Medically reviewed by Jill Johnson, FNP
Written by Our Editorial Team
Last updated 10/6/2022
When it comes to performance, the bedroom is understandably the last place you want to have a bad outing.
Unfortunately, many men -- an estimated 30 million in the United States alone -- deal with some degree of erectile dysfunction (ED) during sex.
ED can have a serious impact on your sexual function and satisfaction. When ED prevents you from being able to get an erection over the long term, it can even have a negative effect on your relationships.
If you find it difficult to get an erection from time to time, it’s generally nothing to feel too worried about -- after all, we all have off days. However, if you experience persistent difficulty getting or maintaining normal erections, you may be dealing with erectile dysfunction.
Below, we’ve explained what erectile dysfunction is, as well as the numerous factors that can all play a role in the development of ED.
We’ve also listed the most common symptoms of erectile dysfunction, as well as the options you have available to treat ED and improve your sexual health.
Erectile dysfunction is a common condition in which you may find it difficult to get or maintain an erection, even with adequate sexual desire and sexual stimulation.
ED can vary in severity. Some men with erectile dysfunction may only be able to get an erection inconsistently, or find it difficult to maintain an erection during sex, while others might not be able to get an erection at all.
A variety of factors can play a role in the development of erectile dysfunction, including factors related to your physical health and your mental wellbeing.
Erections rely on a combination of proper nerve function and blood flow. When you feel sexually aroused -- usually in response to sexual stimulation -- your nervous system promotes the flow of blood to the tissue inside your penis, called the corpora cavernosa.
As blood flows into your corpora cavernosa, pressure starts to build and your penis will become larger and firmer, creating an erection.
Because erections are so dependent on nerve function and blood flow, any condition that affects your nervous system or cardiovascular health can potentially cause ED.
Common physical causes of ED include:
Hypertension (high blood pressure)
Atherosclerosis (clogged arteries)
Chronic kidney disease (CKD)
Multiple sclerosis (MS)
Type 2 diabetes
Injuries to your penis and surrounding area
Complications from prostate surgery, bladder cancer surgery or radiation therapy
These conditions can affect nerve function and/or blood flow, which may make it more difficult to supply your penis with enough blood for an erection when you feel sexually aroused.
Certain medications used to treat these issues, including prescription medications for high blood pressure, antiandrogens (medications that reduce serum testosterone levels), sleeping pills and antidepressants such as selective serotonin reuptake inhibitors, may cause or worsen ED.
Habits that affect your physical health, such as smoking, being overweight or obese, consuming alcohol excessively, using recreational drugs or having a sedentary lifestyle, are also known risk factors for erectile dysfunction.
In addition to physical health problems, certain mental health issues may also increase your risk of erectile dysfunction.
Common psychological causes of ED include:
Feelings of guilt about sex
Anxiety, including sexual performance anxiety
Severe or chronic stress
Our guide to the psychological factors that can cause ED goes into more detail about how your mental health can affect your sexual performance.
The most common symptom of erectile dysfunction is difficulty getting or maintaining an erection that’s firm enough to have penetrative sex with your partner.
This symptom can vary in severity. For some men, ED is an occasional issue that pops up every now and again. For others, it’s an ongoing, severe problem that makes having sex in any form a difficult, stressful process.
We’ve discussed the range of symptoms involved in erectile dysfunction below and covered the way in which each symptom may affect your erections and sexual function.
If you have erectile dysfunction, you may find it difficult to get an erection, even when you feel sexually aroused. You may notice that no matter how sexually stimulated you are, your penis just doesn’t seem to respond.
This issue might occur when you try to engage in sexual activity with your partner or when you masturbate at home. If your ED is severe, you may find it difficult to get an erection at any time, even when you feel as if you’re in the mood for sex.
Not all men with erectile dysfunction are incapable of getting an erection at all. If you have mild or moderate ED, you may be able to get an erection when you feel sexually aroused, but find it difficult to maintain it for long enough to have sex.
You may also be able to get nocturnal erections (morning wood) -- erections that develop while you’re sleeping.
If you have mild or moderate ED, you may occasionally be able to get and maintain an erection that’s firm and long-lasting enough to have sex. However, your erections might be inconsistent, meaning you can’t reliably get and maintain an erection every time you feel like having sex.
Some men with erectile dysfunction don’t find it too difficult to get an erection, but are only able to get partially hard when they’re sexually aroused.
If you have mild or moderate ED, you may be able to get an erection when you’re aroused, but not one that’s firm enough to reliably penetrate your partner. This can make some types of sex difficult and affect you and your partner’s ability to enjoy sexual activity.
When erectile dysfunction makes it difficult for you to have sex, it can have a range of additional effects on your lifestyle and wellbeing.
If you have moderate or severe erectile dysfunction, you may have a higher risk of experiencing relationship issues, including a loss of intimacy. You may also be more at risk of certain mental issues, including depression, anxiety and low self-esteem.
ED can also contribute to sexual frustration. You might feel unfulfilled and unable to enjoy sex in a positive way -- an issue that could contribute to more severe ED symptoms.
While erectile dysfunction can be frustrating and stressful to deal with when it occurs, the good news is that it’s almost always treatable.
Treatment for erectile dysfunction typically involves using medication to improve your erections, as well as improving your general health and treating any underlying conditions that may play a role in sexual dysfunction.
If you think you may have erectile dysfunction, it’s best to talk to your healthcare provider. They might ask you about your symptoms, speak with you about your sexual history and give you a physical exam.
Most of the time, ED can be treated with medication to improve blood flow to the erectile tissue inside your penis and make getting an erection easier.
Currently, there are several FDA-approved oral medications for erectile dysfunction, which are part of a class of drugs called PDE5 inhibitors. These include:
Sildenafil. The active ingredient in Viagra®, sildenafil works quickly and provides relief from erectile dysfunction for approximately four hours.
Vardenafil. The active ingredient in Levitra®, vardenafil provides relief from ED for five to six hours per dose.
Avanafil. Available as Stendra®, avanafil is a newer ED medication that starts working in as little as 15 minutes and is less likely to cause certain side effects.
We offer several proven medications for erectile dysfunction online, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate.
ED medications are safe, convenient and effective for most men, but they can sometimes cause adverse effects. Our guide to what you should expect from ED medication explains how you can use these medications safely, as well as what you may experience during treatment.
Most men experience improvements after starting medication for ED. However, in certain cases, your healthcare provider may recommend a different type of treatment to improve your erections and sexual function.
Other treatment options for ED include:
Changes to your lifestyle. Your healthcare provider may suggest being more physically active, losing weight, reducing your alcohol intake or making other changes to your life to promote better erections and sexual health.
Treating underlying health conditions. If you have cardiovascular disease, high blood pressure, diabetes mellitus or another type of health issue, your healthcare provider may recommend treating it before using ED medication.
Vacuum devices. If you have ED due to an injury or complications from surgery, using a vacuum pump (also referred to as a “vacuum erection device”) might help you to get and maintain an erection when you’re aroused.
Testosterone replacement therapy (TRT). If you have erectile dysfunction, a weak sex drive and other sexual health problems due to low levels of testosterone, your healthcare provider may suggest testosterone replacement therapy.
Counseling. If your erectile dysfunction is caused by a mental health issue, taking part in therapy may help you to make progress and improve your sexual function. We offer a range of mental health services online, including private online counseling.
Surgery. If you have severe ED that doesn’t get better with other treatments, your best option might be surgery. Several types of surgery are used to treat ED, including repair of the blood vessels inside your penis and the placement of a penile implant.
Because a variety of different physical and psychological factors can all contribute to ED, there isn’t a one-size-fits-all medical treatment that’s best for everyone.
If you have ED, your healthcare provider will select the best form of treatment for you based on your symptoms, medical history and needs.
The bedroom is a mishap-friendly zone -- some days you're not in the mood, other times you're more than excited, both of which can lead to occasional erectile issues.
However, where these issues become frequent, it can be a sign that you’re affected by erectile dysfunction that may require treatment.
If you have ED, it’s important to get help. You can do this by talking to your healthcare provider or taking part in an erectile dysfunction consultation online.
You’ll receive thorough advice and, if appropriate, a prescription for medication to help you get and maintain an erection more easily.
Interested in learning more about treating erectile dysfunction? Our guide to treatment options for ED goes into more detail about the best ways to improve your erections and sexual health, from medication to psychotherapy, vacuum constriction devices, kegel exercises and more.