Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 10/13/2021
Study data suggests it affects 18 million men over the age of 20 in the United States. It affects men of all ages and backgrounds, but becomes increasingly prevalent with age. Millions of men struggle with it, but shockingly few ever seek treatment.
What condition is this common while remaining underdiagnosed and, in many cases, untreated?
These words are enough to make any man feel nervous. Erectile dysfunction, or ED, is a highly personal problem that many men find embarrassing or shameful to talk about.
Men who fail to seek treatment for erectile dysfunction often feel as though they are alone in their suffering, but nothing could be further from the truth.
A study on male aging found that as many as 40 percent of men experience some degree of erectile dysfunction by the time they reach 40, and the prevalence of ED rises as high as 70 percent by the age of 70.
Erectile dysfunction is common, but many men fail to learn even the basics about exactly what it is, what causes it and what can be done to treat and prevent it.
Keep reading to learn more about this common condition, its potential causes and the steps that you can take to best manage it.
Erectile dysfunction is a condition in which you’re either unable to get an erection, or unable to sustain an erection sufficient for penetrative sex.
Like many other forms of sexual dysfunction, ED can vary in severity. Some men with ED find it difficult or impossible to get hard, while others may be able to get an erection but not maintain it, or only get an erection that’s slightly firm.
Erectile dysfunction can be something that affects you once every now and then or a recurring, long-term problem that makes it hard to maintain a satisfying sex life.
The basics of erectile dysfunction are simple enough, but what -- exactly -- happens that makes it so difficult to get an erection?
Inside your penis, there are two long, cylindrical chambers called the corpora cavernosa, which contain a myriad of blood vessels and tissues, as well as one major artery in each chamber.
When you become sexually aroused, your nervous system signals to your penis. This triggers a local response in which the muscles of your corpora cavernosa relax, allowing blood to flow into your penis and make it larger and firmer.
This flow of blood to your penis is essential for healthy erections. The more blood is able to flow into your corpora cavernosa, the easier it becomes to sustain a firm erection that allows you and your partner to have sex.
Erectile dysfunction occurs when blood either isn’t able to flow into your penis, or doesn’t flow to your corpora cavernosa for another reason.
Sometimes, erectile dysfunction happens at the same time as other forms of sexual dysfunction, such as premature ejaculation, delayed ejaculation, anorgasmia (difficulty reaching orgasm) or a low sex drive. In other cases, it’s an isolated issue that occurs on its own.
A variety of factors can cause or contribute to erectile dysfunction, including your physical health and wellbeing, your mental health, certain lifestyle choices and even your use of certain medications or substances.
Because male sexual arousal is a fairly complex process, it can sometimes be difficult to identify a specific cause.
Sexual arousal starts in your brain, but it also involves your nervous system, muscles and blood vessels. It can even be impacted by factors such as your emotions and your production of some sex-related hormones.
If a problem develops that involves any of these things, erectile dysfunction could be a potential consequence.
Generally speaking, the causes of erectile dysfunction can be sorted into three main categories: physical causes, psychological causes and medications or substances.
Though each of these categories has its own set of contributing factors, many cases of erectile dysfunction involve causes from several categories.
Here’s an overview of each category, as well as the specific issues that can cause or contribute to ED:
Erectile dysfunction is often caused by physical health factors, including those that affect blood flow and nerve function.
Since erections are all about healthy blood flow, it’s common for cardiovascular health issues to affect your sexual health and erectile function.
Common physical causes of erectile dysfunction include heart disease, atherosclerosis (clogged arteries), high cholesterol and hypertension, or high blood pressure. These issues can all affect your cardiovascular health and potentially restrict the flow of blood to your penis.
Other forms of vascular disease can also reduce blood flow and make it more difficult to develop or sustain an erection.
There is also a link between stomach problems and ED.
Another common physical cause of ED is type 2 diabetes, which can damage your arteries and nervous system. This can lower blood flow to your penis and affect your ability to feel physical sensation, including in your penis and surrounding tissue.
Conditions that damage your nervous system can also cause or contribute to ED. These include multiple sclerosis (MS), as well as local injuries to the nerves around your penis, spinal cord and pelvis caused by surgery, radiation therapy or accidental damage.
Finally, certain lifestyle factors that affect your physical health can have an effect on your risk of developing erectile dysfunction.
For example, habits such as smoking can increase your risk of developing ED by harming your cardiovascular system. Excessive alcohol consumption is also linked to a higher risk of sexual dysfunction, including ED.
In many cases, erectile dysfunction is rooted in psychological issues, especially in men under 40 years of age. Because sexual arousal starts in the brain, psychological conditions can be a significant contributing factor to ED.
Sometimes, these mental health issues are specific to sex. For example, many men develop a form of anxiety called sexual performance anxiety, which can cause extreme nervousness that occurs before or during sex.
Others may experience feelings of guilt about having sex, or worries about engaging in certain types of sexual activity.
Beyond depression and anxiety, stress may also be a major factor in erectile dysfunction. When stress is severe or chronic, it can interfere with your brain sending signals to allow extra blood to flow to your penis, making it more difficult for you to get and stay hard during sex.
Though it can sometimes be difficult to pin down the specific cause for your erectile dysfunction, it is always worth the effort. Left untreated, ED can contribute to worsened stress and anxiety as well as low self-esteem, relationship issues and a reduced quality of life.
We’ve discussed these causes and the impact they can have on your sexual performance more in our full guide to the psychological causes of ED.
In addition to physical and psychological causes, erectile dysfunction is occasionally caused by certain medications and substances.
Many common medications can affect your vascular and nervous systems, potentially causing ED as a side effect. Others can affect your brain and make it more difficult to become aroused or sexually stimulated.
When erectile dysfunction is caused by a medication or other substance, it may be referred to as drug-induced erectile dysfunction, or impotence caused by medications.
Common medications that may cause or contribute to erectile dysfunction include:
Medications for high blood pressure. Certain blood pressure medications, including diuretics and beta-blockers, can cause or contribute to ED. Other medications used to treat high blood pressure may interact with PDE5 inhibitors used to treat ED.
Antidepressants. Lots of widely-used antidepressants, including selective serotonin reuptake inhibitors (SSRIs), can cause sexual side effects, including a reduced libido, difficulty reaching orgasm and erectile dysfunction.
Antiandrogens. Some antiandrogens (medications that reduce production of male sex hormones) may cause ED. These medications are often used to treat prostate cancer and certain androgen-dependent medical conditions.
Antihistamines. Several antihistamines used to treat allergies are associated with ED, including diphenhydramine (the active ingredient in Benadryl®).
Prescription sedatives. Some prescription sedatives used to treat anxiety and difficulty sleeping may cause erectile dysfunction.
Medications for Parkinson’s disease. Erectile dysfunction is a known side effect of several medications used to treat and manage Parkinson’s disease symptoms.
In addition to common medications, many illicit substances can either cause or worsen erectile dysfunction. These include cocaine, amphetamines and heroin, as well as medications used as recreational drugs such as barbiturates.
There’s also a link between marijuana and erectile dysfunction, as well as other sexual function issues such as difficulty reaching orgasm.
Erectile dysfunction can be frustrating to deal with, especially when it prevents you from having a satisfying, fulfilling sex life. However, almost all cases of ED can be treated.
Treatment of erectile dysfunction starts with an accurate diagnosis. You can get this by meeting with your primary care provider, by talking to an ED doctor online, or by talking to a specialist in men’s reproductive health, such as a urologist.
In many cases, diagnosing erectile dysfunction requires little more than a physical examination, a quick chat about your medical history and a review of your symptoms.
Depending on the severity of your ED, your general sexual function and other factors, you may benefit from one of the following treatment options.
These medications work by increasing blood flow to your penis, making it easier for you to get and stay hard when you’re sexually aroused. Most oral ED medications can be taken 30 to 60 minutes before sex, making them easy to use during a night out or at home.
You can learn more about these medications, their effects and how to use them in our guide to the most common ED treatments and drugs.
It’s important to be aware that ED medications can interact with other common drugs, including some used to treat hypertension and cardiovascular disease. We’ve covered these in our guide to common sildenafil interactions.
We offer brand name and generic versions of several ED medications, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate.
When ED is caused by a psychological issue, such as anxiety, depression or worries about sex, psychotherapy can be beneficial.
Several different forms of psychotherapy are used to treat psychological ED, including cognitive behavioral therapy (CBT) and sex therapy. The goal of therapy is to help you overcome feelings that affect your ability to have sex and develop systems for controlling them in the future.
Depending on the root cause of your ED, you may benefit from therapy on its own or along with the use of ED medication.
An alternative to oral ED medications, vacuum erection devices create an erection with vacuum pressure by drawing blood into your penis. Some of these devices are used with a band to hold blood inside your penis and sustain your erection during sex.
You may benefit from using a vacuum device if oral medications for ED aren’t totally effective for you, or if you’ve recently undergone surgery that affects your ability to get an erection.
Although they’re invasive and rarely used unless necessary, surgical options for treating erectile dysfunction do exist.
Surgery shouldn’t be your first choice for treating ED, especially if you’ve yet to try medication or therapy. However, if you have a physical injury or condition that’s causing you to experience ED, a surgical procedure may be your best treatment option.
The most common type of surgery for ED involves fitting a malleable or inflatable penile implant, allowing you to maintain an erection firm enough for sex.
When erectile dysfunction is caused by a venous leak (an inability to maintain blood pressure in the penis), it may be treated with corrective vascular surgery.
Because of the costs and recovery time associated with ED surgery, these procedures are only used when other treatment options for erectile dysfunction aren’t effective.
As you age, it’s normal for your testosterone levels to gradually decline. As a result of this, many men start to experience symptoms of low testosterone, such as weaker erections and a reduced level of interest in sex, as they enter their 30s, 40s or 50s.
Although it’s still possible to get an erection with low levels of testosterone, many guys with low testosterone feel less sexually aroused and experience a reduction in things like morning wood.
If you have low testosterone and ED, your healthcare provider may suggest using testosterone replacement therapy (TRT). This treatment involves using artificial testosterone to restore your testosterone levels to the normal range.
TRT can cause side effects and it isn’t for everyone. However, if you have low testosterone and notice that it’s affecting your sexual performance, it may be an option worth considering.
When erectile dysfunction is caused by a lifestyle factor, such as limited exercise, an unhealthy diet or obesity, changing your habits and lifestyle may help to improve your sexual function and reduce the severity of your ED.
As we’ve covered in our guide to the best ways to naturally protect your erection, habits such as taking part in regular exercise, eating a diet that’s rich in fruits and vegetables and getting lots of healthy sleep can have a noticeable positive impact on your sexual health.
It can also help to overcome bad habits, such as by limiting your alcohol consumption or quitting smoking.
When you’re choosing an erectile dysfunction treatment, you should take your time. There are countless options available, and while none of them are perfect, some of them may be a better fit for you than others.
There’s no “best” ED treatment for everyone. Since a variety of factors can cause or contribute to erectile dysfunction, it’s important to identify what could be affecting your sexual health, then choose a treatment that matches your specific symptoms and needs.
One important thing to be aware of is that many of the over-the-counter ED “treatments” sold in gas stations, convenience stores and online not only don’t work, but often aren’t safe.
These products are often marketed as “male enhancement” pills that can treat ED, boost sexual stamina and improve just about every aspect of your sexual performance. They typically contain a mix of herbal ingredients and make big claims about their efficacy and results.
While not all of these products are outright scams, many have been found to contain unlabeled, unsafe ingredients, including hidden pharmaceutical ingredients made in unsafe conditions.
You can find out more about these products, as well as the risks associated with using them, by scrolling through the FDA’s list of tainted sexual enhancement products.
Before starting any treatment, it’s important to inform your healthcare provider about any drugs or supplements you currently use and to familiarize yourself with the common side effects of ED treatments.
Once you’ve learned about erectile dysfunction, its risk factors and its potential causes, you’ll be in a much stronger position to assess your own erectile function and take action.
If you’ve experienced any of the symptoms of ED recently, it may be worth reaching out to your healthcare provider for help.
If you choose to seek help, make sure to give your healthcare provider as much information as you can about your symptoms, including when they started, their frequency and the impact that ED has on your sexual function.
Another option is to seek help online. Using our telehealth platform, you can consult a licensed healthcare provider and access ED medications such as sildenafil, tadalafil and Stendra after a private online consultation.
Want to learn more about ED before taking action? Our guide to the most common symptoms of erectile dysfunction shares more about what to look for before you visit a healthcare provider, as well as what you can do to treat ED for good.