What To Know About Erectile Dysfunction (ED)

By Natalya Lopushnyan, MD
Medically reviewed
January 18, 2021

Erectile dysfunction (ED) is the inability to get or keep an erection that is firm enough to have sexual intercourse. While it may sound scary, this condition is incredibly common – studies have estimated that it affects up to one-third of the total male population.

This article will go over the basics of ED, discussing the causes, risk factors, treatment options, and prevention options. Let’s take a closer look at all-things-ED.

What is Erectile Dysfunction?

Erectile dysfunction, sometimes called impotence, is the inability to get and keep and erection that is firm enough for sexual intercourse.

While ED is not something that most people talk about, this male sexual dysfunction is very common:

  • Approximately 40% of men in their forties experience some degree of ED
  • The number of men suffering from erectile dysfunction increases with age
  • By the age of 70, about 70% of men will have ED.

Problems with ED can affect man’s self-esteem, cause relationship problems, and contribute to increased stress levels. It can also be a sign of an underlying health issue, such as heart disease or diabetes, so it is important to seek treatment as soon as possible if you are experiencing symptoms.

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Symptoms

Symptoms of ED are easy to recognize.

Typically, ED symptoms involve difficulty performing the following activities:

  • Getting an erection during sexual activity
  • Keeping an erection during sexual activity
  • Achieving an orgasm during sexual activity
  • Ejaculation
  • Reduced interest and sexual desire

If you’ve experienced any of these symptoms, talk to a doctor about treatment options.

Causes and Risk Factors

Erections and sexual desire involve a complex process that depends on man’s brain, emotions, nerves, hormones, and blood vessels. All those components must work together to achieve a satisfying sexual experience.

This interconnection also means that dysfunction in any of those areas can lead to problems with erections.

Before we get into the causes of ED, its important to understand how an erection comes to be:

  1. During sexual arousal man’s brain and nerves signal the blood vessels to deliver more blood to the penis
  2. Following that, blood fills the spongy parts of the penis, which is called the corpus cavernosum
  3. The blood flow into the corpus cavernosum is what causes the erection of the penis

The main causes of the ED can be divided into physical and psychological buckets.

Physical Causes

The most common physical reasons for erectile dysfunction are conditions that damage nerves and blood vessels and include the following:

  • Diabetes: Men with diabetes have a much higher chance of having damaged nerves and blood vessels which leads to poor erections or no erections at all. Also, men with diabetes tend to develop ED at a younger age compared to their nondiabetic counterparts. History of poorly controlled diabetes is one of the main risk factors for ED.
  • Heart or cardiovascular disease: Men with hear or vascular disease are at a higher risk for ED due more narrow or “stiffer” arteries and veins.
  • High blood pressure (hypertension)
  • High cholesterol
  • Clogged blood vessels (atherosclerosis)
  • Metabolic syndrome: a cluster of symptoms and signs that include hypertension, high blood sugar, increase fat around the waist, and high cholesterol
  • Obesity
  • Neurologic diseases: These include any back/spinal cord issues, multiple sclerosis (MS), Parkinson’s disease, diabetic neuropathy, etc. Neurologic diseases affect nerves that go to the penis causing worsening of the erections.
  • Smoking or any other tobacco use
  • Alcoholism or any other substance abuse
  • History of prostate cancer and treatments for prostate cancer
  • Low testosterone
  • Past surgeries or injuries to the pelvis
  • Previous back injury or surgery
  • Previous radiation therapy
  • Peyronie’s disease: a condition that causes scar tissue to develop on the inside of the penis. It usually happens in men who already suffer from ED but may lead to even worse ED by restricting blood flow inside the penis. Often men with Peyronie’s disease will also have a curvature of the penis during erections, making intercourse even more problematic.
  • Certain prescription medications: Most common medications that affect men’s erections will include antidepressants and blood pressure medicines.
  • Older age

As you can see, there are many physical conditions that may contribute to your erectile dysfunction. Talk to a doctor to gain a better understanding of which of these conditions is affecting you.

Psychological Causes

ED can also be due to a variety of psychological causes, most common of which are the following:

  • Stress. If a man has high stress levels in his life, his sexual function and performance tend to suffer. Brain plays a major role in initiating sexual excitement and high stress levels tend to interfere with that function leading to loss of libido, interest, and overall worse sexual performance
  • Depression
  • Performance Anxiety. This is especially common in men who have had trouble with erections in the past. They may become increasingly worried that the problem will happen again, leading to even worse erection issues
  • Guilt. A man may feel guilty that they are not satisfying their partner, preventing them from achieving erection
  • Other major mental health conditions as well as some medications that are used to treat them
  • Relationship and partner issues

Psychological causes of ED may be treated differently than physical causes. Make sure you are giving your medical provider a full history (more on that in the next section!) so that they can get to the root of your ED issues from the start.

Diagnosis

Most of the times men will self-diagnose with ED.

Once it is determined that ED is an issue, your doctor will ask you for a detailed medical history to help determine the cause.

Here are a few of questions that are usually covered:

  • When did ED start, and did it begin gradually or suddenly?
  • Frequency of the intercourse
  • Quality of erections
  • Assessment of the psychological and lifestyle factors (tobacco, alcohol consumption, stress level, history of depression)
  • Current medications
  • Previous treatment for ED
  • Any previous trauma or surgery

Once a complete history is obtained, medical professional will assess severity of the problem and will recommend appropriate treatments.

Occasionally, other diagnostic tests may be needed. Depending on the severity of your ED, your doctor may order:

  • Blood tests for hormone levels
  • Liver and kidney function tests
  • Thyroid tests
  • Nocturnal penile tumescence (NPT) test
  • Ultrasound
  • Penile injection test

These test will help determine whether an underlying condition is the cause of your ED, and which treatment options are appropriate for you.

Treatment Options for Erectile Dysfunction

Erectile dysfunction treatment typically includes any of the following: options:

Let’s take a closer look at each of these to see which might be right for you.

Medications for ED

Perhaps the most common treatment option for ED, oral medications – sometimes referred to as PDE5 inhibitors – are a standard first-line of treatment.

The most common prescription drugs for ED are:

All of these medications work on increasing blood flow to the penis by relaxing the blood vessels that deliver blood. They work better in patients without significant nerve damage.

If your doctor finds that you have lower testosterone levels, they may prescribe testosterone to help treat your ED. Testosterone will not help if your ED is caused by circulatory or nerve problems, though, so be sure to rule those out before taking it.

Testosterone is also ineffective for treating age-related ED and hypogonadism. Make sure you rule all of these things out before deciding on a treatment plan.

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Side Effects of ED Medications

ED medications vary in dosage, duration, and side effects.

The most commonly prescribed medications are sildenafil (Viagra) and tadalafil (Cialis). These last for about 6 and 18 hours, respectively.

Taking the medication will not produce an erection in itself. You will also need to engage in sexual stimulation or foreplay.

The medication will improve the erection and make the overall quality of your sexual experience better.

Medications are usually taken 45 minutes to 1 hour prior to intercourse with a glass of water. They work better if taken on an empty stomach, as that improves absorption and delivery of the medicine.

Side effects are not very common with ED medications. However, when they occur, they typically include:

These side effects usually resolve within a few hours of taking the medication.

More severe side effects of ED medications include:

  • vision changes
  • priapism, or an erection that last over 4 hours or does not go away

If either of these things occur, seek medical care right away.

ED medications should not be taken by patients who:

  • Take nitrates, which are medications commonly prescribed for chest pain
  • Have heart disease or heart failure
  • Or have very low blood pressure (hypotension)

If you are continuously experiencing side effects, be sure to talk to your doctor. They can provide alternative options to treat your ED.

Lifestyle Changes

Erectile function reflects the general health of your body. That is to say, the healthier you are, the better your erections are.

Lifestyle modifications can improve the quality of your erection by improving your overall health. Changes may include, but are not limited to:

  • smoking cessation
  • weight loss
  • improved diet
  • pelvic floor exercises, which can treat both ED and premature ejaculation issues

All of these have shown to improve both overall health and quality of erections in men.

In fact, men who stopped smoking for a year have reported 25% improvement in their erections. Additionally, a third of men who committed to a weight loss program reported that their ED virtually disappeared over time.

Penile Injections and Suppositories

One of the options for patients who do not respond to oral ED medications is to try penile injections or intraurethral suppository. Let’s take a look at what either of these options might mean for you.

Penile Suppositories

An intraurethral suppository is essentially a small pellet that is inserted into man’s urethra to aid the erection. The pellet contains alprostadil, which is a medication that improves blood flow to the penis.

The suppository is absorbed through the urethra and starts working within 10-15 minutes. Because of its direct nature, the suppository is faster-working than oral medication options.

Side effects of penile suppositories may include:

  • pain with insertion
  • burning inside the penis
  • minor bleeding

Talk to your doctor if you experience any side effects beyond the ones listed here.

Penile Injections

Penile injections are similar to suppositories, in that they also contain compounds that allow a better blood flow to the penis.

Generally, a man will self-inject a small amount of medication into a side of the penis 10-15 minutes before the intercourse.

Because these injections are delivered directly to the penile tissue, they frequently work in men who are unable to take oral medications such as sildenafil or tadalafil.

Injections, however, are uncomfortable for some men and may cause swelling, minor bleeding, and possibly scaring of the penis over the long term. Talk to your doctor about these side effects and whether injections might be right for you.

Penis Pump

A vacuum device – or penis pump – is a hollow tube that is placed over man’s penis and is used to suck out the air inside the tube. The sucking of the pump creates vacuum that pulls more blood into the penile tissue, thus improving your erection.

While some men find it helpful, penis pump can be cumbersome to use.

Penile Implant Surgery

For patients with severe ED who do not respond to other options, there is an option for an insertion of an Inflatable Penile Prosthesis (IPP).

IPP is a hydraulic device that is implanted inside the penis and replaces the erectile tissue. It generally has a small pump that is placed inside the scrotum.

By squeezing the pump fluid travels to the IPP cylinders inside the penis and produces an erection.

Penile implant is a very reliable method to treat ED, however, it involves surgery and post-surgical recovery. It is not recommended for older men, as the recovery time is a risk.

Prevention

There are certain steps that can be taken to prevent or delay ED.

Given that ED is associated with so many underlying conditions – obesity, diabetes, vascular disease, hypertension, and more – minimizing your risk for those conditions can help minimize your ED.

ED prevention involves:

  • Maintaining a healthy weight
  • Eating a healthy diet
  • Controlling your high blood pressure and cholesterol
  • Reducing your stress levels and tending to your anxiety or other mental health concerns
  • Exercising regularly
  • Quitting smoking and limiting your alcohol consumption

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When to See a Doctor

Occasional problems with erections are common and should not be a cause for concern. However, if those issues are becoming more frequent and sexual intercourse is no longer enjoyable for you or your partner, you may benefit from talking to a doctor.

Talking to your doctor about your ED is important because:

  • ED is treatable and treating it will likely improve your overall quality of life
  • ED can be a sign of underlying conditions such as heart disease or high blood pressure, so you’ll want to inform your doctor to rule those things out
  • ED can be linked to stress, anxiety, and depression. Treating your underlying mental health may improve your ED as well

Erectile dysfunction does not mean the end of your sex life. A doctor can help you figure out which treatment makes sense for you.

How K Health Can Help

K Health provides a simple, accessible option for ED treatment. Chat with a doctor on your phone to determine whether you are experiencing ED. Your doctor will then prescribe you medication, which can be picked up at a local pharmacy or shipped discreetly directly to you. They will also provide a longer-term care plan to help you manage your ED.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Natalya Lopushnyan, MD

Dr. Natalya Lopushnyan is a board certified Urologist specializing in Men's Health. She earned her degree in Biochemistry from University of Massachusetts Boston, graduating Summa Cum Laude. Her MD is from Yale. She completed Urology Residency at the University of Washington in Seattle.