Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 2/2/2022
As a man, it’s normal to have trouble getting or keeping an erection occasionally. However, if you frequently find it difficult to get an erection or maintain a firm enough erection to have sex, you might have erectile dysfunction (ED).
Erectile dysfunction is the inability for a man to get and maintain an erection that’s firm enough to have penetrative sex. ED is also referred to as impotence, but the term “impotence” is used less often when referring to this common condition.
Erectile dysfunction affects around 30 million men in the United States and hundreds of millions worldwide. According to data from the Massachusetts Male Aging Study (MMAS), 52 percent of men aged between 40 and 70 have mild to moderate ED.
Although the term “ED” is often associated with a complete inability to get an erection, the reality of erectile dysfunction is that it can vary in severity. You may have ED if you
Can get a normal erection, but find it difficult to maintain it during sex
Find it difficult to get an erection every time you want to have sex
Can’t get an erection at all, even when you’re sexually stimulated
Our article on how to know if you have ED goes more into detail on this.
For some men, ED is a short-term problem that happens every now and then. For others, it may be a long-term issue that develops over the course of years or decades.
Erectile dysfunction can occur for a variety of reasons. Sometimes, a psychological issue such as stress or feelings of guilt can trigger ED. In other cases, ED can be a sign that you may also have an underlying health problem.
Certain habits, such as your use of tobacco products, medications or alcohol can also contribute to erection issues and make it harder for you to maintain a fulfilling sex life.
When ED occurs at a bad moment, it can hurt your self-confidence. Luckily, erectile dysfunction is one of the easiest forms of sexual dysfunction to treat, either with FDA-approved medications, non-pharmaceutical treatments or a mix of both.
While getting an erection may seem simple, like many other bodily functions, it’s actually kind of amazing.
From a physical standpoint, your penis grows in size when you’re sexually aroused as the result of a complex sequence of events and balancing act that involves your nervous system, vascular system and -- you guessed it -- the erectile tissue of your penis.
Here’s what’s going on:
Inside your penis, there are two erectile chambers called the corpora cavernosa. These areas of soft tissue run along the left and right sides of your penis, extending all the way from your pelvis to the head of your penis (the glans penis).
When you’re sexually aroused due to physical or mental stimulation, your brain initiates an erection by sending chemical messages to the penis. This causes the muscles of the corpora cavernosa to relax and allows blood to flow into the tissue.
One particular chemical (cyclic GMP/cGMP) relaxes the corpora cavernosa and allows blood to flow into the base of the penis. As blood flows into the soft tissue of the penis, it expands and becomes firmer.
As the penis expands, a fibrous membrane called the tunica albuginea wraps around the corpora cavernosa, stopping blood flow from flowing out of the penis and maintaining the erection during sex.
Following orgasm and ejaculation, the process occurs in reverse. The muscles inside the penis start to contract, stopping blood flow into the tissue and promoting blood flow back into the circulatory system.
Like many other bodily functions we take for granted, this all happens behind the scenes while you’re focused on, well, more interesting things going on in front of you.
Erections can last from less than one minute to one hour or longer. Our guide to how long your erection should last goes into more detail about the process of developing an erection, as well as steps that you can take to maintain your erections for longer.
The most common symptom of erectile dysfunction is is exactly what you’d expect -- difficulty getting and/or maintaining an erection during sex. If your ED is persistent, it can also cause mental symptoms, such as reduced confidence and less interest in sexual activity.
Below, we’ve listed several of the most common symptoms of erectile dysfunction, as well as how each one may affect you.
One of the most obvious signs of ED is difficulty getting an erection. You might find it difficult to get hard, even if you’re in the mood for sex. In some cases, you might find it challenging to get any erection, while in others you may find it difficult to get a firm enough erection for sex.
In addition to making it difficult to get an erection, ED can involve difficulty keeping an erection during sexual intercourse.
Even if you can get an erection before sexual activity without much difficulty, you may find that it’s difficult to stay hard while you’re having sex. Even if you don’t fully lose your erection, you may notice that your penis becomes less firm during sexual intercourse.
This loss of penile firmness can affect your enjoyment of sex and may make it difficult to reach orgasm and ejaculate.
Because of its effects on sexual performance, erectile dysfunction can cause sometimes result in psychological problems, such as sexual performance anxiety, depression or a reduced level of interest in sex.
When ED is severe or persistent, it can also affect your relationships and contribute to reduced intimacy and an unfulfilled sex life.
Sometimes, erectile dysfunction can develop because of Peyronie’s disease -- a condition that involves a curve in the penis caused by scar tissue. When ED occurs with Peyronie’s disease, it can involve painful erections.
If you’re worried about erectile dysfunction, it’s best to talk to your healthcare provider as soon as you experience multiple incidents in which you find it difficult to develop and/or maintain an erection during sex.
It’s especially important to talk to your healthcare provider if you’ve had persistent difficulty with erections that’s lasted for several months.
It’s common to deal with occasional issues maintaining an erection, especially if you’ve recently consumed alcohol or taken other medication prior to sex. If you find it difficult to get or maintain an erection once every few weeks or months, you may not have clinical ED.
However, it’s important to seek help if you frequently experience these symptoms. ED is highly treatable, and getting expert help early can help you to identify its cause and work out the most effective ED solution.
Erectile dysfunction can occur for a range of reasons. Sometimes, it’s caused by one or several physical problems that affect blood flow or nerve function. In other cases, it may be caused by a psychological issue that affects your self-confidence or sexual arousal.
Since erections depend on proper nerve function and healthy, consistent blood flow, a variety of physical issues can potentially cause ED. Physical causes of erectile dysfunction include:
Cardiovascular disease. Because blood flow plays such an important role in erections, common forms of heart disease such as coronary artery disease (CAD) are often linked to erectile dysfunction.
Hypertension (high blood pressure). Elevated blood pressure can damage your blood vessels and reduce blood flow throughout your body. This may cause or worsen erectile dysfunction.
Atherosclerosis (clogged arteries). When your arteries become clogged due to plaque buildup from high cholesterol, it can affect blood flow. This can cause or worsen erectile dysfunction.
Diabetes. Erectile dysfunction is closely associated with diabetes. Both type 1 and type 2 diabetes can reduce blood circulation and nerve function, both of which are important for healthy erections.
Chronic kidney disease. Having kidney disease can significantly increase your risk of developing erectile dysfunction. Approximately 70 percent of men with end stage renal disease are affected by ED.
Hormonal imbalances. Some hormonal conditions, such as hypothyroidism (low levels of thyroid hormone) and hyperthyroidism (high levels of thyroid hormone) are associated with ED. Low testosterone levels may also play a role in erectile dysfunction.
Multiple sclerosis (MS). Erectile dysfunction is common in men with multiple sclerosis, often as a result of neurological complications, psychological factors and side effects of some multiple sclerosis medications.
Metabolic syndrome. Research has linked ED with metabolic syndrome, a combination of diabetes, high blood pressure and obesity. Metabolic syndrome is associated with an elevated risk of heart disease and stroke.
Parkinson’s disease. Parkinson’s disease is linked with several sexual health problems in men, including a reduced level of sexual interest, ejaculation disturbances and erectile dysfunction.
Physical damage to the penis. Damage to the penis and surrounding area, whether it’s from prostate/bladder surgery, radiation therapy or injuries, can affect nerve function and blood flow and potentially cause erectile dysfunction.
Sleep disorders. Some sleep disorders, such as obstructive sleep apnea, are linked to erectile dysfunction. One study found that 51 percent of men with sleep apnea also had some degree of ED.
Medications. Some medications, including blood pressure medications, medications for prostate cancer therapy, antidepressants, prescription sleep aids, ulcer medications and appetite suppressants, can cause or contribute to ED.
Sexual arousal is both physical and psychological. When you’re feeling mentally unwell or under stress, you may find it harder to get an erection. Psychological causes of ED include:
Depression. Depression often causes sexual symptoms, including a reduced libido and difficulties with sexual arousal. If you’re depressed, you may find it more difficult to get an erection before and during sex.
Sexual performance anxiety. It’s normal to occasionally feel anxious about sex. When this anxiety is overly severe or persistent, it may affect your ability to get and maintain an erection.
Feelings of guilt about sex. You might find it harder to relax and achieve an erection if you feel guilty about certain types of sexual activity, or about engaging in sexual activity at all.
Relationship issues. If you’re going through relationship issues that affect your level of trust in or attraction to your partner, this could affect your sexual function and contribute to erectile dysfunction.
Pornography usage. Although the link between porn and erectile dysfunction isn’t quite crystal clear, some research suggests that problematic porn consumption may lead to a form of erectile dysfunction called porn-induced ED.
Our guide to the psychological causes of erectile dysfunction goes into greater detail about how the factors above may affect your erections and sexual performance.
Erectile dysfunction can potentially affect men of all ages and backgrounds. However, like with other medical conditions, certain factors may increase your risk of developing ED.
Common risk factors for erectile dysfunction include:
Age. Erectile dysfunction becomes more common with age. In one review, researchers noted that men have a roughy 40 percent chance of developing ED by age 40, with this risk increasing by 10 percent with each additional decade.
Obesity. Weight and erectile dysfunction are closely linked. Research shows that many men presenting with ED have a high BMI, and that your risk of developing ED increases by a substantial amount if you’re overweight or obese.
Tobacco use. Nicotine and other chemicals inside cigarettes, cigars and other tobacco products can damage your cardiovascular system. If you smoke, you have a higher risk of developing erectile dysfunction.
Alcohol consumption. While the occasional drink won’t harm your sexual functioning, consuming large amounts of alcohol or drinking on a regular basis may cause erectile dysfunction.
Recreational drug use. Both legal and illegal drugs can affect your sexual health and contribute to ED. For example, use of marijuana is linked to several sexual problems, including erectile dysfunction.
Lack of physical activity. You may have a higher risk of developing ED if you get little or no exercise. Living a sedentary lifestyle is also associated with other risk factors for ED, such as obesity and vascular disease.
Our full guide to erectile dysfunction risk factors discusses these issues and the effects they can have on your sexual health in more detail.
If you think you have erectile dysfunction, it’s best to speak to a healthcare provider. You can do this by talking to your primary care provider about your worries, scheduling an appointment with a urologist or by talking to a provider online about erectile dysfunction treatments.
To diagnose erectile dysfunction, your healthcare provider may ask about ED symptoms you’ve experienced and how long they’ve persisted. You may also be asked about your sexual history, general medical history and lifestyle to see if you have any risk factors for ED.
Your healthcare provider may ask you if you get morning erections, if you’re able to maintain an erection during sex or about your sexual self-confidence.
While talking about these subjects may feel embarrassing, it’s important to give as much detail as you can. Remember that ED is a common issue and that your healthcare provider has likely asked these questions hundreds of times before.
Your healthcare provider may perform a physical exam. During this exam, they may check your penis and testicles for signs of reduced sensation. They may also check for signs of damage to your penis, or for signs of hormonal issues such as extra body hair or puffy breast tissue.
To check for cardiovascular risk factors for ED, your healthcare provider may record your blood pressure and/or take your pulse in your extremities.
You may be asked to complete a test for ED. Several tests are used to diagnose ED and identify potential causes, including:
Blood tests. You may need to provide a blood sample. Blood testing can help to show health issues such as clogged arteries, diabetes, chronic kidney disease and hormonal problems that can cause or contribute to erectile dysfunction.
Imaging test. If your healthcare provider suspects your ED is caused by low blood flow to your penis, they may perform an imaging test called a Doppler ultrasound. This type of test measures arterial flow through the blood vessels inside your penis.
Injection test. This type of test, called intracavernosal injection, involves injecting your penis with an erectile dysfunction medication. Your healthcare provider might use this test to identify the cause of your erectile dysfunction.
Nocturnal erection test. Your healthcare provider may provide you with a small plastic device to wear around your penis while you sleep. This type of test helps to check if you are physically able to have nighttime erections.
Most of these tests are performed in your healthcare provider’s office. You may need to perform several tests to help your healthcare provider accurately diagnose erectile dysfunction and work out the most effective form of treatment.
Although erectile dysfunction can be a frustrating issue when it occurs, it’s usually an easy one to treat.
To treat ED, your healthcare provider will look at your symptoms and the potential cause of your erectile dysfunction. Based on your needs, they may prescribe ED medication, suggest therapy or recommend a combination of different treatment approaches.
Erectile dysfunction is typically treated with oral medication. Currently, there are several drugs for ED that have received approval from the FDA. The most common are sildenafil (the active ingredient in Viagra®), tadalafil (Cialis®), vardenafil (Levitra®) and avanafil (Stendra®).
These medications belong to a class of drugs called PDE5 inhibitors, which work by increasing blood flow to the tissue inside your penis. This makes it easier to get an erection after sexual stimulation. Currently, all are prescription medications.
All of these medications are common first-line treatment options for ED. However, there are a few key differences between them that may make one a better choice for you than others:
Sildenafil is the most common ED medication on the market. It’s been available since 1998 and is available as a generic or as Viagra. It works in 30 to 60 minutes and offers relief from erectile dysfunction for approximately four hours.
Tadalafil is a longer-acting ED medication that’s available as a generic and as Cialis. A typical dose of tadalafil starts working in about one hour and may provide relief from ED for up to 36 hours.
Vardenafil is a short-acting ED medication that’s available as a generic or as Levitra. It has similar effects to sildenafil, but typically lasts for slightly longer.
Avanafil is a newer, more selective ED medication. It starts working in 15 to 30 minutes and is less likely to cause side effects than older ED medications. Currently, avanafil is only available under the brand name Stendra.
We offer several erectile dysfunction medications online, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate.
Erectile dysfunction isn’t always caused by physical factors. From depression to anxiety, many cases of erectile dysfunction have their root in mental health issues that can affect the way you think and feel about sex.
Some mental health disorders may also weaken your sexual desire, which may have additional effects on your sexual response and performance.
If your erectile dysfunction is linked to a psychological issue, there are several treatment options that may be effective. These include:
Sex therapy. This is a specialized form of counseling that’s intended to help people with sexual difficulties overcome them. Some research suggests that sex therapy may help to treat psychological ED.
Cognitive-behavioral therapy (CBT). This type of therapy involves learning techniques to change thought patterns and behavior. It’s sometimes combined with techniques used in sex therapy to treat issues such as erectile dysfunction.
Counseling. When erectile dysfunction is caused by anxiety or depression, talking with a therapist may help. You can take part in counseling locally or from your home using our online therapy services.
In addition to medication and therapy, other forms of treatment for erectile dysfunction can often produce benefits. These include:
Vacuum erection devices. Vacuum devices create an erection by pulling blood into the tissue inside your penis. You’ll typically need to use this type of device with a small ring to maintain your erection during sex.
Alprostadil. This medication is an injectable treatment for ED. It works by causing blood to flow into the penis. The effects of alprostadil are instant, making it a fast and effective option for when oral drugs for ED don’t work.
Penile implants. Also known as a penile prosthesis, an inflatable implant can be placed inside the penis to help create an erection. This type of device is installed surgically by a urologist or other medical professional.
Surgical treatment. If your ED is caused by arterial damage that causes venous outflow or a blockage, it may need vascular surgery. Surgery for ED is generally only used when prescription drugs and other forms of treatment aren’t effective.
Topical ED creams. Creams are one of several future treatment options for ED that are currently being studied. One cream, called Vitaros®, is sold as a prescription medication in the UK but has yet to receive FDA approval in the United States.
Changing your lifestyle and habits can help prevent erectile dysfunction. If you already have ED, making healthy changes to your lifestyle may also improve your symptoms and help you to have a normal sex life without the use of medication.
You can reduce your risk of developing ED by:
Quitting smoking. Smoking damages your cardiovascular system and increases your risk of developing erectile dysfunction. It also makes you more likely to develop other health issues, including heart disease and cancer. If you smoke, try to quit.
Eating a balanced diet. Eating a healthy diet helps to keep your blood pressure in the normal range, which may help to prevent ED. Limiting your intake of foods high in fat, sodium and simple sugars can also help to prevent obesity.
Limit your alcohol consumption. It’s okay to enjoy a beer, glass of wine or cocktail on occasion. However, excessive drinking can contribute to ED. Try to limit your intake of alcohol to one or two small servings per day.
Avoid using illicit drugs. Many recreational drugs can affect your sexual performance, health and function. For example, some drugs may affect your ability to become aroused or contribute to psychological issues that can cause ED.
Keep yourself physically active. Working out improves your sexual function by making your heart stronger and increasing blood flow. Try to get at least 30 minutes of exercise every day, even if it’s just a brisk walk around your neighborhood.
Erectile dysfunction is a common issue. Luckily, it’s also a treatable one. By taking action early and talking to your healthcare provider, you can treat erectile dysfunction and enjoy a fulfilling, satisfying sex life.
Interested in learning more about erectile dysfunction? Our guides to the most common erectile dysfunction medications, the main causes of erectile dysfunction and talking about ED with your partner cover three important aspects of treating ED.
You can also access FDA-approved ED medications online via our telehealth platform following a consultation with a licensed healthcare provider.