Risk Factors

Symptoms

Erectile Dysfunction

(ED; Impotence; Male Erectile Disorder)

by Michael Jubinville, MPH

Definition

Erectile dysfunction (ED) is trouble getting or keeping an erection of the penis. The penis is not firm enough to have sex.

Causes

An erection happens when blood fills the penis. Some blood vessels open 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 nerves.

ED may be caused by:

Blood vessel injury or disease
Harm to nerves that control blood vessels or feeling in the penis
Stress that change how the nerves work—more likely with sudden ED
Hormone problems such as low testosterone or thyroid disease
Certain medicines such as those that treat high blood pressure, mental health problems, or heart rhythm problems
Problems in the penis caused by Peyronie disease, hypospadias, or penile fracture

Risk Factors

ED is more common in those aged 40 years and older. The risk increases with age. Things that increase the risk of ED are:

Overweight and obesity
Diabetes
High blood pressure
High cholesterol
Peripheral neuropathy
Prostate problems
Surgery on related nerves, spinal cord, blood vessels, or prostate
Smoking
Too much alcohol
Use of illegal drugs
Lack regular exercise
Certain medicines

Symptoms

The main symptom of ED is not being able to get or keep an erection long enough to have sex.

Diagnosis

The doctor will ask about symptoms and health past. A physical exam will be done. This will include a genital and rectal exam.

The doctor will ask about the quality of erections. This may include questions about the time of day, how rigid the erection is, and how long it lasts. The doctor may also ask about your mental state, desire, arousal, ejaculation, and orgasms. The answers can help point to the source of the problem.

A test you can do at home will check for erections while you sleep. Erections during sleep may mean the cause is psychological. Problems with an erection during sleep points to a physical cause.

Other tests may include:

Blood tests—to check for health problems such as diabetes or high cholesterol, or look at testosterone levels
Doppler ultrasound—to check blood flow in the penis

Treatment

ED care may involve one or more of these:

Lifestyle Habits

Some changes in daily habits can improve tissue health and blood flow. General steps are:

Weight loss, if needed. This can also help balance hormones.
Quit smoking.
Regular exercise.
Limit alcohol to 2 drinks or less a day.
Stop illegal drug use.
Relaxation habits and stress management.

Medicine

ED can be treated with medicine to:

Relax muscles and improve blood flow to the penis—cannot be taken with nitrates
Boost testosterone levels—only helpful if you have low testosterone

ED medicine can be taken by mouth or as a shot, or be placed on the skin or into the tip of the penis.

Talk to your doctor before taking any over the counter medicine for ED. Some of them may be unsafe.

Vacuum Devices

A vacuum device pulls blood into the penis. A band is placed around the penis to keep the erection.

Surgery

Surgery can be used to fix blood vessels or other structural problems.

Penile Implants

Implants may be placed in the penis. The implants can be inflated to make an erection when needed.

Penile Implant

Sex Therapy

Sex therapy may help ED caused by:

Relationship problems
Anxiety
Depression

This can be done alone or with a partner.

Prevention

To help lower your chances of ED:

Follow any care plans to treat high blood pressure, diabetes, or depression.
Keep your weight in a healthy range.

RESOURCES:

Family Doctor—American Academy of Family Physicians
https://familydoctor.org

Urology Care Foundation
https://www.urologyhealth.org

CANADIAN RESOURCES

Health Canada
https://www.canada.ca

Sex & U—The Society of Obstetricians and Gynaecologists of Canada
http://www.sexandu.ca

References:

Erectile dysfunction. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/erectile-dysfunction. Accessed July 17, 2020.

Erectile dysfunction. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction. Accessed July 17, 2020.

Erectile dysfunction. Urology Care Foundation website. Available at:
...(Click grey area to select URL)
Accessed July 17, 2020.

Shamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013;381(9861):153-165.

Last reviewed July 2020 by EBSCO Medical Review Board Adrienne Carmack, MD
Last Updated: 10/02/2020

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