The ultimate guide to erectile dysfunction: symptoms, causes, and solutions

With more than 3 million U.S. cases reported per year, erectile dysfunction is extremely common. All you have to do is turn on the television and you’ll quickly become familiar with the slew of treatments and drugs available.   

Erectile dysfunction, or impotence, is the inability to get or maintain an erection. It can also mean you are not happy with the size or hardness of your erections. It’s often self-diagnosable, seldom requires lab testing, and—most importantly—is treatable.

A common type of male sexual dysfunction, erectile dysfunction tends to become more common as you get older. That said, there are many types and causes of erectile dysfunction and it can occur at any age. It can be linked to certain prescription medications, lifestyle choices, including smoking and excessive alcohol intake, and a number of underlying health conditions, both physical and mental.

Although some people have trouble talking to medical professionals about erectile dysfunction, it’s important to be open with your doctor and remember that he or she is  there to help. Given erectile dysfunction is sometimes a sign of other underlying health issues, discussing it with your doctor can be beneficial to improving your overall health.

Speaking openly to your doctor about your erectile dysfunction will ensure you’re recommended the best treatment options, be it taking medication, or making lifestyle changes like meditating, reducing alcohol intake, or losing weight.

Symptoms

The main symptom of erectile dysfunction is not being able to get or keep an erection firm enough for sex. Erectile dysfunction can also mean that you’re unable to get an erection at all. For some men, it means you can’t get an erection consistently, or can only maintain brief erections.

Erectile dysfunction symptoms can include:

• Not being able to get an erection
• Difficulty maintaining an erection
• Unable to keep an erection firm enough for sex
• Brief erections
• Cannot achieve an erection consistently
• Reduced sexual desire

Causes

Sexual health is a complex business involving a combination of your hormones, nervous system, muscles, blood vessels, and brain. Because of this complexity, there are different types and causes of ED, both emotional and physical. Below are some common causes of erectile dysfunction.

Psychological and emotional issues:

• stress
• general anxiety
• performance anxiety
• depression
• sleep disorders
• relationship problems
• guilt about sexual performance or certain sexual activities
• low self-esteem

Underlying medical conditions and diseases:

• cardiovascular disease (heart disease)
• diabetes
• high blood pressure (hypertension)
• hyperlipidemia (high cholesterol)
• metabolic syndrome (combination of increased blood pressure, high insulin, body fat around the waist, and high cholesterol)
• multiple sclerosis
• Parkinson’s disease 
• stroke
• spinal cord injuries
• alcoholism/substance abuse
• tobacco use
• liver or kidney disease
• pituitary gland conditions
• Peyronie’s disease (scar tissue inside the penis)
• injury from treatments for prostate cancer, including radiation therapy and prostate surgery
• injury to the penis, prostate, bladder, or pelvis
• surgery for bladder cancer 
• nerve damage
• low testosterone
• premature ejaculation

Cardiovascular disease and diabetes in particular can have a significant effect on the likelihood of a man developing erectile dysfunction, with men who have diabetes being more than three times more likely to develop the condition than men who do not have diabetes. This can be partially attributed to the disease’s effect on blood vessels, ultimately lowering blood flow to the penis. Controlling diabetes, however, may help prevent and treat erectile dysfunction. 

Certain medications can increase the likelihood of a man experiencing erectile dysfunction:

• Antidepressants and other psychiatric medicines
• Antihistamine medicines (some are used for allergies; others, for heartburn, such as Zantac)
• High blood pressure medicines and diuretics (water pills), particularly thiazides (such as hydrochlorothiazide) and beta blockers (such as metoprolol, atenolol)
• Parkinson’s disease medicines
• Hormonal medicines
• Opiates (such as fentanyl, codeine, morphine, oxycodone)
• Recreational drugs including marijuana and cocaine

Lifestyle factors and behaviors:

• obesity or being overweight
• increased age
• alcohol use
• smoking
• not exercising

Given the many and varied causes of erectile dysfunction, including emotional factors, medications, lifestyle choices, and underlying conditions, it’s important to be comprehensive and open when speaking to your doctor. This will help him or her effectively diagnose and treat your condition, and get you back to enjoying a healthy erectile function.

Although erectile dysfunction becomes more likely in older men, aging itself does not cause the condition, and fortunately it can be diagnosed and treated at any age.

Diagnosis/Tests

For many men, a physical exam and answering questions regarding medical history are all that’s needed for a doctor to diagnose erectile dysfunction and recommend a treatment.

In fact, one of the first things a doctor will often do to help diagnose erectile dysfunction is take your medical and sexual history. An example of some of the questions they may ask include:

During sexual activity, how often are you able to maintain an erection?
How would you rate your level of sexual desire?
Have you had any surgeries or treatments recently?
Do you take any over-the-counter or prescription medications?
Do you drink alcohol, smoke, or use any recreational drugs?

Some men find it uncomfortable to speak with a healthcare professional about erectile dysfunction and sexual health, so remember that with over 3 million cases a year in the U.S., you’re not alone and there are effective treatment options available. The more your doctor knows about you, the easier it will be for him or her to help treat the cause of your erectile dysfunction and assess any risk factors you may have.

If your doctor suspects that an underlying condition might be involved, or you’ve communicated any existing chronic conditions, he or she may recommend further tests or a consultation with a specialist. Often, getting the underlying cause under control will improve erectile function.

Diagnosis of erectile dysfunction may include:

• review of health and sexual history
• mental health exam
• physical exam
• blood tests
• urine tests
• imaging tests, including ultrasound
• nocturnal erection test
• injection test

Along with the review of your health and sexual history, it’s likely your doctor will perform a physical exam to help diagnose the cause of your erectile dysfunction. Just like some men are uncomfortable speaking about their sexual issues, others are put off by the thought of a physical exam. To put your mind at ease and to help manage your expectations, here is what your doctor may check during the physical exam:

• the sensitivity of your penis to touch. This is to determine if the nervous system may be the cause of the erectile dysfunction.
• the shape and appearance of the penis. For example, a curve in an erect penis can be caused by Peyronie’s disease.
• physical indicators of hormonal problems, such as excess body hair or breast enlargement
• blood pressure, as high blood pressure often contributes to erectile dysfunction
• pulse in both your wrist and ankles. This will help indicate any circulation problems.

Although not necessary for an initial check, some patients may prefer to go to a urologist, a doctor who specializes in the area of male reproductive organs (urology).

Solutions

A common condition for men, erectile dysfunction is often treatable. Treatments are varied, and depend on the underlying cause of the erectile dysfunction. Some of the treatments that may be used include:

• Lifestyle changes
  • Reducing alcohol intake
  • Quitting smoking
  • Losing weight
  • Increasing exercise
  • Meditation
• Reviewing medicines that may be contributing to your erectile dysfunction, and discussing alternatives with your doctor
• Psychotherapy to help reduce depression, anxiety or stress
• Oral Prescription Medication
• Injectable Prescription Medication
• Testosterone Therapy
• Vacuum devices
• Penile implants

If you’re interested in natural remedies, losing weight could be one of the more effective solutions to erectile dysfunction. A study out of Harvard reported that just 30 minutes of walking a day had the potential to reduce the risk of erectile dysfunction by 41%. This is backed by other research that indicates moderate exercise can be beneficial to obese middle-aged men struggling with erectile dysfunction.

RELATED: Levitra vs. Viagra

Given two major causes of erectile dysfunction are vascular disease and diabetes, both of which are more likely with obesity, it makes sense that weight loss can help men overcome erectile dysfunction. In fact, the likelihood of a man having erectile dysfunction increases 50% if he has a 42-inch waist compared to man with a 32-inch waist. Obesity also plays a role in hormone imbalances, another contributor to erectile dysfunction in men.

Speaking of exercise, according to a British trial, another possible treatment for erectile dysfunction is to practice Kegel exercises. Blood flow is a major contributor to erectile dysfunction, and a strong pelvic floor (strengthened through these exercises) may help keep blood from leaving the penis, thereby improving rigidity during erections.

While some men find that treating an underlying condition, like hypertension, or making changes to their lifestyle through diet, exercise, or therapy is all they need to treat their erectile dysfunction and enjoy an active sex life, others may require prescription medication to manage their erectile dysfunction.

RELATED: Revatio vs. Viagra

When considering prescription medication to treat erectile dysfunction, popular options include FDA-approved Viagra (sildenafil), Levitra (vardenafil), Cialis (tadalafil), and Stendra (avanafil). Sometimes, doctors will prescribe sildenafil in the form of generic Revatio, which is just a lower dose but the same medication. Each of these medications allow the penis to fill with blood and become erect by relaxing the muscles that surround the penis. These medications work similarly, however there are some subtle differences, such as how long they last, how they’re administered, how long they take to take effect, and potential side effects.

For example, Viagra can last for around four hours, while Cialis often lasts much longer—up to 36 hours in some cases. (For a breakdown of Cialis versus Viagra, read more here.)

Another example is that avanafil may not be suitable for patients whose erectile dysfunction is caused by heart disease.

RELATED: Stendra vs. Viagra

Bearing this in mind, it’s important to discuss your lifestyle and preferences with your doctor when establishing which prescription option will work best for you. It may take some trial and error to find the best fit for your needs.

With any of these oral prescription medications, patients should stop treatment and seek urgent treatment if there is a loss of vision, or sudden decrease or loss of hearing.

It’s also important to note that it’s commonly advised that these medications should not be used in combination with nitrates, often prescribed for chest pain. So don’t forget, always tell your doctor about any other medications—prescription or nonprescription—that you’re taking so they can advise you effectively and assess any risk factors.