Erectile dysfunction, or ED, is a common form of sexual dysfunction that affects about 30 million men in the United States alone.
If you have erectile dysfunction, you may find it difficult to develop or maintain an erection that’s firm enough for sex.
Alternatively, you might be able to get an erection, but not on a consistent enough basis to have sex when you want to.
Sometimes, problems in your nervous system can affect your sexual function and either cause or worsen erectile dysfunction.
This type of erectile dysfunction is referred to as neurogenic, or neurological ED.
Below, we’ve discussed how ED develops, as well as how neurological factors may affect your erectile function and sexual performance.
We’ve also explored the treatment options that are currently available for erectile dysfunction, including ED that’s caused by or linked to neurological factors.
Neurological erectile dysfunction, or neurological ED, is any form of erectile dysfunction that’s caused by impairment to your nervous system.
Your nervous system plays a significant role in the process of develooping and maintaining an erection before and during sex.
Erections start with stimulation and arousal. When you feel aroused due to physical contact or sexual imagery, nerves in your brain and pelvic area send impulses to the erectile tissue inside your penis.
These impulses cause the blood vessels that supply your erectile tissue to expand, increasing the amount of blood that flows into your penis.
It’s this blood that gives an erection its size and firmness. As blood continues to flow into your penis, a fibrous membrane called the tunica albuginea contracts, holding the blood inside the tissue and sustaining your erection, allowing you to have sex.
This process depends on a few things. Most importantly:
When your nervous system is impaired, this process may be interrupted, preventing you from being able to get and/or sustain an erection.
Several issues can cause neurological erectile dysfunction, including damage to your nervous system from injuries or surgery and neurological conditions that damage the nerves in certain parts of your body.
Common causes of neurological ED include:
Although neurological issues can cause or worsen erectile dysfunction, they aren’t always the only factor. Other common causes of ED include:
Treatment for ED can vary based on its cause. If you have erectile dysfunction, it’s important to talk to your healthcare provider to learn what could be causing it, as well as what options you have for treating your symptoms and improving your sexual performance.
Just like ED caused by poor cardiovascular health or psychological issues, neurological erectile dysfunction can vary in severity.
If you have neurological erectile dysfunction, you may:
The symptoms of neurological ED mirror the symptoms of cardiovascular ED.
Most cases of neurological ED improve with treatment, although some — particularly those that involve complex, major injuries — can be challenging to treat.
When it comes to treating neurological erectile dysfunction, the general principle is that it’s best to start with the least invasive forms of treatment, then explore other options.
We’ve listed the current treatment options for neurological ED below, with additional information on how each treatment option works, its effects and more.
Many cases of neurological ED can be treated with medication. Common ED medications, such as sildenafil (the active ingredient in Viagra®, AKA generic Viagra), tadalafil (Cialis®) and others are often prescribed for men with ED caused by multiple sclerosis, Parkinson’s disease and other conditions.
These medications, which are called PDE5 inhibitors, work by increasing the level of blood flow to the erectile tissue inside your penis.
Most PDE5 inhibitors work quickly, meaning you can take them approximately one hour before you plan to have sex.
Some, such as tadalafil, provide long-lasting effects and work for a couple days at a time.
Currently, all PDE5 inhibitors require a prescription, meaning you’ll need to talk to a healthcare provider before you can purchase and use them.
Hims offers several brand name and generic ED medications online, including sildenafil, tadalafil and others, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate.
When oral ED medications aren’t effective at treating neurological ED, other medications may be used instead.
In some cases, neurological ED may be treated using injectable medications, such as Trimix®, which contains alprostadil papaverine and phentolamine.
These medications require some preparation and aren’t as easy to use as drugs like sildenafil, but they’re often effective.
We’ve discussed these medications and their effectiveness in more detail in our full guide to ED injections.
Unfortunately, medications like sildenafil and tadalafil aren’t always fully effective for men with neurological ED.
When medication doesn’t work on its own, your healthcare provider may recommend using a vacuum constriction device (VCD, or penis pump).
These devices, which consist of a cylinder, manual or electric pump and constriction ring, are designed to draw blood into your penis.
Used correctly, they can improve the quality of your erections and help you to enjoy more satisfying, fulfilling sex.
Research shows that VCDs work well.
One review published in the International Journal of Impotence Research noted high satisfaction rates among men who use these devices.
Vacuum constriction devices can cause certain side effects, and need to be used with care. We’ve discussed these devices, their effects and the evidence to support their use in our guide to penis pumps for erectile dysfunction.
If other treatments for neurological ED aren’t effective, your healthcare provider may suggest a penile implant.
Penile implants are usually reserved as a last option for treating ED. They’re usually effective, but they require surgical intervention and, as such, aren’t as convenient as using medication or a vacuum constriction device to improve your sexual function.
Currently, two types of penile implants are available — inflatable implants that feature a hydraulic system to produce erections, and rigid prostheses.
Erectile dysfunction often occurs as a result of damage to your nervous system, whether due to an injury, surgery or a medical condition that affects your nerve function.
While some forms of neurological ED improve with the passage of time, others require ongoing treatment and management.
Several treatment options are available for neurological ED, medications, devices and surgical procedures.
Although these aren’t effective for everyone, many men find that they can produce real, noticeable improvements in their erections and sexual performance.
Hims offers a selection of ED treatments online, including medications such as sildenafil, tadalafil and avanafil (sold under the brand name Stendra®).
These medications require an online consultation with a licensed healthcare provider, who will determine if a prescription is appropriate.