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Erectile Dysfunction (ED)

What is erectile dysfunction?

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.

What causes erectile dysfunction?

ED often happens when blood flow to the penis is reduced or nerves in the area aren’t working properly. Many physical and emotional factors can lead to ED.

Common causes and risk factor include:

  • Heart disease 
  • High blood pressure or high cholesterol
  • Diabetes (men with diabetes are 2 to 3 times more likely to have ED)
  • Hormone problems (endocrinopathies)
  • Nerve damage or neurological disorders
  • Depression, anxiety or stress
  • Relationship or emotional concerns
  • Excessive alcohol use
  • Smoking
  • Certain medications or recreational drugs
  • Obesity or lack of physical activity
  • Pelvic trauma or Peyronie’s disease
  • Surgery for prostate, bladder or colon cancer
  • Concerns about sexual performance 

How is erectile dysfunction diagnosed?

 If ED is affecting your quality of life, talk to your doctor. Most often, your primary care provider can diagnose and begin treatment for ED. 

What to expect during your evaluation 

  • Questions about your symptoms, medical history and lifestyle 
  • A physical exam, possibly including a prostate check 
  • Blood or urine tests 
  • A review of your medications and mental health 
  • Questions about your sexual history (these help guide treatment) 

Your doctor may refer you to a urologist, a specialist in urinary and sexual health, for additional care. 

What are the treatment options for ED?

Treatment starts by addressing the underlying causes. Your doctor may suggest:

  • Lifestyle changes
  • Eat a heart-healthy diet
  • Lower your cholesterol
  • Maintain a healthy weight
  • Exercise regularly
  • Quit smoking
  • Limit alcohol use 

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.

Mental health support

You may also want to see a mental health professional to treat stress, depression, anxiety, relationship issues or performance anxiety related to sexual intercourse.

Medications for erectile dysfunction

Prescription ED pills improve blood flow to the penis. These include: 

  • Sildenafil (Viagra) 
  • Tadalafil (Cialis) 
  • Vardenafil (Levitra) 
  • Avanafil (Stendra) 

Your doctor can help you choose the best one based on your needs and medical history.

Other medical treatments for erectile dysfunction

If pills don’t work, other options may help:

Local treatments before sex

  • Intra-urethral medication (inserted into the penis)
  • Penile injections (injected at the base of the penis)
  • Vacuum erection devices (draw blood into the penis using suction)

Penile implants (prostheses)

Surgical implants can be an option if other treatments don’t work. These devices allow you to control when and how you get an erection.

Should I try supplements for ED?

Many men consider over-the-counter supplements for ED. But some products may contain hidden ingredients or unsafe drug levels. The FDA warns against using these supplements without talking to a doctor. It’s safer to speak with a health care provider about proven treatment options.

When to see a doctor about erectile dysfunction

If you’re regularly having trouble with erections, it’s time to talk to a doctor. ED is a common and treatable condition. Getting care can improve your health, confidence and relationships.