Erectile Dysfunction

Erectile dysfunction (ED) is a common problem among male adults, but it isn’t one that many feel comfortable discussing with their doctors.

There are more than 3 million cases of ED in the U.S. every year, and it’s important to talk to your doctor if you are experiencing symptoms.



ED may point to other medical issues, and it can significantly impact your quality of life.

Erectile Dysfunction
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What Is Erectile Dysfunction?


Erectile dysfunction is defined by difficulty getting or maintaining an erection during sexual activity. Individuals with ED may also have reduced sexual desire and other issues with sexual performance, such as premature or delayed ejaculation.


The causes behind ED can vary dramatically. Male arousal is complex, so there may be several things going on that contribute to erectile dysfunction. Physical, psychological, and environmental triggers may all be at play. Often, a combination of factors is to blame, which is why it is often helpful to discuss ED with a mental health professional in addition to your primary care physician.


Signs and Symptoms


ED is indicated by trouble getting an erection or difficulty maintaining an erection throughout sexual activity. Alternatively, you may achieve a partial erection, but it is not firm enough for intercourse. Reduced sex drive can be a symptom too, but men may still experience ED even with normal sexual desire.


Almost all men will experience performance issues occasionally, but this does not always indicate erectile dysfunction. For example, drinking too much alcohol may make it temporarily difficult to achieve an erection. When you have consistent difficulty with physical arousal, you are experiencing ED.




Most people associate erectile dysfunction with age. However, about 5% of men under 40 will experience ED. In addition, aging is not a guarantee that ED will occur. Erectile dysfunction can be treated at any age. Along with age, the following are risk factors:


  • Heart disease

  • Prescription drug use

  • Obesity

  • Alcohol abuse

  • Diabetes

  • Hypertension

  • Prostate cancer treatment

  • Tobacco Use

  • Stress

  • Depression

  • Sleep disorders

  • Anxiety disorders

  • Surgeries or injuries affecting the groin or spinal cord


Erections occur when blood fills chambers in the penis called corpora cavernosa. As these chambers become full, the penis expands and stiffens. Anything that blocks nerve impulses controlling this process or that restricts blood flow can cause ED. Along with medical conditions physically blocking an erection, psychological factors may prevent an erection from occurring. These factors essentially short-circuit the impulses that trigger nerve responses in the brain and genitals. These include:


  • Relationship difficulties

  • Financial stress

  • Infertility

  • Work related stress

  • Low self-esteem

  • Performance anxiety




Most men will first discuss ED with their primary care physician, who can provide some types of treatment. Your doctor may review your medical history and talk about your symptoms. Often, the doctor will also schedule a few tests to explore possible underlying causes for ED.


  • Physical Exam – Your doctor may physically exam the penis and testicles, checking for nerve response.

  • Blood Pressure Screening – High blood pressure can be a cause of ED. Blood pressure screening is part of a normal medical checkup, and it will be a point of consideration if your numbers are too high.

  • Blood Tests – When patients present symptoms of ED, they will usually undergo a blood test to screen for low testosterone. Other screenings may include diabetes testing, cholesterol screening, and more in-depth hormonal screenings.

  • Urine Tests – Urine tests are most frequently ordered to diagnose ED by screening for diabetes.

  • Ultrasound – In some cases, ultrasound imaging may be useful to observe how blood actually moves through the penis. Ultrasound imaging allows the doctor to see moving parts of the body in real-time, so it can show any abnormalities or obstructions in the blood flow.


Along with physical examinations, your doctor may recommend booking an appointment with a therapist for a psychological screening. This is especially likely if you are experiencing erectile dysfunction at a young age or with an absence of any physical causes. During this screening, a psychologist may ask you questions to screen for depression, anxiety disorders, and other mental health conditions that could lead to ED.


Treatment and Care


There are several treatment modalities to address erectile dysfunction. For some men, treatment of any underlying conditions will be enough to resolve the problem. Other men benefit from medication, while others still might utilize lifestyle changes and psychotherapy to address ED.


As you seek treatment for ED, it’s important to recognize that it is not always a long-term problem. It is also an issue that you should discuss openly with your sexual partner. Here’s a closer look at the treatment options you may have available.


  • Medication – Medication is perhaps the most familiar type of treatment for erectile dysfunction. Prescription medication taken orally can facilitate an erection during times of arousal. Medication for ED comes under many brand names, but all contain nitric oxide, which relaxes muscles in the penis to increase blood flow and make an erection more likely in response to arousal.

  • Lifestyle Changes – Many men will respond well to lifestyle changes to address ED. Exercise in particular has proven to be highly effective in improving erectile dysfunction. Other beneficial lifestyle changes can include quitting smoking, losing weight, improving your diet, and improving communication with your sexual partner.

  • Psychotherapy – Seeing a mental health specialist can address any mood or behavioral disorders that may contribute to ED. Even without a diagnosis of anxiety or depression, therapy may still be helpful. It can provide useful tools for managing stress and dealing with problems in your relationship that may interfere with your sexual performance.

  • Surgery – In cases where medication is ineffective and other treatment options have been exhausted, surgical care may be appropriate. Penile implants allow control over when an erection occurs and how long it lasts.


When to Seek Medical Attention


Erectile dysfunction doesn’t tend to go away on its own. In fact, it might only become more stressful if you don’t address it with the help of your doctor. Along with talking to your doctor, you should also be open and honest with your partner.

This page offers general health information to facilitate discussion with your telehealth provider. You must not rely on the information on our website as an alternative to medical advice from your doctor or other professional healthcare provider.

If this is a medical emergency, please call 911. For mental health emergencies, call 988.

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