Erectile dysfunction, or impotence, is a male sexual dysfunction that refers to difficulty achieving and maintaining a sufficiently firm erection to engage in sexual activity.
Various physical and psychological factors, such as cardiovascular disease, diabetes, hormonal imbalances, anxiety, depression, and relationship issues, can cause ED. Certain lifestyles, such as cigarette smoking, high intake of alcohol, and a sedentary lifestyle, can also contribute to the development of ED.
The condition can significantly impact an individual’s quality of life. It may cause feelings of shame, frustration, and inadequacy. However, effective treatments are available, such as medication, psychotherapy, lifestyle changes, and in some cases, surgery. (1)
Erectile Dysfunction (ED) is characterized by a variety of symptoms that affect an individual’s ability to to attain and uphold an erection while engaging in sexual activities. These symptoms include:
- Inconsistent ability to achieve an erection may occur sometimes, but not every time an individual wishes to engage in sexual activity.
- Difficulty in maintaining an erection during sexual intercourse, resulting in a reduced ability to engage in sexual activity.
- The inability to achieve an erection at any time can significantly impact an individual’s sexual function and overall quality of life. (2)
When to see a doctor
If you are experiencing occasional difficulties with achieving or maintaining an erection, it may not necessarily be a cause for concern. However, if the problem becomes more frequent and persistent, it could be a sign of erectile dysfunction (ED), which requires medical attention.
ED is more common in older men but can affect individuals of all ages. In most cases, ED is caused by physical factors, such as cardiovascular disease, diabetes, hormonal imbalances, and neurological disorders. In some cases, psychological factors such as anxiety, depression, or relationship issues can also contribute to the development of ED.
If you are experiencing persistent symptoms of ED, seeking medical attention from your healthcare provider is recommended. They can perform a physical examination, review your medical history, and recommend appropriate diagnostic tests to determine the underlying cause of your symptoms. They may also suggest treatment options, which can include medication, therapy, lifestyle changes, or surgery, depending on the underlying cause of your ED. (3)
Physical causes of erectile dysfunction
Various physical and psychological factors can cause erectile dysfunction (ED). However, physical causes are the most common and account for 90% of ED cases. Here are some of the common physical causes of ED:
- Cardiovascular disease and narrowing of blood vessels
- High blood pressure
- High cholesterol
- Obesity and metabolic syndrome
- Parkinson’s disease
- Multiple sclerosis
- Hormonal disorders (thyroid and testosterone deficiency)
- Peyronie disease
- Substance abuse
- Alcohol use disorder
- Prostate disease medications
- Complications of Surgical Operations
- Pelvic or spinal cord injury
- Pelvic radiation therapy
- Certain drugs for high blood pressure, heart medications (digoxin), anxiety treatments, antidepressants, opioid painkillers, some cancer drugs, anticholinergics, and hormone drugs. (4)
Psychological causes of erectile dysfunction
Physical factors primarily cause erectile dysfunction (ED), but psychological factors can also contribute to the condition in about 10% to 20% of cases. It is important to note that psychological factors may be a secondary reaction to an underlying physical cause. Childhood abuse or sexual trauma may be responsible for the psychological effects of ED in some cases. The most common psychological causes of erectile dysfunction include:
- Low self-esteem
Men who experience persistent ED that causes distress for themselves or their partners may benefit from seeking medical advice and treatment, including therapy in conjunction with medical treatment for those whose ED is caused by psychological factors. (5)
Some of the risk factors associated with ED include:
- Age: As a man ages, the risk of developing ED increases.
- Health conditions: Certain conditions, such as prostate problems, type 2 diabetes, hypertension, high cholesterol, neurogenic disorders, chronic sleep disorders, depression, and many chronic diseases like renal failure and dialysis, may increase the risk of developing ED.
- Lifestyle choices: Smoking, alcohol use, and poor diet can contribute to ED.
- Medications: Certain prescription medications (drugs used to treat high blood pressure, depression, anxiety, and cancer) may increase the risk of ED.
- Psychological factors: Stress, anxiety, guilt, depression, and low self-esteem can all contribute to ED.
- Poor sexual practices: Lack of sexual knowledge, poor sexual techniques, and inadequate interpersonal relationships can also increase the risk of ED. (6)
Erectile dysfunction can lead to a range of complications, including physical and psychological issues. Physically, ED can be a sign of underlying health conditions such as heart disease, diabetes, or high blood pressure. ED can also make it difficult to engage in sexual activity, leading to frustration and relationship problems.
In addition, ED can affect a person’s self-esteem, leading to mental health conditions such as anxiety. In some cases, the treatment for ED, such as medications or surgery, can have side effects or complications. Hence it is important to seek medical attention if you experience symptoms of ED to prevent further complications. (7, 8)
There are several steps you can take to help prevent erectile dysfunction (9):
- Quit smoking: Smoking is linked to heart and blood vessel disease, which can lead to ED. Even when heart and blood vessel disease and other possible causes of ED are taken into account, smoking still increases the chances that you will have ED.
- Follow a healthy eating plan: To help maintain erectile function, choose whole-grain foods, low-fat dairy foods, fruits and vegetables, and lean meats. Avoid foods high in fat, especially saturated fat and sodium. Following a healthy eating plan can help you aim for a healthy weight and control your blood pressure and diabetes, which may help prevent ED. Also, avoid drinking too much alcohol.
- Maintain a healthy weight to prevent diabetes and high blood pressure: Maintaining a healthy weight can help delay the onset of diabetes and keep your blood pressure down. Losing weight may help reduce inflammation, increase testosterone levels, and increase self-esteem, all of which may help prevent ED.
- Be physically active: Physical activity increases blood flow through your body, including the penis. Talk with a healthcare professional before starting new activities, and aim for at least 30 minutes of activity most days of the week.
- Avoid using illegal drugs: Using illegal drugs may prevent you from getting or keeping an erection and may mask other psychological, emotional, or physical factors that may be causing your ED. Talk with your healthcare provider if you need drug abuse help.
To diagnose erectile dysfunction (ED), doctors typically begin by taking a medical and sexual history of the patient, followed by a physical and mental health exam. During the medical and sexual history, doctors will ask questions about the patient’s sexual activity, including their confidence in obtaining and maintaining an erection, frequency of firm erections during sexual stimulation, satisfaction with sexual intercourse, and more.
The physical exam usually involves checking the penis’s appearance, sensitivity, and blood flow and conducting lab and imaging tests to detect possible causes of ED, such as diabetes or hormonal problems. Additionally, doctors may conduct a nocturnal erection test or injection test to determine whether the cause of ED is physical or psychological. By gathering this information, doctors can better understand the patient’s ED problem and develop an effective treatment plan. (10)
Erectile dysfunction (ED) can be treated by working with a healthcare professional to identify and treat underlying medical causes. Lifestyle changes such as quitting smoking, limiting alcohol, increasing physical activity, and maintaining a healthy weight can help reduce ED. Counseling may help if psychological or emotional issues are causing ED.
A healthcare professional can prescribe medications such as sildenafil, vardenafil, tadalafil, or avanafil to help maintain an erection. Injectable medications and suppositories such as alprostadil can also help, and a vacuum device can be used to draw blood into the penis. Surgery is generally considered a last-resort treatment option. (11)
- Ziegelmann, What is erectile dysfunction? A Mayo Clinic expert explains, https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776#:~:text=Erectile%20dysfunction%2C%20also%20known%20as,experience%20some%20form%20of%20ED.
- Symptoms & Causes of Erectile Dysfunction, https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes
- Saling, Discussing Erectile Dysfunction With Your Doctor, https://www.webmd.com/erectile-dysfunction/guide/discussing-erectile-dysfunction-with-your-doctor, 2022
- MacGill, What’s to know about erectile dysfunction, https://www.medicalnewstoday.com/articles/5702, 2023
- Erectile Dysfunction: Psychological Causes, https://www.webmd.com/erectile-dysfunction/guide/ed-psychological-causes
- Cornell, Complications of Erectile Dysfunction, https://www.urosurgeryhouston.com/blog/complications-of-erectile-dysfunction
- Buttaccio, Symptoms of Erectile Dysfunction, https://www.verywellhealth.com/erectile-dysfunction-signs-symptoms-and-complications-4160525#toc-complications
- Preventing Erectile Dysfunction, https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/prevention
- Diagnosis of Erectile Dysfunction, https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/diagnosis
- Treatment for Erectile Dysfunction, https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment