED is often an important warning sign of abnormal blood vessels throughout the body; medical treatment and lifestyle changes can help prevent serious complications like a heart attack or stroke.[2, 13]
  • Emotional and relationship health: Seeking treatment is also important because erectile dysfunction can negatively impact sex life and relationships. The available treatments discussed above can greatly improve quality of life.
  • Side effects: The insertion of a prosthetic device can be complicated by infection. Immediate medical attention is needed if redness, warmth, and/or pain occur. Medications used to treat ED can lead to an erection lasting too long, resulting in permanent damage to the penis due to trapped blood; emergency care should be sought for an erection lasting longer than 4 hours.[10] Dangerously low blood pressure, resulting in lightheadedness or loss of consciousness, can occur if PDE-5 inhibitors are taken with prescribed nitrate medications or recreational drugs containing nitrates (“poppers”).[14] Vision loss is a rare side effect of PDE-5 inhibitors and should prompt immediate medical attention.[10]