Everything You Need to Know About Erectile Dysfunction (ED)

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What is erectile dysfunction (ED)?

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.

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.

What causes an erection?

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.

Erectile dysfunction causes

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

  • cardiovascular disease
  • diabetes
  • hypertension, or high blood pressure
  • high cholesterol
  • obesity
  • low testosterone levels or other hormone imbalances
  • kidney disease
  • increased age
  • stress
  • anxiety
  • depression
  • 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

Your doctor may prescribe medication to help you manage the symptoms of ED. You may need to try several medications before you find one that works.

Testosterone therapy (TRT) may also be recommended if you have low levels of testosterone.

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.

Medications for ED can cause side effects. If you’re experiencing unpleasant side effects, talk to your doctor. They may be able to recommend a different medication. Get more information on the medications used to treat ED.

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.
  • Injection test. During this test, a medication is injected into your penis to stimulate an erection. This allows your doctor to evaluate the firmness of the erection and how long it lasts.
  • 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. Here’s how:

  • 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.
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.


Yoga can help to relax your mind and body. Since stress or anxiety can cause or contribute to ED, practicing yoga may be an effective way to ease ED symptoms.

Erectile dysfunction natural treatment

For some men, natural remedies may help treat ED.

Herbs and supplements

Certain herbs and supplements have been shown to treat ED, with varying degrees of success, including:

  • Asparagus racemosus
  • dehydroepiandrosterone (DHEA)
  • ginseng, such as Korean red ginseng
  • L-arginine
  • L-carnitine
  • yohimbe

Horny goat weed and zinc may help as well.

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.


Prostatic massage, a form of massage therapy, may be used for ED. Prostatic massage is often used in combination with other treatments.

During prostatic massage, a practitioner will massage the tissues in and around the groin to promote blood flow to your penis. You may need to undergo a massage several times a week. The length of massage treatment depends on your symptoms.

So far, there have only been limited studies on prostatic massage and its effectiveness. Get tips on finding a practitioner, and more, with the help of this short guide.

The bottom line

Multiple options exist for people looking for natural ways to treat their ED. Try one of the options above or even a combination of them. Remedies like acupuncture and massage can even be paired with other traditional medications. Find out more about the effect of lifestyle changes on ED.

Erectile dysfunction surgery

In cases where medications aren’t effective, your doctor may recommend surgical treatment. There are two types of procedures that may be used: implants and vascular surgery.

A penile implant, also referred to as a prosthesis, can be placed in the penis. There are two different types. An inflatable implant allows you to use a pump to make your penis larger, while a malleable implant allows you to adjust the position of your penis manually.

Vascular surgery repairs arteries that may be blocked. This can help to restore adequate blood flow to the penis. Younger men are typically better candidates for this type of procedure.

Every surgery has its benefits and drawbacks. Be sure to discuss these with your doctor if you decide to undergo surgery for ED. Check out this guide to penile implants, learn how they’re placed, and discover what recovery is like.

Erectile dysfunction and diabetes

ED and diabetes can occur together. In fact, the risk of developing ED is approximately 50 percent in men who have diabetes. But why is this?

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. Other risk factors can include injuries.

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


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. Find out more ways to prevent ED.