A wide array of mental and physical health factors can contribute to ED.
When a person is unable to achieve or sustain an erection that is sufficient for sexual intercourse, it is considered erectile dysfunction (ED). Mental health issues, physical health problems and even certain lifestyle choices are some of the main factors that can cause ED.
Here are detailed answers to the most pressing questions about the condition and other important facts about erectile dysfunction.
When a man becomes sexually aroused, his brain sends chemical signals to the blood vessels in the penis. In response to those signals from the brain, the blood vessels in the penis relax and open up, letting more blood flow in.
Twin chambers called corpora cavernosa, which run along both sides of the penis, swell with blood and become rigid. The outflow of the blood is constricted so there is more blood entering the penis than leaving, which causes it to become rigid.
It is that interruption of blood-flow stasis that gets the penis erect and keeps it that way. The more blood that rushes to the penis, the more firm and erect the penis becomes.
Most men experience ED at some point in their lives. For many of them, the cause may be strictly situational: maybe they had too much to drink or are affected by performance anxiety with a new partner. For others, ED can be a persistent problem that causes stress and frustration.
While older men are at greater risk of developing ED, men of any age can experience it. The National Institutes of Health (NIH) reports that more than 30 million men in the United States have erectile dysfunction. A 2017 study published in The Journal of Sexual Medicine suggests that number may be as high as 47 million.
This isn't a new problem, either. In fact, researchers have found ED has been a problem for men since the beginning of recorded history.
Sexual arousal is a key component to achieving and maintaining an erection, so it makes sense that any issues with elements that contribute to sexual arousal can lead to ED. These elements include hormones, the brain, blood flow, muscles, nerves and even emotions.
Mental health issues such as stress or anxiety can sometimes cause ED or make it worse. In most situations, ED is caused by a combination of physical and psychological factors.
Physical health conditions that can be an underlying cause of ED include, but aren't limited to, the following:
Psychological causes for ED can include:
Lifestyle factors that can cause ED include:
Organic ED, also known as organic impotence, is a term that describes ED caused by the physical inability to achieve and sustain an erection firm enough for intercourse. This distinction is drawn because ED can be split into two general categories: organic ED and psychogenic ED.
Psychogenic ED occurs due to psychological problems such as anxiety, depression, stress, shame, guilt and more.
The mind is a powerful thing, and when you're struggling with your mental health, it can have the power to kill your erection. Mental health issues can sometimes serve as the sole cause of ED. Often, however, they are one of multiple causes or even secondary reactions to underlying physical causes of ED.
Research has found about 25 percent of men with ED also have anxiety and/or depression.
Some of the most common psychological causes of ED include the following:
Symptoms of ED include difficulty achieving an erection, trouble maintaining an erection sufficient for intercourse, and an overall reduced sex drive. If you are experiencing ED, don't hesitate to reach out to your doctor. Fortunately, treatment options are available for ED, and they are targeted at the various causes across the organic and psychogenic spectrums.
For some men, ED may come and go. For others, it can be a persistent problem, and a frustrating one at that. If you have concerns about your ability to achieve and maintain an erection, consult your doctor. You should also let your doctor know if your sexual dysfunction goes beyond just ED, particularly if you experience premature or delayed ejaculation.
Sometimes a doctor can diagnose ED based solely on a quick physical examination and taking a medical history. However, if you have chronic health conditions or your doctor thinks an underlying health problem may be the cause of your ED, further evaluation may be necessary.
In some cases, this may be performed by a specialist and include blood tests, urine tests, a psychological exam or an ultrasound of the penis to examine the blood vessels and assess blood flow.
Recommended treatment for ED typically depends on a person's age, any underlying medical conditions they may have, the severity of symptoms and their desire for treatment.
Common treatment options vary from medication to devices to surgery to prostheses (as a last resort).
Oral medications, such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra), are effective at helping some men achieve and maintain an erection sufficient for intercourse.
If low testosterone is the cause of your ED, your doctor may recommend testosterone replacement therapy (TRT), which not only helps sexual function but also mood, bone density, muscle mass and libido. It can negatively impact fertility, though, so if that's a concern, be sure to mention it to your doctor.
Wearable devices can relieve ED symptoms for some men in a noninvasive manner. These tools include vacuum pumps, which use vacuum action to pull blood into the penis, and a constriction device placed at the base of the penis that restricts blood outflow during sex, aiding in maintaining an erection.
One of the newest ED treatments on the market is Eddie®, an FDA-registered Class II medical device designed to treat erectile dysfunction and improve male sexual performance. In 2021 clinical trials, published in 2023, Eddie proved effective in treating men with physically, psychologically and pharmacologically induced ED. Eddie is a safe treatment that does not have the negative side effects of prescription pills, nor does it require a prescription to obtain.
Surgery may be the only treatment option for men whose ED is the result of previous pelvic surgery or physical trauma.
A malleable or inflatable penile implant can be put in the penis. This is usually a solution of last resort which allows the patient to have either a permanently firm penis that can be bent downward when not in use or one that can be inflated before sex and deflated afterward.
Microsurgical penile revascularization is a treatment option typically reserved for men younger than 50 who have suffered blunt trauma injury with a localized arterial lesion. The procedure is performed the same way a cardiac bypass is done, but the donor artery is taken from the leg to bypass the arterial lesion that is creating blood flow issues for the penis.
Sexual intimacy is often an integral part of romantic relationships. Erectile dysfunction can put stress not only on the person suffering from it but on their partner, too. It's not uncommon for an individual with ED to feel guilty, inadequate or as if they are failing their partner. This can lead to feelings of insecurity, frustration and dissatisfaction within the relationship that can bring other problems to the surface and manifest as arguments over things seemingly unrelated.
If you're not in a relationship, ED can make dating seem even more difficult than it already is. Fortunately, you don't have to let ED run your life, as treatments are readily available. Talk to your doctor so you can pursue the solution that's right for you.
There's not always a surefire way to prevent ED, but there are a number of measures you can take to significantly reduce your risk of experiencing it. These include the following:
Clinical research trials are always looking for patients to help researchers work toward uncovering information that can advance medical treatment for ED. If you're interested in acting as a subject in a clinical trial, the National Institutes of Health's website has information on clinical trials that are currently recruiting participants.
These trials are aimed at finding and testing new ways to prevent, detect and treat ED. Be sure to do plenty of research before moving forward. Clinical trials may be right for some people, but they may not be for others.
Erectile dysfunction is treated by addressing the underlying cause of the condition. These causes can include mental health issues, physical health problems, lifestyle choices or a combination of all of these. Talk with your doctor about your symptoms so you can take the next steps toward determining the cause of your ED and seeking treatment.
The treatment for ED depends on the cause. Treatment may include treating underlying health problems, such as heart disease and diabetes, or seeking professional help for mental health issues. In some cases, making lifestyle changes such as quitting tobacco, eating healthy, exercising regularly, maintaining a healthy weight and avoiding excessive alcohol consumption can help reduce or eliminate ED symptoms.
The primary symptom of erectile dysfunction is the inability to achieve and maintain an erection sufficient for intercourse.
