Erectile Dysfunction: Causes, Symptoms, Diagnosis and Treatment

Erectile dysfunction can be a sign of a physical or psychological condition. It can cause stress, relationship strain and low self-confidence.

The main symptom is a man's inability to get or keep an erection firm enough for sexual intercourse.

Patients suffering from erectile dysfunction should first be evaluated for any underlying physical and psychological conditions. If treatment of the underlying conditions doesn't help, medication and assistive devices, such as pumps, can be prescribed.

    Some men have occasional trouble getting or keeping an erection, which can be considered normal.

    If this problem becomes frequent or lasts a long time, you should see your doctor.

    There are many causes of ED. Sometimes the culprit is another health issue.

    Signs and Symptoms of Erectile Dysfunction

    If you have ED, you might experience:

    • Trouble getting an erection
    • Trouble keeping an erection for a long enough period of time
    • Reduced sex drive
    • Feelings of embarrassment or guilt
    • Low self-esteemright up arrow
    Erectile Dysfunction

    Symptoms of Other Sexual Disorders

    Some sexual disorders are related to ED and may cause similar symptoms to ED, such as:

    • Premature ejaculation (ejaculating too soon)
    • The inability to have an orgasm after sufficient stimulation
    • Delayed ejaculation (when ejaculation takes too long)

    Causes and Risk Factors of Erectile Dysfunction

    An erection occurs when blood fills the penis. Normally, when a man becomes sexually aroused, blood vessels, muscles, nerves, and hormones work together to create an erection. Symptoms of ED can occur when this process is disrupted.

    Some men experience symptoms only occasionally. For others, the symptoms are constant and interfere with their sexual relationships.

    ED is a complex condition that can be caused by a variety of factors. Often, there’s more than one issue that’s responsible for ED.

    Physical Causes

    Other medical conditions can cause ED symptoms. Common physical causes include:

    • Heart disease or atherosclerosis (inflammation and narrowing of the arteries)
    • High blood pressure
    • High cholesterol
    • Obesity
    • Diabetes
    • Stroke
    • Metabolic syndrome (a cluster of risk factors that includes high blood pressure, elevated insulin levels, high cholesterol and triglycerides, and increased body fat around the waist)
    • Parkinson’s disease
    • Multiple sclerosis (MS)
    • A brain or spinal cord injury
    • Chronic kidney disease
    • Nerve disorders
    • Hypogonadism (a condition where the body doesn’t make enough testosterone)
    • Peyronie’s disease (scar tissue inside the penis)
    • Sleep disorders

    Medications That May Contribute to Erectile Dysfunction

    Certain prescription medicines can cause ED, too. These may include:

    • Diuretics (pills that increase urine flow)
    • High blood pressure meds
    • Antihistamines
    • Antidepressants
    • Parkinson's disease drugs
    • Antiarrhythmics (drugs for irregular heartbeat)
    • Tranquilizers and sedatives
    • Muscle relaxants
    • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Histamine H2-receptor antagonists
    • Hormones
    • Chemotherapy medications
    • Prostate cancer drugs
    • Anti-seizure medications
    It’s important to tell your doctor about all the drugs you take, including nonprescription ones, so they can determine if any of your meds could be responsible for your symptoms.

    Psychological Causes of Erectile Dysfunction

    Psychological factors that may lead to ED include:

    • Depression
    • Anxiety
    • Other mental health disorders
    • Stress
    • Feeling self-conscious or nervous about sex
    • Relationship problems

    The Role of Hormones in Erectile Dysfunction

    Sometimes, ED happens when your hormones are out of balance. Your doctor can perform a blood test to check your hormones.

    Other Factors to Consider Regarding ED

    ED can also be caused by tobacco or alcohol use.

    Additionally, surgeries or procedures that target the spinal cord or pelvic area can lead to ED. Radiation therapy to the testicles can also cause impotence.

    How Is Erectile Dysfunction Diagnosed?

    To diagnose ED, your doctor may only need to ask you some questions and perform a physical exam.

    But if underlying conditions are a suspected cause for your ED, you may need certain tests, such as:

    Blood test A blood sample may help your doctor look for signs of diabetes, heart disease, low testosterone, or other issues such as liver or kidney disease.

    Urine test A urine test can look for markers of diabetes.

    Ultrasound/Doppler exam This test can let your doctor see if you have problems with penile blood flow.

    Psychological exam Your doctor might screen you for depression or another mental health disorder that could be linked to ED symptoms.

    What Should You Tell Your Doctor About Symptoms?

    When talking to your doctor, be as open and honest about your symptoms as possible. Tell your healthcare provider how often you have symptoms and how long you’ve had them.

    You should also tell your physician:

    • About all the medications you take
    • If you have any other health conditions
    • If you drink alcohol or use tobacco products
    • Additionally, it’s a good idea to share any life changes or stressors that could be affecting your mental health, such as the death of a loved one, a job change, the birth of a child, or trouble in your relationship.

    Prognosis of Erectile Dysfunction

    The prognosis for men with ED is generally favorable.

    While many cases of ED are caused by medical conditions that can’t be cured, various treatment options can help restore sexual function.


    Duration of Erectile Dysfunction

    The duration of ED depends on what causes it and how you respond to your treatment. Many men notice an immediate improvement when they start on medication or another form of treatment.right up arrow
    Treatment and Medication Options for Erectile Dysfunction
    Several treatment options are available to help ED. Sometimes, resolving underlying medical conditions will also improve your ED symptoms.


    Medication Options

    There are several types of ED medications, including:

    Oral drugs Popular medicines like sildenafil (Viagra), tadalafil (Adcirca, Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra) work by boosting the effects of nitric oxide — a chemical that relaxes muscles in the penis. Note that drugs in this class (PDE-5 inhibitors) are contraindicated in patients who take nitrates in any form, because the combination can lead to severe hypotension.

    Injections Some medicines can be injected or placed inside the penis to help create an erection.

    Testosterone Your doctor may recommend that you take this hormone if your levels are low.

    Devices and Surgery

    Your healthcare provider may recommend a vacuum device, also called a “penis pump,” to help you get an erection. The pump helps pull blood into your penis, so you can achieve an erection that lasts long enough for sexual intercourse. It’s paired with an elastic ring that helps you maintain an erection.

    Surgery is also an option for some men with ED. During this procedure, doctors place penile implants in the penis. There are different types of procedures, depending on your goals and preferences.

    Counseling and Therapy

    Often, men with ED benefit from talking to a therapist, especially if they suffer from depression, anxiety, or low self-esteem. If relationship problems are a factor, couples therapy may be useful.

    Alternative and Complementary Therapies

    Many supplements and alternative therapies are marketed to help men with ED. The U.S. Food and Drug Administration (FDA) warns that these products may contain potentially harmful drugs, contaminated formulations, or unknown dosages of pharmacologically active medications. They can also interact with other medications you take.

    Always talk to your doctor before trying any supplement for ED.

    Other alternative therapies that may help reduce stress, and in turn, ease ED symptoms, include:


    • Acupuncture
    • Massage
    • Meditation
    • Yoga

    Prevention of Erectile Dysfunction

    Certain measures can help you lower your risk of ED. These include:

    • Eat a healthy diet
    • Stop smoking
    • Lose excess weight
    • Exercise daily
    • Maintain normal blood pressure and cholesterol levels
    • Get help for alcohol or drug addiction problems
    • Learn about the side effects of medicines you take
    • Consider couples counseling if you and your partner are having trouble communicating

    Complications of Erectile Dysfunction

    ED can lead to complications, including:

    • Low self-esteem
    • Stress
    • Anxiety
    • Relationship issues
    • A lack of intimacy
    • An unfulfilling sex life
    • Inability to get your partner pregnant
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