Erectile dysfunction (ED) is a common type of male sexual dysfunction. It is when a man has trouble getting or keeping an erection. ED becomes more common as you get older. But it's not a natural part of aging.

Some people have trouble speaking with their doctors about sex. But if you have ED, you should tell your doctor. ED can be a sign of health problems. It may mean your blood vessels are clogged. It may mean you have nerve damage from diabetes. If you don't see your doctor, these problems will go untreated.

Your doctor can offer several new treatments for ED. For many men, the answer is as simple as taking a pill. Getting more exercise, losing weight, or stopping smoking may also help.

Erectile dysfunction (ED) is a condition in which you are unable to get or keep an erection firm enough for satisfactory sexual intercourse. ED can be a short-term or long-term problem. You have ED when you:

• can get an erection sometimes, but not every time you want to have sex
• can get an erection, but it does not last long enough for fulfilling or satisfactory sex
• are unable to get an erection at any time

Health care professionals, such as primary care providers and urologists, often can treat ED. Although ED is very common, it is not a normal part of aging. Talk with a health care professional if you have any ED symptoms. ED could be a sign of a more serious health problem.

You may find it embarrassing and difficult to talk with a health care professional about ED. However, remember that a healthy sex life can improve your quality of life and is part of a healthy life overall. Health care professionals, especially urologists, are trained to speak to people about many kinds of sexual problems.

ED is very common. It affects about 30 million men in the United States.

You are more likely to develop ED if you

• are older
• have certain diseases or conditions
• take certain medicines
• have certain psychological or emotional issues
• have certain health-related factors or behaviors, such as overweight or smoking

Many different factors affecting your vascular system, nervous system, and endocrine system can cause or contribute to ED.

Although you are more likely to develop ED as you age, aging does not cause ED. ED can be treated at any age.

Certain diseases and conditions

The following diseases and conditions can lead to ED:

• type 2 diabetes
• heart and blood vessel disease
• atherosclerosis
• high blood pressure
• chronic kidney disease
• multiple sclerosis
• Peyronie’s disease
• injury from treatments for prostate cancer, including radiation therapy and prostate surgery
• injury to the penis, spinal cord, prostate, bladder, or pelvis
• surgery for bladder cancer

Men who have diabetes are two to three times more likely to develop ED than men who do not have diabetes. Read more about diabetes and sexual and urologic problems.

Taking certain medicines

ED can be a side effect of many common medicines, such as

• blood pressure medicines
• antiandrogens—medicines used for prostate cancer therapy
• antidepressants
• tranquilizers, or prescription sedatives—medicines that make you calmer or sleepy
• appetite suppressants, or medicines that make you less hungry
• ulcer medicines

View a list of specific medicines that may cause ED.

Certain psychological or emotional issues

Psychological or emotional factors may make ED worse. You may develop ED if you have one or more of the following:

• fear of sexual failure
• anxiety
• depression
• guilt about sexual performance or certain sexual activities
• low self-esteem
• stress—about sexual performance, or stress in your life in general

Certain health-related factors and behaviors

The following health-related factors and behaviors may contribute to ED:

• smoking
• drinking too much alcohol
• using illegal drugs
• being overweight
• not being physically active

With ED, a man can’t get or keep an erection firm enough for sex. ED is common in middle-aged and older men – as many as 30 million in the United States have it. Men with diabetes are three times more likely to have ED. Getting older doesn’t cause ED, but it does increase your chance of getting it.

First, some facts. Here’s what ED isn’t:

• Occasional trouble having an erection. That really does happen to everyone.
• Less interest in sex. ED happens when a man wants to have sex but can’t have or keep an erection.
• Problems with ejaculation, which can mean a structural problem with the penis.

It’s not uncommon to have trouble getting an erection sometimes, but if it gets worse, happens often, or prevents you from living the life you want, it’s time to get it checked out.

Men who have diabetes are more likely to have heart disease, and ED can be a warning sign of blood vessel problems. If you have both, talk to your doctor about treatment. Some ED medicines are not safe to take with certain heart medicines, though, so make sure you let your doctor know about any medicines you’re taking.

Causes of ED

• Damage from high blood sugar or high blood pressure to nerves and blood vessels needed to have an erection
• Some medicines for high blood pressure, depression, or allergies (don’t stop taking them, but do talk with your doctor to see if you can take a different medicine or lower the dose)
• Treatment for prostate cancer or an enlarged prostate
• Surgery that affects the pelvic area or spinal cord
• Using tobacco or alcohol
• Sleep disorders

It’s important to visit your doctor to find out if any of these causes are contributing to ED.

ED Treatment

It can be tough to talk about ED, but it’s a conversation you need to have with your doctor so you can get treated. The good news is more than 95% of men – you and almost all of the other guys in the waiting room with you – can be treated successfully.

• Medicine: If you have normal nerve function, you could take a type of medicine that increases blood flow to the penis. Sometimes these medicines don’t work well for guys with diabetes and should NOT be taken if you’re also taking nitrates for your heart. Be sure to check with your doctor about any possible medicine interactions.
• Testosterone: Sometimes having low testosterone (low T) can cause ED. Men with diabetes are twice as likely to have low T than men who don’t have diabetes. Taking testosterone may help you have normal erections or help ED medicine work better. It can also make low blood sugar worse and increase blood pressure, so make sure to get regular checkups to spot and manage any problems.
• Vacuum device: This is a plastic tube that fits over the penis, creating a low-pressure vacuum that causes an erection. An elastic ring is slipped onto the base of the penis to hold blood in and maintain the erection. With training, about 75% of men can get an erection firm enough for sex.
• Injection or suppository: For an immediate erection just before sex, you can inject a medicine into the side of the penis with a very small needle, or place a tiny pill in the urethra (the tube urine comes out of).
• Implant: A penile implant placed inside the penis by surgery is often recommended if other treatments don’t work. However, if you’re having trouble managing your blood sugar, your chance for infection after surgery is higher and your doctor may advise against an implant.

Sometimes treatment for ED can cause a long-lasting erection. If yours lasts more than two to four hours, go to your doctor or the emergency room right away. This very painful condition can lead to permanent damage if not treated immediately.

95% of ED is Treatable

ED doesn’t have to sideline you. Almost all men can be treated successfully. Talk to your doctor!

Symptoms of ED include

• being able to get an erection sometimes, but not every time you want to have sex
• being able to get an erection, but not having it last long enough for sex
• being unable to get an erection at any time

ED is often a symptom of another health problem or health-related factor.

A doctor, such as a urologist, diagnoses erectile dysfunction (ED) with a medical and sexual history, and a mental health and physical exam. You may find it difficult to talk with a health care professional about ED. However, remember that a healthy sex life is part of a healthy life. The more your doctor knows about you, the more likely he or she can help treat your condition.

Medical and sexual history

Taking a medical and sexual history is one of the first things a doctor will do to help diagnose ED. He or she will ask you to provide information, such as

• how you would rate your confidence that you can get and keep an erection
• how often your penis is firm enough for intercourse when you have erections from sexual stimulation
• how often you are able to maintain an erection during sexual intercourse
• how often you find sexual intercourse satisfying
• if you have an erection when you wake up in the morning
• how you would rate your level of sexual desire
• how often you’re able to climax, or orgasm, and ejaculate
• any surgeries or treatments that may have damaged your nerves or blood vessels near the penis
• any prescription or over-the-counter medicines you take
• if you use illegal drugs, drink alcohol, or smoke

This information will help your doctor understand your ED problem. The medical history can reveal diseases and treatments that lead to ED. Reviewing your sexual activity can help your doctor diagnose problems with sexual desire, erection, climax, or ejaculation.

Mental health and physical exam

A health care professional may ask you some personal questions and use a questionnaire to help diagnose any psychological or emotional issues that may be leading to ED. The health care professional may also ask your sexual partner questions about your relationship and how it may affect your ED.

He or she also will perform a physical exam to help diagnose the causes of ED. During the physical exam, a health care professional most often checks your

• penis to find out if it’s sensitive to touch. If the penis lacks sensitivity, a problem in the nervous system may be the cause.
• penis’s appearance for the source of the problem. For example, Peyronie’s disease causes the penis to bend or curve when erect.
• body for extra hair or breast enlargement, which can point to hormonal problems.
• blood pressure.
• pulse in your wrist and ankles to see if you have a problem with circulation.

Lab tests

Blood tests can uncover possible causes of ED, such as diabetes, atherosclerosis, chronic kidney disease, and hormonal problems.

Imaging tests

A technician most often performs a Doppler ultrasound in a doctor’s office or an outpatient center. The ultrasound can detect poor blood flow through your penis. The technician passes a handheld device lightly over your penis to measure blood flow. Color images on a computer screen show the speed and direction blood is flowing through a blood vessel. A radiologist or urologist interprets the images. During this exam, a health care professional may inject medicine into your penis to create an erection.

Other tests

Nocturnal erection test. During a nocturnal, or nighttime, erection test, you wear a plastic, ring-like device around your penis to test whether you have erections during the night while you sleep. This test usually takes place at home or in a special sleep lab. A more involved version of this test uses an electronic monitoring device that will record how firm the erections are, the number of erections, and how long they last.

Each night during deep sleep, a man normally has three to five erections. If you have erections during either type of test, it shows that you are physically able to have an erection and that the cause of your ED is more likely a psychological or emotional issue. If you do not have an erection during either test, your ED is more likely due to a physical cause.

Injection test. During an injection test, also called intracavernosal injection, a health care professional will inject a medicine into your penis to cause an erection. In some cases, a health care professional may insert the medicine into your urethra instead. The health care professional will evaluate how full your penis becomes and how long your erection lasts. Either test helps the health care professional find the cause for your ED. The tests most often take place in a health care professional’s office.

Change your medicines

If a medicine you need for another health condition is causing ED, your doctor may suggest a different dose or different medicine. Never stop taking a medicine without speaking with your doctor first. Read about which medicines make it more likely that you’ll develop ED.

Prescribe medicines you take by mouth

A health care professional may prescribe you an oral medicine, or medicine you take by mouth, such as one of the following, to help you get and maintain an erection:

• sildenafil (Viagra)
• vardenafil (Levitra, Staxyn)
• tadalafil (Cialis)
• avanafil (Stendra)

All of these medicines work by relaxing smooth muscles and increasing blood flow in the penis during sexual stimulation. You should not take any of these medicines to treat ED if you are taking nitrates to treat a heart condition. Nitrates widen and relax your blood vessels. The combination can lead to a sudden drop in blood pressure, which may cause you to become faint or dizzy, or fall, leading to possible injuries.

Also talk to your health care professional if you are taking alpha-blockers to treat prostate enlargement. The combination of alpha-blockers and ED medicines also could cause a sudden drop in blood pressure.

A health care professional may prescribe testosterone if you have low levels of this hormone in your blood. Although taking testosterone may help your ED, it is often unhelpful if your ED is caused by circulatory or nerve problems. Taking testosterone also may lead to side effects, including a high red blood cell count and problems urinating.

Testosterone treatment also has not been proven to help ED associated with age-related or late-onset hypogonadism. Do not take testosterone therapy that hasn’t been prescribed by your doctor. Testosterone therapy can affect how your other medicines work and can cause serious side effects.

Prescribe injectable medicines and suppositories

Many men get stronger erections by injecting a medicine called alprostadil into the penis, causing it to become filled with blood. Oral medicines can improve your response to sexual stimulation, but they do not trigger an automatic erection like injectable medicines do.

Instead of injecting a medicine, some men insert a suppository of alprostadil into the urethra. A suppository is a solid piece of medicine that you insert into your body where it dissolves. A health care professional will prescribe a prefilled applicator for you to insert the pellet about an inch into your urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes.

Discuss alternative medicines

Some men say certain alternative medicines taken by mouth can help them get and maintain an erection. However, not all “natural” medicines or supplements are safe. Combinations of certain prescribed and alternative medicines could cause major health problems. To help ensure coordinated and safe care, discuss your use of alternative medicines, including use of vitamin and mineral supplements, with a health care professional. Also, never order a medicine online without talking with your doctor.

You can work with a health care professional to treat an underlying cause of your erectile dysfunction (ED). Choosing an ED treatment is a personal decision. However, you also may benefit from talking with your partner about which treatment is best for you as a couple.

Lifestyle changes

Your health care professional may suggest that you make lifestyle changes to help reduce or improve ED. You can

• quit smoking
• limit or stop drinking alcohol
• increase physical activity and maintain a healthy body weight
• stop illegal drug use

You can seek help from a health professional if you have trouble making these changes on your own.

Go to counseling

Talk with your doctor about going to a counselor if psychological or emotional issues are affecting your ED. A counselor can teach you how to lower your anxiety or stress related to sex. Your counselor may suggest that you bring your partner to counseling sessions to learn how to support you. As you work on relieving your anxiety or stress, a doctor can focus on treating the physical causes of ED.

As many as 30 million American men have erectile dysfunction (ED). If you’re one of them, you should discuss the situation with your health care provider. Conventional treatments are available that may help you. Another important reason to see your health care provider is that ED may be a sign of an underlying health problem that needs to be treated, such as clogged blood vessels or nerve damage from diabetes.

Effective medical treatment for ED is available only through a health care provider. If you see a dietary supplement or other product marketed for ED that you can buy without a prescription, be cautious. The product may be fake or even dangerous.

Bottom Line

No complementary health approaches have been shown to be safe and effective for sexual enhancement or treating ED. Safety is a serious concern with regard to dietary supplements promoted for ED or sexual enhancement.

Researchers have studied a variety of herbal remedies for ED, but the amount of research on each herb has been small, and much of the research has been done in animals rather than people. Currently, there is no definite evidence that any herbal products are effective or safe for ED.

A few studies have tested acupuncture for ED, but the amount of research is too small to allow any conclusions to be reached about whether it’s helpful.

Safety

Many supplements promoted for ED and sexual enhancement—sometimes called “herbal Viagra”—have been found to be tainted with drug ingredients or related substances. Some products include combinations of multiple ingredients or excessively high doses, both of which can be dangerous. Consumers can’t tell whether a product contains these ingredients because they’re not listed on the product label.

The drug ingredients in some ED supplements may interact with prescription drugs in harmful ways. For example, some of them may interact with drugs that contain nitrates, leading to a dangerous decrease in blood pressure. People with diabetes, high blood pressure, high cholesterol, or heart disease often take drugs containing nitrates, and men with these conditions frequently have ED.

The U.S. Food and Drug Administration (FDA) warns consumers to beware of ED/sexual enhancement products that:

• Promise quick results (within 30 to 40 minutes)
• Are advertised as alternatives to FDA-approved prescription drugs
• Are sold in single servings
• Advertise via spam or unsolicited e-mails
• Have labels written primarily in a foreign language
• Have directions and warnings that mimic FDA-approved products.

Complications of ED may include

• an unfulfilled sex life
• a loss of intimacy between you and a partner, resulting in a strained relationship
• depression, anxiety, and low self-esteem
• being unable to get a partner pregnant

Depression, anxiety, and low self-esteem can also contribute to ED, creating a cycle of health problems.

You can help prevent many of the causes of erectile dysfunction (ED).

Quit smoking

If you smoke, get help quitting. Smoking is linked to heart and blood vessel disease, which can lead to ED. Even when heart and blood vessel disease and other possible causes of ED are taken into account, smoking still increases the chances that you will have ED.

Follow a healthy eating plan

To help maintain erectile function, choose whole-grain foods, low-fat dairy foods, fruits and vegetables, and lean meats. Avoid foods high in fat, especially saturated fat, and sodium. Follow a healthy eating plan to help aim for a healthy weight, and control your blood pressure and diabetes. Controlling your blood pressure and diabetes may help prevent ED.

Also, avoid drinking too much alcohol. If you are having trouble cutting out alcohol, see a counselor who has expert knowledge in treating people who drink too much.

Maintain a healthy weight to prevent diabetes and high blood pressure

Maintaining a healthy weight also can help delay the start of diabetes and keep your blood pressure down. Talk with your doctor about how to prevent diabetes—or manage the disease if you already have it. Get regular checkups to measure your blood pressure.

If you need to lose weight, talk with your health care provider about how to lose weight safely. Ask for a referral to a dietitian who can help you plan healthy meals to lose weight. Losing weight may help reduce inflammation, increase testosterone levels, and increase self-esteem, all of which may help prevent ED. If you are at a healthy weight for your height, maintain that weight through healthy eating and physical activity.

Be physically active

Physical activity increases blood flow through your body, including the penis. Talk with a health care professional before starting new activities. Beginners should start slow, with easier activities such as walking at a normal pace or gardening. You can gradually work up to harder activities, such as walking briskly or swimming. Aim for at least 30 minutes of activity most days of the week.

Avoid using illegal drugs

Using illegal drugs may prevent you from getting or keeping an erection. For instance, some illegal drugs may prevent you from becoming aroused or feeling other sensations. Using illegal drugs may mask other psychological, emotional, or physical factors that may be causing your ED. Talk with your health care provider if you think you need help with drug abuse.