Erectile Dysfunction (ED)

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Definition & Facts

What is erectile dysfunction?

Erectile dysfunction (ED) is a condition in which you are unable to get or keep an erection firm enough for satisfactory sexual intercourse. ED can be a short-term or long-term problem. You have ED when you

  • can get an erection sometimes, but not every time you want to have sex
  • can get an erection, but it does not last long enough for fulfilling or satisfactory sex
  • are unable to get an erection at any time

Health care professionals, such as primary care providers and urologists, often can treat ED. Although ED is very common, it is not a normal part of aging. Talk with a health care professional if you have any ED symptoms. ED could be a sign of a more serious health problem.

You may find it embarrassing and difficult to talk with a health care professional about ED. However, remember that a healthy sex life can improve your quality of life and is part of a healthy life overall. Health care professionals, especially urologists, are trained to speak to people about many kinds of sexual problems.

Does erectile dysfunction have another name?

ED is sometimes called impotence, but health care professionals use this term less often now so it won’t be confused with other, nonmedical meanings of the word.

How common is erectile dysfunction?

ED is very common. It affects about 30 million men in the United States.1

A man and a woman walk on a beach.
Although erectile dysfunction (ED) is very common, it is not a normal part of aging; talk with your health care professional about treatment.

Who is more likely to develop erectile dysfunction?

You are more likely to develop ED if you

  • are older
  • have certain diseases or conditions
  • take certain medicines
  • have certain psychological or emotional issues
  • have certain health-related factors or behaviors, such as overweight or smoking

Read about how certain factors can cause or contribute to ED.

What are the complications of erectile dysfunction?

Complications of ED may include

  • an unfulfilled sex life
  • a loss of intimacy between you and a partner, resulting in a strained relationship
  • depression, anxiety, and low self-esteem
  • being unable to get a partner pregnant

Depression, anxiety, and low self-esteem can also contribute to ED, creating a cycle of health problems.

References

Symptoms & Causes

What are the symptoms of erectile dysfunction?

Symptoms of ED include

  • being able to get an erection sometimes, but not every time you want to have sex
  • being able to get an erection, but not having it last long enough for sex
  • being unable to get an erection at any time

ED is often a symptom of another health problem or health-related factor.

A man having trouble sleeping.
Erectile dysfunction (ED) is often a symptom of another health problem.

What causes erectile dysfunction?

Many different factors affecting your vascular system, nervous system, and endocrine system can cause or contribute to ED.

Although you are more likely to develop ED as you age, aging does not cause ED. ED can be treated at any age.

Certain diseases and conditions

The following diseases and conditions can lead to ED:

Men who have diabetes are two to three times more likely to develop ED than men who do not have diabetes. Read more about diabetes and sexual and urologic problems.

Taking certain medicines

ED can be a side effect of many common medicines, such as

View a list of specific medicines that may cause ED.

Certain psychological or emotional issues

Psychological or emotional factors may make ED worse. You may develop ED if you have one or more of the following:

  • fear of sexual failure
  • anxiety
  • depression
  • guilt about sexual performance or certain sexual activities
  • low self-esteem
  • stress—about sexual performance, or stress in your life in general

Certain health-related factors and behaviors

The following health-related factors and behaviors may contribute to ED:

  • smoking
  • drinking too much alcohol
  • using illegal drugs
  • being overweight
  • not being physically active

Diagnosis

How do doctors diagnose erectile dysfunction?

A doctor, such as a urologist, diagnoses erectile dysfunction (ED) with a medical and sexual history, and a mental health and physical exam. You may find it difficult to talk with a health care professional about ED. However, remember that a healthy sex life is part of a healthy life. The more your doctor knows about you, the more likely he or she can help treat your condition.

Medical and sexual history

Taking a medical and sexual history is one of the first things a doctor will do to help diagnose ED. He or she will ask you to provide information, such as

  • how you would rate your confidence that you can get and keep an erection
  • how often your penis is firm enough for intercourse when you have erections from sexual stimulation
  • how often you are able to maintain an erection during sexual intercourse
  • how often you find sexual intercourse satisfying
  • if you have an erection when you wake up in the morning
  • how you would rate your level of sexual desire
  • how often you’re able to climax, or orgasm, and ejaculate
  • any surgeries or treatments that may have damaged your nerves or blood vessels near the penis
  • any prescription or over-the-counter medicines you take
  • if you use illegal drugs, drink alcohol, or smoke

This information will help your doctor understand your ED problem. The medical history can reveal diseases and treatments that lead to ED. Reviewing your sexual activity can help your doctor diagnose problems with sexual desire, erection, climax, or ejaculation.

A health care professional takes a man’s blood pressure.
A doctor will take a medical and sexual history to help diagnose the cause of your erectile dysfunction (ED).

Mental health and physical exam

A health care professional may ask you some personal questions and use a questionnaire to help diagnose any psychological or emotional issues that may be leading to ED. The health care professional may also ask your sexual partner questions about your relationship and how it may affect your ED.

He or she also will perform a physical exam to help diagnose the causes of ED. During the physical exam, a health care professional most often checks your

  • penis to find out if it’s sensitive to touch. If the penis lacks sensitivity, a problem in the nervous system may be the cause.
  • penis’s appearance for the source of the problem. For example, Peyronie’s disease causes the penis to bend or curve when erect.
  • body for extra hair or breast enlargement, which can point to hormonal problems.
  • blood pressure.
  • pulse in your wrist and ankles to see if you have a problem with circulation.

Lab tests

Blood tests can uncover possible causes of ED, such as diabetes, atherosclerosis, chronic kidney disease, and hormonal problems.

Imaging tests

A technician most often performs a Doppler ultrasound in a doctor’s office or an outpatient center. The ultrasound can detect poor blood flow through your penis. The technician passes a handheld device lightly over your penis to measure blood flow. Color images on a computer screen show the speed and direction blood is flowing through a blood vessel. A radiologist or urologist interprets the images. During this exam, a health care professional may inject medicine into your penis to create an erection.

Other tests

Nocturnal erection test. During a nocturnal, or nighttime, erection test, you wear a plastic, ring-like device around your penis to test whether you have erections during the night while you sleep. This test usually takes place at home or in a special sleep lab. A more involved version of this test uses an electronic monitoring device that will record how firm the erections are, the number of erections, and how long they last.

Each night during deep sleep, a man normally has three to five erections. If you have erections during either type of test, it shows that you are physically able to have an erection and that the cause of your ED is more likely a psychological or emotional issue. If you do not have an erection during either test, your ED is more likely due to a physical cause.

Injection test. During an injection test, also called intracavernosal injection, a health care professional will inject a medicine into your penis to cause an erection. In some cases, a health care professional may insert the medicine into your urethra instead. The health care professional will evaluate how full your penis becomes and how long your erection lasts. Either test helps the health care professional find the cause for your ED. The tests most often take place in a health care professional’s office.

Treatment

How can I treat erectile dysfunction?

You can work with a health care professional to treat an underlying cause of your erectile dysfunction (ED). Choosing an ED treatment is a personal decision. However, you also may benefit from talking with your partner about which treatment is best for you as a couple.

Lifestyle changes

Your health care professional may suggest that you make lifestyle changes to help reduce or improve ED. You can

You can seek help from a health professional if you have trouble making these changes on your own.

Go to counseling

Talk with your doctor about going to a counselor if psychological or emotional issues are affecting your ED. A counselor can teach you how to lower your anxiety or stress related to sex. Your counselor may suggest that you bring your partner to counseling sessions to learn how to support you. As you work on relieving your anxiety or stress, a doctor can focus on treating the physical causes of ED.

 A woman and man talk with each other and a counselor.
Your counselor may suggest that you bring your partner to counseling sessions to learn how to support you.

How do doctors treat erectile dysfunction?

Change your medicines

If a medicine you need for another health condition is causing ED, your doctor may suggest a different dose or different medicine. Never stop taking a medicine without speaking with your doctor first. Read about which medicines make it more likely that you’ll develop ED.

Prescribe medicines you take by mouth

A health care professional may prescribe you an oral medicine, or medicine you take by mouth, such as one of the following, to help you get and maintain an erection:

All of these medicines work by relaxing smooth muscles and increasing blood flow in the penis during sexual stimulation. You should not take any of these medicines to treat ED if you are taking nitrates to treat a heart condition. Nitrates widen and relax your blood vessels. The combination can lead to a sudden drop in blood pressure, which may cause you to become faint or dizzy, or fall, leading to possible injuries.

Also talk to your health care professional if you are taking alpha-blockers to treat prostate enlargement. The combination of alpha-blockers and ED medicines also could cause a sudden drop in blood pressure.

A health care professional may prescribe testosterone if you have low levels of this hormone in your blood. Although taking testosterone may help your ED, it is often unhelpful if your ED is caused by circulatory or nerve problems. Taking testosterone also may lead to side effects, including a high red blood cell count and problems urinating.

Testosterone treatment also has not been proven to help ED associated with age-related or late-onset hypogonadism. Do not take testosterone therapy that hasn’t been prescribed by your doctor. Testosterone therapy can affect how your other medicines work and can cause serious side effects.

A man seated taking oral medicine with water.
A health care professional may prescribe you an oral medicine to help you get and maintain an erection.

Prescribe injectable medicines and suppositories

Many men get stronger erections by injecting a medicine called alprostadil into the penis, causing it to become filled with blood. Oral medicines can improve your response to sexual stimulation, but they do not trigger an automatic erection like injectable medicines do.

Instead of injecting a medicine, some men insert a suppository of alprostadil into the urethra. A suppository is a solid piece of medicine that you insert into your body where it dissolves. A health care professional will prescribe a prefilled applicator for you to insert the pellet about an inch into your urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes.

Discuss alternative medicines

Some men say certain alternative medicines taken by mouth can help them get and maintain an erection. However, not all “natural” medicines or supplements are safe. Combinations of certain prescribed and alternative medicines could cause major health problems. To help ensure coordinated and safe care, discuss your use of alternative medicines, including use of vitamin and mineral supplements, with a health care professional. Also, never order a medicine online without talking with your doctor.

A health care professional listens to a male patient.
To help ensure coordinated and safe care, discuss your use of alternative medicines, including use of vitamin and mineral supplements, with a health care professional.

How will side effects of erectile dysfunction medicines affect me?

ED medicines that you take by mouth, through an injection, or as a pellet in the urethra can have side effects, including a lasting erection known as priapism. Call a health care professional right away if an erection lasts 4 hours or longer.

A small number of men have vision or hearing loss after taking oral ED medicines. Call your health care professional right away if you develop these problems.

Prescribe a vacuum device

A vacuum device causes an erection by pulling blood into the penis. The device has three parts:

  • a plastic tube, which you put around your penis
  • a pump, which draws air out of the tube, creating a vacuum
  • an elastic ring, which you move from the end of the tube to the base of your penis as you remove the tube

The elastic ring maintains the erection during intercourse by preventing blood from flowing back into your body. The elastic ring can remain in place up to 30 minutes. Remove the ring after that time to bring back normal circulation and to prevent skin irritation.

You may find that using a vacuum device requires some practice or adjustment. Using the device may make your penis feel cold or numb and have a purple color. You also may have bruising on your penis. However, the bruises are most often painless and disappear in a few days. Vacuum devices may weaken ejaculation but, in most cases, the devices do not affect the pleasure of climax, or orgasm.

A black and white illustration of a man using a vacuum device on his penis. The device includes an elastic ring, a pump, and a cylinder.
A vacuum device causes an erection by pulling blood into the penis.

Recommend Surgery

For most men, surgery should be a last resort. Talk with your doctor about whether surgery is right for you. A urologist performs surgery at a surgical center or hospital to

  • implant a device to make the penis erect
  • rebuild arteries to increase blood flow to the penis

Implanted devices. Implanted devices, known as prostheses, can help many men with ED have an erection. Implants are typically placed by a urologist. The two types of devices are

  • inflatable implants, which make your penis longer and wider using a pump in the scrotum
  • malleable implants, which are rods that allow you to manually adjust the position of your penis

You usually can leave the hospital the day of or day after the surgery. You should be able to use the implant 4 to 6 weeks after the surgery.

Once you have either implant, you must use the device to get an erection. Possible problems with implants include breaking and infection.

Artery reconstruction. Surgery to repair arteries can reverse ED caused by blockages that stop blood flow to the penis. Usually men younger than 30 are the best candidates for this type of surgery.

Prevention

What steps can I take to prevent erectile dysfunction?

You can help prevent many of the causes of erectile dysfunction (ED).

Quit smoking

If you smoke, get help quitting. Smoking is linked to heart and blood vessel disease, which can lead to ED. Even when heart and blood vessel disease and other possible causes of ED are taken into account, smoking still increases the chances that you will have ED.

Follow a healthy eating plan

To help maintain erectile function, choose whole-grain foods, low-fat dairy foods, fruits and vegetables, and lean meats. Avoid foods high in fat, especially saturated fat, and sodium. Follow a healthy eating plan to help aim for a healthy weight, and control your blood pressure and diabetes. Controlling your blood pressure and diabetes may help prevent ED.

Also, avoid drinking too much alcohol. If you are having trouble cutting out alcohol, see a counselor who has expert knowledge in treating people who drink too much.

Men and women eat a healthy meal together.
Take steps to prevent erectile dysfunction (ED): quit smoking, follow a healthy eating plan, maintain a healthy weight, and be physically active.

Maintain a healthy weight to prevent diabetes and high blood pressure

Maintaining a healthy weight also can help delay the start of diabetes and keep your blood pressure down. Talk with your doctor about how to prevent diabetes—or manage the disease if you already have it. Get regular checkups to measure your blood pressure.

If you need to lose weight, talk with your health care provider about how to lose weight safely. Ask for a referral to a dietitian who can help you plan healthy meals to lose weight. Losing weight may help reduce inflammation, increase testosterone levels, and increase self-esteem, all of which may help prevent ED. If you are at a healthy weight for your height, maintain that weight through healthy eating and physical activity.

Be physically active

Physical activity increases blood flow through your body, including the penis. Talk with a health care professional before starting new activities. Beginners should start slow, with easier activities such as walking at a normal pace or gardening. You can gradually work up to harder activities, such as walking briskly or swimming. Aim for at least 30 minutes of activity most days of the week.

Avoid using illegal drugs

Using illegal drugs may prevent you from getting or keeping an erection. For instance, some illegal drugs may prevent you from becoming aroused or feeling other sensations. Using illegal drugs may mask other psychological, emotional, or physical factors that may be causing your ED. Talk with your health care provider if you think you need help with drug abuse.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

July 2017
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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
Tom Lue, M.D., University of California San Francisco