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(ED; Impotence; Male Erectile Disorder)
by Heather Smith
Erectile dysfunction (ED) is the inability to attain or maintain an erection of the penis that is firm enough for sexual intercourse.
To initiate and maintain an erection, the penis must fill with blood. One type of blood vessel opens wide to allow blood into the penis. Meanwhile, a second type of blood vessel squeezes down to keep the blood from leaving the penis. Nerve signals cause the proper changes in the blood vessels.
The following factors can cause erectile dysfunction:
The blood vessels that keep the blood from leaving the penis may be injured or have disease. This can cause a leak in these vessels. Blood can escape through these leaks during an erection. This means that an erection cannot occur or may not last long.
Problems with the nerves and blood vessels can cause ED. Conditions that can cause problems include:
Psychological Factors TOP
Many of the nerve signals needed for an erection come from the brain. Emotional problems may play a role 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. Expect questions about the frequency, quality, and duration of your erections. Your answers may help the diagnosis.
Your bodily fluids may be tested. This can be done with blood tests.
Nocturnal Penile Tumescence Testing
This test will monitor erections while you sleep. Involuntary erections during sleep are normal. If you have ED but have normal erections during sleep, the problem may be emotional. If you have problems with an erection even while you sleep, the problem may be physical.
Doppler imaging is used to look at the blood flow. The test is done to check for blood flow in the penis. It will also look for blockage in the arteries or veins that supply the penis.
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 is done to repair the blood vessel leaks. This has been shown to be effective in some cases.
Penile Implants TOP
Implants may be placed in the penis. The implants can be inflated to simulate 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:
...(Click grey area to select URL)
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: 9/7/2017
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