At one point or another, most adult men will have trouble getting or maintaining an erection long enough to have sex. This usually resolves on its own with little to no treatment. However, when it becomes a permanent problem, it is called erectile dysfunction (ED).
Erectile dysfunction can be caused by a physical problem, an emotional problem, or a combination of the two. Many men are reluctant to see a doctor for their ED. However, when this happens on a regular basis, it can affect your personal life and overall health.
This article discusses the causes and symptoms of erectile dysfunction, how it’s diagnosed, how it’s treated, and when you should see your doctor.
Symptoms of erectile dysfunction
Erectile dysfunction is a common problem among men, affecting approximately 30 million men in the United States. Erectile dysfunction usually develops over time, although it can come on suddenly for no apparent reason.
It’s not ED when it happens occasionally, for example, after a night of several drinks or even for a week when you are under severe stress. However, it can be erectile dysfunction when it occurs 25% of the time or more.
The main symptoms of erectile dysfunction are:
- Difficulty having an erection: The inability to have an erection firm enough to have sex when you want to.
- Difficulty keeping an erection: The inability to keep an erection firm long enough to end or truly enjoy sex.
Other physical symptoms of erectile dysfunction that you might experience include:
For many men, erectile dysfunction also causes emotional and psychological distress. Erectile dysfunction can affect your relationships and your self-esteem, and can lead to feelings of guilt, embarrassment, shame, or other difficult emotions.
A mix of physical and psychological factors can contribute to ED. For example, a physical illness could interfere with your body’s ability to have an erection. This can create anxiety and make the problem of erectile dysfunction even worse.
Sexual arousal is a complex bodily function influenced by a combination of age, hormones, stress, emotions, nervous system, muscle tone, circulation, etc.
The most common cause of erectile dysfunction is arteriosclerosis-a condition in which the arteries harden. With erectile dysfunction, arteriosclerosis can start in the penile arteries and then progress until it affects the arteries that supply the heart with blood.
Other factors and conditions that could lead to erectile dysfunction include:
- Traumatic injury: Any trauma to the spine, pelvis, or perineum that damages the blood vessels in the penis can cause erectile dysfunction.
- Vascular disease: Erectile dysfunction can be an early sign of vascular diseases like atherosclerosis, in which the arteries harden due to the build-up of plaque, as well as coronary artery disease.
- Diabetes: About 35% to 50% of men with diabetes have ED; diabetes can contribute to erectile dysfunction because of the way it damages the nerves that control erections.
- Depression: Medicines for depression and antidepressants are known to cause erectile dysfunction. Men with erectile dysfunction and depression should be screened for cardiovascular disease, as the three often occur together.
- Nervous problems: Many nerve problems resulting from diabetes, spinal cord injury, chronic alcoholism, multiple sclerosis, heavy metal poisoning and others are all associated with erectile dysfunction.
- Medications : Erectile dysfunction can be a side effect of drugs used to treat high blood pressure, anxiety and depression, glaucoma (eye drops), kidney failure (dialysis), cancer (chemotherapy), etc.
- Hormones: Abnormal levels of thyroid hormones, testosterone, or a hormone called prolactin can lead to erectile dysfunction.
Erectile dysfunction can be its own condition, but in many cases, it is a symptom of another underlying condition.
Your risk of developing erectile dysfunction is higher if you have one or more of the following:
Increasing age is also a significant risk factor for erectile dysfunction. It is estimated that 8% of men aged 40-49 and 76% of men over 75 suffer from erectile dysfunction. Increasing age is also a risk factor for several of the conditions listed above, including prostate cancer, high blood pressure, and heart disease.
Men with erectile dysfunction are 33% more likely than men without erectile dysfunction to have a co-morbid disease.
The key to solving erectile dysfunction is finding and treating the underlying cause as early as possible. Your doctor will likely use four types of procedures to find out why you have erectile dysfunction.
First, your doctor may start by asking you questions about your medical and sexual history. They may ask you questions about your libido, how long you’ve had symptoms, and whether you’re able to ejaculate or reach orgasm.
From there, your doctor will move forward with a physical examination to check for problems with your hormones, nervous system, circulation, or other physical characteristics.
Then your doctor may order a blood test, urinalysis, or other laboratory tests to measure your hormone and cholesterol levels. They will also check for high levels of liver enzymes, which can tell them if there is inflammation in your body.
Finally, your doctor may want to perform a psychosocial examination to assess your mental health and make sure your ED is not caused by any emotional or psychological distress.
There is no need to feel shame throughout this process. Rest assured that your doctor has probably seen and heard all of this before, so it’s best to be honest. Your doctor’s only goal is to diagnose you correctly and get you on the right track.
Erectile Dysfunction Physician Discussion Guide
Get our printable guide for your next doctor’s appointment to help you ask the right questions.
Your doctor will determine your treatment based on several factors, including your age and general health, medical history, and treatment preferences.
If a separate condition is underlying your ED, resolving that condition will likely be your doctor’s first concern.
For example, if your doctor finds that a hormonal irregularity is causing your erectile dysfunction, they may recommend hormone replacement therapy. In particular, you may be given testosterone replacement therapy if your testosterone levels are low. This therapy can be injected, applied topically to the skin or taken through a skin patch.
If treating the underlying disease does not resolve your erectile dysfunction or if you do not have an underlying disease to begin with, you may be prescribed one of the following:
- Viagra (sildenafil)
- Levitra (vardenafil)
- Cialis (tadalafil)
- Stendra (avanafil)
These drugs carry a risk of side effects. To reduce your risk, make sure you are clear with your doctor about any other prescription or over-the-counter medications you are already taking.
Finally, if you and your doctor have exhausted all other treatment options and you still have erectile dysfunction, your doctor may recommend a penile prosthesis, which can simulate an erection at any time. There are two types:
a inflatable penile prosthesis is a pump with a reservoir filled with saline solution that is surgically implanted into your penis and scrotum. Opening the valve to the reservoir will create an erection; releasing the valve will make your penis saggy.
A semi-rigid penile prosthesis consists of two bendable rods that are implanted in your penis, which you can straighten or bend manually as needed.
Both types of penile implant surgeries have a high patient satisfaction rate and are considered to be safe. However, as with any surgery, there is always a risk of complications, including uncontrolled bleeding and wound infection.
ED can be temporary or it can last for several years. According to a study published in the Journal of Sexual Medicine, ED has an average remission rate of 25% in five years.
Erectile dysfunction is a very common condition, especially in older men. The condition can result from physical injury or illness, emotional or psychological distress, or a combination of the two.
Since erectile dysfunction is associated with many co-morbid conditions, it’s important to see your doctor if you’re having trouble getting or maintaining an erection. Your doctor may use physical and psychological procedures and lab tests to find the cause of your ED.
A word from Verywell
Despite the frequency of erectile dysfunction, many men feel deeply uncomfortable talking about it with their sexual partner (s). Being unable to communicate your needs will only heighten your relationship, slow down your healing, and keep you from coping.
Be honest and open with your partner when discussing your ED. Hear what they have to say. You may find that there are other exciting ways to give and receive sexual pleasure, even when sex is not an option.
Frequently Asked Questions
What physically happens when a man suffers from erectile dysfunction?
Typically, there is a lack of blood flow to the penis or the penis is not able to trap and hold blood long enough to maintain an erection.
Either can occur for a variety of underlying health conditions that affect the circulatory system, such as high blood pressure, heart disease, diabetes, or certain cancer treatments.
How do I know if I have ED?
There are three criteria for erectile dysfunction:
- Possibility of having an erection sometimes when you want to make love but not always, Where
- Ability to have an erection but unable to maintain it, Where
- Being unable to get an erection under any circumstances
Is there a self test for erectile dysfunction?
There is no diagnostic test for ED. Occasionally, a urologist will ask a patient to do a nocturnal penile tumescence (NPT) test, which can indicate if he has spontaneous erections while sleeping, or a penile plethysmograph, which assesses blood flow to the penis in response to exciting material.
Both can help determine whether a physical condition is wholly or partially responsible for erectile dysfunction.