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.

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Speak with a doctor

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.

How does an erection occur?

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.

Causes of Erectile dysfunction

There are many possible causes of ED, and they can include both emotional and physical conditions. Common causes include:

Cardiovascular disease (heart disease)


Hypertension (high blood pressure)

High cholesterol

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Low testosterone levels or other hormone imbalances

Kidney disease

Increased age




Relationship problems

Certain prescription medications, such as those used to treat high blood pressure or depression

Sleep disorders

Drug use

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.

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.

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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.

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 your partner reconnect emotionally, which may also help your ED.

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.

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:

Premature ejaculation

Delayed ejaculation

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.

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.

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.

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.

You may find that it’s easier initially to do Kegels while lying down. Eventually, you can start trying them when you’re sitting or standing.

Aerobic exercise

Moderate to vigorous exercise is not only good for your overall health, but also can increase blood flow, possibly helping with ED. Examples include running and swimming.

Several specific foods, from cocoa to watermelon, may help with ED. Find out what other foods you may want to add to your grocery cart.

Speak with your doctor before buying herbs and supplements, and proceed with caution. Many aren’t regulated, which means they might contain additional ingredients not listed on their labels.

Additionally, some supplements, such as yohimbe, are associated with potentially dangerous side effects.

Your doctor may be able to recommend reputable brands as well. Avoid purchasing products online, unless your doctor confirms that they’re safe. Get more expert advice on herbs for ED.

Erectile dysfunction and diabetes

ED and diabetes can occur together. In fact, the risk of developing ED is approximately 50 percent.

Diabetes affects how your body processes glucose. When glucose isn’t stored correctly, excess glucose can be found in your blood, leading to high blood sugar. There are two major types of diabetes: type 1 diabetes and type 2 diabetes.

Having high amounts of sugar in your blood can lead to damage of the blood vessels and nerves. This damage can also affect the blood vessels and nerves located around the penis, leading to difficulties attaining or maintaining an erection.

If you have diabetes, it’s important that you work with your doctor to keep your blood sugar under control. This can help to prevent damage that can lead to ED.

Risk factors

There are many risk factors that may increase your likelihood of developing ED. These risk factors are often related to blood flow and circulation.

One important risk factor for ED is increasing age. As you get older, you may find that it’s more difficult to get or maintain an erection. You may also notice that you may require more direct stimulation to get an erection.

Additional risk factors for ED include:

Having a medical condition such as cardiovascular disease or diabetes

having a psychological condition such as anxiety or depression

Having overweight, particularly obesity

Sustaining an injury to or having surgery on your pelvic area

Taking certain medications, such as antidepressants or blood pressure medications

Undergoing specific medical treatment, such radiation therapy for cancer

Using tobacco products, drugs, or alcohol

Although the risk of ED increases with age, ED isn’t inevitable. In general, the healthier you are, the better your sexual function. Learn more about aging and ED.

It’s important to remember that ED is a common condition. If you’re experiencing symptoms of ED, you should discuss them with your doctor as soon as possible. That way, they can rule out underlying causes and begin a treatment plan.


There are several steps you can take to help prevent ED. Many of these steps involve making healthy lifestyle changes. Therefore, they’re not only good for preventing ED, but also for improving your overall health.

Follow the advice below to help prevent ED:

Keep medical conditions such as heart disease and diabetes under control.

Make sure that you get regular exercise.

Maintain a healthy weight.

Focus on eating a healthy diet.

Find ways to reduce or manage stress.

Seek help if you’re experiencing anxiety or depression.

Quit smoking.

Only use alcohol in moderation.

Avoid using drugs that haven’t been recommended by your doctor.

You should also be sure to keep up with your regular checkups. Your doctor will monitor important clinical measurements, such as your blood pressure and cholesterol levels. This can help with early identification and treatment of conditions that can potentially lead to ED.

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