Nearly all people with male genitals will experience difficulty getting—or keeping—an erection during sex at some point in their lives. This is totally normal, and if it happens less than 20% of the time, it’s nothing to worry about.
In cases where it occurs more than half the time, or with high regularity, it may be erectile dysfunction (ED). While it may feel embarrassing to discuss this with a doctor, it’s important to talk to a professional—not only because we can help alleviate the issue, but also because ED is sometimes a sign of a more serious health condition. Additionally, the emotional burden of dealing with ED can have a negative impact on a person’s self-esteem, mental health, and intimate relationships.
Fortunately, most cases of ED are very treatable and many men are able to successfully enjoy a healthy sex life with the right treatment plan.
What Is Erectile Dysfunction?
Erectile dysfunction, also called ED or impotence, describes an inability to attain an erect penis or maintain a firm enough erection to have sex.
Symptoms of ED can include struggling to achieve an erection at all, difficulty keeping the penis erect long enough to complete intercourse, or an inability to ejaculate even when the penis is erect.
It’s important to note that most men will occasionally encounter difficulty achieving an erection. This is normal and not considered a major medical issue. If the issue persists over time or happens frequently, it may be diagnosed as ED.
Because ED interferes with intercourse and other sexual activities, it often results in emotional symptoms including feelings of anxiety (particularly around engaging in sex), embarrassment, shame, and low self-esteem.
ED may also directly or indirectly contribute to a decreased sex drive. In some cases, men may experience a physical decrease in sexual interest, while in other cases, the emotional symptoms will make sex feel less appealing or even daunting.
A male erection occurs due to a combination of signals and processes in the brain, hormones, nerves, muscles, and blood vessels. If any one of these systems is hindered, it can interrupt the ability to achieve or keep an erection. Therefore, both physical and psychological issues (or a combination of both) can cause ED. Other common causes of ED include issues with blood flow, nerve supply, or hormones.
Erectile dysfunction is categorized as primary or secondary.
- Primary ED: If a male has struggled with ED his entire life, he has primary ED. This is rare and almost always has a psychological source.
- Secondary ED: The majority of ED cases are secondary ED. This is when a male had normal erectile function in the past but recently experiences struggles that persist. Secondary ED usually has a physical source but may be triggered or worsened by psychological factors.
Physical causes of ED
The majority of ED cases stem from physical causes, rather than psychological issues. Common physical causes of ED include:
- Atherosclerosis: This condition causes the arteries in the penis to become clogged or narrow due to a buildup of plaque on the artery walls. This obstructs the blood flow to the penis that’s needed to maintain an erection. Atherosclerosis is the most common cause of ED and can be worsened by a number of factors, including heart disease and high blood pressure.
- Heart disease: ED is considered a risk factor for heart disease. Research supports that men who have experienced ED are more likely to have symptoms of heart disease in the future.
- Diabetes: ED is common in men who live with type 2 diabetes. Over time, the blood sugar fluctuations that come with diabetes can damage the nerves and blood vessels, impacting erectile function.
- High blood pressure: Because high blood pressure can damage the arteries, it can reduce the amount of blood that’s able to circulate through the penis. One study found that up to 30% of men with high blood pressure also report ED. Unfortunately, ED is a side effect of some medications used to treat hypertension.
- High cholesterol: High cholesterol can cause or contribute to atherosclerosis, which blocks blood flow to the penis.
- Obesity: Obesity increases a person’s risk level for heart disease, high cholesterol, and diabetes, all of which can lead to ED. In some cases, obesity can contribute to low self-esteem and emotional challenges that increase the likelihood of ED.
- Hormonal disorders: Conditions that impact hormone levels, such as testosterone deficiency, can result in ED.
- Pelvic or spinal injuries: An injury to the pelvic area or the spinal cord can limit the body’s ability to maintain an erection. Radiation therapy that impacts the pelvic region may also cause ED.
- Neurological conditions: Neurological conditions such as multiple sclerosis (MS), Parkinson’s disease, and stroke can interrupt the nerve signals sent from the brain to the penis that are needed to achieve and maintain an erection.
- Lifestyle habits: Smoking, alcoholism, and substance abuse of drugs such as cocaine cause physical effects on the body that can impact the nerves and nervous system, blood vessels and arteries, or hormones—all of which are essential parts of erectile function.
Lastly, ED is a side effect of a variety of prescription drugs, including:
- Heart medications
- High blood pressure medications
- Anxiety medications
- Drugs that alter hormones
- Drugs that impact the central nervous system
- Some cancer treatments
- Prostate treatments
- Cimetidine, which is used to treat peptic ulcers
Always consult your doctor before stopping a medication you’ve been prescribed or changing your medication dosage or schedule.
Psychological causes of ED
Fewer cases of ED are caused entirely by psychological issues, but it happens. Psychological effects that cause, contribute to, or worsen ED include:
- Anxiety disorders
- Fear of intimacy
- Low self-esteem
- Relationship problems such as emotional tension or poor communication
Treatments for ED may include medication and/or lifestyle changes. For moderate cases of ED, external sex aids can also be used to achieve or maintain an erection during intercourse. If other treatments aren’t successful, a doctor may recommend surgery.
The most common prescription medications used to address ED are phosphodiesterase-5 inhibitors (otherwise known as PDE-5 inhibitors). This includes:
- sildenafil (Viagra)
- tadalafil (Cialis)
- avanafil (Stendra)
- vardenafil (Levitra)
These help to relax the blood vessels, increase blood flow, and lower blood pressure, all of which increase erectile function.
Most PDE-5 inhibitors are taken in pill form as needed, usually within 30 to 60 minutes before having intercourse. Be sure to follow your doctor’s specific instructions for when to take any PDE-5 and how much to take. In most cases, you should not take more than one dose in a 24-hour period, as this can increase the risk of serious side effects.
While most side effects of PDE-5 inhibitors are mild and will resolve on their own, if you experience any side effects for longer than two weeks, contact your doctor. These milder side effects include:
- Upset stomach, nausea, or vomiting
- Flushed skin on and around the face
- Respiratory infection
- Sore throat, or symptoms of bronchitis
- Runny nose
When taking any PDE-5, it’s important to be familiar with the potential serious side effects, listed below. If you experience any of these, call 911 or go to the hospital right away.
- Sudden blurred vision, dizziness, lightheadedness, nausea, or vomiting
- An erection that lasts more than four hours (priapism)
- Sudden loss of vision
- Sudden loss of hearing or ringing in the ears (tinnitus)
- Chest pain, shortness of breath, dizziness, lightheadedness, trouble speaking, confusion, or any other symptoms of heart attack or stroke
If PDE-5 inhibitors aren’t successful or you can’t take an oral pill, prostaglandin E1 may be an option. You inject this medication into the penis through the opening of the urethra.
Certain lifestyle changes may help to reduce ED or prevent it in the first place.
- Exercise: Moderate daily physical exercise may lower your likelihood of ED. One Harvard study found that 30 minutes of exercise each day was associated with about a 40% reduced risk of ED.
- Diet changes: Eating a healthy diet similar to the Mediterranean diet (high in vegetables, fruit, legumes, and fish and low in red and processed meats and trans fats) may help reduce the risk of ED.
- Weight management: Maintaining a healthy weight may significantly lower the risk of ED. Excess fat can interfere with hormones involved in erectile function, and being overweight long term increases a person’s risk of heart disease, diabetes, and other factors that make ED more likely. If your weight is considered overweight or obese, losing weight may help prevent or resolve ED.
- Vascular health: Forming good habits that promote a healthy vascular system may reduce and prevent ED. This means exercising, eating right, and taking other treatment steps to maintain healthy blood pressure, cholesterol, and blood sugar levels. When any of these rise to unhealthy levels, they can damage the arteries and nerves that connect to the penis.
- Counseling and therapy: Attending behavioral therapy or counseling may help to treat or resolve the emotional and psychological symptoms of ED. Anxiety and depression can contribute to ED, so treating the underlying causes of these issues can alleviate or significantly reduce ED. In some cases, once ED has become a problem, the fear of ED occurring can increase the likelihood of it happening again. A counselor or therapist can help provide behavioral treatment to address these fears and anxieties, reducing the likelihood of ED in the future.
- Kegel exercises: Strong pelvic floor muscles contribute to rigidity and firmness during an erection and help to prevent blood from leaving the erect penis. Kegel exercises are excellent for working the pelvic floor muscles. Repeat these multiple times a day to increase strength over time.
- Quitting unhealthy substances: Quitting smoking, reducing alcohol consumption, and seeking help for drug abuse can all have a positive impact to decrease the symptoms of ED.
Pumps and penis sleeves
In some cases, a man may choose to use sexual aids to treat ED by externally creating an erection. Two popular products include penis pumps and penis sleeves.
A penis pump (also called a vacuum erection device) consists of a plastic tube that covers the penis and is attached to a hand- or battery-powered pump, along with a ring (also called a constriction band) that goes around the base of the penis once it’s erect. When pumped, the vacuum device sucks the air out from the tube. The resulting change in air pressure causes blood to fill the blood vessels, triggering an erection. Penis pumps can be an effective treatment for those with moderate ED.
A penis sleeve is used by people with and without ED to make sex more pleasurable. For people experiencing ED, it may help to maintain an erection during intercourse. This product is a sleeve that goes over the penis, with a ball loop or belt attached to keep it in place. A penis sleeve is highly dependent on a person’s and their partner’s sexual preferences and may not work for everyone with ED.
A doctor will only consider surgery in the most severe cases of ED, after other treatment options have not succeeded. It’s recommended that people with ED attempt as many non-surgical treatments as possible before considering surgical options.
The two main surgeries for ED are:
- Vascular surgery to correct blood vessel issues that are causing ED, helping to improve blood flow and access to the penis.
- Penile implant surgery: A surgeon implants inflatable rods into the penis, connecting the rods to a reservoir filled with saline solution (inserted in the abdominal wall) and a pump hidden in the scrotum. When you squeeze the pump, the saline solution fills the rods, creating an erection. The device is deflated after an erection is no longer desired. This surgery is usually successful.
The best prevention for ED is a healthy lifestyle. All of the below may help reduce the risk of ED:
- Quitting or limiting the use of tobacco products, alcohol, and other drugs
- Getting some type of physical activity most (if not all) days of the week
- Reducing or managing stress
- Maintaining a healthy weight
- Visiting your doctor for regular physicals to monitor vascular health
For people with conditions that increase the risk of ED—including heart disease, diabetes, and mental health illnesses—seeking professional help to address these can often greatly reduce or alleviate related ED symptoms.
When to See a Doctor
If you experience ED more than half the time when engaging in sexual activities or if you are concerned about ED, talk to your primary care physician. It may feel uncomfortable or embarrassing at first, but it’s worthwhile to have the conversation, as ED is quite treatable.
It’s also important to discuss ED because it may be an early sign of a health issue such as heart disease or even neurological conditions. Your doctor will ask questions and conduct the appropriate blood tests to check for any more serious underlying conditions.
How K Health Can Help
Up to 52% of men experience some form of erectile dysfunction in their lifetime. It is one of the most common conditions men face.
If you think you may be experiencing ED, download the K Health app today. There, you can check your symptoms, confirm your condition, speak with a board-certified doctor, and get the prescription you need.
Frequently Asked Questions
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.