What Is Erectile Dysfunction?

Not being able to have or maintain an erection can be frustrating and provoke worry. But there’s good news: Most men with erectile dysfunction can be helped.

At some point, you’ve probably heard an insensitive joke about a man’s sexual performance in the bedroom and other inappropriate comments about erectile dysfunction (ED). But for men experiencing ED (sometimes called impotence), the condition is anything but funny.

It can be emotionally upsetting, provoking anxiety and sometimes affecting relationships. What’s more, it can be a sign of a health problem that needs attention.

So, instead of making light of the problem, ignoring it, or feeling chronically worried about the condition, understanding what erectile dysfunction is, what causes it, and what help is available for ED can calm worries and, often, rectify the problem.

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Understanding what erectile dysfunction is — and what it isn’t

Erectile dysfunction is the inability to get and maintain an erection firm enough for satisfying sexual relations. Around 30 million men in the U.S. have ED. Although it’s more common in middle-aged and older men, age alone doesn’t cause erectile dysfunction, according to the Centers for Disease Control and Prevention (CDC).

To understand erectile dysfunction, it’s important to know what the condition isn’t.

For instance, going through a time in life when a man simply isn’t particularly interested in sex is not the same as ED. Erectile dysfunction is when you want to have sex, but you can’t.

Erectile dysfunction is not the same as having a problem ejaculating, either. Instead, ejaculation difficulty can indicate there’s a structural problem with the penis and should prompt a visit to a doctor.

If a man has occasional trouble achieving or keeping an erection, it’s not unusual. It’s not the same as erectile dysfunction because not being able to “keep it up” really does happen to almost all men from time to time, the CDC emphasizes.

You should see a doctor, however, if you have trouble achieving or keeping an erection happens frequently and seems to be getting worse, if it is preventing you from leading the life you want, or it’s causing difficulty in a relationship.

Causes of erectile dysfunction

Determining the cause of erectile dysfunction is not easy without a thorough medical history and evaluation. That’s because ED can have psychological and physical causes. It can also be the result of lifestyle choices and even medications you take.

There’s no doubt some men have a difficult time talking to a healthcare professional about their sex lives and erection woes. But such concerns are nothing new to your family doctor, or a urologist (a specialist in urinary and sexual health concerns). The more your doctor knows about you and your problem, the quicker the cause can be found and likely treated.

To diagnose erectile dysfunction, a doctor will typically go over your medical and sexual history and conduct a mental health and physical exam, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Depending on the findings are, the doctor may order lab or imaging tests.

While age isn’t a direct cause of ED, several health conditions that are more common as men age can be related to erectile dysfunction. For instance, men with diabetes are three times more likely to have ED than men without that disease. Having diabetes raises the risk of heart disease, too, and ED can be a warning sign of blood vessel problems caused by cardiovascular disease.

In addition, nerve and blood vessel damage from uncontrolled high blood sugar or high blood pressure can interfere with your ability to have and maintain an erection, the CDC points out.

Other causes of erectile dysfunction can include sleep disorders, treatment for prostate cancer or an enlarged prostate gland, and surgery that has affected the pelvic area or spinal cord. Parkinson's disease, multiple sclerosis, Peyronie's disease (development of scar tissue inside the penis), and low testosterone levels are also potential causes.

ED can be the result of certain prescription medications for hypertension, allergies, or depression, but never stop taking those drugs without talking to your doctor. A change in dosage or another type of medication may help resolve or improve erection problems.

Smoking, excessive use of alcohol and recreational drugs, obesity, and lack of regular physical exercise can contribute to erectile dysfunction. Lifestyle changes in those areas can improve your overall health and help treat your ED problem.

It’s important to remember that male sexual arousal is a complex process that involves your brain and emotions. Stress, depression, and anxiety can cause or worsen erectile dysfunction. The NIDDK advises asking your doctor to recommend a therapist if psychological or emotional issues are causing or contributing to your ED problem.

A counselor can teach you how to lower your stress and anxiety levels while your doctor focuses on treating any medical problems causing or contributing to your erectile dysfunction. Your counselor may suggest that you bring your partner to some therapies sessions to learn how to support you as you deal with ED, too.

Most men with erectile dysfunction can be helped

The good news is more than 95 percent of men with erectile dysfunction can be treated successfully, according to the CDC.

In addition to treating any medical or psychological treatments causing or contributing to the problem, a variety of ways to help ED are available.

Prescription medications, such as sildenafil (Viagra), tadalafil (Cialis), and others, work to relieve erectile dysfunction, relaxing smooth muscles and increasing blood flow in the penis during sexual stimulation and erectile dysfunction. Testosterone treatment for men with low levels of this hormone (a condition most common in men with diabetes) can also help treat ED.

Other approaches to treating erectile dysfunction include using a prescription vacuum device that fits over the penis. Used prior to intercourse, it uses a low-pressure vacuum to stimulate an erection. If other treatments don’t work, a penile implant placed inside the penis surgically may be an option.

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