All About Erectile Dysfunction (ED)

Medically reviewed by Adrian Rawlinson, MD Written by the Hims Editorial Team Last updated 7/10/2020

What is Erectile Dysfunction?

Erectile dysfunction (ED) is the inability for a guy to achieve and maintain an erection firm enough for sex. ED is the same as impotence, but impotence is used less often when referring to this common condition.

ED affects hundreds of millions of men. Statistics from the Massachusetts Male Aging Study show that about 52% of men experience erectile dysfunction at some point in life.

As a man, it’s normal to have trouble getting or keeping an erection occasionally. However, if you frequently have difficulty getting an erection or maintaining a firm erection during sex, you might have ED.

Erectile dysfunction can occur for a variety of reasons. Sometimes, a psychological issue or nervousness can trigger ED. In other cases, ED can be a sign that you might also have an underlying health problem.

Factors like your use of tobacco products, other medications or alcohol can also contribute to erection issues, making it harder for you to maintain a fulfilling sex life.

When ED occurs at a bad moment, it can affect your self-confidence. Luckily, ED is one of the easiest sexual dysfunctions to treat. Today, a variety of safe, FDA-approved medications and non-pharmaceutical treatments are available to help men of all ages treat ED.

How an Erection Works

Normal erectile function is pretty amazing. Physically, your penis grows in size and becomes rigid as the result of a sequence of events and a complex balancing act that happens inside your body. Here’s what’s going on:

  • Your penis has two erectile chambers (corpora cavernosa), running along the top on left and right sides, extending from your pelvis all the way to the head of your penis (glans penis). Two main arteries and several veins move blood in and out.
  • When you’re aroused (due to physical or mental stimulation), your brain initiates an erection by sending chemical messages to the blood vessels in your penis.
  • One particular chemical (cyclic GMP/cGMP) relaxes the corpora cavernosa, allowing blood to rush in.
  • At the same time, the veins close up due to increased pressure, and less blood flows out.
  • The accumulation of blood makes the penis expand and stiffen. You now have an erection.
  • Conversely, the penis softens and shrinks - eventually returning to a flaccid state - when cGMP is broken down by another chemical (phosphodiesterase-5/PDE-5).

Symptoms of Erectile Dysfunction

The most common symptom of erectile dysfunction is difficulty developing and maintaining an erection during sex. Persistent erectile dysfunction can also affect your sexual confidence and potentially cause you to become less interested in sexual activity.

Difficulty getting an erection

Erectile dysfunction can make it difficult for you to get an erection, even if you’re in the mood for sex. Erection problems can range in severity -- sometimes, you might find it difficult to get any erection, while in other cases you might find it difficult to get a firm enough erection for sex.

Difficulty maintaining an erection

Erectile dysfunction can make it difficult for you to maintain an erection during sexual intercourse. Even if you get an erection before sexual activity without difficulty, you may find it difficult or impossible to keep a firm erection during sex, which can impact your experience, orgasm and ejaculation.

Loss of interest in sexual activity

If you have erectile dysfunction, it can affect your self-confidence and make you avoid sexual activity. Many men with erectile dysfunction feel less interested in sex and lose some or all of their motivation to pursue sexual relationships.

I think I have ED. When should I see my doctor?

If you’re worried about impotence, it’s best to talk to your doctor as soon as you experience multiple incidents in which you have difficulty getting or keeping an erection during sex.

It’s especially important to talk to your doctor if you’ve had persistent difficulty with erections that has lasted for several months.

It’s very normal to experience one-off, occasional issues maintaining an erection, especially if you’ve consumed alcohol or taken other medication prior to sex. If you have trouble getting or maintaining an erection once every few weeks or months, you might not have ED.

Erectile dysfunction is an extremely common condition that affects men of all ages. Your doctor will be able to work out if your erectile dysfunction is caused by a physical health problem or a psychological issue, then provide an appropriate treatment.

Erectile Dysfunction Causes

Erectile dysfunction can develop for a variety of reasons. Sometimes, erectile dysfunction is a sign that you might have an underlying cardiovascular health issue. In other cases, ED can be caused by psychological factors such as anxiety or nervousness about sex.

Physical Causes of Erectile Dysfunction
  • Heart disease. Persistent erectile dysfunction is a common sign of heart disease. Heart disease can contribute to dysfunction of the inner lining of your blood vessels, making it more difficult to get and maintain an erection.
  • High blood pressure. High blood pressure is an extremely common cause of erectile dysfunction. Many medications used to treat high blood pressure can also contribute to ED and worsen existing difficulties with sexual performance.
  • High cholesterol. High cholesterol levels can damage blood vessels, making it harder to get and maintain an erection. Several medications used to treat high cholesterol are linked to improvements in sexual function for men with ED.
  • Type 1 or Type 2 Diabetes. Up to 75% of men with diabetes also have erectile dysfunction. Diabetes can also contribute to a reduced level of interest in sex, due to its effects on your production of hormones such as testosterone.
  • Metabolic syndrome. Several studies have linked erectile dysfunction and metabolic syndrome, a cluster of medication conditions that can increase your risk of diabetes, heart disease and stroke.
  • Parkinson’s disease. Men with Parkinson’s disease frequently develop ED. Some of the medications used to treat Parkinson’s disease can also worsen erectile dysfunction and other sexual disorders.
  • Sleep disorders. Sleep disorders such as sleep apnea are closely linked with erectile dysfunction.
  • Multiple sclerosis. Erectile dysfunction is common for men with multiple sclerosis, with some studies indicating that up to 91% of men with MS will also experience ED at some point in life.
  • Alcoholism. Chronic use of alcohol can cause erectile dysfunction, even in men with no other physical health issues. Not only does alcohol decrease sexual performance on its own, but chronic use of alcohol can potentially cause permanent nerve damage.
  • Prostate cancer/enlarged prostate. Several treatments for prostate cancer or enlarged prostate can affect your ability to get and maintain an erection during sex. Cialis (tadalafil) is approved by the Food and Drug Administration to treat both ED and enlarged prostate. Talk to your doctor or visit a specialist in urology (urologist) to discuss treatment with tadalafil.
Psychological Causes of Erectile Dysfunction
  • Stress. If you feel stressed due to certain events in your professional or personal life, it might affect your sexual performance. Many men experience erectile dysfunction during stressful periods in their lives.
  • Anxiety or depression. Anxiety and depression can both contribute to sexual issues such as erectile dysfunction. In fact, studies indicate that psychological issues such as anxiety and depression are some of the most common causes of ED.
  • Relationship issues. If you’re going through relationship issues that affect your level of trust in or attraction to your partner, this could cause or worsen erectile dysfunction and make sex more difficult.
  • Pornography. Although it hasn’t been extensively studied, some experts believe that frequent use of pornography can cause ED. Our guide to porn-induced ED goes into more detail on how porn can affect your erections and sexual performance.
Risk Factors for Erectile Dysfunction
  • Obesity. If you’re overweight or obese, you’re significantly more likely to develop ED than someone with a healthy weight. ED is particularly common in men with an obese BMI and is often worsened by other health conditions caused by obesity.
  • Tobacco use. Long-term use of cigarettes, cigars and other tobacco products restricts blood flow, making it more difficult for you to develop and maintain an erection during sexual activity.
  • Medications. A wide range of medications, including antidepressants and hypertension medications, can affect blood flow, libido and other factors that contribute to getting and keeping an erection.
  • Illicit drug use. Use of countless illegal drugs can affect your sexual performance and cause a range of issues, including ED.
  • Injuries and surgery. Injuries to your lower body, as well as medical procedures such as prostate surgery or radiation treatment, can increase your risk of erectile dysfunction and other sexual disorders.

Erectile Dysfunction Diagnosis

To diagnose erectile dysfunction, your doctor will ask about ED symptoms you’ve experienced and how long they’ve persisted. Your doctor might also ask about your long-term health history to determine if you have any risk factors for ED.

As part of the diagnosis, your doctor might ask you to complete a physical examination. Factors such as your blood pressure, heart function and prostate health can all contribute to ED, making a complete physical important for identifying the root cause.

Although conversation about your symptoms and in-person testing are usually enough for your doctor to diagnose erectile dysfunction, you might also be asked to complete a nocturnal penile tumescence (NPT) test.

Erectile Dysfunction Treatment

Most of the time, erectile dysfunction is easy to treat. To treat ED, your doctor will look at your symptoms and the potential cause of your ED, then either prescribe medication or recommend an option such as therapy or preventative lifestyle changes to help you get the best results.

Erectile Dysfunction Medication

Currently, there are several safe, proven, FDA-approved medications used to treat erectile dysfunction. The most common are sildenafil (best known as Viagra), tadalafil (Cialis) and vardenafil (Levitra). These medications are part of a class of drugs called PDE5 inhibitors, which work by slowing the action of the enzyme responsible for shifting the penis from erect to flaccid state after sex.

  • Sildenafil (active ingredient in Viagra) is the most common erectile dysfunction medication on the market. It’s a quick-acting medication that improves erections within 30 to 60 minutes of use, with effects that usually last for three to five hours. Talk to a physician about prescription sildenafil or Viagra.
  • Tadalafil (active ingredient in Cialis) is a longer-lasting treatment for erectile dysfunction. It usually starts to work within 60 minutes of consumption and can produce improved erections for 36 hours or longer. Because of this, tadalafil is often known as the “weekend” ED medication. Ask a doctor about trying tadalafil or brand-name Cialis.
  • Vardenafil has similar effects to sildenafil. It starts to work within 30 to 60 minutes and typically lasts for slightly longer than sildenafil, with most men experiencing improved erections for five to eight hours after use.

Hims offers convenient, affordable ED solutions in the form of ED pills and medications. ED medications require an online consultation with a physician* who will determine if a prescription is appropriate.

Psychological ED Treatment

Erectile dysfunction isn’t always caused by physiological factors. From depression to anxiety, many cases of erectile dysfunction have their root cause in mental health factors that change the way you think about sex. Mental health disorders can also lessen your sexual desire, or libido, which can make it hard to want to have sex in the first place.

If your erectile dysfunction is caused by a psychological problem, there are several treatment options that you can use. They include:

  • Counseling, which can help you identify factors that contribute to anxiety, depression and other psychological issues and work to overcome them.
  • Sex therapy, which can help you feel less stressful and more confident during sex to overcome ED.
  • Sexual performance anxiety therapy, which can help you identify and overcome any nervousness and anxiety that you feel specifically during sex.
Other ED Treatments

In addition to medication, lifestyle changes and psychological treatment, there are several other ways to treat erectile dysfunction:

  • Surgery. Some types of vascular surgery can improve blood flow to your penis, helping you to get and maintain firmer erections.
  • Alprostadil. Alprostadil is an injectable medication that expands your blood vessels to make achieving and maintaining an erection easier.
  • ED treatment devices. Vacuum erection devices (called vacuum constriction devices or VCDs) and other products may provide some help for ED.
  • Penile inflatable implants. Penile implants or prostheses are used to treat ED in men with spinal cord injuries or other mobility issues that can cause erectile dysfunction.

There are also several other erectile dysfunction treatments currently being researched for potential use in the future, including topical creams and drugs that work via the central nervous system to improve erection quality.

Erectile Dysfunction Prevention

Changing your lifestyle and habits may help prevent erectile dysfunction. If you already have ED, making healthy changes to your lifestyle might also improve your symptoms and help you to have a normal sex life without the use of medication.

The most effective preventative lifestyle changes for ED include:
  • Eating a healthy diet to reduce your blood pressure levels and help you maintain a normal, healthy weight.
  • Exercise and regular physical activity to promote optimal heart health and blood circulation throughout your body.
  • Reducing your alcohol consumption to improve your overall health and reduce your risk of experiencing alcohol-induced ED.
  • Avoiding cigarettes and other tobacco products, which can affect blood circulation and worsen ED.
  • Managing stress that you experience in your professional life or relationships.
  • Changing medications that could affect your blood flow and erection quality.

Read More About Erectile Dysfunction

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 erectile dysfunction.