Updated: Oct 13, 2020
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What is erectile dysfunction (ED)? Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. It’s sometimes referred to as impotence, although this term is now used less often.
Occasional ED isn’t uncommon. Many men experience it during times of stress. Frequent ED, however, can be a sign of health problems that need treatment. It can also be a sign of emotional or relationship difficulties that may need to be addressed by a professional.
What causes an erection? ED can occur because of problems at any stage of the erection process. An erection is the result of increased blood flow into your penis. Blood flow is usually stimulated by either sexual thoughts or direct contact with your penis.
When a man is sexually excited, muscles in the penis relax. This allows for increased blood flow through the penile arteries, filling two chambers inside the penis. As the chambers fill with blood, the penis grows rigid. An erection ends when the muscles contract and the accumulated blood can flow out through the penile veins.
Erectile dysfunction causes There are many possible causes of ED, and they can include both emotional and physical conditions. Common causes include:
hypertension, or high blood pressure
low testosterone levels or other hormone imbalances
certain prescription medications, such as those used to treat high blood pressure or depression
consuming too much alcohol
using tobacco products
certain health conditions, such as Parkinson’s disease or multiple sclerosis (MS)
damage to the pelvic area through injury or surgery
Peyronie’s disease, which causes scar tissue to develop in the penis
ED can be caused by only one of these factors or by several of them. That’s why it’s important to work with your doctor so that they can rule out or treat any underlying medical conditions. Learn more about the causes of ED.
Erectile dysfunction treatment Treatment for ED will depend on the underlying cause. You may need to use a combination of treatments, including medication or talk therapy.
Medications Your doctor may prescribe medication to help you manage the symptoms of ED. You may need to try several medications before you find one that works. The following oral medications stimulate blood flow to your penis to help treat ED:
Vardenafil (Levitra, Staxyn)
NZT-V 112mg Sildenafil w/Aminos
NZT-C 24 Tadalafil w/Aminos
Alprostadil (Caverject, Edex, MUSE) is another medication that can be used to treat ED. It can be administered in two ways: as a penile suppository or as a self-injection at the base or side of the penis.
Testosterone therapy (TRT) may also be recommended if you have low levels of testosterone.
Medications used for other conditions may cause ED. Talk to your doctor about your medications and whether they could be causing your symptoms. There may be others that you can take instead. Never stop taking medications without first talking to your doctor. Medications for ED can cause side effects. If you’re experiencing unpleasant side effects, talk to your doctor. They may be able to recommend a different medication. Get more information on the medications used to treat ED.
Talk therapy A number of psychological factors can cause ED, including:
post-traumatic stress disorder (PTSD)
If you’re experiencing psychological ED, you may benefit from talk therapy. Over several sessions, you and your therapist will discuss:
major stress or anxiety factors
your feelings around sex
subconscious conflicts that could be affecting your sexual well-being
If ED is affecting your relationship, consider speaking with a relationship counselor as well. Relationship counseling can help you and you partner reconnect emotionally, which may also help your ED. Explore the effects of stress and anxiety on ED.
Vacuum pumps This treatment uses the creation of a vacuum to stimulate an erection. Blood is drawn into the penis as the device is used, leading to an erection. A vacuum pump device consists of a few different components:
a plastic tube, which you place over your penis
a pump, which works to create the vacuum by drawing air out of the plastic tube
an elastic ring, which you’ll move to the base of your penis as you remove the plastic tube
The elastic ring functions to maintain the erection, holding the blood in the penis and preventing it from returning to circulation. It can be left in place for 30 minutes. Read more about vacuum pumps and how to use them. Erectile dysfunction symptoms You may have ED if you regularly have:
trouble getting an erection
difficulty maintaining an erection during sexual activities
reduced interest in sex
Other sexual disorders related to ED include:
anorgasmia, or the inability to achieve orgasm after ample stimulation
Speak with your doctor if you have any of these symptoms, especially if they’ve lasted for 3 or more months. They can help determine whether your symptoms are caused by an underlying condition that requires treatment. Erectile dysfunction tests Testing for ED can involve a variety of steps, including a physical examination and taking your health and sexual history. Additional tests may be performed to determine if your symptoms are caused by an underlying condition. Physical exam You should expect a physical exam where your doctor will listen to your heart and lungs, check your blood pressure, and examine your testicles and penis. They may also recommend a rectal exam to check your prostate.
Psychosocial history Your doctor will ask you questions or request that you fill out a questionnaire about your symptoms, health history, and sexual history. The responses can help them evaluate the severity of your ED.
Some questions that you may be asked include:
How long have you been experiencing ED? Did it come on suddenly or gradually?
Are you having any problems with feeling sexual desire, ejaculating, or reaching orgasm?
How often do you have sex? Has this frequency changed recently?
How firm are your erections? Is this affected by particular situations or types of stimulation?
Do you wake up in the morning or in the middle of the night with erections?
How’s your current relationship? What expectations do you and your partner have for each other? Have there been any changes?
Have you recently been experiencing a lot of stress?
What medications are you currently taking? Do you use tobacco, alcohol, or nonprescription drugs?
Do you have any underlying conditions or have you had any surgery on or injury to your pelvic area?
Additional tests Your doctor may perform additional testing to help diagnose your ED. Tests can include:
Ultrasound. An ultrasound can be used to examine the blood vessels of the penis to determine if there’s a problem with penile blood flow.
Nocturnal penile tumescence (NPT) test. A portable, battery-powered device, worn on the thigh, is used to evaluate the quality of your nocturnal erections. Data is stored in the device, which your doctor can access later.
Injection test. During this test, a medication is injected into your penis to stimulate an erection. This allows your doctor to evaluate the firmness of the erection and how long it lasts.
Urine tests. Urine tests can be used to check for diabetes or other underlying health conditions.
Blood tests. Blood tests can be used to check for conditions such as diabetes, heart disease, thyroid issues, and low levels of testosterone.
These tests can help your doctor guide your treatment as well as determine if an underlying condition may be causing your ED. Find out more about how blood tests can be used to diagnose ED. Erectile dysfunction exercises Certain exercises can also help with ED. Kegel exercises Kegel exercises are simple movements you can do to strengthen your pelvic floor muscles. Here’s how:
Identify your pelvic floor muscles. To do this, stop peeing midstream. The muscles you use to do this are your pelvic floor muscles.
Now that you know where these muscles are, contract them for 3 seconds. Then release them.
Repeat this exercise 10 to 20 times in a row, three times a day.
A small 2005 study compared two groups of men with ED. The first group of men performed regular pelvic floor muscle exercises with a physiotherapist. They also received biofeedback and advice on lifestyle changes. The second group only received advice on lifestyle changes.
Men in the first group saw their penile function improve significantly after 3 months of regular pelvic floor muscles exercises. Men in the second group saw little improvement after 3 months.
For the next 3 months, all participants were given at-home exercises to perform. After 6 months in total had elapsed, 40 percent of all participants (including some men who had belonged to the second group) had regained normal erectile function.
A 2019 literature review also concluded that pelvic floor exercises were effective at