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The Facts About Erectile Dysfunction

A wide array of mental and physical health factors can contribute to ED.

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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.

What is an erection?

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.

Facts, stats and history

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.

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.

What causes ED?

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:

  • Heart disease
  • Diabetes
  • Obesity
  • High blood pressure (hypertension)
  • Low testosterone levels
  • Metabolic syndrome
  • Parkinson's disease
  • Multiple sclerosis
  • Pelvic or spinal cord injuries
  • Peyronie's disease
  • Some treatments for prostate cancer or enlarged prostate

Psychological causes for ED can include:

Lifestyle factors that can cause ED include:

  • Excessive alcohol consumption
  • Tobacco use
  • Use of certain medications
  • Poor sleep patterns

Organic erectile dysfunction

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.

Psychological causes

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:

  • Depression. Individuals with depression experience deep feelings of sadness and hopelessness. Depression can make it difficult for the brain to send off the chemical signals to stimulate the blood flow necessary to achieve and maintain an erection. Symptoms of depression—fatigue, low self-esteem and apathy, among others—can complicate sexual function, too.
  • Anxiety. When a person is anxious, they experience a spike in fear and alertness that can lead to rapid heart rate, high blood pressure and fatigue. This can lead to sexual dysfunction, especially if the anxiety is centered around an individual's fear of not being able to perform sexually.
  • Stress. Stress can leave you feeling distracted, which may get in the way of the sexual arousal necessary to achieve and maintain an erection. When the body is under too much stress, the brain releases cortisol, a hormone that triggers the blood vessels in the penis to constrict. This prevents blood from flowing to the penis and can cause ED.

Symptoms of ED

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.

When to call the doctor

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.

How is ED diagnosed?

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.

How is erectile dysfunction treated?

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.

Hormone replacement therapy

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.

Medical devices

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, 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.

Surgical treatment

Surgery may be the only treatment option for men whose ED is the result of previous pelvic surgery or physical trauma.

Penile prosthesis

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

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.

Living with ED

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:

  • Eating a healthy diet
  • Maintaining a healthy weight
  • Exercising regularly
  • Managing stress
  • Drinking less
  • Quitting smoking

Clinical trials

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.


How do you fix erectile dysfunction?

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.

What is the easiest way to treat erectile dysfunction?

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.

How can you tell if a man has erectile dysfunction?

The primary symptom of erectile dysfunction is the inability to achieve and maintain an erection sufficient for intercourse.