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Understanding erectile dysfunction (ED)

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Although ED can affect sexual function, relationships, and well-being, treatments are available, including medications, medical devices, and surgical procedures.
Medically reviewed by Matt Coward, MD, FACS
Written by Rashida Ruwa, RN
Updated on February 2, 2024

ED can affect your ability to get and maintain an erection that is strong enough for sexual intercourse.

While occasional erectile difficulties can occur, persistent ED can significantly affect self-esteem, relationships, and overall well-being.

ED is treatable, and there are various treatment options available.

A note on sex and gender: Sex and gender exist on spectrums. This article uses the term “male” when discussing people assigned male at birth.

What is ED?

Adult males working out in a fitness class as one of the health habits to develop when understanding erectile dysfunction
Photography by Maskot/Getty Images

ED can be short or long term. It is widespread in males ages 40 years and older, and according to a 2019 study review, the global prevalence of ED ranges from 3—76.5%, according to age.

While many males have difficulty maintaining an erection from time to time, persistent ED can negatively affect their self-esteem, relationships, and overall quality of life.

What are the risk factors and causes? 

Several physical or psychological factors can lead to ED.

Physical causes may include:

  • increased age
  • heart disease
  • diabetes
  • low testosterone levels
  • high blood pressure
  • smoking
  • obesity
  • certain prescription medications, like antidepressants

Psychological factors that may cause ED include:

  • persistent stress
  • anxiety (particularly anxiety around sexual performance)
  • depression
  • difficulties in relationships, such as conflicts or lack of emotional intimacy

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When should you see a doctor?

If you are experiencing persistent difficulties in getting or maintaining an erection, consider talking with a healthcare professional. They can diagnose ED by asking about your medical history, performing a physical examination, and recommending lab tests if necessary.

During your visit, a doctor or healthcare professional may ask about your symptoms, medical conditions, use of medications, and lifestyle factors that can lead to ED. 

It’s important to be open and honest during this discussion, as it will help them to make an accurate diagnosis and recommend appropriate treatment options.

During the consultation, a healthcare professional may ask you the following questions to monitor ED severity and provide proper guidance:

  • How long have you been experiencing difficulties getting or keeping an erection?
  • Have you noticed any changes in the firmness of your erections?
  • Do you have morning erections? If so, how frequent and how firm are they?
  • Have you experienced any decrease in your sexual desire or libido?
  • Are you able to achieve an erection during masturbation or self-stimulation?
  • How is your overall emotional well-being, including stress, anxiety, or depression?
  • How is your relationship with your partner?
  • Do you have any underlying medical conditions like diabetes, high blood pressure, or cardiovascular disease?
  • What medications are you currently taking, including over-the-counter supplements or herbal remedies?
  • Have you had any recent surgeries or medical procedures that may affect your erectile function?
  • Are there any lifestyle choices such as smoking, increased alcohol consumption, or recreational drug use that may impact your sexual function?

Medications for ED

Some medications that doctors frequently prescribe for ED include.

Phosphodiesterase type 5 inhibitors (PDE5 inhibitors)

PDE5 inhibitors include:

  • Sildenafil (Viagra): Sildenafil (Viagra) enhances blood flow to the penis, leading to improved erections. You typically take it 30 minutes–4 hours before sexual activity.
  • Tadalafil (Cialis): Tadalafil (Cialis) has a longer duration of action compared to sildenafil (Viagra), allowing for flexibility in sexual activity. 
  • Vardenafil (Levitra): Similar to sildenafil (Viagra), vardenafil (Levitra) helps increase blood flow to the penis. You typically take this 1 hour before sexual activity.

Alprostadil

Alprostadil is available in various formulations, including:

  • Alprostadil injection (Caverject): The alprostadil (Caverject) involves an injection into the base or side of the penis using a fine needle. This enhances blood flow, causing an erection.
  • Alprostadil suppository (MUSE): MUSE is a small pellet you insert into the urethra using a prefilled applicator. The pellet dissolves, releasing the medication and stimulating blood flow.
  • Alprostadil cream (Vitaros): You apply this cream to the tip of the penis, and the medication is absorbed through the urethra, helping with erections.

Testosterone replacement therapy

Testosterone replacement therapy helps with ED by improving erectile function and libido. However, doctors would only offer this treatment if you have a diagnosis of hypogonadism or low testosterone.

There are many formulations for testosterone, including:

  • Testosterone gel (Androgel): Applying Androgel to the skin daily helps increase testosterone levels.
  • Testosterone injections: Doctors typically give these injections every 2–4 weeks to supplement testosterone levels. Examples include testosterone enanthate (Xyosted) and testosterone cypionate (Depo-testosterone).
  • Testosterone patches: You apply these patches to the skin daily. They continuously produce testosterone.

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Medical devices for ED

Sometimes, a healthcare professional may recommend medical devices to help with erectile function. These devices may include:

  • A vacuum erection device (VED): This is a pump that creates a vacuum around the penis, drawing blood into the organ and causing an erection. Once an erection is firm, you place a constriction ring at the base of the penis to maintain the erection.
  • Constriction devices: These are often made from silicon and allow blood to flow into the penis but not back out again, helping to keep a firm erection. An example is Eddy by Giddy

Although medical devices effectively treat ED, they may require proper instruction and practice to achieve the desired results. Consider talking with a healthcare professional who can guide device selection, usage, and maintenance.

Surgical procedures 

Typically, doctors only consider surgical procedures for ED for people experiencing severe ED or where other treatment options have not worked.

A penile implant is the primary surgical procedure for ED. It involves surgically placing inflatable or semirigid rods into the penis to allow for an erection when desired.

Surgery carries risks and potential complications, so doctors only recommend it where other treatments have been unsuccessful.

Preventing ED

While it may not be possible to prevent all instances of ED, certain lifestyle adaptations can reduce the risk of developing or worsening the condition. 

Lifestyle modifications may include:

  • ensuring you exercise as regularly as possible
  • eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins
  • managing stress and anxiety, where possible
  • avoiding or quitting smoking if you smoke
  • limiting alcohol consumption if you drink alcohol

What to do if you or your partner have ED

If you or your partner have ED, it is important to communicate openly about the condition. Being honest, discussing needs, and offering support and understanding can ensure you both get the proper support. 

If your partner has ED, encourage them to seek medical advice and offer to accompany them to appointments if they feel comfortable with that.

Remember that ED is a medical condition and not a reflection of how you or your partner feels about your relationship. 

Summary

ED is a common condition that can have physical and psychological causes. Consider talking with a doctor or healthcare professional if you are experiencing difficulties with getting or keeping an erection, as this condition is treatable.

Treatment options, including medications, medical devices, and surgical procedures, can help improve erectile function for many people.

Additionally, making lifestyle modifications and managing underlying medical conditions can support your overall sexual health.

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