Health Conditions A-Z Sexual Health Erectile Dysfunction Causes To Know—and Ways To Treat the Condition The cause of erectile dysfunction can be physical, psychological, or a combination of both. By Suzie Glassman Suzie Glassman Twitter Website Suzie Glassman is a freelance writer specializing in parenting, wellness, fitness, mental health, and education. Her work appears in WIRED, Parents, Health, Insider, SheKnows, Triathlete, and more. health's editorial guidelines Published on December 13, 2021 Share Tweet Pin Email Some people have an "off" night occasionally. While it may be frustrating, it usually isn't any cause for concern. But what if someone, time and time again, is having trouble getting and keeping an erection? Known as erectile dysfunction (ED), that continued inability to have an erection may not only be stressful, but it may also be a sign of an underlying health condition. Here's what to know about ED, including its symptoms, causes, and treatment, as well as how to prevent it and talk to your partner about it. Getty Images What Is Erectile Dysfunction? Erectile dysfunction is the inability to get and maintain an erection adequate for penetrative sex. "While it's not uncommon for a man to have trouble from time to time, men diagnosed with ED have persistent problems for three months or more," said Tobias Kohler, MD, professor of urology at the Mayo Clinic and secretary of the Sexual Medicine Society of North America (SMSNA). ED affects as many as 30 million people in the U.S., making it the most commonly reported sex problem for people with penises. Even though it's common, ED is not a normal part of aging. Symptoms Any of the following symptoms can be a sign of ED: Having an erection sometimes but not every time you want to have sexHaving an erection but not having it last long enough for penetrative sexBeing unable to get an erection Causes Erectile dysfunction can result from a problem involving the vascular, nervous, or endocrine systems. The causes of ED can be physical, psychological, or a combination of both. Physical Causes Often, ED is a symptom of another health problem. So even though people may find it embarrassing to approach their healthcare provider with concerns, doing so can help uncover a more serious underlying condition. There are a lot of factors affecting your different systems that can be behind ED: Vascular system "The most common cause for ED is not getting enough blood flow into the penis, which could be due to atherosclerotic disease of the cavernosal arteries responsible for supplying blood to the penis," said Darshan Patel, MD, assistant professor of urology at UC San Diego Health. "Because the arteries of the penis are half the size of the arteries to the heart, they can clog about three to five years sooner and are a warning sign of a future heart attack or stroke." High blood pressure and high cholesterol also contribute to the narrowing of the arteries that allow blood into the penis, leading to ED, according to Dr. Kohler. On the other hand, medications used to treat these conditions, like beta-blockers and thiazide, can cause ED. Nervous system Trauma or damage to the nerves that feed into the penis also causes problems with erections. Spinal cord injuries and conditions like multiple sclerosis, Parkinson's, and spina bifida affect these nerves, making it more challenging to sustain intercourse. Diabetes is another condition that can lead to nerve damage. Known as diabetic neuropathy, the nerve damage can affect the genitals and urinary tract. In fact, those who have diabetes are 2–3 times more likely to develop ED than those who do not have diabetes. Other physical causes These are some of the other potential causes of ED: Injury from treatments for prostate cancer (i.e., radiation therapy and prostate surgery) Chronic kidney disease Peyronie's disease (the development of scar tissue inside the penis) Some prescription medications (antidepressants, antihistamines, chemotherapy, etc.) Something that could be the cause but likely isn't? Low testosterone. "Most of the time, your testosterone must be very low to affect the penis," said Dr. Kohler. "With low testosterone, you'll lose interest in sex and have low energy, but treating low testosterone doesn't fix the penis as much as it does other vascular causes. You're much more likely to be disappointed with testosterone replacement alone to fix ED." Psychological Causes Worrying about your sexual performance or psyching yourself out makes the situation worse. "If a guy has a bad night, he may start freaking out that something is wrong, and he gets scared. Fear causes your body to release adrenaline, and then its light's out. Nothing's going to work," said Dr. Kohler. Adrenaline sends blood to your heart, brain, and lungs and away from organs like the penis as part of the fight-or-flight response. Besides fear of sexual failure and anxiety about sexual performance, guilt about certain sexual activities, as well as low self-esteem, are other psychological/emotional factors that can lead to or worsen ED. Depression, anxiety, and stress also lead to lower sex drive, less energy, and problems with erections. Unfortunately, medications to treat those conditions have side effects that can exacerbate the issue. Talk to your healthcare provider if this is the case. Risk Factors "The most common risk factors for ED are linked to lifestyle choices that can disrupt blood flow and circulation, like smoking, excessive alcohol use, poor diet, stress, and lack of exercise," said Dr. Patel. Age is another important risk factor. "As you get older, the blood vessels themselves are not as robust, and you're more at risk for other medical problems," said Dr. Kohler. Treatment If you've dealt with symptoms of ED for several months, it's important to see your healthcare provider or a urologist. They'll complete a physical exam and ask you to provide a thorough medical history. "Typically, that's all that's needed to diagnose ED, but if your doctor suspects an underlying medical complication, you might need further testing or be referred to a specialist," said Dr. Kohler. Lifestyle Changes When treating ED, Dr. Kohler and Dr. Patel said patients get the biggest bang for their buck by improving their overall health first. Reaching a healthy weight, exercising regularly, eating a healthy diet, and quitting smoking can lead to the most lasting improvements. And sometimes, treating an underlying condition is enough to reverse ED. Medications Beyond lifestyle changes and treating the underlying cause, many other safe and effective ED treatments are available, including medications. The following medications use nitrates to increase blood flow to the penis by widening the blood vessels: Avanafil (Stendra)Sildenafil (Viagra)Tadalafil (Cialis)Vardenafil (Levitra, Staxyn) If you are already taking nitrates to treat a heart condition, you should avoid taking these medications for erectile dysfunction. Besides medication, someone might also get treated for ED with the following: Penile injection therapy: Patients are taught to self-inject a medication called alprostadil through a small needle at the base of the penis five to 10 minutes before sexual activity.Vacuum erection devices: A clear plastic cylinder with an opening at one end is placed over the penis. A pump then connects to the cylinder, drawing out air and creating a vacuum. Once the penis is erect, the user places an elastic ring at the base of the penis, reducing blood flow out.Penile implant surgery: A penile implant or prosthesis is surgically inserted into the penis. Before having sex, you use a pump in the scrotum to fill the penis with fluid. After, you can deflate the device to return to your normal state. Surgery is the most reliable therapy for providing patients with the ability to get an erection on demand and is generally recommended after other treatment options have failed, according to Dr. Kohler. "Many clinics also market supplements specifically for erectile dysfunction or low testosterone, but it's important to know there's not much research behind their effectiveness," Dr. Patel said. "For the most part, these supplements just contain lower doses of things like Viagra." 5 Tips for Having Less Painful Sex if You Have Endometriosis Prevention "I tell patients if you take good care of your health, your penis will take good care of you," said Dr. Kohler. "Things like eating a healthy diet, exercise, and quitting smoking are powerful for both preventing dysfunction and curing it. With care, you can have great sexual function into your 70s and 80s." Here are more tips from Dr. Kohler and Dr. Patel on what you can do to prevent ED: Get regular check-ups with your healthcare provider to monitor your blood pressure and cholesterol Eat plenty of protein and avoid foods that are high in saturated fat Get adequate sleep Reduce stress at work and home Address mental health issues with a healthcare provider or therapist Advice for Couples Erectile dysfunction can put a strain on a relationship, especially when partners don't talk openly about what's going on. Dr. Patel said many resources could help start the conversation, like online forums, podcasts, and sex therapy. If you're the partner of a loved one struggling with erectile issues, consider the following tips from Dr. Kohler: Formulate a plan. Dr. Kohler advised couples to be bold, have courage, and set up an appointment with a healthcare provider. Come with an open mind, ready to discuss what's happening, and set up a treatment plan.Help your partner talk to their healthcare provider. You may be able to remember changes or symptoms your partner has forgotten that are important for the healthcare provider to know.Help your partner with therapy. You can help your partner to adhere to the plan you've developed with the healthcare provider.Understand the physiology and psychology of sexual function. Once you know more about the underlying causes, you can help your partner understand why ED happens and make it less embarrassing. You can also learn more about your role in treatment options. A Quick Review Erectile dysfunction is a common issue that many people struggle with. A wide array of causes include lifestyle changes, underlying health conditions, or psychological causes. If you have had difficulty getting and/or maintaining an erection for more than three months, discuss your symptoms and medical history with a healthcare provider. They will be able to determine the cause and ultimately help you formulate a treatment plan. Was this page helpful? Thanks for your feedback! Tell us why! Other Submit Sources Health.com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & facts for erectile dysfunction. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & causes of erectile dysfunction. National Library of Medicine. Drugs that may cause erection problems. Deng, N., Thirumavalavan, N., Beilan, J. A., Tatem, A. J., Hockenberry, M. S., Pastuszak, A. W., & Lipshultz, L. I. (2018). Sexual dysfunction and infertility in the male spina bifida patient. Translational andrology and urology, 7(6), 941–949. Sexual Medicine Society of North America. Spinal cord injury. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes, sexual, & bladder problems. Endocrine Society. Adrenal hormones. National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for erectile dysfunction.