Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.
Having erection trouble from time to time isn't necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection also can be a sign of an underlying health condition that needs treatment and a risk factor for heart disease down the road.
If you're concerned about erectile dysfunction, talk to your doctor — even if you're embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.
Symptoms
Erectile dysfunction symptoms might include persistent:
- Trouble getting an erection
- Trouble keeping an erection
- Reduced sexual desire
When to see a doctor
A family doctor is a good place to start when you have erectile problems. See your doctor if:
- You have concerns about your erections or you're experiencing other sexual problems, including ejaculatory dysfunction, such as premature or delayed ejaculation
- You have diabetes, heart disease or another known health condition that might be linked to erectile dysfunction
- You have other symptoms along with erectile dysfunction
Causes
Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction.
Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.
Physical causes of erectile dysfunction
In most cases, erectile dysfunction is caused by something physical. Common causes include:
- Heart disease
- Clogged blood vessels (atherosclerosis)
- High cholesterol
- High blood pressure
- Diabetes
- Obesity
- Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
- Parkinson's disease
- Multiple sclerosis
- Peyronie's disease — development of scar tissue inside the penis
- Certain prescription medications
- Tobacco use
- Alcoholism and other forms of substance abuse
- Sleep disorders
- Treatments for prostate cancer or enlarged prostate
- Surgeries or injuries that affect the pelvic area or spinal cord
Psychological causes of erectile dysfunction
The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:
- Depression, anxiety or other mental health conditions
- Stress
- Relationship problems due to stress, poor communication or other concerns
Common Treatments for ED: Medications
Standard treatments for ED include lifestyle changes, such as:
Medications like Viagra, Cialis, or Levitra increase blood flow to the penis. But they can also cause side effects, including:
Men who have experienced a stroke or have uncontrolled diabetes or low blood pressure should not take ED medications.
Testosterone replacement and erection-inducing injections are also available. Side effects may include:
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