Erectile dysfunction (ED) is the inability to achieve an erection, or dissatisfaction with the size, rigidity or duration of erections. You might also hear it referred to as impotence. If you have symptoms of erectile dysfunction, you may have trouble getting an erection, get an erection that doesn’t last long enough for sexual activity, or get an erection sometimes, but not every time you would like to have sex.
Other sexual disorders related to, but different than, ED include premature ejaculation, delayed ejaculation and anorgasmia (the inability to have an orgasm even after sufficient stimulation).
Many men occasionally have problems with erections. But with ED, problems occur more often or become more frequent. It’s a condition many men deal with, even though they may not want to discuss it. Untreated, ED can lead to low self-esteem, depression or relationship problems. But by talking to your doctor, you can get the treatment you need. Here’s what to know about erectile dysfunction.
There’s a process that occurs when you get an erection. Blood flows into two chambers inside the penis, which are called the corpus cavernosum. The tissues in these chambers trap blood. During arousal, the blood vessels in the corpus cavernosa relax and blood fills these chambers. This additional blood is what makes the penis firm. After orgasm, these tissues contract, the blood circulates back into the bloodstream and the penis becomes soft again. ED occurs when you don’t get enough blood flow to your penis, or when the nerves in and around your penis don’t work properly.
Certain medical conditions related to your vascular system, nervous system or endocrine systems can cause ED. Men of any age can experience it, but it’s more common in older men. However, aging alone doesn’t cause ED.
Risk factors and potential causes of erectile dysfunction include:
If your problems with getting and maintaining erections are becoming bothersome, you most often can see your primary care physician for diagnosis and treatment. Since ED can stem from various causes, getting the correct diagnosis is essential. When you talk to your doctor about your erectile dysfunction concerns, you’ll probably be asked questions about your erection problems, medical history, lifestyle and heart health. Be prepared to answer questions about prescription medications and other drugs, smoking, alcohol use and physical or mental health problems.
Your doctor may also ask specific questions about your sex life. You might feel uncomfortable answering these questions. But they can help your doctor figure out exactly why you are experiencing ED and what the best treatment options are. It’s essential to answer them truthfully.
Your doctor will evaluate your overall health with a physical exam. That might include checking your heart and blood pressure. You may need a digital rectal exam to check your prostate. And your doctor will likely examine your penis and testicles for any issues that could be contributing to ED. They might also take blood or urine samples and send them to a lab for analysis.
In some cases, your PCP may refer you to a urologist—a doctor who specializes in sexual and urinary conditions—for care.
To treat ED, you’ll often start with taking care of other health problems that could be contributing to it. For example, improving the control of diabetes could help reduce ED symptoms.
Your doctor may suggest lifestyle changes such as:
If prescription drugs are a potential cause of ED, your doctor can talk to you about the pros and cons of changing or stopping your medication. Don’t stop taking any medication without talking to your doctor first.
You may also want to see a mental health professional to treat stress, depression, anxiety, relationship issues or performance anxiety related to sexual intercourse.
In addition to those options, there are three lines of treatment for ED that treat it directly:
For many men, psychosexual therapy is helpful in combination with these treatment options. Even if you have a physical condition that’s causing ED, sex therapy can help address issues that are impacting your ability to function sexually. Therapy can also help sexual partners better understand and accept the impact of ED on the relationship.
Some men with ED may feel embarrassed or uncomfortable talking about their symptoms with their doctor. They might turn to dietary supplements for a more private way to treat ED. However, according to the U.S. Food and Drug Administration, these supplements can include hidden or undisclosed ingredients. They may also have the same ingredients found in prescription-grade, FDA-approved medications, but in inconsistent doses. If you have symptoms of ED, it’s best to talk to a health care professional about your options for treatment.
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