(ED; Impotence; Male Erectile Disorder)
by Heather Smith
Erectile dysfunction (ED) is trouble getting or keeping an erection of the penis that is firm enough for sex.
An erection happens when blood fills the penis. Some blood vessels opens wide to let blood flow into the penis. Other blood vessels shrink to keep the blood from leaving the penis. The change in the blood vessels is controlled by signals from nerves. ED may be caused by problems with any of these steps, such as:
The blood vessels that keep the blood in the penis may be injured or have disease. Blood can leak out from the damaged areas during an erection. It may be difficult to get or keep an erection because the blood keeps leaking out.
ED may be caused by:
Psychological Factors TOP
Emotional stress may change nerve signals from the brain. This is more likely a cause in men who suddenly develop ED.
Risk Factors TOP
ED is more common in men who are 65 and older. It is also more common in men of Hispanic descent.
Factors that increase your chance of developing ED include:
You will be asked about your symptoms and medical history. A physical exam will be done. The doctor will ask about the quality and length of erections. Your answers may help the diagnosis.
Nocturnal penile tumescence testing will give the doctor more information. The test will check for erections while you sleep. If you have normal erections during sleep the cause may be emotional. If you have problems with an erection even while you sleep, the cause may be physical.
Other tests may be done to look for a cause:
Treatment options include:
Your doctor may prescribe:
Use caution and talk to your doctor before taking any over-the-counter medications for ED. Some of them may be unsafe.
A vacuum device pulls blood into the penis. A band will then be placed around the penis to keep the erection. A vacuum device may include:
Vascular Surgery TOP
Vascular surgery may be helpful for some. It is done to repair the blood vessel leaks.
Penile Implants TOP
Implants may be placed in the penis. The implants can be inflated when needed to make an erection.
Sex Therapy TOP
Sex therapy may help ED resulting from:
Family Doctor—American Academy of Family Physicians
Urology Care Foundation
Canadian Urological Association
Sex & U—The Society of Obstetricians and Gynaecologists of Canada
Erectile dysfunction. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated February 29, 2016. Accessed September 7, 2017.
Erectile dysfunction. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
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Updated March 28, 2012. Accessed September 7, 2017.
Viera A, Shenenberger D, Green G. Am Fam Physician. 1999;60(4):1159-1166.
What is erectile dysfunction? Urology Care Foundation website. Available at:
...(Click grey area to select URL)
Accessed September 7, 2017.
Last reviewed September 2017 by EBSCO Medical Review Board Adrienne Carmack, MD
Last Updated: 2/1/2018
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